Variation of health-related quality of life assessed by caregivers and patients affected by severe childhood infections.

BACKGROUND: The agreement between self-reported and proxy measures of health status in ill children is not well established. This study aimed to quantify the variation in health-related quality of life (HRQOL) derived from young patients and their carers using different instruments. METHODS: A hospital-based cross-sectional survey was conducted between August 2010 and March 2011. Children with meningitis, bacteremia, pneumonia, acute otitis media, hearing loss, chronic lung disease, epilepsy, mild mental retardation, severe mental retardation, and mental retardation combined with epilepsy, aged between five to 14 years in seven tertiary hospitals were selected for participation in this study. The Health Utilities Index Mark 2 (HUI2), and Mark 3 (HUI3), and the EuroQoL Descriptive System (EQ-5D) and Visual Analogue Scale (EQ-VAS) were applied to both paediatric patients (self-assessment) and caregivers (proxy-assessment). RESULTS: The EQ-5D scores were lowest for acute conditions such as meningitis, bacteremia, and pneumonia, whereas the HUI3 scores were lowest for most chronic conditions such as hearing loss and severe mental retardation. Comparing patient and proxy scores (n = 74), the EQ-5D exhibited high correlation (r = 0.77) while in the HUI2 and HUI3 patient and caregiver scores were moderately correlated (r = 0.58 and 0.67 respectively). The mean difference between self and proxy-assessment using the HUI2, HUI3, EQ-5D and EQ-VAS scores were 0.03, 0.05, -0.03 and -0.02, respectively. In hearing-impaired and chronic lung patients the self-rated HRQOL differed significantly from their caregivers. CONCLUSIONS: The use of caregivers as proxies for measuring HRQOL in young patients affected by pneumococcal infection and its sequelae should be employed with caution. Given the high correlation between instruments, each of the HRQOL instruments appears acceptable apart from the EQ-VAS which exhibited low correlation with the others

Cost-utility analysis of the screening program for early oral cancer detection in Thailand.

ObjectiveTo assess the cost-utility of an oral precancer screening program compared to a no-screening program in Thailand.Materials and methodsMarkov models were performed to simulate costs and Quality Adjusted Life-Years (QALYs) of both the screening and no-screening programs in the Thai population aged over 40 years. There are four steps to the screening program in Thailand: 1) mouth self-examination (MSE); 2) visual examination by trained dental nurses (VETDN); 3) visual examination by trained dentists (VETD); and 4) visual examination by oral surgeons (VEOS). The societal perspective and lifetime horizon were applied. Variables used were derived from the pilot study of the oral precancer screening program in Roi Et province as well as through patient interviews and local and international literature reviews. Results were presented in terms of Incremental Cost-Effectiveness Ratios (ICER). Sensitivity analysis was performed to assess parameters uncertainty.ResultsThe screening program yielded higher costs (1,362 Baht) and QALYs (0.0044 years) than the no screening program, producing an ICER of 311,030 Baht per QALY gained. This indicates that the screening program is cost-ineffective in the Thai context, where the cost-effectiveness threshold is THB 160,000 per QALY gained. However, the programs will be cost-effective if the screening program are improved in one of three ways; 1) the sensitivity and specificity of MSE are more than 60%, 2) the sensitivity and specificity of VETDN are greater than 90%, or 3) the low accuracy steps like MSE or VETDN are removed from the screening program.ConclusionThe screening program is found to be cost-ineffective for oral precancer detection in Thailand. However, this study suggests 3 alternative policy options to ensure the cost-effectiveness of the program

Comparison of benefit-cost ratios and changes from the base-case scenario according to varying proportions of disease severity.

<p>Comparison of benefit-cost ratios and changes from the base-case scenario according to varying proportions of disease severity.</p

Categories of structural chromosome abnormalities (SCA) and important assumptions used in the analysis.

<p>Categories of structural chromosome abnormalities (SCA) and important assumptions used in the analysis.</p

A scatterplot showing the results from probabilistic sensitivity analysis.

<p>A scatterplot showing the results from probabilistic sensitivity analysis.</p

Results of costs and benefits from Strategy I and Strategy II under base-case assumptions.

<p>Results of costs and benefits from Strategy I and Strategy II under base-case assumptions.</p

Tornado diagram showing the effect of varying each parameter on the benefit-cost ratio.

<p>Tornado diagram showing the effect of varying each parameter on the benefit-cost ratio.</p

Decision tree of diagnostic strategies for the reduction of recurrent structural chromosome abnormalities in Thailand.

<p>Decision tree of diagnostic strategies for the reduction of recurrent structural chromosome abnormalities in Thailand.</p

Means and standard errors (SE) of input parameters.

<p>Means and standard errors (SE) of input parameters.</p