This study sought to identify attributes of treatment important to haematologists in making their decisions regarding optimal care for inhibitor patients in the United States. A conjoint analysis using a discrete choice experiment was conducted to elicit factors that are most important to haematologists. Twelve product attributes were chosen based on published literature and expert opinion: risk of human viral infections, possibility that the titre of the inhibitor may rise, reduction in the likelihood of dose-related thromboembolic events, the number of infusions required to stop haemorrhage, infusion preparation time, infusion time, infusion volume, time required to stop bleeding, time required to alleviate pain, prophylaxis use, ability to undergo major surgery and cost of medications. Thirty haematologists completed the questionnaires via face-to-face interviews at a scientific meeting in April 2006. Data were analysed using a multinomial logit model to obtain the relative importance of each attribute. Responding haematologists had considerable experience in treating haemophilia patients with inhibitors (average : 13 +/- 9 years). 'Time required to stop bleeding' was the most important factor affecting treatment decisions [relative importance (RI) = 16.3%]. Physicians also preferred treatments that resulted in quick pain relief [RI = 12.9%], reduced the possibility that the titre of inhibitor may rise [RI = 12.8%], required fewer number of infusions to stop a haemorrhage [RI = 12.7%] and reduced the risk of human viral infection [RI = 10.8%]. This study revealed that certain clinical outcomes attributes are the most preferred and important. These findings can assist decision makers in their assessments of optimal first-line care.
Treatment preferences of haemophilia patients with inhibitors have not been well documented. This study sought to identify treatment attributes that patients/caregivers consider most important in the USA, inasmuch as those preferences may affect patient adherence to treatment plans. A discrete choice experiment was conducted to elicit treatment preferences. Haemophilia patients with inhibitors, or their caregivers on their behalf, completed a written survey that elicited preferences for treatment features and levels synthesized from the medical literature including: risk of viral transmission, rise in inhibitor titre, reduction in thromboembolic events, number of infusions, preparation time, infusion time/volume, time required to stop bleeding/alleviate pain, use of prophylaxis, use of major surgery and medication cost. Relative importance (RI) of preferences was modelled using a multinomial logit function. Most respondents were male (49 of 51, 96.1%); mean age, 20.7 years (SD = 18.8) and 88.5% of patients had haemophilia type A. The three most important patient-identified treatment attributes were as follows: time required to stop bleeding (RI = 19.3), possibility that the level of inhibitor may rise (RI = 14.3) and risk of contracting a virus from the product (RI = 13.5). Haemophilia patients with inhibitors and their caregivers appear to be willing to accept treatments that may be more inconvenient and painful as long as the treatments are effective in quickly controlling bleeds, do not increase inhibitor levels and do not pose a risk for viral contraction. Study findings provide meaningful input to the clinical community from patients and caregivers and support the importance of physicians understanding their patients' treatment preferences.
Despite recent advances in blood screening techniques, transfusions are not risk-free procedures. Screening for viral and bacterial infections as well as other newly emerging agents continues to attract attention in the medical and health policy communities. At the same time, as healthcare costs rise and available financial resources are limited, governments and other decisionmaking bodies increasingly require cost-effectiveness analyses to justify (or reject) allocation of those limited resources to new technologies. These cost-effectiveness analyses can demonstrate effectively the benefits and risks of the technologies with respect to their impact on clinical, economic and patient quality-of-life outcomes. This paper reviews the costs of transfusion in several countries and discusses the cost-effectiveness of various transfusion-relevant blood safety interventions as well as other preventative measures. Blood safety measures tend to have high cost-effectiveness ratios, suggesting that the cost per life year saved is high. However, given the extraordinarily high value that society places on measures to reduce unintentional deaths and injuries, particularly those related to blood safety, and the importance of this issue in policy decision-making, such high ratios may be acceptable.
Although the care of patients with pancreatitis‐related complications is estimated to be much more resource‐intensive than that provided to other critically‐ill patients, information on the cost of acute pancreatitis is limited. OBJECTIVES: To examine trends in the incidence and cost of acute pancreatitis‐related hospitalizations in the United States, and to ascertain patient disposition at discharge to evaluate the extent to which costs may extend beyond the initial hospitalization. METHODS: Data were obtained from the 1995–1997 Health care Cost and Utilization Project database. ICD‐9‐CM code 577.0 was used to identify hospitalizations with a primary or secondary diagnosis of acute pancreatitis. Patient demographics, length of stay (LOS), total charges (in constant 1995 dollars), and discharge status were assessed. RESULTS: Between 1995 and 1997, the number of acute pancreatitis‐related hospitalizations increased by 9.1% from 241,178 to 263,136. During that period, the average LOS decreased by 9.5% from 8.4 days to 7.6 days and the mean hospital charges decreased by 4.9% from $19,222 to $18,280. Using LOS 15 days as a proxy for severity, severe acute pancreatitis‐related hospital discharges decreased from 30,444 in 1995 to 27,839 in 1997. During that period, the average LOS remained constant (28.9–28.4 days) and the mean charges increased from $77,572 to $82,043. Nationwide, the projected pancreatitis‐related inpatient charges have increased from $4.6 to $4.8 billion. Despite representing 12% of admissions, severe acute pancreatitis‐related charges represented 49% of all acute pancreatitis‐related inpatient charges. 38–41% of patients were discharged to another facility, suggesting that these cost estimates are conservative. CONCLUSIONS: Acute pancreatitis is a major financial burden on health care systems due to high inpatient costs and frequent need for medical care that extends beyond the hospital stay. Despite a reduction in charge per case, total inpatient charges of pancreatitis have increased to rising incidence.
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