Physicians' preference values for hepatitis C health states and antiviral therapy: A survey

BACKGROUND: Physicians' perspectives regarding hepatitis C shape their approach to patient management. We used utility analysis to evaluate physicians' perceptions of hepatitis C-related health states (HS) and their threshold to recommend treatment. METHODS: A written questionnaire was administered to practicing physicians. They were asked to rate hepatitis C health states on a visual analog scale ranging from 0% (death) to 100% (health without hepatitis C). Physicians then judged quality of life associated with the side effects of antiviral therapy for hepatitis C and indicated the sustained virological response rate that they would require to recommend treatment. RESULTS: One hundred and thirteen physicians from five states were included. Median utility ratings for hepatitis C health states declined significantly with increasing severity of symptoms: HS1-No Symptoms, No Cirrhosis (88%; 12% reduction from good health), HS2-Mild Symptoms, No Cirrhosis (66%), HS3-Moderate Symptoms, No Cirrhosis (49%), HS4-Mild Symptoms, Cirrhosis (40%), HS5-Severe Symptoms, Cirrhosis (18%) [p < 0.001]. The median rating for life with side effects of antiviral therapy was 47%, suggesting a 53% reduction from good health. That was similar to the utility value for HS3-Moderate Symptoms, No Cirrhosis. The median threshold value for recommending treatment was a sustained response rate of 60%. CONCLUSIONS: 1) Physicians' utility ratings for hepatitis C health states were inversely related to the severity of disease manifestations described. 2) Physicians viewed side effects of therapy unfavorably and indicated that on average, they would require a 60% sustained response rate before recommending treatment, which far exceeds the efficacy of current antiviral therapy for hepatitis C in the majority of patients

An innovative cost modelling system to support lean product and process development

This paper presents a cost modelling system for lean product and process development to support proactive decision making and mistake elimination at the design stage. The foundations of the system are based upon three lean product and process development enablers, namely: Set-based concurrent engineering, knowledge-based engineering, and mistake proofing (Poka-yoke). The development commenced with an industrial field study of eleven leading European industries from the aerospace, automotive, telecommunication, medical and domestic appliance sectors. Based on the requirements of industrial collaborators, the developed system comprises six modules: value identification, manufacturing process/machines selection, material selection, geometric features specification, geometric features and manufacturability assessment, and manufacturing time and cost estimation. The work involved the development of a feature-based cost estimation method for the resistance spot welding process. The developed system was finally validated using an industrial case study. The developed system has the capability to provide estimates related to product cost and associated values concurrently, facilitate decision making, eliminate mistakes during the design stage, and incorporate ‘customer voice’ during a critical decision making stage