Estimation of Quality-Adjusted Life Expectancy in Patients Under Prolonged Mechanical Ventilation

Hung, Mei-Chuan; Yan, Yuan-Horng; Fan, Po-Sheng; Lin, Ming‐Shyan; Chen, Cheng-Ren; Kuo, Lu-Cheng; Yu, Chong‐Jen; Wang, Jung‐Der

doi:10.1016/j.jval.2010.09.006

Cited by 15 publications

(17 citation statements)

References 31 publications

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“…The current study measured the losses of QALE due to the combination of cognitive impairment and multimorbidity, and then discovered significantly additional burden from the interaction of cognitive impairment and multimorbidity at both individual and population levels. Unlike previous studies [26,43,44], our consequences were confirmed by losses of QALE based on the representative sample of a country rather than patient-based clinical studies.…”

Section: Discussionsupporting

confidence: 54%

Estimation of losses of quality-adjusted life expectancy attributed to the combination of cognitive impairment and multimorbidity among Chinese adults aged 45 years and older

Xiong

Liu

Qiao

et al. 2020

Preprint

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21Objectives: This study aims to estimate the losses of quality-adjusted life expectancy (QALE) due to the 22 joint effect of cognitive impairment and multimorbidity, and further to confirm additional losses 23 attributable to their interaction among the middle-aged and elderly Chinese. 24 Methods: The National Cause of Death Monitoring Data were linked with the China Health and 25 Retirement Longitudinal Study (CHARLS). A mapping and assigning method was used to estimate 26health utility values, which were further used to calculate QALE. Losses of QALE were measured by 27 comparing the differences between subgroups. And all the losses of QALE were displayed at two levels:28 the individual and the population level. 29Results: At age 45, the individual-level and population-level losses of QALE (95% CI) attributed to the 30 combination of cognitive impairment and multimorbidity were 7. 606 (5.679, 9.566) years and 4.297 31 (3.425, 5.200) years. The losses (95% CI) for cognitive impairment alone were 3.104 (2.287, 3.954) years 32 and 1.709 (1.318, 2.132) years at two levels. Similarly, the losses (95% CI) for multimorbidity alone 33 were 3.526 (2.528, 4.556) years and 1.914 (1.235, 2.625) years at two levels. Additional losses due to34 their interaction were indicated by the 0.976 years of the individual-level gap and 0.674 years of the 35 population-level gap.36 Conclusion: Among the middle-aged and elderly Chinese, cognitive impairment and multimorbidity 37 resulted in much losses of QALE, and additional QALE losses were seen due to their interaction at both 38 individual and population levels.39 40 3 Introduction 41 Age-associated cognitive impairment is a transition link between healthy aging and dementia with 42 the 10% conversion rate, featuring declines in memory, attention, and cognitive function [1]. At the end 43 of 2019, the population aged 65 and above in China accounted for 176.0 million [2]. And a large-sample, 44multi-region study showed that the prevalence (95% CI) of total dementia for the population aged 65 45 years and older in China was 5.60% (3.50%, 7.60%) in 2019 [3]. Moreover, mild cognitive impairment 46 (MCI) is estimated >4 times more common than dementia [1, 4]. 47Meanwhile, age-dependent noncommunicable diseases (NCD) are proved to experience a 48 continuous increase among the elders in the near decades [5]. Nearly 50% of the NCD burden in China 49 occurred in people aged 65 years and older [6], while 47.5% of the elderly aged 65+ had ≥ 2 chronic 50 conditions [7]. Multimorbidity, which is defined as the co-occurrence of two or more chronic diseases in 51 an individual, is widely observed beyond two-thirds of older adults [8, 9]. Many patient-based studies 52 suggested that older adults with at least two diseases were more susceptible to develop cognitive 53 impairment [10][11][12][13][14][15][16][17][18]. The hypothesis that multimorbidity may increase the risk of cognitive impairment 54 has also been verified in population-based researches [10][11][12] 14]. 55Despite the documented ris...

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Section: Discussionsupporting

confidence: 54%

Estimation of losses of quality-adjusted life expectancy attributed to the combination of cognitive impairment and multimorbidity among Chinese adults aged 45 years and older

Xiong

Liu

Qiao

et al. 2020

Preprint

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show abstract

“…According to our previous study, however, most patients undergoing PMV survive only approximately 1.5 to 2 years, and approximately 62% of them suffer from cognitive impairments and poor quality of life. Accounting for these factors results in an overall quality-adjusted life expectancy of only 0.3 to 0.4 and 0.6 to 0.7 quality-adjusted life-years [25,26]. The present study therefore further provided crucial estimates of the median survival and life expectancies of patients undergoing PMV with different diagnoses or co-morbidities, as summarised in Tables 2 and 3.…”

Section: Discussionmentioning

confidence: 87%

Life expectancies and incidence rates of patients under prolonged mechanical ventilation: a population-based study during 1998 to 2007 in Taiwan

