Smoking and health-related quality of life in English general population: Implications for economic evaluations

Copyright @ 2012 Vogl et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This article has been made available through the Brunel Open Access Publishing Fund.Background: Little is known as to how health-related quality of life (HRQoL) when measured by generic instruments such as EQ-5D differ across smokers, ex-smokers and never-smokers in the general population; whether the overall pattern of this difference remain consistent in each domain of HRQoL; and what implications this variation, if any, would have for economic evaluations of tobacco control interventions. Methods: Using the 2006 round of Health Survey for England data (n = 13,241), this paper aims to examine the impact of smoking status on health-related quality of life in English population. Depending upon the nature of the EQ-5D data (i.e. tariff or domains), linear or logistic regression models were fitted to control for biology, clinical conditions, socio-economic background and lifestyle factors that an individual may have regardless of their smoking status. Age- and gender-specific predicted values according to smoking status are offered as the potential 'utility' values to be used in future economic evaluation models. Results: The observed difference of 0.1100 in EQ-5D scores between never-smokers (0.8839) and heavy-smokers (0.7739) reduced to 0.0516 after adjusting for biological, clinical, lifestyle and socioeconomic conditions. Heavy-smokers, when compared with never-smokers, were significantly more likely to report some/severe problems in all five domains - mobility (67%), self-care (70%), usual activity (42%), pain/discomfort (46%) and anxiety/depression (86%) -. 'Utility' values by age and gender for each category of smoking are provided to be used in the future economic evaluations. Conclusion: Smoking is significantly and negatively associated with health-related quality of life in English general population and the magnitude of this association is determined by the number of cigarettes smoked. The varying degree of this association, captured through instruments such as EQ-5D, may need to be fed into the design of future economic evaluations where the intervention being evaluated affects (e.g. tobacco control) or is affected (e.g. treatment for lung cancer) by individual's (or patients') smoking status

Resource use and costs of care for treating asthma and COPD in the Netherlands

Dit rapport geeft een uitgebreid overzicht van het gebruik en de kosten van zorg bij astma en COPD ("Chronic Obstructive Pulmonary Disease", Chronische bronchitis en Longemfyseem). Astma kost ongeveer 313 euro per patient, waarvan de helft aan medicatie wordt besteed. COPD kost ongeveer 915 euro per patient en de belangrijkste kostenposten zijn ziekenhuisopnames, medicatie en thuiszorg. De gepresenteerde cijfers over de kosten nu en in de toekomst leveren belangrijke informatie op voor beleid ten aanzien van deze twee aandoeningen.De kosten voor astma in Nederland bedroegen ongeveer 141 miljoen euro, 67 miljoen voor mannen en 74 miljoen voor vrouwen. De kosten voor COPD in Nederland bedroegen ongeveer 280 miljoen euro, 161 miljoen voor mannen en 119 miljoen voor vrouwen. Beide schattingen zijn voor het jaar 2000. Projecties van deze kosten over de tijd geven een indicatie voor toekomstige ontwikkelingen voorzover deze nu waar te nemen zijn in de data. Bij gelijkblijvende zorg en prijzen zullen de kosten voor astma in 2025 gestegen zijn naar ongeveer 170 tot 180 miljoen euro en voor COPD naar ongeveer 440 tot 495 miljoen euro. Wanneer de projecties rekening houden met trends in de kosten van zorg, dan stijgen de kosten voor astma naar 460 tot 500 miljoen euro en voor COPD naar 1000 tot 1100 miljoen euro. Per patiknt zijn de kosten voor COPD ruwweg drie keer die voor astma, terwijl de totale kosten in Nederland voor COPD tweemaal zo hoog zijn als die voor astma. De verwachte stijging in de kosten voor COPD is groter dan de stijging in de kosten voor astma.This report presents information on health care utilisation and health care related costs for asthma and Chronic Obstructive Pulmonary Disease (COPD) in the Netherlands. Furthermore, projections of future costs are given. Total costs for treating asthma in 2000 were estimated at 141 million euro, 67 million for men and 74 million for women. About 53% of these total costs concerned costs for medication. Costs per patient came to approximately 315 euro. Projections of these costs into the future showed that, assuming constant treatment patterns and costs, the total costs for asthma were projected to increase to 170-180 million euro in 2025. When trends in costs per person were included, the projections resulted in a higher cost increase to about 460-500 million euro. Total costs for treating COPD in 2000 were estimated at 280 million euro, 161 million for men and 119 million for women. Main cost drivers were hospitalizations (27%), medication (22%), and homecare (19%). Costs per patient were about 915 euro. Total costs per severity stage were estimated for mild, moderate, severe and very severe COPD at about 23, 104, 99, and 55 million euro, respectively. Projections of these costs into the future showed that, assuming constant treatment patterns and costs, the total costs for COPD were projected to increase to 440-495 million euro. When trends in costs per person were included, the projections resulted in an even higher cost increase to about 1000-1100 million euro. The increase in costs for COPD was higher than that for asthma.Nederlands Astmafond

