Health outcomes research in medicine最新文献_第2页

Impact of Treatment Attributes of Peginterferon for Hepatitis C on Quality of Life and Treatment Preference 聚乙二醇干扰素治疗丙型肝炎属性对生活质量和治疗偏好的影响

Health outcomes research in medicine

Pub Date : 2012-08-01 DOI: 10.1016/j.ehrm.2012.05.003

Cicely Kerr PhD , Andrew Lloyd DPhil , Shehzad Ali PhD , Charles Gore , David A. Tyas PhD

Objectives

A key aim of hepatitis C virus (HCV) treatment development is to maximize efficacy while minimizing adverse events that impact on patient health-related quality of life (HRQL) and adherence, a significant issue for HCV treatment efficacy. In order to inform treatment development priorities, this study aimed to capture HRQL impact of flu-like symptoms experienced after peginterferon treatment injections and capture the value to patients of less frequent treatment injections.

Study Design

An online survey was conducted with 72 patients who were receiving peginterferon treatment. The survey comprised: patient experience of flu-like symptoms as a result of peginterferon treatment injections; utility values for impact of these symptoms on HRQL; patient preferences for treatment attributes of injection frequency, days experiencing flu-like symptoms and efficacy.

Results

Over 90% of participants had experienced flu-like symptoms after a peginterferon treatment injection. Mean HRQL for HCV patients with no flu-like symptoms was 0.73, while mean HRQL for HCV patients with current flu-like symptoms was 0.43. Increase in frequency of treatment injections per 4 weeks (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.52-0.63, P < 0.001), days per month of experiencing flu-like symptoms (OR 0.73, 95% CI 0.69-0.76, P < 0.001), and percentage treatment efficacy (OR 1.05, 95% CI 1.05-1.06, P < 0.001) were all independent predictors of patient treatment preferences.

Conclusion

Flu-like symptoms experienced as a result of peginterferon treatment injections have a substantial HRQL impact for patients. This study demonstrates how important avoiding flu-like symptoms and reducing treatment injections are for patients in addition to treatment efficacy.

丙型肝炎病毒(HCV)治疗发展的一个关键目标是最大限度地提高疗效，同时最大限度地减少影响患者健康相关生活质量(HRQL)和依从性的不良事件，这是HCV治疗疗效的一个重要问题。为了告知治疗发展的优先事项，本研究旨在捕获聚乙二醇干扰素治疗注射后出现的流感样症状对HRQL的影响，并捕获较少注射治疗的患者的价值。研究设计:对72例接受聚乙二醇干扰素治疗的患者进行在线调查。该调查包括:患者因注射聚乙二醇干扰素治疗而出现流感样症状;这些症状对HRQL的影响的效用值;患者偏好的治疗属性包括注射频率、出现流感样症状的天数和疗效。结果超过90%的参与者在注射聚乙二醇干扰素治疗后出现流感样症状。无流感样症状的HCV患者的平均HRQL为0.73，而目前有流感样症状的HCV患者的平均HRQL为0.43。每4周注射治疗次数增加(优势比[OR] 0.57, 95%可信区间[CI] 0.52-0.63, P <0.001)，每月出现流感样症状的天数(OR 0.73, 95% CI 0.69-0.76, P <0.001)，治疗有效率百分比(OR 1.05, 95% CI 1.05-1.06, P <0.001)都是患者治疗偏好的独立预测因子。结论:注射聚乙二醇干扰素治疗后出现的流感样症状对患者的HRQL有重大影响。这项研究表明，除了治疗效果外，避免流感样症状和减少治疗注射对患者有多重要。

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引用次数: 4

Androgen Deprivation Therapy for Prostate Cancer Prevention: What Impact Do Related Adverse Events Have on Quality of Life? 雄激素剥夺治疗预防前列腺癌:相关不良事件对生活质量有何影响?

Health outcomes research in medicine

Pub Date : 2012-08-01 DOI: 10.1016/j.ehrm.2012.04.002

Cicely Kerr MSc, PhD , Andrew Lloyd DPhil , Donna Rowen MSc, PhD , Toni Maslen MSc , John Brazier PhD

Objectives

To elicit utilities for health-related quality-of-life (HRQL) impact of adverse events (AEs) associated with androgen-deprivation therapy (ADT) for prostate cancer prevention.

