Limitations of the Methods Used for Calculating Quality-Adjusted Life-Year Values

Duru, Gérard; Auray, Jean-Paul; Béresniak, Ariel; Lamure, Michel; Paine, Abby; Nicoloyannis, Nicolas

doi:10.2165/00019053-200220070-00004

Cited by 46 publications

(29 citation statements)

References 5 publications

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“…It is worth mentioning that the average number of expected lifespan for inhabitants of Łódź in 2011 was 70.1 for males and 78.4 for females. These values were lower than the average value for Poland by 1.9 years for males and 2.6 years for females, and also lower than average life span for inhabitants of the European Union by 6.0 and 3.8 years respectively [20,21]. …”

Section: Introductionmentioning

confidence: 99%

Self-rated quality of life of city-dwelling elderly people benefitting from social help: results of a cross-sectional study

Bryła

Burzyńska

Maniecka-Bryła

2013

Health Qual Life Outcomes

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BackgroundThe percentage of people aged 65 or older living in Poland is 13.6%, but 17.2% in Łódź. The aim of the study was to identify factors correlating with the self-rated quality of life of elderly inhabitants of cities applying for social help, on the basis of a cross-sectional study.MethodsThe study was conducted in Łódź, a large Polish city, between September 2011 and February 2012 in a group of people applying for help in the Municipal Social Welfare Centre. Four hundred and sixty-six respondents aged 65 or older were included in the study. The tool used in the study was an interview questionnaire. The respondents answered questions on their demographic situation, living conditions, financial, health and social situation. The authors also applied the WHOQOL-BREF Questionnaire, the Activities of Daily Living Scale (ADL) and the Geriatric Depression Scale (GSOD). For statistical purposes, the authors used single- and multiple-factor regression and the Statistica 9.0 Program. The results were presented as an odds ratio (OR) with a 95% confidence interval (CI); the adopted significance level was p < 0.05. The authors applied the Pearson’s x2 test in order to evaluate the structure of the studied group and the subpopulation, who were aged 65 or older and using social help, throughout the city.ResultsLogistic regression confirmed that a high quality of life depends on the following variables: university education (OR = 2.31; p < 0.05), an income which is sufficient to live (OR = 1.63; p < 0.05), no heart palpitations (OR = 2.32; p < 0.05), stable blood pressure (OR = 2.32; p < 0.05), no headaches (OR = 1.55; p < 0.05), no pain in the chest (OR = 1.51; p < 0.01), no shortness of breath (OR = 1.51; p < 0.01), no tiredness (OR = 2.08; p < 0.05), a score on the Geriatric Depression Scale pointing to a lack of suspected depression (OR = 9.88; p < 0.001 if the person does not suffer from depression and OR = 6.33; p < 0.001 if there is uncertain depression) as well as not using nursing services, a score on the ADL Scale confirming the person’s fitness and participation in family gatherings.ConclusionsA subjective evaluation of the quality of life of the elderly depends on many factors. An identification of these factors might be helpful in implementing steps aimed at improving the quality of life of elderly people who, as a consequence, will need less social help: particularly nursing services.

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Section: Introductionmentioning

confidence: 99%

Self-rated quality of life of city-dwelling elderly people benefitting from social help: results of a cross-sectional study

Bryła

Burzyńska

Maniecka-Bryła

2013

Health Qual Life Outcomes

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“…Many published “cost-effectiveness” models are in fact cost-utility models, using “Quality Adjusted Life Years” (QALY) as subjective outcome measure [15,18-20]. The QALY method has received criticism, not only because different utility instruments (such as HUI, EQ5D or SF-6D questionnaires) generate statistically divergent utility scores in the same RA population, but because they can also lead to widely different cost-utility ratios [21-24]. This is raising much ethical questions, which also explains why the cost-utility (QALY ) approach is now banned from key countries such as USA, Germany and France [25].…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness Modelling of Sequential Biologic Strategies for the Treatment of Moderate to Severe Rheumatoid Arthritis in Finland