Resource use and costs of care for treating asthma and COPD in the Netherlands

This report presents information on health care utilisation and health care related costs for asthma and Chronic Obstructive Pulmonary Disease (COPD) in the Netherlands. Furthermore, projections of future costs are given. Total costs for treating asthma in 2000 were estimated at 141 million euro, 67 million for men and 74 million for women. About 53% of these total costs concerned costs for medication. Costs per patient came to approximately 315 euro. Projections of these costs into the future showed that, assuming constant treatment patterns and costs, the total costs for asthma were projected to increase to 170-180 million euro in 2025. When trends in costs per person were included, the projections resulted in a higher cost increase to about 460-500 million euro. Total costs for treating COPD in 2000 were estimated at 280 million euro, 161 million for men and 119 million for women. Main cost drivers were hospitalizations (27%), medication (22%), and homecare (19%). Costs per patient were about 915 euro. Total costs per severity stage were estimated for mild, moderate, severe and very severe COPD at about 23, 104, 99, and 55 million euro, respectively. Projections of these costs into the future showed that, assuming constant treatment patterns and costs, the total costs for COPD were projected to increase to 440-495 million euro. When trends in costs per person were included, the projections resulted in an even higher cost increase to about 1000-1100 million euro. The increase in costs for COPD was higher than that for asthma.Dit rapport geeft een uitgebreid overzicht van het gebruik en de kosten van zorg bij astma en COPD ("Chronic Obstructive Pulmonary Disease", Chronische bronchitis en Longemfyseem). Astma kost ongeveer 313 euro per patient, waarvan de helft aan medicatie wordt besteed. COPD kost ongeveer 915 euro per patient en de belangrijkste kostenposten zijn ziekenhuisopnames, medicatie en thuiszorg. De gepresenteerde cijfers over de kosten nu en in de toekomst leveren belangrijke informatie op voor beleid ten aanzien van deze twee aandoeningen.De kosten voor astma in Nederland bedroegen ongeveer 141 miljoen euro, 67 miljoen voor mannen en 74 miljoen voor vrouwen. De kosten voor COPD in Nederland bedroegen ongeveer 280 miljoen euro, 161 miljoen voor mannen en 119 miljoen voor vrouwen. Beide schattingen zijn voor het jaar 2000. Projecties van deze kosten over de tijd geven een indicatie voor toekomstige ontwikkelingen voorzover deze nu waar te nemen zijn in de data. Bij gelijkblijvende zorg en prijzen zullen de kosten voor astma in 2025 gestegen zijn naar ongeveer 170 tot 180 miljoen euro en voor COPD naar ongeveer 440 tot 495 miljoen euro. Wanneer de projecties rekening houden met trends in de kosten van zorg, dan stijgen de kosten voor astma naar 460 tot 500 miljoen euro en voor COPD naar 1000 tot 1100 miljoen euro. Per patiknt zijn de kosten voor COPD ruwweg drie keer die voor astma, terwijl de totale kosten in Nederland voor COPD tweemaal zo hoog zijn als die voor astma. De verwachte stijging in de kosten voor COPD is groter dan de stijging in de kosten voor astma

Richtlijnen voor de lange termijn behandeling van kinderen met astma en kosteneffectiviteit