Study Design

Cross-sectional, online survey of men aged ≥55 years, experiencing symptoms similar to one or more AEs related to ADT (erectile dysfunction [ED], loss of libido, gynecomastia, ejaculatory problems) outside the context of treatment for prostate cancer (n = 190, plus n = 10 had prostate cancer, included to allow greater representation of men with gynecomastia) and an age/sex equivalent control group (n = 100). Utilities were collected using the EQ-5D and a condition-specific measure of sexual HRQL from which a preference-based single index could be scored (SQoL-3D). Regression analysis was used to estimate the impact of the AE on utility values using a variety of model types.

Results

Many participants reported more than one symptom, including ED (most common at n = 139), reduced libido (n = 99), ejaculatory disorder (n = 98), and gynecomastia (n = 20). EQ-5D and SQoL-3D utilities were weakly correlated (r = 0.296). From the ordinary least squares regression, EQ-5D and SQoL-3D disutilities were estimated for ED (−0.042; −0.074), reduced libido (−0.053; −0.048), ejaculatory disorder (−0.047; −0.028), and gynecomastia (−0.043; − 0.038), respectively. The use of tobit regression did not improve model predictions.

Conclusions

Utility values elicited in this study provide useful indicators of the impact of AEs related to ADT in older men for use in cost-effectiveness evaluation of prophylaxis for prostate cancer, and of benefits of treatments for sexual dysfunction or gynecomastia in older men.

目的探讨与雄激素剥夺治疗(ADT)预防前列腺癌相关的不良事件(ae)对健康相关生活质量(HRQL)的影响。研究设计:横断面，在线调查年龄≥55岁，在前列腺癌治疗背景之外经历与ADT(勃起功能障碍[ED]，性欲丧失，男性乳房发育不良，射精问题)相关的一个或多个ae症状的男性(n = 190，加上n = 10的前列腺癌患者，包括更多的男性男性乳房发育不良)和年龄/性别相当的对照组(n = 100)。使用EQ-5D和一种特定条件的性HRQL测量方法收集实用工具，基于偏好的单一指数可以从中评分(sql - 3d)。使用回归分析来估计AE对效用值的影响，使用各种模型类型。结果许多参与者报告了不止一种症状，包括ED (n = 139)，性欲下降(n = 99)，射精障碍(n = 98)和男性乳房发育(n = 20)。EQ-5D与sql - 3d效用呈弱相关(r = 0.296)。通过普通最小二乘回归，估计ED的EQ-5D和sql - 3d负效用(- 0.042;- 0.074)，性欲下降(- 0.053;−0.048)，射精障碍(−0.047;−0.028)，男性乳房发育(−0.043;−0.038)。使用tobit回归并没有改善模型预测。结论本研究得出的效用值为老年男性ADT相关ae的影响提供了有用的指标，可用于前列腺癌预防的成本-效果评估，以及老年男性性功能障碍或男性乳房发育症治疗的获益评估。

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引用次数: 5

Advancing Patient Care through Outcomes Research 通过结果研究推进患者护理

Health outcomes research in medicine

Pub Date : 2012-08-01 DOI: 10.1016/j.ehrm.2012.07.001

Donald E. Stull Jr. PhD (Editor-in-Chief)

引用次数: 0

Burden of Early-Stage Triple-Negative Breast Cancer in a US Managed Care Plan 美国管理医疗计划中早期三阴性乳腺癌的负担

Health outcomes research in medicine

Pub Date : 2012-05-01 DOI: 10.1016/j.ehrm.2012.03.001

Onur Başer MS, PhD , Wenhui Wei MS, PhD , Henry J. Henk MS, PhD , April Teitelbaum MD , Lin Xie MS

Objective

Triple-negative breast cancer (TNBC) is a high-grade breast cancer with an aggressive clinical course. We examined the recurrence rate, health care utilization, and cost of early-stage TNBC in the US managed care setting.

