Including information about co-morbidity in estimates of disease burden: results from the World Health Organization World Mental Health Surveys

Background The methodology commonly used to estimate disease burden, featuring ratings of severity of individual conditions, has been criticized for ignoring co-morbidity. A methodology that addresses this problem is proposed and illustrated here with data from the World Health Organization World Mental Health Surveys. Although the analysis is based on self-reports about one's own conditions in a community survey, the logic applies equally well to analysis of hypothetical vignettes describing co-morbid condition profiles. Method Face-to-face interviews in 13 countries (six developing, nine developed; n=31 067; response rate=69.6%) assessed 10 classes of chronic physical and nine of mental conditions. A visual analog scale (VAS) was used to assess overall perceived health. Multiple regression analysis with interactions for co-morbidity was used to estimate associations of conditions with VAS. Simulation was used to estimate condition-specific effects. Results The best-fitting model included condition main effects and interactions of types by numbers of conditions. Neurological conditions, insomnia and major depression were rated most severe. Adjustment for co-morbidity reduced condition-specific estimates with substantial between-condition variation (0.24-0.70 ratios of condition-specific estimates with and without adjustment for co-morbidity). The societal-level burden rankings were quite different from the individual-level rankings, with the highest societal-level rankings associated with conditions having high prevalence rather than high individual-level severity. Conclusions Plausible estimates of disorder-specific effects on VAS can be obtained using methods that adjust for co-morbidity. These adjustments substantially influence condition-specific rating

The impact of initial antibiotic treatment failure: real-world insights in patients with complicated, health care-associated intra-abdominal infection

Pascale Peeters,1 Kellie Ryan,2 Sudeep Karve,2 Danielle Potter,3 Elisa Baelen,4 Sonia Rojas-Farreras,5 Jesús Rodríguez-Baño6 1Real-World Insights, IQVIA, Saint-Ouen, France; 2Health Economics and Outcomes Research, AstraZeneca, Gaithersburg, MD, USA; 3Medical Evidence and Observational Research Center, AstraZeneca, Gaithersburg, MD, USA; 4Real-World Insights, IQVIA, St Prex, Switzerland; 5Real-World Insights, IQVIA, Barcelona, Spain; 6Department of Medicine, Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena – Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, Seville, Spain Purpose: The RECOMMEND study (NCT02364284; D4280R00005) assessed the clinical management patterns and treatment outcomes associated with initial antibiotic therapy (IAT; antibiotics administered ≤48 hours post-initiation of antibiotic therapy) for health care-associated infections across five countries.Patients and methods: Data were collected from a retrospective chart review of patients aged ≥18 years with health care-associated complicated intra-abdominal infection (cIAI). Potential risk factors for IAT failure were identified using logistic regression analyses.Results: Of 385 patients with complete IAT data, bacterial pathogens were identified in 270 (70.1%), including Gram-negative isolates in 221 (81.9%) and Gram-positive isolates in 92 (34.1%). Multidrug-resistant (MDR) pathogens were identified in 112 patients (41.5% of patients with a pathogen identified). IAT failure rate was 68.3% and in-hospital mortality rate was 40.8%. Multivariate regression analysis demonstrated three factors to be significantly associated with IAT failure: patients admitted/transferred to the intensive care unit during index hospitalization, isolation of an MDR pathogen and previous treatment with β-lactam antibiotics.Conclusion: We reveal the real-world insights into the high rates of IAT failure and mortality observed among patients with cIAI. These data highlight the challenges associated with choosing IAT, the impact of MDR pathogens on IAT outcomes and the importance of tailoring IAT selection to account for local epidemiology and patient history. Keywords: complicated intra-abdominal infection, health care associated, initial antibiotic treatment, clinical outcome, real-world treatment pattern

ExtaviJect® 30G device for subcutaneous self-injection of interferon beta-1b for multiple sclerosis: a prospective European study