The prevalence of certain chronic diseases is growing and new treatments become available. Therefore, in the future, the resources required to care for chronically ill patients may increase. If available budgets are limited, it is important to consider the efficiency of interventions to guarantee a maximum pay-off in terms of better health and quality of life within the given budget. An interesting question therefore is whether for specific diseases knowledge on cost effectiveness, epidemiology and the effects of interventions can be combined in a model to determine more efficient allocations of resources. The present report contains the first steps towards such a model of the long-term care for children with asthma. In particular, the report presents the following results: (1) a classification of existing interventions for the long-term care of asthmatic children, (2) a summary of "standard" care as presented in guidelines, and (3) a review of cost-effectiveness studies, summarising what is known about the costs and effects of interventions.De zorg voor chronisch zieken doet een toenemend beroep op middelen binnen en buiten de gezondheidszorg. Een doelmatige besteding van de beschikbare middelen moet ertoe leiden dat voor een gegeven budget, besteed aan interventies, de opbrengsten in termen van verbeteringen in de gezondheid van patienten zo groot mogelijk zijn. Vanuit maatschappelijk perspectief is het een interessante vraag of voor specifieke aandoeningen de beschikbare kennis over epidemiologie, effectiveit en kosteneffectiviteit kan worden gecombineerd binnen een model om daarmee een efficientere allocatie van middelen over interventies en groepen patienten te onderzoeken. Het voorliggende rapport biedt een verslag van beschikbare kennis op het terrein van richtlijnen en kosteneffectiviteit wat betreft de lange termijn behandeling van kinderen met astma. De volgende resultaten worden gepresenteerd: (1) een gestructureerde indeling van bestaande interventies voor de lange termijn zorg bij kinderen met astma, (2) een vergelijking van vier recente richtlijnen en samenvatting van de "standaard" zorg, en (3) een overzicht van de resultaten van kostenefffectiviteitsstudies

Richtlijnen voor de lange termijn behandeling van kinderen met astma en kosteneffectiviteit

De zorg voor chronisch zieken doet een toenemend beroep op middelen binnen en buiten de gezondheidszorg. Een doelmatige besteding van de beschikbare middelen moet ertoe leiden dat voor een gegeven budget, besteed aan interventies, de opbrengsten in termen van verbeteringen in de gezondheid van patienten zo groot mogelijk zijn. Vanuit maatschappelijk perspectief is het een interessante vraag of voor specifieke aandoeningen de beschikbare kennis over epidemiologie, effectiveit en kosteneffectiviteit kan worden gecombineerd binnen een model om daarmee een efficientere allocatie van middelen over interventies en groepen patienten te onderzoeken. Het voorliggende rapport biedt een verslag van beschikbare kennis op het terrein van richtlijnen en kosteneffectiviteit wat betreft de lange termijn behandeling van kinderen met astma. De volgende resultaten worden gepresenteerd: (1) een gestructureerde indeling van bestaande interventies voor de lange termijn zorg bij kinderen met astma, (2) een vergelijking van vier recente richtlijnen en samenvatting van de "standaard" zorg, en (3) een overzicht van de resultaten van kostenefffectiviteitsstudies.The prevalence of certain chronic diseases is growing and new treatments become available. Therefore, in the future, the resources required to care for chronically ill patients may increase. If available budgets are limited, it is important to consider the efficiency of interventions to guarantee a maximum pay-off in terms of better health and quality of life within the given budget. An interesting question therefore is whether for specific diseases knowledge on cost effectiveness, epidemiology and the effects of interventions can be combined in a model to determine more efficient allocations of resources. The present report contains the first steps towards such a model of the long-term care for children with asthma. In particular, the report presents the following results: (1) a classification of existing interventions for the long-term care of asthmatic children, (2) a summary of "standard" care as presented in guidelines, and (3) a review of cost-effectiveness studies, summarising what is known about the costs and effects of interventions.VW

The disease burden of multimorbidity and its interaction with educational level

Introduction Policies to adequately respond to the rise in multimorbidity have top-priority. To understand the actual burden of multimorbidity, this study aimed to: 1) estimate the trend in prevalence of multimorbidity in the Netherlands, 2) study the association between multimorbidity and physical and mental health outcomes and healthcare cost, and 3) investigate how the association between multimorbidity and health outcomes interacts with socio-economic status (SES). Methods Prevalence estimates were obtained from a nationally representative pharmacy database over 2007–2016. Impact on costs was estimated in a fixed effect regression model on claims data over 2009–2015. Data on physical and mental health and SES were obtained from the National Health Survey in 2017, in which the Katz-10 was used to measure limitations in activities of daily living (ADL) and the Mental Health Inventory (MHI) to measure mental health. SES was approximated by the level of education. Generalized linear models (2-part models for ADL) were used to analyze the health data. In all models an indicator variable for the presence or absence of multimorbidity was included or a categorical variable for the number of chronic conditions. Interactions terms of multimorbidity and educational level were added into the previously mentioned models. Results Over the past ten years, there was an increase of 1.6%-point in the percentage of people with multimorbidity. The percentage of people with three or more conditions increased with +2.1%-point. People with multimorbidity had considerably worse physical and mental health outcomes than people without multimorbidity. For the ADL, the impact of multimorbidity was three times greater in the lowest educational level than in the highest educational level. For the MHI, the impact of multimorbidity was two times greater in the lowest than in the highest educational level. Each additional chronic condition was associated with a greater worsening in health outcomes. Similarly, for costs, where there was no evidence of a diminishing impact of additional conditions either. In patients with multimorbidity total healthcare costs were on average €874 higher than in patients with a single morbidity. Conclusion The impact of multimorbidity on health and costs seems to be greater in the sicker and lower educated population

