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Objetivo: Comparar o implante transcateter de valva aórtica (TAVI) ao tratamento conservador em pacientes inoperáveis ou à cirurgia de troca valvar (SAVR) em pacientes com risco cirúrgico alto ou intermediário conforme a Society of Thoracic Surgeons (STS), por meio de uma revisão sistemática de avaliações econômicas completas. Avaliar a variabilidade de modelos econômicos, parâmetros, pressupostos e sua influência nos resultados finais. Métodos: Foi realizada uma busca da literatura nas bases Medline, EMBASE, Cochrane Library, Web of Science, SciELO e International HTA Base e busca manual. Foram incluídas análises econômicas completas baseadas em modelos econômicos publicadas entre 2011 e 2022, em português, inglês e espanhol. A qualidade dos estudos foi avaliada usando o instrumento QHES (Quality of Health Economic Studies). Resultados: Foram incluídos 36 estudos, majoritariamente análises de custo-utilidade (64%), da Europa (41%), utilizando dados de eficácia dos estudos PARTNER. O modelo de Markov (61%) foi predominante. O custo da prótese do TAVI foi um parâmetro de impacto na análise de sensibilidade nos três grupos. Os estudos alcançaram uma boa qualidade no instrumento QHES. Conclusão: O TAVI tendeu a ser custo-efetivo em relação aos comparadores. Os modelos não foram homogêneos nos parâmetros, horizontes temporais e taxa de desconto, podendo impactar a custo-efetividade do TAVI e dificultar a comparação dos resultados entre diferentes países e perspectivas.
ABSTRACT Objective: To compare transcatheter aortic valve implantation (TAVI) to conservative treatment in inoperable patients or to valve replacement surgery (SAVR) in patients at high or intermediate surgical risk according to the Society of Thoracic Surgeons (STS), through a systematic review of comprehensive economic evaluations. Evaluate the variability of economic models, parameters, assumptions and their influence on final results. Methods: A literature search was performed in Medline, EMBASE, Cochrane Library, Web of Science, SciELO and International HTA Base and manual search. Complete economic analyzes based on economic models published between 2011 and 2022 in Portuguese, English and Spanish were included. The quality of the studies was evaluated using the QHES (Quality of Health Economic Studies) instrument. Results: Thirty-six studies were included, mostly cost-utility analyses (64%), from Europe (41%), and using efficacy data from the PARTNER studies. The Markov model (61%) was predominant. The cost of the TAVI prosthesis was the most important parameter in the sensitivity analysis in the three groups. The studies achieved a good quality in QHES instrument. Conclusion: TAVI tended to be cost-effective relative to comparators. The models were not homogeneous in parameters, time horizons and discount rate, which may have an impact on the cost-effectiveness of TAVI, making it difficult to compare the results between different countries and perspectives.
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Aortic Valve Stenosis , Cost-Benefit Analysis , Cost-Effectiveness Analysis , Systematic ReviewABSTRACT
Resumen El opio y sus derivados, y recientemente los opioides, han acompañado a la humanidad desde las civilizaciones más antiguas hasta la actualidad. Sus efectos analgésicos, hipnóticos y placenteros no pasaron desapercibidos para los antiguos, los consideraron de utilidad médica y beneficiosa para el estado de ánimo. Hoy en día no existe otro tipo de medicamentos que puedan tratar el dolor más intenso tan eficientemente como estos potentes analgésicos. Sin embargo, el uso médico y recreativo de los opiáceos y los opioides conlleva riesgos para la salud, como la tolerancia, la hiperalgesia y la adicción. Actualmente, además de ser indiscutiblemente el tratamiento médico más poderoso para mitigar el sufrimiento ocasionado por el dolor, se ha convertido también en un problema de salud pública debido a la alta cantidad de personas con trastorno por uso de opioides y por las muertes ocasionadas por sobredosis. En esta revisión se hará mención de las bondades de los opiáceos y opioides, y también de los efectos no deseados que estos producen.
