The effect of disease adaptation information on general population values : a case study using rheumatoid arthritis states.

Objective: The Washington Panel on Cost-effectiveness in Health and Medicine recommends that economic evaluation of healthcare technologies uses values for health states elicited from the general population rather than patients. However, general population respondents do not necessarily recognize the possibility of adapting to the impaired state. This thesis examines how informing the general population about disease adaptation influences their values. Rheumatoid arthritis (RA) states are used as an illustration. Methods: This work employed a sequential mixed-methods design using three components. First, Rasch and cluster analyses were used to construct RA states. Simultaneously, a novel adaptation exercise consisting of audio-recordings of patients discussing disease adaptation was developed. Second, semi-structured interviews were conducted with 12 general population respondents to identify the effect of adaptation information on their perceptions of RA. Finally, the influence of this information on health state values from a random sample of the general population (n = 200) was assessed quantitatively and the factors contributing to this change were identified. Results: The first component of this study defined three RA states. In the second, the qualitative interviews revealed that the adaptation exercise encouraged the general population to empathize with the messages in the audio-recordings. Finally, the third component showed that the adaptation exercise was effective at changing health state values; for example, for the severe RA state, a mean (standard deviation) change of 0.17 (0.34) (p < 0.01) was observed. Individuals who were younger, were healthier, recognized the importance of coping strategies, and comprehended the valuation task were more likely to increase their values. Conclusions: The results from this thesis demonstrate a novel method of informing the general population about disease adaptation. After undertaking the adaptation exercise, most respondents increased their values for the given health states. Thus, important contributions are made to an emerging field of developing better informed general population values

The EORTC QLU-C10D: The Canadian Valuation Study and Algorithm to Derive Cancer-Specific Utilities From the EORTC QLQ-C30

Objective. The EORTC QLQ-C30 is widely used for assessing quality of life in cancer. However, QLQ-C30 responses cannot be incorporated in cost-utility analysis because they are not based on general population’s preferences, or utilities. To overcome this limitation, the QLU-C10D, a cancer-specific utility algorithm, was derived from the QLQ-C30. The aim of this study was to obtain Canadian population utility weights for the QLU-C10D. Methods. Respondents from a Canadian research panel expressed their preferences for 16 choice sets in an online discrete choice experiment. Each choice set consisted of two health states described by the 10 QLU-C10D domains plus an attribute representing duration of survival. Using a conditional logit model, responses were converted into utility decrements by evaluating the marginal rate of substitution between each QLU-C10D domain level with respect to duration. Results. A total of 3,363 individuals were recruited. A total of 2,345 completed at least one choice set and 2,271 completed all choice sets. The largest utility decrements were associated with the worse levels of Physical Functioning (−0.24), Pain (−0.18), Role Functioning (−0.15), Emotional Functioning (−0.12), and Nausea (−0.12). The remaining domains and levels had decrements of −0.05 to −0.09. The utility of the worst possible health state was −0.15. Conclusion. Respondents from the general population were most concerned with generic health domains, but Nausea and Bowel Problems also had an impact on the individual’s utility. It is unclear as to whether cancer-specific domains will affect cost-utility analysis when evaluating cancer treatments; this will be tested in the next phase of the study

Australian utility weights for the EORTC QLU-C10D, a multi-attribute utility instrument derived from the cancer-specific quality of life questionnaire, EORTC QLQ-C30

Background: The EORTC QLU-C10D is a new multi-attribute utility instrument derived from the widely-used cancer-specific quality of life questionnaire, EORTC QLQ-C30. The QLU-C10D contains ten dimensions (Physical, Role, Social and Emotional Functioning; Pain, Fatigue, Sleep, Appetite, Nausea, Bowel Problems), each with 4 levels. To be used in cost-utility analysis, country-specific valuation sets are required. Objective: To provide Australian utility weights for the QLU-C10D. Methods: An Australian online panel was quota sampled to ensure population representativeness by sex and age (≥18y). Participants completed a discrete choice experiment (DCE) consisting of 16 choice-pairs. Each pair comprised two QLU-C10D health states plus life expectancy. Data were analysed using conditional logistic regression, parameterised to fit the quality-adjusted life-year framework. Utility weights were calculated as the ratio of each QOL dimension-level coefficient to the coefficient on life expectancy. Results: 1979 panel members opted-in, 1904 (96%) completed at least one choice-pair, and 1846 (93%) completed all 16 choice-pairs. Dimension weights were generally monotonic: poorer levels within each dimension were generally associated with greater utility decrements. The dimensions that impacted most on choice were, in order, Physical Functioning, Pain, Role Functioning and Emotional Functioning. Oncology-relevant dimensions with moderate impact were Nausea and Bowel Problems. Fatigue, Trouble Sleeping and Appetite had relatively small impact. The value of the worst health state was -0.096, somewhat worse than death. Conclusions: This study provides the first country-specific value set for the QLU-C10D, which can facilitate cost-utility analyses when applied to data collected with the EORTC QLQ-C30, prospectively and retrospectively

