Variability among methods to assess patients' well-being and consequent effect on a cost-effectiveness analysis

Hornberger, John; Redelmeier, Donald A.; Petersen, John D.

doi:10.1016/0895-4356(92)90099-9

Cited by 180 publications

(58 citation statements)

References 21 publications

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“…These results have little meaning, however, unless they are considered within the context of health benefits that might be achieved by spending the same amount of money on other medical interventions. For example, the cost-effectiveness of interferon-␣ 2 b for the treatment of patients with chronic hepatitis B infection who are hepatitis B surface e antigen-positive has been estimated to be $12,000 per life year gained, 40 the cost-effectiveness for hemodialysis has been estimated to be $43,000 per quality-adjusted life year (QALY), 41 whereas endoscopic surveillance of patients with Barrett' s esophagus would cost approximately $50,000 per QALY. 42 Among interventions for coronary heart disease, the cost-effectiveness ratio for implantable cardioverterdefibrillator ranges between $26,000 and $40,000 per lifeyear gained whereas that of coronary artery bypass grafting for three-vessel disease ranges between $16,500 and $28,800 per quality adjusted life year.…”

Section: Discussionmentioning

confidence: 99%

Partial hepatectomy or orthotopic liver transplantation for the treatment of resectable hepatocellular carcinoma? A cost-effectiveness perspective

et al. 1998

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The treatment of patients with compensated liver cirrhosis and small hepatocarcinomas remains controversial. Whereas partial hepatectomy (PH) is currently recommended, the role of orthotopic liver transplantation (OLT) has become progressively accepted. We used the techniques of decision analysis to measure the clinical benefits and the economic consequences of immediate resection versus transplantation in patients with compensated cirrhosis and who were diagnosed with small hepatocellular carcinoma (HCC). We restricted our analysis to patients with resectable carcinomas, which is either solitary tumor (I 5 cm in diameter), or multiple tumors (up to 3), none being G 3 cm in diameter and, in both cases, no tumor invasion of blood vessels. We took into account the risks of tumor spreading and dissemination and/or development of decompensated cirrhosis while waiting for donor organs because organ shortage is presented as the main obstacle to transplantation in these patients. Our analysis suggests that orthotopic liver transplantation (OLT) offers a substantial survival benefit compared with resection, ranging from a minimum of 1 year to a maximum of 4.7 years depending on treatment-related survival rates. However, the magnitude of this benefit relies on the availability of an organ donor; therefore, if the waiting period exceeds 6 to 10 months, depending on tumor growth pattern, the increase in life expectancy provided by transplantation is overwhelmed by the risks that patients face while waiting for transplantation. Consequently, partial resection becomes the preferred strategy. The predicted marginal cost-effectiveness ratios of transplantation compared with resection would range between $44,454 and $183,840 per additional year gained mainly influenced by the time delay before getting a transplant. We conclude that compared with partial hepatectomy (PH), OLT for resectable hepatocarcinoma(s) offers substantial survival benefit among well-targeted subgroups of patients as long as an organ donor is available within a maximal 6 to 10 months time delay, which is a plausible scenario in most centers with a liver transplant program.However, the marginal cost-effectiveness ratios incurred by this strategy are higher than that of many other current medical interventions. (HEPATOLOGY 1998;28:436-442.)For most patients with cirrhosis, hepatocellular carcinoma (HCC) presents as an advanced tumor. In this setting, palliation is the only option and, consequently, patients survive for only a few months. Nonetheless, some of them with small curable HCC will be recognized at an earlier stage, either incidentally, or through screening programs. 1 In this latter subgroup, representing approximately 10% of diagnosed HCC, there is considerable controversy about the best treatment modality. 2,3,4,5,6 Until recently, the current approach was to recommend surgical resection in the form of PH (segmentary or subsegmentary resection), with 5-year survival rates achieving 40% to 50% when this policy was restricted to patients with uninod...