Puolakka

Blåfield²,

Kauppi³

et al. 2012

TORJ

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Objective: The main objective was to compare the cost-effectiveness of therapeutic options in moderate or severe rheumatoid arthritis (RA) when a clinical response to a first TNF-blocker, either etanercept (ETA), adalimumab (ADA), or infliximab (INF), is insufficient.Methods: Effectiveness criteria were defined as remission (RS), low disease activity (LDAS), and moderate to high disease activity (MHDAS). Cost-effectiveness was derived as cost per day in RS and in LDAS using simulation modelling to assess six sequential biologic strategies over 2 years. Each sequential treatment strategy was composed of three biologic agents and included a first anti-TNF agent, ETA, ADA or INF, followed by either abatacept (ABA) or rituximab (RTX) as a second therapeutic option in case of an insufficient response, followed by another anti-TNF agent in case of further insufficient response.Results: Over two years and taking into account biologic costs, the following estimated mean costs per day in RS and LDAS were respectively of €829 and €428 for the biologic sequence composed of ADA-ABA-ETA, €1292 and €516 for the sequence ADA-RTX-ETA, €829 and €429 for the sequence ETA-ABA-ADA, €1292 and €517 for the sequence ETARTX- ADA, €840 and €434 for the sequence INF-ABA-ETA, and €1309 and €523 for the sequence INF-RTX-ETA.Conclusion: The treatment sequences including ABA as the second biologic option appear more cost-effective than those including RTX in a patients with moderate to severe RA and an insufficient response to a first anti-TNF agent.

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“…Although this indirect method of determining preference is popular ( 28 ), there are criticisms with regard to the validity of utilities generated and to their lack of sensitivity in various disease states (29)(30)(31). Such methods do not measure patient preferences directly, and differences have been found in utility scores derived from different instruments ( 32,33 ).…”

Section: Discussionmentioning

confidence: 99%

Quality-of-Life Assessment of Fibroid Treatment Options and Outcomes

Fennessy

Kong²,

Tempany³

et al. 2011

Radiology

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Purpose:To obtain utilities (a unit of measure of a person's relative preferences for different health states compared with death or worst possible outcome) for uterine fi broids before and after treatment and to measure short-term utilities for the following uterine fi broid treatments: abdominal hysterectomy, magnetic resonance (MR) imaging-guided focused ultrasound surgery, and uterine artery embolization (UAE). Materials and Methods:This retrospective study was approved by the institutional review board and was HIPAA compliant. The waiting trade-off (WTO) method, a variation on the time trade-off (TTO) method, is used to obtain utilities for diagnostic procedures on the basis of the fact that people wait longer to avoid noxious tests and/or procedures. The WTO method provides short-term quality of life tolls in terms of quality-adjusted life-weeks by scaling wait times with pre-and posttreatment utilities. Utilities for uterine fi broids before and after treatment were obtained with the TTO method and a visual analog scale (VAS) by using a questionnaire administered by means of a phone interview. WTO wait times were adjusted for quality of life with VAS and TTO utilities and a transformation of VAS. Wait times were compared by using nonparametric tests. The study participants included 62 patients who had undergone abdominal hysterectomy, 74 who had undergone UAE, and 61 who had undergone MR imaging-guided focused ultrasound surgery. Results:Quality of life increased with all treatments. The median WTO wait time was higher for hysterectomy (21.6 weeks) than for UAE or MR imaging-guided focused ultrasound surgery (14.1 weeks for both) ( P , .05). Quality-adjusted life-week tolls were smaller when scaled according to TTO than when scaled according to VAS or transformation of VAS. Conclusion:Quality of life increased after all fi broid treatments. WTO is feasible for assessing the quality-adjusted morbidity of treatment procedures.q RSNA, 2011Supplemental material: http://radiology.rsna.org/lookup /suppl

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Limitations of the Methods Used for Calculating Quality-Adjusted Life-Year Values

Cited by 46 publications

References 5 publications

Self-rated quality of life of city-dwelling elderly people benefitting from social help: results of a cross-sectional study

Self-rated quality of life of city-dwelling elderly people benefitting from social help: results of a cross-sectional study

Cost-Effectiveness Modelling of Sequential Biologic Strategies for the Treatment of Moderate to Severe Rheumatoid Arthritis in Finland

Quality-of-Life Assessment of Fibroid Treatment Options and Outcomes

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