Study Design

A retrospective study using linked cancer registry, health care claims, and social administration databases.

Methods

This retrospective study used the Impact Intelligence Oncology Management cancer registry, linked to 1999-2009 administrative claims, from a national managed care health plan and also Social Security Administration mortality data. Patients with stage I-III TNBC and non-TNBC were followed from diagnosis to recurrence, disenrollment, or end of observation period. Risk-adjusted recurrence rate, health care utilization, and costs during the follow-up period were compared.

Results

A total of 1967 women (403 with TNBC) were included; 289 (14.7%) had local/distant recurrence during the follow-up period. Patients with TNBC were younger (53.68 vs. 56.16 years, P < .0001) and more likely to experience recurrence compared with non-TNBC (21.6% vs. 12.9%, P < .0001; adjusted hazard ratio = 2.11, P < .0001). In terms of adjusted annual health care utilization and costs, patients with TNBC had significantly higher numbers of hospitalizations (1.20 vs. 0.90, P = .001); hospitalization days (8.80 vs. 4.97, P < .0001); and emergency department (ED) visits (1.45 vs. 0.95, P = .009). They also had significantly higher inpatient costs (all-cause: $9154 vs. $5501; cancer-related: $5632 vs. $2869; P < .0001 for both); and ED costs (all-cause: $303 vs. $182, P = .003; cancer-related: $240 vs. $138, P = .012).

Conclusions

This study demonstrates that, compared with non-TNBC, early-stage TNBC is associated with higher rate of recurrence, resulting in increased health care utilization and costs.

目的三阴性乳腺癌(TNBC)是一种具有侵袭性临床病程的高级别乳腺癌。我们研究了美国管理医疗机构中早期TNBC的复发率、医疗保健利用率和成本。研究设计一项回顾性研究，使用相关的癌症登记、医疗保健索赔和社会管理数据库。方法:本回顾性研究使用Impact Intelligence Oncology Management癌症登记处，与1999-2009年国家管理医疗保健计划的行政索赔和社会保障管理局的死亡率数据相关。对I-III期TNBC和非TNBC患者进行从诊断到复发、退组或观察期结束的随访。在随访期间比较经风险调整的复发率、医疗保健利用和费用。结果共纳入女性1967例(TNBC 403例);随访期间局部/远处复发289例(14.7%)。TNBC患者较年轻(53.68岁vs. 56.16岁，P <.0001)，与非tnbc相比更容易复发(21.6% vs. 12.9%， P <。;调整风险比= 2.11,P <。)。在调整后的年度医疗保健使用率和费用方面，TNBC患者的住院次数显著高于TNBC患者(1.20 vs. 0.90, P = .001);住院天数(8.80比4.97,P <。);急诊就诊(1.45 vs. 0.95, P = 0.009)。他们的住院费用也明显更高(全因:9154美元对5501美元;癌症相关:5632美元vs 2869美元;P & lt;两者均为0.0001);ED费用(全因:303美元vs 182美元，P = 0.003;癌症相关:240美元对138美元，P = 0.012)。结论与非TNBC相比，早期TNBC有较高的复发率，导致医疗保健利用率和费用增加。

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引用次数: 3

Cost-effectiveness of Treating Chronic Anemia with Epoetin Alfa among Hemodialysis Patients in the United States 美国血液透析患者用促生成素治疗慢性贫血的成本-效果

Health outcomes research in medicine

Pub Date : 2012-05-01 DOI: 10.1016/j.ehrm.2012.03.004

Peter Quon MPH , Matthew Gitlin PharmD , John J. Isitt MS , Sumit Mohan MD , William M. McClellan MD, MPH , Jill Javier BS , Gregory de Lissovoy PhD, MPH , Christopher S. Hollenbeak PhD

Objectives

The objectives of this analysis were to assess health and economic consequences of targeting hemoglobin (Hb) levels around 10-11 g/dL relative to 9-10 g/dL using an economic model and to explore the impact of different assumptions on cost-effectiveness.

