Impact of Complementarity and Heterogeneity on Health Related Utility of Life

This study aims at identifying determinants of health related quality of life in Poland, and in particular at verifying whether health domains are complements or substitutes and what the impact of heterogeneity of population on the health state valuation is. The paper uses data in panel structure coming from a survey conducted in Poland and consisting of 6700 valuations (after data cleaning) of EQ-5D health states with time trade-off method. Several econometric models are built in order to detect the impact of complementarity and heterogeneity. Random effects models as well as random parameters models estimated using Bayesian approach are used. The results show that health domains are complementary goods. Especially the lack of pain/discomfort is a complement to other health domains. Demographic factors influence how health state change impacts utility. These factors encompass sex, education, respondent's health state and even belief in life after death.health related quality of life, QALY, EQ-5D, complementarity, heterogeneity

5-Fluoro-1,3-dihydro-2,1-benzoxaborol-1-ol

In the crystal structure of the title compound, C7H6BFO2, a broad-spectrum anti­fungal drug (AN2690), the planar [maximum deviation 0.035 (1) Å] mol­ecules form centrosymmetric R 2 2(8) dimers via strong O—H⋯O hydrogen bonds. The dimers are arranged into layers by weak inter­molecular C—H⋯O and C—H⋯F hydrogen bonds. The symmetry of this two-dimensional supra­molecular assembly can be described by the layer group p and topologically classified as a simple uninodal four-connected two-dimensional network of a (4.4.4.4.6.6) topology. Further weak C—H⋯O inter­actions build up the three-dimensional structure

Valuation of EQ-5D Health States in Poland: First TTO-Based Social Value Set in Central and Eastern Europe

ABSTRACTObjectiveCurrently, there is no EQ-5D value set for Poland. The primary objective of this study was to elicit EQ-5D Polish values using the time trade-off (TTO) method.MethodsFace-to-face interviews with visitors of inpatients in eight medical centers in Warsaw, Skierniewice, and Puławy were carried out by trained interviewers. Quota sampling was used to achieve a representative sample of the Polish population with regard to age and sex. Modified protocol from the Measurement and Value of Health study was used. Each respondent ranked 10 health states and valued 4 health states using the visual analog scale and 23 using the TTO. Mean and variance stability tests were performed to determine whether using a larger number of health states per respondent would yield credible results. Modeling included random effects and random parameters models.ResultsBetween February and May 2008, 321 interviews were performed. Modeling based on 6777 valuations resulted in an additive model with all coefficients statistically significant, R2 equal to 0.45, and value −0.523 for the worst possible health state. Means and variance did not differ significantly for states valued in the middle and at the end of the TTO exercise.ConclusionsThis is the first EQ-5D value set based on TTO in Central and Eastern Europe so far. Because the values differ considerably from those elicited in Western European countries, its use should be recommended for studies in Poland. Increasing the number of health states that each respondent is asked to value using TTO seems feasible and justifiable

The optimal choice of combination therapy with beta-blockers and calcium channel antagonists in everyday practice of hypertensive patients with concomitant ischemic heart disease — findings from BETAMLO Registry