Hung

Chen

et al. 2011

Crit Care

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IntroductionThe present study examined the median survival, life expectancies, and cumulative incidence rate (CIR) of patients undergoing prolonged mechanical ventilation (PMV) stratified by different underlying diseases.MethodsAccording to the National Health Insurance Research Database of Taiwan, there were 8,906,406 individuals who obtained respiratory care during the period from 1997 to 2007. A random sample of this population was performed, and subjects who had continuously undergone mechanical ventilation for longer than 21 days were enrolled in the current study. Annual incidence rates and the CIR were calculated. After stratifying the patients according to their specific diagnoses, latent class analysis was performed to categorise PMV patients with multiple co-morbidities into several groups. The life expectancies of different groups were estimated using a semiparametric method with a hazard function based on the vital statistics of Taiwan.ResultsThe analysis of 50,481 PMV patients revealed that incidence rates increased as patients grew older and that the CIR (17 to 85 years old) increased from 0.103 in 1998 to 0.183 in 2004 before stabilising thereafter. The life expectancies of PMV patients suffering from degenerative neurological diseases, stroke, or injuries tended to be longer than those with chronic renal failure or cancer. Patients with chronic obstructive pulmonary disease survived longer than did those co-morbid with other underlying diseases, especially septicaemia/shock.ConclusionsPMV provides a direct means to treat respiratory tract diseases and to sustain respiration in individuals suffering from degenerative neurological diseases, and individuals with either of these types of conditions respond better to PMV than do those with other co-morbidities. Future research is required to determine the cost-effectiveness of this treatment paradigm.

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“…The sum of the total area under this curve was the QALE with quality-adjusted life years (QALYs) as the common unit [23]. Our QoL data were taken from a sample of 142 patients under PMV and measured using the EQ-5D Health Questionnaire and were classified into either partial or poor cognition [24,25]. Partial cognition was defined as an Mini Mental State Examination score higher than 15.…”

Section: Methodsmentioning

confidence: 99%

Incidence, life expectancy and prognostic factors in cancer patients under prolonged mechanical ventilation: a nationwide analysis of 5,138 cases during 1998-2007

Shih

Hung

et al. 2013

Crit Care

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IntroductionThis study is aimed at determining the incidence, survival rate, life expectancy, quality-adjusted life expectancy (QALE) and prognostic factors in patients with cancer in different organ systems undergoing prolonged mechanical ventilation (PMV).MethodsWe used data from the National Health Insurance Research Database of Taiwan from 1998 to 2007 and linked it with the National Mortality Registry to ascertain mortality. Subjects who received PMV, defined as having undergone mechanical ventilation continuously for longer than 21 days, were enrolled. The incidence of cancer patients requiring PMV was calculated, with the exception of patients with multiple cancers. The life expectancies and QALE of patients with different types of cancer were estimated. Quality-of-life data were taken from a sample of 142 patients who received PMV. A multivariable proportional hazards model was constructed to assess the effect of different prognostic factors, including age, gender, type of cancer, metastasis, comorbidities and hospital levels.ResultsAmong 9,011 cancer patients receiving mechanical ventilation for more than 7 days, 5,138 undergoing PMV had a median survival of 1.37 months (interquartile range [IQR], 0.50 to 4.57) and a 1-yr survival rate of 14.3% (95% confidence interval [CI], 13.3% to 15.3%). The incidence of PMV was 10.4 per 100 ICU admissions. Head and neck cancer patients seemed to survive the longest. The overall life expectancy was 1.21 years, with estimated QALE ranging from 0.17 to 0.37 quality-adjusted life years for patients with poor and partial cognition, respectively. Cancer of liver (hazard ratio [HR], 1.55; 95% CI, 1.34 to 1.78), lung (HR, 1.45; 95% CI, 1.30 to 1.41) and metastasis (HR, 1.53; 95% CI, 1.42 to 1.65) were found to predict shorter survival independently.ConclusionsCancer patients requiring PMV had poor long-term outcomes. Palliative care should be considered early in these patients, especially when metastasis has occurred.

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Estimation of Quality-Adjusted Life Expectancy in Patients Under Prolonged Mechanical Ventilation

Abstract: Theses results of poor prognosis would provide stakeholders evidence for communication to facilitate clinical decisions. The estimation may be used in future studies to facilitate the cost-effectiveness and reduction of the health gap.

Cited by 15 publications

References 31 publications

Estimation of losses of quality-adjusted life expectancy attributed to the combination of cognitive impairment and multimorbidity among Chinese adults aged 45 years and older

Estimation of losses of quality-adjusted life expectancy attributed to the combination of cognitive impairment and multimorbidity among Chinese adults aged 45 years and older

Life expectancies and incidence rates of patients under prolonged mechanical ventilation: a population-based study during 1998 to 2007 in Taiwan

Incidence, life expectancy and prognostic factors in cancer patients under prolonged mechanical ventilation: a nationwide analysis of 5,138 cases during 1998-2007

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