Study Design

Clinical and economic impact of treating anemia in the US hemodialysis population to target Hb levels of 10-11 g/dL and 9-10 g/dL was assessed using a Markov model. A sensitivity analysis assessed the effects of varying assumptions on the model.

Results

Our cost-effectiveness analysis suggests that maintaining Hb 10-11 g/dL would result in average reductions of 0.51 hospitalizations and increases of 0.09 quality-adjusted life years per patient, with hospitalization cost offsets of $15,340 over 5 years when compared with Hb of 9-10 g/dL. Over the lifetime of the patient, cost-effectiveness improved with hospitalization cost offsets of $21,450 and increases of 0.12 quality-adjusted life years. Sensitivity analysis of individual parameters showed that mortality, hospitalization, health preference, and time horizon of the model had the most influence on cost-effectiveness.

Conclusions

Our analysis suggests that epoetin alfa use targeting Hb levels of 10-11 g/dL relative to 9-10 g/dL may result in better patient outcomes and lower costs. The sensitivity analysis highlighted how assumptions affected cost-effectiveness conclusions; the appropriateness of these assumptions will remain uncertain until new research in today’s dialysis population examining the effects of targeting to lower Hb levels is conducted.

本分析的目的是利用经济模型评估血红蛋白(Hb)水平在10-11 g/dL左右相对于9-10 g/dL的健康和经济后果，并探讨不同假设对成本效益的影响。研究设计:使用马尔可夫模型评估美国血液透析人群治疗贫血的临床和经济影响，以达到10-11 g/dL和9-10 g/dL的血红蛋白水平。敏感性分析评估了不同假设对模型的影响。结果我们的成本-效果分析表明，维持Hb 10-11 g/dL将导致每位患者平均减少0.51次住院，增加0.09个质量调整生命年，与Hb 9-10 g/dL相比，住院费用在5年内抵消15,340美元。在患者的整个生命周期中，成本效益得到提高，住院费用抵销额为21 450美元，质量调整生命年增加0.12年。个体参数的敏感性分析显示，模型的死亡率、住院率、健康偏好和时间范围对成本-效果的影响最大。结论sour分析表明，与9-10 g/dL相比，将促生成素用于Hb水平为10-11 g/dL的患者可获得更好的疗效和更低的成本。敏感性分析强调假设如何影响成本效益结论;这些假设的适当性仍然不确定，直到在今天的透析人群中进行新的研究，检查降低血红蛋白水平的目标的影响。

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引用次数: 3

Health Care Utilization and Associated Costs of Hepatitis A in Adults in a US Commercially Insured Population 美国商业保险人群中成人甲型肝炎的医疗保健利用和相关费用

Health outcomes research in medicine

Pub Date : 2012-05-01 DOI: 10.1016/j.ehrm.2012.03.003

Debra F. Eisenberg MS, PhD , Stuart J. Burstin MD , Christy Fang MS , Derek A. Misurski PhD

Objective

To examine the impact of acute hepatitis A on health care utilization and cost in a commercially insured population.

Study Design

This observational, retrospective cohort study used medical and pharmacy claims data from January 1, 2004 through October 31, 2009. A matched control group consisted of patients without hepatitis A during the study period. Descriptive statistics were used to assess differences between hepatitis A patients (cases) and controls.

Results

The case and control groups each contained 2331 patients. In the 12-month post-index period, 482 (20.7%) cases and 193 (8.3%; P < .0001) controls had inpatient (INP) hospitalizations (adjusted mean estimated costs [AMEC] $4433 and $1244 [P < .0001], respectively). Emergency department (ED) services occurred in 382 (16.4%) cases, versus 277 (11.9%; P < .0001) controls (AMEC $225 and $132 [P < .0001], respectively). The mean number of outpatient services (OUT) for cases was 21.5 (±22.1) versus 14.7 (±18.2) for controls, with AMEC $4132 and $2092, respectively. The mean number of physician visits was 9.1 (±9.9) and 5.5 (±7.4) for each group, respectively [AMEC $1025 vs. $577; P < .0001]. There were 20.13 (±24.1) and 19.37 (±24.5) pharmacy claims, with AMEC $1565 and $1115 (P < .0001), in cases and controls, respectively. Adjusted mean total estimated associated costs were $11,479 and $5323 (P < .0001), respectively. Multivariate regression results demonstrated that patients with hepatitis A have higher total medical costs even after adjusting for age, sex, comorbidities, pre-index cost, and hepatitis A vaccination.