Abstract Opium and its derivatives, and recently the opioids have accompanied the humankind since the ancient civilizations to the present day. Its analgesic, hypnotic and pleasant effects did not go unnoticed by ancient people, which considered most of these effects of medical utility and noticed that they had remarkable mood benefits. Currently, there are no other kind of drugs that can palliate intense pain as efficiently as these powerful analgesics. However, the medical and recreational use of opiates and opioids may carry health risks such as tolerance, hyperalgesia, and addiction. Nowadays, in addition to being indisputably the most powerful medical treatment to alleviate the suffering caused by pain, it has also become a public health problem due to the high number of people with opioid use disorder that have facilitated deaths caused by opioids overdose. In this review we will discuss the medical benefits of opiates and opioids, as much as the unwanted effects they produce.
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The extent, purpose, and model of performance assessment should be guided by our understanding of clinical competence. We have come a long way from believing that competence is generic, fixed, and transferable across contents; to viewing competence as dynamic, incremental, contextual, and non-transferable. However, our pattern of assessment largely remains what it was many years ago. Contemporary educationists view competency assessment as different from traditional format. They place more emphasis on the role of expert subjective judgment, especially for performance and domain-independent competencies. Such assessments have conclusively shown their validity, reliability, and utility. They; however, require trained assessors, trust between the teachers and the taught, and above all, a political and administrative will for implementation.
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Background: P drugs are preferred or priority or personal choice drugs of the prescriber for a disease which should be prepared by the doctor. Aims and Objectives: This study was done to describe the process of P drug selection done in the task-based learning (TBL) group. Materials and Methods: This was a descriptive study done in the Department of Pharmacology of a Government Medical College in Central Kerala for a period of 2 months (June 1, 2018, to July 31, 2018) after receiving clearance from the Institutional Review Board. Participants who performed task-based learning of P drug concept were assessed for the proper completion of various steps in P drug selection. Results: All the participants could write the proper diagnosis and therapeutic objectives in the task sheet for case scenario related to absence seizure, angina, Type 2 diabetes mellitus, grand mal epilepsy, and pregnancy-induced hypertension. The weights assigned for efficacy, safety, cost, and suitability varied with each student, however, the most common weights were 0.4, 0.4, 0.1, and 0.1. The weights assigned amongst the eight clinical scenarios were found to differ with P < 0.001 for efficacy, safety, cost, and suitability on doing Kruskal–Wallis test. On doing one-way analysis of variance for group score F = 21.02 and drug score F = 20.91, both were found to differ significantly across the conditions with P < 0.001. The selected P drug was improperly prescribed across the clinical conditions except for that of bronchial asthma. Conclusion: TBL using multi-attributive analysis for P drug selection ensured considering various factors during its selection process for P drug selection.
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Pesquisa transversal com objetivo de analisar a associação entre qualidade de vida e comportamentos desenvolvidos por indivíduos hipertensos durante o período de isolamento social, devido à pandemia da COVID-19. O estudo foi realizado através de ligações telefônicas e avaliou adultos cadastrados na atenção primária de saúde. A prática de atividade física foi avaliada pelo Questionário Internacional de Atividade Física, sendo somadas a duração e a frequência das atividades e o tempo total sentado durante a semana e fim de semana. A qualidade de vida foi analisada através do Sistema Descritivo EQ-5D, considerando o score utilidade e o estado geral de saúde. Presença de doenças e comportamentos durante o isolamento social, assim como aspecto emocional e ambiente para realização de atividades físicas foram analisados. Foram utilizados os testes t de Studant e ANOVA one way para comparação de grupos