Wstęp Stosowanie terapii skojarzonej lekami obniżającymiciśnienie tętnicze umożliwia uzyskaniewiększego efektu hipotensyjnego z zastosowaniemmniejszych dawek poszczególnych leków oraz wiążesię z istotnie mniejszym ryzykiem działań niepożądanychzależnych od dawki. Oprócz preparatówzłożonych zawierających inhibitor konwertazy angiotensynylub sartan oraz lek moczopędny lub antagonistęwapnia dostępne są także połączenia beta--adrenolityku i antagonisty wapnia, charakteryzującesię również istotnymi korzyściami klinicznymi.Celem pracy było określenie w ogólnopolskim rejestrzeBETAMLO charakterystyki klinicznej chorychpoddanych terapii skojarzonej beta-adrenolitykiemoraz antagonistą wapnia, w tym także szczegółowyopis farmakoterapii skojarzonej.Materiał i metody Ogólnopolski rejestr BETAMLOprzeprowadzony od kwietnia do czerwca 2011roku miał na celu ocenę praktyki leczenia farmakologicznegonadciśnienia tętniczego skojarzonegoz obiektywnie rozpoznaną chorobą wieńcową. Wykorzystującspecjalnie skonstruowaną ankietę zgromadzononastępujące dane o chorych: dane demograficzne,czynniki ryzyka oraz elementy stylużycia, stratyfkacja ryzyka w nadciśnieniu tętniczymskojarzonym z rozpoznaną chorobą wieńcową orazdane dotyczące aktualnej farmakoterapii. Ankietabyła anonimowa oraz badanie miało charakterw pełni nieinterwencyjny.Wyniki Łącznie w badaniu BETAMLO wzięłoudział 677 lekarzy, którzy zebrali dane o 13 541 chorych.Liczba chorych, u których stosowano leczenie skojarzone beta-adrenolitykiem oraz antagonistą wapnia, wyniosła 6343 (46,8% całej populacji rejestruBETAMLO), w tym kobiety stanowiły 46,6%;średni wiek: 66,4 roku w przypadku kobiet i 63,7roku w grupie mężczyzn. W grupie chorych zewspółistnieniem choroby niedokrwiennej sercai nadciśnienia tętniczego odsetek stosujących antagonistęwapnia i beta-adrenolityki wzrastał w przypadkudodatkowego występowania niewydolnościnerek i cukrzycy. Nie towarzyszyła temu jednak poprawakontroli ciśnienia tętniczego i spoczynkowejczynności serca. Najczęściej stosowaną dobowądawką amlodipiny było 5 mg, natomiast w przypadkubeta-adrenolityków: 5 mg bisoprololu, 50 mg metoprololu,12,5 mg karwedilolu i 5 mg nebiwololu.Największe zapotrzebowanie na preparat złożonyodnotowano w przypadku kombinacji bisoprololu//amlodipiny (dawek 5/5, 10/10 i 5/10 mg), metoprololu/amlodipiny (dawek 50/5, 100/5, 50/10 i 100/10,75/5 i 75/10 mg), karwedilolu/amlodipiny (dawek12,5/5, 25/5, 25/10 i 12,5/10 mg) oraz nebiwololu//amlodipiny (dawek 5/5, 5/10 i 2,5/5 mg).Wnioski W polskiej populacji pacjentów ze współistnieniemchoroby wieńcowej i nadciśnienia tętniczegoodsetek równoczesnego stosowania beta-adrenolitykówi antagonistów wapnia jest wysoki, co uzasadniapotrzebę wprowadzenia na rynek preparatu złożonego;szczególną popularność mogłoby zdobyć połącznieamlodipiny i bisoprololu w dawce po 5 mg.Background Combined use of antihypertensives can resultin more effective blood pressure lowering achievedwith smaller doses and is associated with reduced risk ofdose related adverse events. Apart from fixed combinationsof ACE inhibitors or angiotensin receptor blockerswith diuretics or calcium channel antagonists there arealso available combinations of beta-blockers and calciumchannel antagonists of well documented clinicalbenefits.Based on BETAMLO national registry we aimed toevaluate the clinical characteristics of patients treatedwith both beta-blockers and calcium channel antagonistsas well as to focus more on combined pharmacotherapy.Material and methods National BETAMLO registry wasconducted from April to June 2011 and focused on „realworld” clinical management of hypertensive patients withconcomitant objectively confirmed ischemic heart disease.A specially designed questionnaire was used to collect dataon: patients demographics, cardiovascular risk factors includinglifestyle, risks’ stratification used for both hypertensionand ischemic heart disease and current drugs used.A study was fully anonymous and non-interventional.Results A total number of 677 physicians participated inBETAMLO registry and reported on 13 541 patients, including6343 (46.8%) treated with both beta-blockers andcalcium antagonists; females represented 46.6% of patients;mean age: 66.4 yrs for females and 63.7 yrs for males. Combinationtherapy with beta-blockers and calcium channelantagonists were more common in ischemic heart diseaseand hypertensive patients and concomitant renal failureand diabetes. However more common use of combinedtherapy was not associated with better blood pressure orheart rate control. The most prevalent daily dose ofamlodipide was 5 mg while for beta-blockers 5, 50, 12.5 and 5 mg for bisoprolol, metoprolol, carvedilol andnebivolol, respectively. The highest demand for combinedpreparation was noted for bisoprolol/amlodipine (doses:5/5, 10/10 and 5/10 mg), metoprolol/amlodipine (doses:50/5, 100/5, 50/10 and 100/10, 75/5 and 75/10 mg),carvedilol/amlodipine (doses: 12.5/5, 25/5, 25/10 and12.5/10 mg) and nebivolol/amlodipine (doses: 5/5, 5/10and 2.5/5 mg).Conclusions In Polish patients with concomitant hypertensionand ischemic heart disease the combined therapywith beta-blockers and calcium channel antagonists is verypopular and justifies introduction of fixed dose combinepreparations; the highest demand can be expected for fixeddose of amlodipine 5 mg and bisoprolol 5 mg