An evaluation of patients’ preferences and health-related quality of life in asthma

Objectives: The objectives of this thesis were i) to quantify patients’ preferences for asthma treatments using a discrete choice experiment (DCE), ii) to evaluate the socioeconomic status (SES) impacts on these preferences, and iii) to assess the construct validity of three preference-based instruments (Health Utility Index Mark 3, EuroQol, and Short Form 6D). Methods: One hundred fifty-seven asthma patients between 19-49 years of age residing in metropolitan Vancouver, British Columbia participated in this cross-sectional study. The patients responded to three preference-based instruments, two disease-specific instruments (standardized version of the Asthma Quality of Life Questionnaire and Asthma Control Questionnaire (ACQ)), and a DCE. The DCE was designed to measure preferences for treatment benefit (symptom-free days (SFDs)), potential risks (oral thrush and tremor/heart palpitation), ease of use (frequency of daily administration and number of inhalers required), and cost. Information regarding the patient’s SES, pulmonary function, asthma medication use, and self-reported asthma control were also obtained. Results: Relationships between the relative preferences and all treatment attributes were generally in the hypothesized directions. Specifically, the patients were willing to pay an additional $14 per month to receive one extra SFD. Patients were willing to pay$26, $79, and$112 to avoid one, two, and three episodes of oral thrush, respectively, and were willing to forego 1.8, 5.5, 7.8 monthly SFDs to avoid one, two, and three episodes of oral thrush, respectively. Annual income and education level affected treatment preferences. Furthermore, the preference-based instruments were able to discriminate across levels of asthma control using the ACQ; however, there was a lack of discrimination between HRQL and asthma control using subjective measures, such as magnitude of short-acting β-agonist use and self-reported control status. Conclusions: The DCE results revealed that patients preferred treatments with more SFDs but they were willing to forego symptom relief to avoid greater frequencies of adverse events. The results demonstrated the construct validity of the preference-based instruments such that they were able to discriminate across the ACQ scores, providing evidence that preference-based instruments could detect minimal changes in asthma states.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat

Quality of Life and Asthma Symptom Control: Room for Improvement in Care and Measurement

AbstractBackgroundThe recent Global Initiative for Asthma management strategy recommends achieving symptom control and minimizing the future risk of poor outcomes as priorities for asthma management.ObjectiveThe objective was to quantify the association between symptom control and health-related quality of life in asthma.MethodsIn a prospectively recruited random sample of adults with asthma, we ascertained symptom control and measured health-related quality of life using a generic (EuroQol five-dimensional questionnaire [EQ-5D]) and a disease-specific (Asthma Quality of Life Questionnaire) instrument, to estimate EQ-5D and five-dimensional Asthma Quality of Life Questionnaire (AQL-5D) utilities, respectively. We measured the adjusted difference in utilities across symptom control levels and calculated the loss of predictive efficiency due to aggregating multiple symptoms into one symptom control variable.ResultsThe final sample included 958 observations from 494 individuals (mean age at baseline 52.2 ± 14.5 years; 67.0% women). Asthma was symptomatically controlled, partially controlled, and uncontrolled in 269 (28.1%), 367 (38.3%), and 322 (33.6%) observations, respectively. A person with symptomatically uncontrolled asthma would gain 0.0512 (95% CI 0.0339–0.0686) in EQ-5D or 0.0802 (95% CI 0.0693–0.0910) in AQL-5D utilities by achieving symptom control. The loss of predictive efficiency was 55.4% and 27.6% for EQ-5D and AQL-5D utilities, respectively.ConclusionsAsthma symptom control status corresponds well with both generic and disease-specific quality-of-life measures. The trade-off, however, between ease of use and predictive power should be reconsidered in developing simplified measures of control. Our results have direct relevance in informing decision-analytic models of asthma and deducing the effect of interventions on quality of life through their impact on asthma control

Understanding the effect of disease adaptation information on general population values for hypothetical health states

