Health state utilities associated with attributes of treatments for hepatitis C

BACKGROUND: Cost-utility analyses are frequently conducted to compare treatments for hepatitis C, which are often associated with complex regimens and serious adverse events. Thus, the purpose of this study was to estimate the utility associated with treatment administration and adverse events of hepatitis C treatments. DESIGN: Health states were drafted based on literature review and clinician interviews. General population participants in the UK valued the health states in time trade-off (TTO) interviews with 10- and 1-year time horizons. The 14 health states described hepatitis C with variations in treatment regimen and adverse events. RESULTS: A total of 182 participants completed interviews (50 % female; mean age = 39.3 years). Utilities for health states describing treatment regimens without injections ranged from 0.80 (1 tablet) to 0.79 (7 tablets). Utilities for health states describing oral plus injectable regimens were 0.77 (7 tablets), 0.75 (12 tablets), and 0.71 (18 tablets). Addition of a weekly injection had a disutility of −0.02. A requirement to take medication with fatty food had a disutility of −0.04. Adverse events were associated with substantial disutilities: mild anemia, −0.12; severe anemia, −0.32; flu-like symptoms, −0.21; mild rash, −0.13; severe rash, −0.48; depression, −0.47. One-year TTO scores were similar to these 10-year values. CONCLUSIONS: Adverse events and greater treatment regimen complexity were associated with lower utility scores, suggesting a perceived decrease in quality of life beyond the impact of hepatitis C. The resulting utilities may be used in models estimating and comparing the value of treatments for hepatitis C. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10198-014-0649-6) contains supplementary material, which is available to authorized users

Recovering from Financial Implications of Flood Impacts—The Role of Risk Transfer in the West African Context

In many West African river basins, households regularly experience floods and the associated impacts. In the absence of widely accessible formal risk transfer mechanisms (e.g., insurance), households often have to cope with financial impacts. Only a few studies have explored the financial effects of floods on agriculture-dependent households in the region and the role formal and informal risk transfer plays in their mitigation. This study addresses this gap, explores flood impacts with financial implications for households, and researches the existing strategies to mitigate them. Moreover, it aims to better understand how different measures influence the recovery process. The study draws on primary data from a household survey (n = 744) in the Lower Mono River basin, combined with stakeholder workshops and semi-structured interviews, and applies a generalized linear model to the survey data. The results reveal four flood impact types with financial implications: agricultural, material, health, and trade. Moreover, a shortened recovery time is significantly associated with assistance from savings groups and cooperatives—groups originally not formed to help during floods. In light of the severe and frequent flood impacts, effective and publicly accepted adaptation measures are needed to enable favorable conditions for creating sustainable and accessible risk transfer mechanisms