Innovative medical technologies in the percutaneous treatment of tricuspid regurgitation in Poland

Tricuspid regurgitation (TR) usually develops secondarily to left-sided heart diseases, whereas primary lesions to the valve apparatus is less common. Untreated severe TR has a poor prognosis and surgical treatment, i.e., valve repair or replacement, is the only treatment option with class I recommendation. However, cardiac surgical procedures may be associated with a high risk of complications. Recent advances in percutaneous approaches to managing structural heart diseases, especially mitral valve diseases, have enabled the implementation of this therapeutic strategy in the population of patients with TR. This paper presents data on the clinical efficacy, cost-effectiveness and expected population size for one of these procedures, namely the TriClip TTVr System procedure. Its efficacy was assessed in the TRILUMINATE study involving 85 patients with co-morbidities and at high surgical risk. After 1 year of follow-up, the reduction in the TR grade was reported in 71% of patients. Clinical improvement in New York Heart Association functional class, a 6-minute walk test, and the quality of life were also observed. A published analysis comparing percutaneous treatment modalities with a drug therapy based on data from medical registers was utilized, and propensity score matching was also employed. Percutaneous treatment reduced 1-year mortality and rehospitalisation risk. The economic analysis showed the use of TriClip TTVr System is cost-effective: the cost of an additional quality-adjusted life year ranged from approximately PLN 85,000 to PLN 100,000, which is below the official threshold in Poland. The potential annual number of candidates for this treatment modality in Poland is estimated at 265

Using a Fuzzy Approach in Multi-Criteria Decision Making with Multiple Alternatives in Health Care

One of the responsibilities of the health care sector regulator is to decide which health technologies (drugs, procedures, diagnostic tests, etc.) should be financed using public resources. That requires taking into account multiple criteria, of which two important ones are: cost and effectiveness of a technology (others being, e.g., prevalence, safety, ethical and social implications). Hence, health and wealth need to be traded off against each other, and hence the willingness-to-pay (WTP) has to be determined. Various approaches to setting WTP have been taken, yet the results differ substantially. In the present paper I claim that the proper approach is to treat WTP as a fuzzy concept (the decision maker may not be able to decidedly state that a given health-wealth trade-off coefficient is acceptable/unacceptable - an idea backed up by the survey presented in the paper). Previous research shows how this fuzzy approach can be embedded in defining the preference relation and pairwise comparisons. In the present paper I account for the fact that there are often more than two alternatives available. To avoid difficulties that might arise (e.g., incompleteness or intransitivity of preferences) I show how the fuzzy approach can be used to define a fuzzy choice function based on the axiomatic approach. Some properties are discussed (e.g., how the approach handles the dominance and extended dominance), and the directions of further research are hinted at

Recursive and conservative decision rules in choice of the health technology under risk

W pracy rozważany jest problem wyboru technologii medycznych z uwzględnieniem wielokryterialności (ocena ze względu na efekt i koszt) oraz niepewności oszacowań ocen wariantów. Przedmiotem opracowania są metody wspierania decydenta, a w szczególności ilustrowania wpływu niepewności na ocenę wariantów. W opracowaniu zaproponowano modyfikację tzw. krzywych akceptowalności (cost-effectiveness acceptability curves, CEAC), tak aby zminimalizować wpływ nieintuicyjnych własności przedstawianych w literaturze (np. naruszeń własności α funkcji wyboru, naruszenia dominacji stochastycznej pierwszego rzędu). W szczególności zaproponowano stosowanie CEAC w oparciu o rekurencyjny lub konserwatywny dobór porównań parami do wykonania. Wykazano, że zaproponowane podejścia eliminują wiele niepożądanych własności CEAC.In real-life decision problems evaluations of decision alternatives are estimated. Decision makers typically want the uncertainty to be visualised in an intuitive way. Presence of multiple criteria complicates the situation further. In health technology assessment cost-effectiveness acceptability curves (CEAC) are often used for sensitivity analysis. The goal of this study is to modify the way CEAC are used, so as to remove non-intuitive properties reported in the literature (while preserving their usefulness in sensitivity analysis). I suggest restricting CEAC to specifically selected pair-wise comparisons, in a recursive and a conservative approach. I show that both approaches remove problems typical for regular CEAC when uncertainty is normally distributed (e.g., CEACs become robust against alternative cloning and modifying correlations; guarantee α property; agree with first-order stochastic dominance). For general distributions the properties of CEACs are also somewhat improved