e ANCOVA para comparações entre os grupos ajustadas. A significância estatística foi pré-fixada em valores inferiores a 5%. Foram entrevistados 659 hipertensos, com idade entre 41 e 93 anos. Observou-se maior qualidade de vida naqueles que praticaram exercício físico (p = 0,015), que não relataram ter a saúde emocional afetada pela pandemia (p = 0,001) e que responderam ter ambiente favorável em casa para prática de atividade física, (p = 0,001). Em conclusão, a qualidade de vida associou-se aos comportamentos positivos dos participantes durante a pandemia, como a prática de atividade física, contudo é necessário que os órgãos públicos se atentem aos baixos níveis de atividade física da população provocados pela pandemia
Cross-sectional research with the objective of analyzing the association between quality of life and behaviors developed by hypertensive individuals during the period of social isolation, due to the COVID-19 pandemic. The study was carried out through telephone calls and evaluated adults registered in primary health care. The practice of physical activity was assessed by the International Physical Activity Questionnaire, adding the duration and frequency of activities and the total time sitting during the week and weekend. Quality of life was analyzed using the Descriptive System EQ-5D, considering the utility score and general health status. Presence of diseases and behaviors during social isolation, as well as the emotional aspect and environment for carrying out physical activities were analyzed. Student's t-test and one-way ANOVA were used for group comparisons and ANCOVA for adjusted between-group comparisons. Statistical significance was pre-set at values below 5%. 659 hypertensive adults aged between 41 and 93 years were interviewed. A better quality of life was observed in hypertensive individuals who practiced physical exercise (p = 0.015), who did not report having their emotional health affected by the pandemic (p = 0.001) and who responded that they had a favorable environment at home for the practice of physical activity, (p = 0.001). In conclusion, QoL was associated with the positive behaviors of the participants during the pandemic, such as the practice of physical activity, however, it is necessary for public agencies to pay attention to the low levels of PA in the population caused by the pandemic
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Humans , Male , Female , Social Isolation , Health Status , COVID-19ABSTRACT
OBJECTIVE To evaluate the cost-effectiveness of pembrolizumab combined with chemotherapy versus placebo combined with chemotherapy in the first-line treatment of advanced or unresectable biliary tract carcinoma （BTC） from the perspective of China’s health system. METHODS A partitioned survival model was constructed based on the KEYNOTE-966 study data. The simulation period was 21 days， and the simulation time was the patient’s whole life. Using quality-adjusted life year （QALY） as the output indicator， the cost-utility analysis method was used to evaluate the cost-effectiveness of the two schemes mentioned above. Univariate and probabilistic sensitivity analyses were performed to verify the results of the basic analysis， and to explore the cost-effectiveness under the scenario of drug donation scheme. RESULTS The basic analysis showed that both the cost and effectiveness of the pembrolizumab group were higher than those of the placebo group， and the incremental cost-effectiveness ratio （ICER） was 3 909 359.78 yuan/QALY， which was higher than the willingness-to-pay （WTP） threshold of 3 times 2022 gross domestic product （GDP） per capita （257 094 yuan）， indicating no cost-effectiveness. The results of univariate sensitivity analysis showed that the utility discount rate， the utility value of progression-free survival （PFS） status， the cost discount rate， and the cost of pembrolizumab had a great influence on ICER. Probabilistic sensitivity analysis verified the robustness of the results of basic analysis， and concluded that when the WTP threshold was greater than 1 500 000 yuan/QALY， the pembrolizumab group became cost-effective. The results of the scenario analysis showed that considering the drug donation scheme of pembrolizumab for low-income people， although its treatment cost was significantly reduced， it was still not cost-effective. CONCLUSIONS At the WTP threshold of 3 times China’s GDP per capita in 2022， pembrolizumab combined with chemotherapy is not cost-effective compared with placebo combined with chemotherapy for advanced or unresectable BTC.