Conclusions

Patients with hepatitis A had significantly higher health care resource utilization and costs during the 1-year post-index period, compared with controls.

目的探讨急性甲型肝炎对商业保险人群医疗保健利用和费用的影响。研究设计:这项观察性、回顾性队列研究使用了2004年1月1日至2009年10月31日的医疗和药房索赔数据。匹配的对照组由研究期间未患甲型肝炎的患者组成。描述性统计用于评估甲型肝炎患者(病例)与对照组之间的差异。结果病例组和对照组各2331例。指数发布后12个月，482例(20.7%)，193例(8.3%);P & lt;0.0001)对照患者住院(调整后平均估计费用[AMEC] 4433美元和1244美元;分别为。])。急诊部门(ED)服务发生了382例(16.4%)，277例(11.9%);P & lt;0.0001)控制(AMEC 225美元和132美元[P <分别为。])。病例的平均门诊次数(OUT)为21.5次(±22.1次)，对照组为14.7次(±18.2次)，AMEC分别为4132美元和2092美元。每组平均就诊次数分别为9.1(±9.9)次和5.5(±7.4)次[AMEC $1025 vs. $577;P & lt;。]。药房索赔分别为20.13(±24.1)件和19.37(±24.5)件，AMEC分别为1565美元和1115美元(P <0.0001)，在病例和对照中分别为。调整后的平均总估计相关成本为11,479美元和5323美元(P <分别。)。多因素回归结果表明，即使在调整了年龄、性别、合并症、指数前成本和甲型肝炎疫苗接种后，甲型肝炎患者的总医疗费用也较高。结论与对照组相比，甲型肝炎患者在指标后1年内的医疗资源利用率和医疗费用明显高于对照组。

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引用次数: 1

The Impact of End-Stage Renal Disease Transfusion Demand on Blood Utilization and Blood Supply in the United States 美国终末期肾病输血需求对血液利用和血液供应的影响

Health outcomes research in medicine

Pub Date : 2012-05-01 DOI: 10.1016/j.ehrm.2012.03.002

Christopher S. Hollenbeak PhD , Matthew Gitlin PharmD , Brian Custer PhD, MPH , William M. McClellan MD , Axel Hofmann ME , Huseyin Naci MHS , Gregory de Lissovoy PhD, MPH , Tracy Mayne PhD

Background

Excess supply of blood is required to ensure availability to patients requiring transfusions at the time of need. End-stage renal disease (ESRD) patients undergoing dialysis account for a substantial portion of the demand for transfusions.

Objective

The purpose of this analysis was to explore the impact of ESRD transfusion demand on the US blood supply and its margin.

Methods

A mathematical model was developed to evaluate the impact on the overall US demand for blood transfusions associated with changes in the mean hemoglobin (Hb) among ESRD patients at Hb levels ranging from 9 to 12 g/dL.

Results

Our results suggested that, based on ESRD prevalence and blood supply estimates and a mean population Hb of 12 g/dL, 27,845 dialysis patients would receive an estimated total of 17,384 units of blood, compared with an estimated 123,503 dialysis patients receiving a total of 288,590 units of blood at a mean population Hb level of 9 g/dL. Based on an assumed supply margin of 10%, our model estimated that approximately 21.9% of this margin would be utilized by ESRD patients with a mean population Hb of 9 g/dL, compared with 8.7% for mean Hb of 10 g/dL, 3.0% for mean Hb of 11 g/dL, and 1.3% for mean Hb of 12 g/dL.

Conclusions

Potential changes in treatment practices for ESRD may shrink the blood margin and limit availability of blood products for other uses, such as for acute injuries and surgical procedures.

