Health-related quality of life; chronic obstructive pulmonary disease and smoking

© 2016 Dr. Foruhar MoayeriThis thesis explores and investigates the challenges around measurement of Quality of Life (QoL) / Health State Utility Value (HSUV) in Chronic Obstructive Pulmonary Disease (COPD), as a chronic disease and its major risk factor, smoking. This thesis is based upon four separate studies, which present original research of 1) systematic literature review on HSUV in COPD, 2) application of the HSUVs in COPD disease progression models, 3) economic evaluation study alongside a clinical trial aimed to improve HSUV in COPD and 4) econometric analysis of the effect of smoking habit transition on the HSUVs. The first study investigates the mean HSUVs in COPD patients in general and specifically in each stage of the disease by using systematic literature review and meta-analysis of studies which reported patients-level utility values elicited by EQ-5D. In order to explore the degree of heterogeneity around the utility values, effects of a variety of clinical and study characteristics have been examined through subgroup analyses. This study represents one of the first meta-analysis and subgroup analysis of HSUV in COPD. It demonstrates considerable inconsistency in utility measures among COPD-related published literature. This study highlights that in case of high level of heterogeneity, appropriate sensitivity analyses are recommended for more accurate health economic appraisals. The second study concerns the compatibility of available COPD progression models with good practices guideline for decision analytic modelling. This study conducts a systematic review of the HSUVs assigned to the different stages of COPD used in modelling studies and compares these with summary measures from meta-analyses of available utility studies. This study demonstrates that on average, COPD decision models used higher values than estimated mean HSUVs from the meta-analysis of the patient-level data. The study suggests that improvement in the consistency of modelling studies may be achieved if published recommendations on good modelling practice, especially the data identification, are followed closely as suggested. The third study is an economic evaluation of the telephone-based cognitive behavioural (TB-CBT) therapy for depression/anxiety comorbidities in COPD patients. Alongside a clinical trial, a cost-utility analysis is performed to measure cost and quality-adjusted life years gained based on the Assessment of Quality of Life (AQoL-4D) measure as a preference-based HSUV scale. This study shows that TB-CBT can be considered as a cost saving approach. This study, by using the concept of loss aversion from prospect theory which is based on individual preference, provides a distinctive interpretation of the incremental cost-effectiveness ratio (ICER) in the south-west quadrant of ICER plane. The fourth study elucidates the effect of the transition from “Smoker” to “Ex-smoker” on QoL (measured by SF-36) in the general Australian population. Panel data from thirteen waves of a nationally representative longitudinal survey of Household Income and Labour Dynamics of Australia is used and piecewise two-way fixed effect linear regression models are adapted. Of the eight SF-36 dimensions, only physical health factors showed pervasively and significant improvements after the smoking transition, irrespective of age and sex and other related time-invariant covariates. This study is one of the first studies analysing the relationship between smoking and QoL measures in general population, taking the advantages of panel data which provides unique opportunity to account for individual heterogeneity and focuses on within-person changes in QoL as smoking status change while controlling for unobserved time-invariant individual characteristics (fixed effects) on observed covariates

Cost-utility analysis of telephone-based cognitive behavior therapy in chronic obstructive pulmonary disease (COPD) patients with anxiety and depression comorbidities: an application for willingness to accept concept

Background: This study evaluated the cost-utility of telephone-based cognitive behavioral therapy (TB-CBT) (experimental arm) in comparison with a placebo-befriending (control arm) program in COPD participants with mild to severe depression and/or anxiety. Methods: The decision rule was based on willingness-to-pay if there is an increased unit of effectiveness (a quality-adjusted life year [QALY] gain) and an increase in cost, and willingness-to-accept (WTA) if there is a reduced unit of effectiveness (a QALY loss) and decrease in cost (a cost-saving). Results: TB-CBT group was associated with a reduction in the incremental cost of AUS−$407.3 (p < 0.001, SE:34.1) plus a negative, nonsignificant incremental QALY gain of −0.008 (SE:0.011) per patient compared to control group. The point estimate of the mean incremental cost-utility ratio was AUS$50,284.0 cost saving per QALY sacrificed (the high value associated with small QALY value in the denominator). Ninety-five percent CI was AUS$13,426 cost sacrificed to AUS$32,018 cost gain (lower values associated with larger QALY values in the denominator). If the societal’s minimum (flooring threshold) WTA is AUS$64,000 per QALY forgone, the probability of TB-CBT being cost-effective was 42% Conclusions: This study showed that TB-CBT can be recommended as a cost-saving and preventive approach over usual care plus befriending program

Investigating the introduction of the alcohol minimum unit price in the Northern Territory. Final report.

On 22 August 2018 amendments to the Northern Territory Liquor Act 1978 (the Act) were passed in the NT Legislative Assembly, introducing a minimum alcohol unit price MUP, commonly referred to as a minimum floor price. On 1 October 2018 the MUP was set at $1.30 per standard drink contained in the alcohol product, where the meaning of 'a standard drink is the volume of a liquor product that contains 10g of ethyl alcohol when measured at 20°C'. The legislative amendment prohibits selling alcohol below the price of$1.30 per standard drink (as compared to the $1.50 recommended by the Riley Review), and imposes the minimum price as an automatic condition of a liquor licence

QUeensland Alcohol-related violence and Night Time Economy Monitoring (QUANTEM): Final Report (April 2019)

In July 2016 the Queensland Government introduced the 'Tackling Alcohol-Fuelled Violence' Policy. Among other initiatives, the Policy introduced statewide restrictions on trading hours.\ua0The Queensland Alcohol-related violence and Night-Time Economy (QUANTEM) project evaluates the effects of this policy

QUeensland Alcohol-related violence and Night-Time Economy Monitoring (QUANTEM) : final report

QUeensland Alcohol-related violence and Night-Time Economy Monitoring (QUANTEM) : final repor