Estimating the Costs of Preventive Interventions

The goal of this article is to improve the practice and reporting of cost estimates of prevention programs. It reviews the steps in estimating the costs of an intervention and the principles that should guide estimation. We then review prior efforts to estimate intervention costs using a sample of well-known but diverse studies. Finally, we illustrate the principles with an example, the Family Bereavement Program. We conclude that example by discussing whether and how the costs of the intervention might differ when implemented in a real-world setting

Responsiveness of PROMIS® to change in chronic obstructive pulmonary disease.

BackgroundChronic obstructive pulmonary disease (COPD) is a progressive chronic disease characterized by airflow obstruction that leads to shortness of breath and substantial negative impacts on health-related quality of life (HRQL). The course of COPD includes periodic acute exacerbations that require changes in treatment and/or hospitalizations. This study was designed to examine the responsiveness of Patient-Reported Outcomes Measurement Information System® (PROMIS®) measures to changes associated with COPD exacerbation recovery.MethodsA longitudinal analysis using mixed-effects models was conducted of people who were enrolled while stable (n = 100) and those who experienced an acute exacerbation (n = 85). PROMIS (physical function, pain interference, pain behavior, fatigue, anxiety, depression, anger, social roles, discretionary social activities, Global Health, dyspnea severity and dyspnea functional limitations) and COPD-targeted HRQL measures were completed at baseline and at 12 weeks.ResultsWe administered PROMIS measures using computer adaptive testing (CAT), followed by administration of any remaining short form (SF) items that had not yet been administered by CAT. Examination of the difference between group differences from baseline to 12 weeks in the stable and exacerbation groups revealed that the exacerbation group changed (improved) significantly more than the stable group in anxiety (p < .001 to p < .01; f2 effect size [ES] = 0.023/0.021), fatigue (p < .0001; ES = 0.036/0.047) and social roles (p < .001 to p < .05; ES = 0.035/0.024). All effect sizes were small in magnitude and smaller than hypothesized. Depression was also statistically significant (p < .05, SF only) but the ES was trivial. For all other PROMIS domains, the differences were not significant and ES were trivial.ConclusionsThis longitudinal study provides some support for the validity of the PROMIS fatigue, anxiety, and social roles domains in COPD, but further evaluation of responsiveness is warranted

Impact of patient characteristics on the risk of influenza/ILI-related complications

BACKGROUND: We sought to quantify the impact of patient characteristics on complications and health care costs associated with influenza and influenza-like illness (ILI) in a nonelderly population. METHODS: Patients with medical reimbursement claims for influenza in the 1996–1997 season were identified from the automated database of a large private New England Insurer (NEI). Influenza care during the 21- day follow-up period was characterized according to age, gender, vaccine status, co-morbidities, prior influenza/ILI episodes, treatments, and recent health care costs and related diagnoses. RESULTS: There were 6,241 patients. Approximately 20% had preexisting chronic lung disease. Overall, 23% had health care services for possible complications, among which respiratory diagnoses were the most common (13%). Two percent of the influenza/ILI episodes involved hospitalization, with a median stay of five days. Factors most strongly predictive of hospitalizations and complications were preexisting malignancy (hospitalizations OR = 3.7 and complications OR = 2.4), chronic heart disease (OR = 3.2 and OR = 1.8), diabetes (OR = 2.2 and OR = 1.7) and recent illnesses that would have counted as complications had they occurred during an influenza/ILI episode (hospitalizations OR = 3.2 and complications OR = 1.5). The same factors affected influenza-related costs and total costs of care as dramatically as they affected complication rates. CONCLUSIONS: Influenza/ILI-related costs are driven by the characteristics that predict complications of influenza. Patients with chronic illness and those with recent acute respiratory events are the most likely to experience complications and hospitalizations

Urinary incontinence and health-related quality of life among older Americans with and without cancer: a cross-sectional study

Abstract Background Few studies have investigated the impact of urinary incontinence (UI) on health-related quality of life (HRQOL) among cancer survivors. UI is prevalent in the general population and can be both an indicator of cancer and a side effect of cancer treatment. UI and cancer diagnoses have been associated with decreases in HRQOL. This study evaluates the prevalence of UI and the impact on HRQOL among older cancer survivors. Methods The prevalence of UI among cancer survivors (breast, prostate, bladder, colorectal, lung, and endometrial/uterine cancers) and those without cancer was estimated using the SEER-MHOS database. Factors associated with UI were investigated using logistic regression and the impact of UI on SF-36 scores was determined using linear regression. Results Over 36% of SEER-MHOS beneficiaries without cancer reported UI and higher prevalence was noted among cancer survivors (37%-54% depending on cancer type). History of bladder, breast, endometrial/uterine, or prostate cancer was associated with higher prevalence of UI. UI was independently associated with both lower physical component scores (PCS) (−1.27; 95%CI:-1.34,-1.20) and mental component scores (MCS) (−1.75; 95%CI −1.83, -1.68). A suggested decreasing trend in the prevalence of UI was associated with a longer time since cancer diagnosis. Conclusions UI was highly prevalent, especially in bladder, endometrial/uterine, and prostate cancer survivors. Improved recognition of UI risk among cancer survivors will help clinicians better anticipate and mediate the effect of UI on individuals’ HRQOL

Lumbar spine radiographic features and demographic, clinical, and radiographic knee, hip and hand osteoarthritis: The Johnston County Osteoarthritis Project