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ObjectiveTo construct and evaluate the transformation model of the Constitution in Chinese Medicine Questionnaire （CCMQ） to SF-6Dv1 health utility and broaden the applications of CCMQ. MethodsThe data of CCMQ and SF-6Dv1 were collected from 595 participants at baseline， 3 months and 6 months after the comprehensive intervention suitable for the corresponding traditional Chinese medicine （TCM） constitution. The estimation and validation datasets were constructed， and four statistical algorithms including the ordinary least squares （OLS）， MM robust regression （MM）， censored least absolute deviations （CLAD） and the Tobit model were used to create alternative models. The mean absolute error （MAE）， root mean square error （RMSE） and intraclass correlation coefficient （ICC） were used to evaluate the prediction performance of the model. ResultsThe constitution scores of all TCM constitutions by CCMQ was significantly correlated with the SF-6Dv1 health utility value measured at three timepoints； the health utility value of the SF-6Dv1 was positively correlated with gentleness type （r=0.596， r=0.578， r=0.606， all P＜0.05） and negatively correlated with eight unbalanced constitutions （r=-0.586~-0.301， all P＜0.05）. The MM established based on the subscale scores of CCMQ was the optimal mapping model， and the MAE， RMSE， and ICC values were 0.0741， 0.0930 and 0.766， respectively. Gentleness type， qi-deficiency type， phlegm-wetness type， qi-constraint type， and age were the primary factors included in the model. The measured and predicted value of SF-6Dv1 had a moderate positive correlation （r=0.673， r=0.617， P＜0.05） and a good consistency as shown by the Bland-Altman plot. ConclusionBy using MM， the CCMQ can be transformed into SF-6Dv1 health utility value for health economics analysis.
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OBJECTIVE To evaluate the cost-effectiveness of denosumab and teriparatide in the treatment of postmenopausal osteoporosis in Chinese women， and provide reference for relevant decision-making. METHODS From the perspective of health system in China， Excel 2003 was used to establish Markov model， and cost-utility analysis was used to evaluate the cost- effectiveness of denosumab or teriparatide combined with Calcium carbonate D3 tablets in the treatment of postmenopausal osteoporosis in Chinese women. Pharmacotherapy effects were obtained with network meta-analysis， and cost and health utility value data were obtained from published literature. The model cycle was 1 year， and the simulation time limit was the patient’s lifetime. Univariate sensitivity analysis and probabilistic sensitivity analysis were used to evaluate the effects of model parameter changes on the robustness of the results. Through scenario analysis， the cost-effectiveness of domestic drug cost used as drug cost of terlipatide group was discussed； the influence of residual effects of teriparatide on the results and the cost-effectiveness of sequential use of desumamab after terlipatide withdrawal were also discussed. RESULTS The effect of denosumab regimen was better than that of terlipatide regimen [13.24 quality-adjusted life years （QALYs） vs. 12.96 QALYs]， with lower cost （51 224.64 yuan vs. 167 102.67 yuan）， denosumab regimen was the absolutely superior regimen. The results of single factor sensitivity analysis showed that the cost and discount rate of Terlipatide injection had greater impact on the results. The results of probability sensitivity analysis showed that when three times of China’s per capita gross domestic product （GDP） in 2021 was used as the threshold of willingness to pay， the probability of cost-effectiveness of denosumab regimen was 93.5%. The results of scenario analysis showed that， whether the drug cost of terlipatide regimen which was replaced by domestic drugs， or the residual effect of terlipatide was considered， or desulmonab was used sequentially after two years of terlipide treatment， denosumab regimen was always the absolute advantage regimen. CONCLUSIONS Denosumab combined with Calcium carbonate D3 tablets is more cost-effective than teriparatide combined with Calcium carbonate D3 tablets in the treatment of postmenopausal osteoporosis in Chinese women.
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This paper introduces the composition of the Chinese version of the European quality of life five-dimension scale (EQ-5D), including two different level scales, EQ-5D-3L and EQ-5D-5L, and summarizes the status quo of the application of the above scales. This paper sorts out the utility value sets of the EQ-5D-3L and EQ-5D-5L scales currently developed based on the Chinese population, and provide an important reference for Chinese researchers to choose suitable scales for research on health-related quality of life and health economics cost-utility analysis in the future.