It has been recommended that economic evaluation of healthcare technologies should use values for hypothetical health states elicited from the general population rather than patients. The drawback is the general population may not consider the possibility of adapting to the impaired state. This study explored the extent to which the general population changes their initial values, and the factors that influenced this change, after being informed with different disease adaptation techniques. Three rheumatoid arthritis states were used for illustration. General population respondents from the United Kingdom initially valued the states. An adaptation exercise followed, where they listened to recordings of patients discussing how they adapted; they then valued the same states again. The differences between the valuations were examined using t-tests. A multivariate regression model was developed to assess the factors that impacted individuals to change their initial values. After undergoing the adaptation exercise, the respondents increased their values for the rheumatoid arthritis states. Younger and healthier individuals were more likely to increase their initial values after being informed.Health state values Utility General population Disease adaptation Time trade-off UK

Colorectal Cancer and Onset of Anxiety and Depression : A Systematic Review and Meta-Analysis

Research suggests that colorectal cancer (CRC) is associated with mental health disorders, primarily anxiety and depression. To synthesize this evidence, we conducted a systematic review and meta-analysis of studies evaluating the onset of anxiety and depression among patients with CRC. We searched EMBASE and Medline from inception to June 2022. We included original, peer-reviewed studies that: used an epidemiologic design; included patients with CRC and a comparator group of individuals without cancer; and evaluated anxiety and depression as outcomes. We used random effects models to obtain pooled measures of associations. Quality assessment was completed using the Newcastle-Ottawa scale. Of 7326 articles identified, 8 were eligible; of which 6 assessed anxiety and depression and 2 assessed depression only. Meta-analyses showed a non-significant association between CRC and anxiety (pooled HR 1.67; 95% CI 0.88 to 3.17) and a significant association between CRC and depression (pooled HR 1.78; 95% CI 1.23 to 2.57). Predictors of anxiety and depression among patients with CRC included clinical characteristics (e.g., comorbidities, cancer stage, cancer site), cancer treatment (e.g., radiotherapy, chemotherapy, colostomy), and sociodemographic characteristics (e.g., age, sex). The impacts of anxiety and depression in patients with CRC included increased mortality and decreased quality of life. Altogether, our systematic review and meta-analysis quantified the risks and impacts of CRC on anxiety and depression, particularly an increased risk of depression after CRC diagnosis. Findings provide support for oncologic care that encompasses mental health supports for patients with CRC.Medicine, Faculty ofPharmaceutical Sciences, Faculty ofOther UBCNon UBCMedicine, Department ofPopulation and Public Health (SPPH), School ofReviewedFacultyResearcherGraduat

Trade-offs, fairness, and funding for cancer drugs: key findings from a deliberative public engagement event in British Columbia, Canada

Background: Spending on cancer drugs has risen dramatically in recent years compared to other areas of health care, due in part to higher prices associated with newly approved drugs and increased demand for these drugs. Addressing this situation requires making difficult trade-offs between cost, harms, and ability to benefit when using public resources, making it important for policy makers to have input from many people affected by the issue, including citizens. Methods: In September 2014, a deliberative public engagement event was conducted in Vancouver, British Columbia (BC), on the topic of priority setting and costly cancer drugs. The aim of the study was to gain citizens’ input on the topic and have them generate recommendations that could inform cancer drug funding decisions in BC. A market research company was engaged to recruit members of the BC general public to deliberate over two weekends (four days) on how best to allocate resources for expensive cancer treatments. Participants were stratified based on the 2006 census data for BC. Participants were asked to discuss disinvestment, intravenous versus oral chemotherapy delivery, and decision governance. All sessions were audio recorded and transcribed. Transcripts were analyzed using NVivo 11 software. Results: Twenty-four individuals participated in the event and generated 30 recommendations. Participants accepted the principle of resource scarcity and the need of governments to make difficult trade-offs when allocating health-care resources. They supported the view that cost-benefit thresholds must be set for high-cost drugs. They also expected reasonable health benefits in return for large expenditures, and supported the view that some drugs do not merit funding. Participants also wanted drug funding decisions to be made in a non-partisan and transparent way. Conclusion: The recommendations from the Vancouver deliberation can provide guidance to policy makers in BC and may be useful in challenging pricing by pharmaceutical companies.Medicine, Faculty ofSouthern Medical Program (Okanagan)Other UBCNon UBCPopulation and Public Health (SPPH), School ofReviewedFacult