Objective—1) To determine the prevalence of lumbar spine individual radiographic features (IRF) of disc space narrowing (DSN), osteophytes (OST) and facet joint osteoarthritis (FOA). 2) To describe the frequencies of demographic, clinic and radiographic knee, hip and hand osteoarthritis (OA) across lumbar spine IRF. 3) To determine factors associated with lumbar spine IRF. Methods—A cross-sectional study of 840 participants enrolled in the Johnston County OA Project (2003-4). Sample-based prevalence estimates were generated for each lumbar spine IRF. Associations between lumbar spine IRF and demographic, clinical and peripheral joint OA were determined with logistic regression models. Results—Sample-based prevalence estimates were similar for DSN (57.6%) and FOA (57.9%) but higher for OST (88.1%) with significant differences across race and gender. Hand and knee OA frequencies increased across IRF whereas the effect was absent for hip OA. African Americans had lower odds of FOA (adjusted odds ratio [aOR]=0.45 (95% CI 0.32, 0.62)) while there was no racial association with DSN and OST. Low back symptoms were associated with DSN (aOR=1.37 (95% CI 1.04, 1.80)) but not OST or FOA. Knee OA was associated with OST (aOR=1.62 (95% CI 1.16, 2.27)) and FOA (aOR=1.69 (95% CI 1.15, 2.49)) but not DSN. Hand OA was associated with FOA (aOR=1.67 (95% CI 1.20, 2.28)) but not with DSN or OST. No associations were found with hip OA. Conclusion—These findings underscore the importance of analyzing lumbar spine IRF separately as the associations with demographic, clinic and radiographic knee, hip and hand OA differ widely

Development of six PROMIS pediatrics proxy-report item banks

<p>Abstract</p> <p>Background</p> <p>Pediatric self-report should be considered the standard for measuring patient reported outcomes (PRO) among children. However, circumstances exist when the child is too young, cognitively impaired, or too ill to complete a PRO instrument and a proxy-report is needed. This paper describes the development process including the proxy cognitive interviews and large-field-test survey methods and sample characteristics employed to produce item parameters for the Patient Reported Outcomes Measurement Information System (PROMIS) pediatric proxy-report item banks.</p> <p>Methods</p> <p>The PROMIS pediatric self-report items were converted into proxy-report items before undergoing cognitive interviews. These items covered six domains (physical function, emotional distress, social peer relationships, fatigue, pain interference, and asthma impact). Caregivers (n = 25) of children ages of 5 and 17 years provided qualitative feedback on proxy-report items to assess any major issues with these items. From May 2008 to March 2009, the large-scale survey enrolled children ages 8-17 years to complete the self-report version and caregivers to complete the proxy-report version of the survey (n = 1548 dyads). Caregivers of children ages 5 to 7 years completed the proxy report survey (n = 432). In addition, caregivers completed other proxy instruments, PedsQL™ 4.0 Generic Core Scales Parent Proxy-Report version, PedsQL™ Asthma Module Parent Proxy-Report version, and KIDSCREEN Parent-Proxy-52.</p> <p>Results</p> <p>Item content was well understood by proxies and did not require item revisions but some proxies clearly noted that determining an answer on behalf of their child was difficult for some items. Dyads and caregivers of children ages 5-17 years old were enrolled in the large-scale testing. The majority were female (85%), married (70%), Caucasian (64%) and had at least a high school education (94%). Approximately 50% had children with a chronic health condition, primarily asthma, which was diagnosed or treated within 6 months prior to the</p> <p>interview. The PROMIS proxy sample scored similar or better on the other proxy instruments compared to normative samples.</p> <p>Conclusions</p> <p>The initial calibration data was provided by a diverse set of caregivers of children with a variety of common chronic illnesses and racial/ethnic backgrounds. The PROMIS pediatric proxy-report item banks include physical function (mobility n = 23; upper extremity n = 29), emotional distress (anxiety n = 15; depressive symptoms n = 14; anger n = 5), social peer relationships (n = 15), fatigue (n = 34), pain interference (n = 13), and asthma impact (n = 17).</p

The use of focus groups in the development of the PROMIS pediatrics item bank

To understand differences in perceptions of patient reported outcome domains between children with asthma and children from the general population. We used this information in the development of patient-reported outcome items for the Patient Reported Outcomes Measurement Information System Pediatrics project

Coexistence of urinary incontinence and major depressive disorder with health-related quality of life in older Americans with and without cancer

This study evaluates the prevalence and factors associated with major depressive disorder (MDD) in a population of cancer survivors and the impact of co-occurring MDD and urinary incontinence (UI) on health-related quality of life (HRQOL)

The effect of DPP-4 inhibitors on asthma control : an administrative database study to evaluate a potential pathophysiological relationship

Acknowledgments The authors acknowledge Koustubh Ranade (MedImmune, Gaithersburg, MD, USA) and Stephen Johnston, a member of the steering committee who was employed by Truven Health Analytics at the time the study was conducted, for their contributions to this study . Truven Health Analytics, an IBM Company, received funding from AstraZeneca in relation to this study. This work was previously presented as a poster at the annual international conference of the American Thoracic Society, May 19–24, 2017, Washington, DC (Colice G, et al. The Effect of Dipeptidyl-Peptidase-4 Inhibitors on Asthma Control: An Administrative Database Study to Evaluate a Potential Pathophysiological Relationship. Am J Respir Crit Care Med. 2017;195:A3050).Peer reviewedPublisher PD