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Cancer is one of the major fatal diseases that seriously threaten human health， and its burden needs to be solved urgently. Health technology assessment （HTA） can provide scientific evidence-based basis for cancer diagnosis， treatment， prevention and related policy formulation. Cost-utility analysis is the gold standard for economic evaluation in HTA， and the accurate measurement of its health utility is one of the key elements to determine the accuracy of its results. This article focuses on systematic introduction of direct measures， multi-attribute health utility scales， and mapping methods in the field of cancer measurement and reviews their applications in cancer patients. Among them， direct measures are complex， costly， and require a high level of subject knowledge； multi-attribute health utility measures are currently the preferred method for measuring health utility in cancer patients； with the continuous development and refinement of disease-specific utility measures in multi-attribute health utility instruments， the mapping method may gradually decrease in future applications. This paper can provide a reference for the selection of health utility measurement tools for HTA in the field of cancer， and provide evidence-based basis for optimizing resource allocation and policy formulation in the field of cancer.
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OBJECTIVE To evaluate the cost-effectiveness of sintilimab combined with chemotherapy than single-use chemotherapy in the first-line treatment of advanced， recurrent or metastatic esophageal squamous cell carcinoma （ESCC） from the perspective of health system of our country， and provide reference for rational use of drug in clinic. METHODS Based on ORIENT-15 study data， TreeAge Pro 2011 software was used to establish a three-state Markov model of non-progressive survival （PFS）， disease progression and death for cost-utility analysis. The model period was 3 weeks， the research time limit was 10 years， and the discount rate was 5%. The main outputs of the model were total cost， quality-adjusted life year （QALY） and incremental cost-effectiveness ratio （ICER）. The 1-3 times of China’s GDP per capita in 2021 was taken as the threshold of willing- ness to pay （WTP）. The uncertainty of the parameters was analyzed by single factor sensitivity analysis and probability sensitivity analysis， and the cost-effectiveness of the two schemes was discussed under three situations： different discount rates， comparison with other similar treatment schemes and charitable drug donation schemes. RESULTS The results of basic analysis showed that compared with chemotherapy plan alone， the ICER of sintilimab combined with chemotherapy was 64 208.75 yuan/QALY， which was less than WTP threshold. The results of single factor sensitivity analysis show that PFS state utility value， cycle cost of sintilimab and discount rate had relatively great influence on the results. Probability sensitivity analysis showed that when WTP≥120 000 yuan， the economic probability of sintilimab combined with chemotherapy plan was 100%. The results of situational analysis showed that sintilimab combined chemotherapy was more cost- effective than single-use chemotherapy. CONCLUSIONS Sintilimab combined with chemotherapy is more cost-effective than single-use chemotherapy in the first-line treatment of advanced， recurrent or metastatic ESCC.
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This paper describes the concepts of assessment theory which are necessary to implement the most desirable assessments, with a particular focus on validity and utility. Validity, classically defined as a trinity of content, criterion-related, and construct, is now encompassed by construct validity. By distinguishing between validity and validation, the process of reinforcing validity through argument-based validation is proposed. Furthermore, we refer to the concept of utility, which takes into account practicality (acceptability and cost) and educational impact, in order to make the assessment practice sustainable. Finally, we will address how learner assessment relates to program evaluation.
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Pharmacoeconomic evaluation is the essential supporting information for the inclusion of rare disease drugs into medical insurance in China. The accurate measurement of the health state utility of rare diseas is of practical significance to the development of rare disease pharmacoeconomic evaluation. Based on the review of pharmacoeconomic evaluation requirements for rare diseases in some countries/regions, we systematically retrieved the published studies on the measurement of health state utility for 121 rare diseases in China and other countries and regions. We identified 17 591 papers in the initial review, and later selected 230 after screening. We also made a comprehensive analysis of the quality of literature, evaluation content and use of tools for measuring health state utility in rare diseases in China. Finally, we analyzed the challenges in measurement in terms of population, instruments use, and application of results and made recommendations based on analysis, hoping to provide reference for the development of rare disease health state utility measurement studies in China.