Gabriel Boeru,1 Ivan Milanov,2 Francesca De Robertis,3 Wojciech Kozubski,4 Michael Lang,5 S&ograve;nia Rojas-Farreras,6 Mark Tomlinson7 1Military Hospital, Bucharest, Romania; 2University Hospital Saint Naum, Sofia, Bulgaria; 3Department of Neurology, Vito Fazzi Hospital of Lecce, Lecce, Italy; 4Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland; 5NeuroPoint Patient Academy and Neurological Practice, Ulm, Germany; 6IMS Health, Barcelona, Spain; 7Novartis Pharma AG, Basel, Switzerland Background: The ExtaviJect&reg; 30G autoinjector was developed to facilitate parenteral self-administration of interferon beta-1b (Extavia&reg;), a first-line disease-modifying therapy in patients with multiple sclerosis. Our aim was to assess patient compliance with treatment when using the autoinjector, patients&#39; and nurses&#39; experiences of using the device, its tolerability, and patient satisfaction. Methods: This was a 12-week, real-world, prospective, observational, noninterventional study conducted in nine European countries. Questionnaires were used to measure patient compliance and to assess patients&#39; and nurses&#39; experiences. All adverse events were recorded by severity, including injection site reactions or pain. Patient satisfaction and health-related quality of life were assessed using the Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9) and EuroQol-5 Dimension (EQ-5D) instruments, respectively. Results: Of 582 patients enrolled, 568 (98%) received at least one injection and attended the first follow-up visit at 6 weeks, and 542 (93%) attended the second follow-up visit at 12 weeks. For the whole study, 548 of 568 (97%) patients were compliant with treatment. Among the various questions assessing whether the device was easy and quick to use accurately, without fear of the needle, 56%&ndash;98% of patients and 59%&ndash;98% of nurses were in agreement. There were nine serious adverse events (four disease-related) reported among the 227 (39%) patients reporting adverse events. Scores increased in the TSQM-9 convenience domain between weeks 6 and 12 (P=0.0009), and in the EQ-5D visual analog scale between baseline and week 12 (P<0.0001), indicating improvement in health-related quality of life. Conclusion: ExtaviJect 30G was convenient to use and was associated with high levels of compliance. Keywords: autoinjector, injections, subcutaneous, interferon beta, multiple sclerosis, relapsing-remitting, patient preference, self-administratio

Obsessive-compulsive symptom dimensions in the general population: results from an epidemiological study in six European countries

BACKGROUND: The prevalence of obsessive-compulsive symptom dimensions and their sociodemographic and psychopathological correlates at the population level are unknown. METHOD: Obsessive-compulsive symptom dimensions and mental disorders were assessed with the Composite International Diagnostic Interview 3.0 in a random subsample (n=2804) of individuals participating in a cross-sectional survey of the adult general population of six European countries. RESULTS: The lifetime prevalence of any obsessive-compulsive symptom dimension was 13%. Harm/Checking was the most prevalent dimension (8%) followed by Somatic obsessions (5%) and Symmetry/Ordering (3%). Females were more likely to have symptoms in Contamination/Cleaning (OR=3, 95%CI=1.06-8.51) and Somatic obsessions (OR=1.88, 95%CI=1.05-3.37). All symptom dimensions were associated with an increased risk of most mental (but not physical) disorders. There were some differences in prevalence between countries. LIMITATIONS: The interference associated with each symptom dimension could not be assessed. Few direct data are available on the validity of the CIDI to assess obsessive-compulsive symptom dimensions. CONCLUSIONS: Obsessive-compulsive symptom dimensions are relatively frequent in the general population. Their sociodemographic and psychopathological correlates may be slightly different in clinical and community samples. They are associated with an increased risk of most mental disorders.status: publishe

Including information about co-morbidity in estimates of disease burden: results from the World Health Organization World Mental Health Surveys

BACKGROUND: The methodology commonly used to estimate disease burden, featuring ratings of severity of individual conditions, has been criticized for ignoring co-morbidity. A methodology that addresses this problem is proposed and illustrated here with data from the World Health Organization World Mental Health Surveys. Although the analysis is based on self-reports about one's own conditions in a community survey, the logic applies equally well to analysis of hypothetical vignettes describing co-morbid condition profiles.MethodFace-to-face interviews in 13 countries (six developing, nine developed; n=31 067; response rate=69.6%) assessed 10 classes of chronic physical and nine of mental conditions. A visual analog scale (VAS) was used to assess overall perceived health. Multiple regression analysis with interactions for co-morbidity was used to estimate associations of conditions with VAS. Simulation was used to estimate condition-specific effects. RESULTS: The best-fitting model included condition main effects and interactions of types by numbers of conditions. Neurological conditions, insomnia and major depression were rated most severe. Adjustment for co-morbidity reduced condition-specific estimates with substantial between-condition variation (0.24-0.70 ratios of condition-specific estimates with and without adjustment for co-morbidity). The societal-level burden rankings were quite different from the individual-level rankings, with the highest societal-level rankings associated with conditions having high prevalence rather than high individual-level severity. CONCLUSIONS: Plausible estimates of disorder-specific effects on VAS can be obtained using methods that adjust for co-morbidity. These adjustments substantially influence condition-specific ratings