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Section: Discussionmentioning

confidence: 99%

Partial hepatectomy or orthotopic liver transplantation for the treatment of resectable hepatocellular carcinoma? A cost-effectiveness perspective

et al. 1998

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“…In general, rating scales, although easy to use, have been found to be subject to measurement bias (119). A number of studies have found that different elicitation methods lead to different preference weights, with most reporting that standardgamble scores are greater than time-tradeoff scores, which are in turn greater than visual-analog scores (13,28,53,81,90,97,127).…”

Section: Techniques For Measuring Preference Weightsmentioning

confidence: 99%

Preference-Based Measures in Economic Evaluation in Health Care

Neumann¹,

Goldie²,

Weinstein³

2000

Annu. Rev. Public Health

258

250

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Estimating preferences for states of health has been an active area of research in recent years. Unlike psychophysical approaches, which discriminate levels of health status, preference-based approaches incorporate values or utilities for health outcomes and can be used in cost-effectiveness analyses to aid resource allocation decisions. This chapter considers issues and controversies involved in using preference-based measures in economic evaluation in health care, with a particular emphasis on cost-utility analysis and the estimation of quality-adjusted life years. Topics considered include techniques for measuring preferences, the use of preference-based classification systems, the relationship between patient and community preferences, methods for obtaining utilities from clinical trials, mapping health status from health utilities, the development of "off-the-shelf" preference weights, and proposed alternatives to quality-adjusted life years. We also consider applications of cost-utility analyses to public health interventions. Although cost-utility analyses have become more popular recently, many challenges remain for the field. Widespread acceptance of the methodology likely awaits more consensus on measurement techniques, as well as educational efforts in the public health and medical communities on the usefulness of the approach.

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“…The different methods employed by the varied valuation techniques give rise to inconsistencies in values for like health states or illnesses (27,42,48,59). These variations arise for a number of reasons, including the differential sensitivity of the measures to particular domains of health that are affected by illness, the differences in how individuals comprehend and implement the weighting tasks, and scaling properties particular to the technique that is used.…”

Section: Generating Values: Qalysmentioning

confidence: 99%

“…Although different conceptualizations of health, together with differing techniques for valuing the states (described briefly in the next section) result in variations in HRQL scores when they are attached to specific disease entities (27,37,39), overall correlations among the instruments have been shown to be quite reasonable (18,20). A number of reviews of these instruments are available to the interested reader who wishes to gain a fuller understanding of the structure of each of the systems (22,32,38,44).…”

Section: Describing Health: Qalysmentioning

confidence: 99%

HALYs and QALYs and DALYs, Oh My: Similarities and Differences in Summary Measures of Population Health

Gold

Stevenson

Fryback

2002

Annu. Rev. Public Health

506

370

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Key Words burden of disease, cost-effectiveness analysis, health-related quality of life s Abstract Health-adjusted life years (HALYs) are population health measures permitting morbidity and mortality to be simultaneously described within a single number. They are useful for overall estimates of burden of disease, comparisons of the relative impact of specific illnesses and conditions on communities, and in economic analyses. Quality-adjusted life years (QALYs) and disability-adjusted life years (DALYs) are types of HALYs whose original purposes were at variance. Their growing importance and the varied uptake of the methodology by different U.S. and international entities makes it useful to understand their differences as well as their similarities. A brief history of both measures is presented and methods for calculating them are reviewed. Methodological and ethical issues that have been raised in association with HALYs more generally are presented. Finally, we raise concerns about the practice of using different types of HALYs within different decision-making contexts and urge action that builds and clarifies this useful measurement field.

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Variability among methods to assess patients' well-being and consequent effect on a cost-effectiveness analysis

Cited by 180 publications

References 21 publications

Partial hepatectomy or orthotopic liver transplantation for the treatment of resectable hepatocellular carcinoma? A cost-effectiveness perspective

Partial hepatectomy or orthotopic liver transplantation for the treatment of resectable hepatocellular carcinoma? A cost-effectiveness perspective

Preference-Based Measures in Economic Evaluation in Health Care

HALYs and QALYs and DALYs, Oh My: Similarities and Differences in Summary Measures of Population Health

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