背景:为确保需要输血的患者在需要时获得充足的血液供应。接受透析的终末期肾病(ESRD)患者占输血需求的很大一部分。目的探讨ESRD输血需求对美国血液供应及其边际的影响。方法建立了一个数学模型，以评估在Hb水平为9至12 g/dL的ESRD患者中平均血红蛋白(Hb)变化对美国总体输血需求的影响。结果:我们的研究结果表明，基于ESRD患病率和血液供应估计以及平均人群Hb为12 g/dL, 27,845名透析患者将接受估计总计17,384单位的血液，而估计123,503名透析患者在平均人群Hb水平为9 g/dL时接受总计288,590单位的血液。假设供应边际为10%，我们的模型估计平均Hb为9 g/dL的ESRD患者将利用该边际的21.9%，而平均Hb为10 g/dL的患者为8.7%，平均Hb为11 g/dL的患者为3.0%，平均Hb为12 g/dL的患者为1.3%。结论ESRD治疗方法的潜在变化可能会缩小血缘，限制其他用途的血液制品的可用性，如急性损伤和外科手术。

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引用次数: 0

Racial Differences in Perinatal Depression among HIV-infected Women 艾滋病毒感染妇女围产期抑郁的种族差异

Health outcomes research in medicine

Pub Date : 2012-05-01 DOI: 10.1016/j.ehrm.2012.03.005

Meg C. Kong PhD , Milap Nahata MS, PharmD , Veronique A. Lacombe PhD , Eric E. Seiber PhD , Rajesh Balkrishnan PhD

Background

Perinatal depression may further complicate the health of women with human immunodeficiency virus (HIV) infection. Diagnosis and subsequent treatment of depressive symptoms may significantly improve the health of mother and newborn.

Objective

We sought to examine the association between race and perinatal depression among a sample of low-income women with HIV infection.

Methods

This retrospective cohort study used data from a multi-state Medicaid administrative claims database to study HIV-infected perinatal women between 2003 and 2007. Multivariate regression analysis was used to study the objective.

Results

The overall prevalence of perinatal depression in the sample (n = 650) was 27.8%. Black women had significantly lower odds of experiencing perinatal depression (odds ratio 0.328; 95% confidence interval 0.225-0.479) compared with non-black women. Non-black women showed significantly higher comorbidity severity scores than black women (0.356 vs. 0.220, P = .035).

Conclusions

This study found that non-black women may be more vulnerable to perinatal depression. Improved health care provider vigilance for depressive symptoms among low-income, HIV-infected women of all races during the perinatal period is warranted.

背景围产期抑郁可能使感染人类免疫缺陷病毒(HIV)的妇女的健康进一步复杂化。抑郁症状的诊断和后续治疗可显著改善母亲和新生儿的健康。目的:在低收入HIV感染妇女中研究种族与围产期抑郁之间的关系。方法本回顾性队列研究使用来自多州医疗补助行政索赔数据库的数据，研究2003年至2007年间感染艾滋病毒的围产期妇女。采用多元回归分析研究目的。结果650例围产儿抑郁总体患病率为27.8%。黑人妇女患围产期抑郁症的几率明显较低(优势比0.328;95%可信区间0.225-0.479)与非黑人女性相比。非黑人女性的合并症严重程度评分明显高于黑人女性(0.356比0.220,P = 0.035)。结论本研究发现，非黑人妇女可能更容易患围产期抑郁症。有必要提高卫生保健提供者对所有种族的低收入艾滋病毒感染妇女围产期抑郁症状的警惕性。

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引用次数: 2

Outcomes Research and Comparative Effectiveness 结果研究与比较效果

Health outcomes research in medicine

Pub Date : 2012-05-01 DOI: 10.1016/j.ehrm.2012.04.001

Donald E. Stull Jr. PhD (Editor in Chief)

引用次数: 0

The Rise of Patient-Centered Outcomes Research 以患者为中心的结果研究的兴起

Health outcomes research in medicine

Pub Date : 2012-02-01 DOI: 10.1016/j.ehrm.2012.01.002

Rachael Fleurence PhD (Associate Editor)

引用次数: 1