Modeling Early Warning Systems: Construction and Validation of a Discrete Event Simulation Model for Heart Failure

Objectives: Developing and validating a discrete event simulation model that is able to model patients with heart failure managed with usual care or an early warning system (with or without a diagnostic algorithm) and to account for the impact of individual patient characteristics in their health outcomes. Methods: The model was developed using patient-level data from the Trans-European Network – Home-Care Management System study. It was coded using RStudio Version 1.3.1093 (version 3.6.2.) and validated along the lines of the Assessment of the Validation Status of Health-Economic decision models tool. The model includes 20 patient and disease characteristics and generates 8 different outcomes. Model outcomes were generated for the base-case analysis and used in the model validation. Results: Patients managed with the early warning system, compared with usual care, experienced an average increase of 2.99 outpatient visits and a decrease of 0.02 hospitalizations per year, with a gain of 0.81 life years (0.45 quality-adjusted life years) and increased average total costs of €11 249. Adding a diagnostic algorithm to the early warning system resulted in a 0.92 life year gain (0.57 quality-adjusted life years) and increased average costs of €9680. These patients experienced a decrease of 0.02 outpatient visits and 0.65 hospitalizations per year, while they avoided being hospitalized 0.93 times. The model showed robustness and validity of generated outcomes when comparing them with other models addressing the same problem and with external data. Conclusions: This study developed and validated a unique patient-level simulation model that can be used for simulating a wide range of outcomes for different patient subgroups and treatment scenarios. It provides useful information for guiding research and for developing new treatment options by showing the hypothetical impact of these interventions on a large number of important heart failure outcomes.</p

Cost-effectiveness of the fixed-dose combination tiotropium/olodaterol versus tiotropium monotherapy or a fixed-dose combination of long-acting β2-agonist/inhaled corticosteroid for COPD in Finland, Sweden and the Netherlands

Objectives Chronic obstructive pulmonary disease (COPD) guidelines advocate treatment with combinations of long-acting bronchodilators for patients with COPD who have persistent symptoms or continue to have exacerbations while using a single bronchodilator. This study assessed the cost-utility of the fixed dose combination of the bronchodilators tiotropium and olodaterol versus two comparators, tiotropium monotherapy and long-acting β2 agonist/inhaled corticosteroid (LABA/ICS) combinations, in three European countries: Finland, Sweden and the Netherlands. Methods A previously published COPD patient-level discrete event simulation model was updated with most recent evidence to estimate lifetime quality-adjusted life years (QALYs) and costs for COPD patients receiving either tiotropium/olodaterol, tiotropium monotherapy or LABA/ICS. Treatment efficacy covered impact on trough forced expiratory volume in 1 s (FEV 1), total and severe exacerbations and pneumonias. The unit costs of medication, maintenance treatment, exacerbations and pneumonias were obtained for each country. The country-specific analyses adhered to the Finnish, Swedish and Dutch pharmacoeconomic guidelines, respectively. Results Treatment with tiotropium/olodaterol gained QALYs ranging from 0.09 (Finland and Sweden) to 0.11 (the Netherlands) versus tiotropium and 0.23 (Finland and Sweden) to 0.28 (the Netherlands) versus LABA/ICS. The Finnish payer's incremental cost-effectiveness ratio (ICER) of tiotropium/olodaterol was €11 000/QALY versus tiotropium and dominant versus LABA/ICS. The Swedish ICERs were €6200/QALY and dominant, respectively (societal perspective). The Dutch ICERs were €14 400 and €9200, respectively (societal perspective). The probability that tiotropium/olodaterol was cost-effective compared with tiotropium at the country-specific (unofficial) threshold values for the maximum willingness to pay for a QALY was 84% for Finland, 98% for Sweden and 99% for the Netherlands. Compared with LABA/ICS, this probability was 100% for all three countries. Conclusions Based on the simulations, tiotropium/olodaterol is a cost-effective treatment option versus tiotropium or LABA/ICS in all three countries. In both Finland and Sweden, tiotropium/olodaterol is more effective and cost saving (ie, dominant) in comparison with LABA/ICS