The objective was to investigate the relationship of disease severity, health beliefs and medication adherence among HIV/AIDS patients. A survey was administered to 72 patients in three different stages of HIV/AIDS (CDC clinical categories A, B, C). Multivariate analyses revealed that there were no significant differences in patients' perceptions of the severity of HIV/AIDS or perceptions of the benefits and barriers for the treatment across three disease stages. However, the most severely ill patients (in stage C) perceived a higher risk of complications if they did not take their medicine as prescribed compared to asymptomatic patients (stage A) (p = 0.01). Also, patients in stages B and C were more adherent to their medications compared to patients in stage A (p = 0.007). Finally, perceived susceptibility-inaction was positively related to medication adherence (p = 0.005) and difficulty in following doctors' instructions was negatively related to patients' medication adherence (p = 0.009). In conclusion, patients' illness experiences are associated with their beliefs about the chances of developing complications if they do not adhere to their medications. Patients who have experienced more complications perceive a stronger relationship between medication non-adherence and AIDS-related complications, and are also more adherent to their medication regimen when compared to patients with no prior complications.

OBJECTIVES: To determine the relationship between diabetes symptom burden and patients' perceptions of health‐related quality of life (HRQL). METHODS: A questionnaire was sent to 3,716 adults with diabetes enrolled in a managed care organization in West Virginia and southeastern Ohio. Diabetes symptom burden was measured using a 17‐item scale (Diabetes TyPE, Form 2.1). The Health Status Questionaire (HSQ‐12), Version 3.0 was utilized to measure patients' perception of their HRQL. Analyses focused on six domains from the HSQ‐12: General Health Perception (GHP), Physical Functioning (PF), Bodily Pain (BP), Energy/Fatigue (EF), Social Functioning (SF), and Mental Health (MH). Linear regression was used to examine the impact of diabetes symptoms on each of the HRQL domains. RESULTS: Usable responses were obtained from 1,027 persons with diabetes (27.6% response rate). The summated scale of diabetes symptom burden had acceptable internal consistency (alpha = 0.90). Analyses revealed a significant inverse relationship between diabetes symptom burden and each of the six domains from the HSQ‐12, when controlling for gender, age, and education. Overall symptom burden was found to be most highly associated with Social Functioning (r = −.57), while somewhat less strongly associated with the other five domains: GHP (r = −.52); PF (r = −.49); BP (r = −.51); EF (r = −.54); MH (r = −.50). As overall symptom burden increases, the patients' perception of health across all six HRQL domains decreases. CONCLUSIONS: Diabetes symptom burden is inversely related to health‐related quality of life. Thus, interventions targeted towards the alleviation of diabetes symptoms should also lead to improvements in patients' perceptions of their health and well‐being.

OBJECTIVE: To evaluate cost‐effectiveness (CE) of three drug therapies for preventing osteoporotic fractures in postmenopausal women from a state Medicaid Program perspective using the estimated risk distribution in the study population. The three therapies are: hormone replacement therapy (HRT), alendronate, and raloxifene. METHODS: A hypothetical cohort of white women aged 45–85 years, postmenopausal, and without past incidence of osteoporotic fractures was treated with one of the three alternatives, and tracked over 3 years in a decision model. The CE ratio was defined as the treatment costs [e.g., medications, monitoring, adverse events (AE)] divided by the number of fractures averted. Treatment Willingness‐To‐Continue (WTC) rate was also considered. Data were collected from literature, expert panel survey, Medicaid claims data, and a risk survey in the study population. Monte Carlo simulations were conducted (distributions used: background risk, cost, and risk reduction rate). Risk or probability of osteoporotic fracture was also divided into three strata: low (risk <0.1), medium (0.10.3). RESULTS: Compared to no therapy, the expected CE of HRT was $29,119 per fracture averted, alendronate: $35,101, and raloxifene: $39,760. The incremental CE was $42,181 for alendronate (relative to HRT) and $85,509 for raloxifene (relative to alendronate). The incremental CE of alendronate and raloxifene were $151,981 and $697,270 among women with low risk (43% of the sample), compared to $11,099 and $34,017 respectively among high‐risk women (26% of the sample). CE was not sensitive to discount rate and AE probabilities. CONCLUSIONS: HRT is the most cost‐effective strategy even though it may have relatively high monitoring and AE costs, and low WTC rate. The significant decrease in marginal costs of Alendronate and Raloxifene in high‐risk women indicates an economic condition to use these two drugs. The study provides a framework to make risk‐appropriate coverage decisions for chemo‐preventive agents.

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OBJECTIVES: The increasing effectiveness of medical treatments for HIV (Human Immunodeficiency Virus) has increased survival time of patients infected with the virus. Because of the high incidence of side effects and the burden of complex medication regimens, an increased emphasis has been placed on the assessment of health‐related quality of life (HRQL) in HIV patients. The purpose of this study is to review and compare instruments used for measuring HRQL in HIV patients. METHODS: Clinical trials involving HIV patients were identified through the use of MEDLINE and AIDSLINE. The HRQL instruments used in these trials included: 1) generic instruments such as the Medical Outcomes Study (MOS) Short‐Form (SF‐36), Sickness Impact Profile, Nottingham Health Profile; 2) utility‐based measures such as the Quality of Well‐Being Scale and the Q‐TWIST (Quality adjusted Time Without Symptoms of disease and Toxicity); and 3) disease‐specific instruments such as the Multidimensional Quality of Life questionnaire for HIV (MQoL‐HIV), Functional Assessment of HIV Infection (FAHI) scale, HIV/AIDS‐Targeted Quality of Life Instrument (HAT‐QoL), HIV Overview of Problem/Evaluation System (HOPES) instrument, HIV Patient Reported Status and Experience (HIV‐PARSE) scale, and the MOS‐HIV scale. Criteria for evaluating the instruments included: comprehensiveness, respondent burden, internal consistency of scales, test‐retest reliability, clinical validity, and responsiveness to change. RESULTS: No instrument was found to be completely devoid of ceiling effects. Although none of the instruments demonstrated perfect psychometric properties, overall, the MOS‐HIV instrument fared better than all its counterparts. The instrument has minimal respondent burden and has shown evidence of internal consistency, test‐retest reliability, validity, and is responsive to changes over time. The instrument has been widely used in clinical trials and has been translated into 14 other languages, and translated forms have been validated. CONCLUSIONS: The MOS‐HIV scale appears to be most optimal for HRQL measurement in clinical trials involving HIV patients.