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OBJECTIVE To systematically sort out and evaluate the health state utility of hemophiliac patients， and to provide reliable parameters for conducting pharmacoeconomic evaluation and health technology assessment. METHODS Retrieved from CNKI， Wanfang data， VIP， CBM， PubMed， Embase， the Cochrane Library， Scopus and Web of Science databases， relevant literature about the measurement of health state utility in hemophiliac patients was collected from the inception to February 2023. After screening literature， extracting data and evaluating the quality of literature， meta-analysis was performed for health state utility with Stata 15.1 software. RESULTS Thirty-eight papers were finally included， with the highest and lowest health utility values of 0.90 and 0.46， respectively. Those studies mostly adopted the EuroQol Five Dimensions Questionnaire （EQ-5D） （73.7%）. Results of meta-analysis showed that health state utility of global hemophiliac patients was 0.69，95% confidence interval was 0.65- 0.74； those of patients with mild， moderate and severe hemophilia were 0.79， 0.70， and 0.64， respectively； health state utility for patients with inhibitors （0.64） was lower than that of patients without inhibitors （0.69）； health state utility for the Chinese patient population was 0.55， which was higher than that of Iranian patients （0.46）， but lower than those of other developed countries. CONCLUSIONS There is some heterogeneity in the results of the studies across countries/regions， with higher health state utility in developed countries than in developing countries. As the severity of hemophilia increases， the trend of decreasing health state utility is obvious.
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OBJECTIVE To evaluate the cost-effectiveness of vericiguat combined with standard treatment in the treatment of heart failure with reduced ejection fraction （HFrEF）. METHODS Based on the results of the VICTORIA trial and related literature， a three-state （including stable state of heart failure， hospitalized state of heart failure and death state） Markov model was constructed. The cycle length was 1 month， the time horizon was 20 years， the discount rate was 5%， and one time China’s per capita gross domestic product （GDP） in 2021 was the willing-to-pay （WTP） threshold. Cost-utility analysis was performed to evaluate the cost-effectiveness of vericiguat combined with standard treatment in the treatment of HFrEF. The output indicators included quality-adjusted life year （QALY） and incremental cost-effectiveness ratio （ICER）. The robustness of the results of the basic analysis was verified by one-way sensitivity analysis and probability sensitivity analysis. RESULTS The ICER of vericiguat combined with the standard treatment plan compared to the standard treatment plan alone was 444 341.95 yuan/QALY， which was more than WTP of this study （80 976 yuan/QALY）. One-way sensitivity analyses showed that the probability of cardiovascular death in both groups was the main influencing parameter for the robustness of the model， but they had little influence on the results of the basic analysis. The probabilistic sensitivity analysis displayed that under the WTP threshold of this study， the possibility of vericiguat combined with the standard treatment plan being more cost-effective was 2.6%. CONCLUSIONS Compared with the standard treatment plan， vericiguat combined with the standard treatment plan is not cost-effective in patients with HFrEF.
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OBJECTIVE To evaluate the cost-effectiveness of sugemalimab in patients with stage Ⅲ non-small cell lung cancer （NSCLC） whose disease had not progressed after concurrent or sequential chemoradiotherapy from the perspective of the Chinese healthcare system. METHODS Based on the GEMSTONE-301 clinical trial，a three-health state partitioned survival model （PartSA） was developed to simulate the progression of disease，with model cycle of 3 weeks and a lifetime time range； the main output indicators of the model were total cost，quality-adjusted life year （QALY），and incremental cost-effectiveness ratio （ICER）； the cost and health output were discounted using 5% discount rate. Using 1-3 times China’s per capita gross domestic product （GDP） in 2022 as the willingness-to-pay （WTP） threshold，the cost-utility analysis method was used for analysis，and sensitivity analysis and scenario analysis were conducted to assess model robustness. RESULTS Compared with placebo，ICER for sugemalimab consolidation therapy was 59 872.57 yuan/QALY，which was less than one time China’s per capita GDP in 2022 （85 698 yuan） as the WTP threshold. The scenario analysis results further confirmed the robustness of the model. The results of single factor sensitivity analysis indicated that the cost of drugs （pembrolizumab，sugemalimab，docetaxel） and the utility value of disease progression status had a significant impact on ICER； the results of the probabilistic sensitivity analysis showed that sugemalimab had 67.2% probability of being cost-effective at one time China’s GDP per capita in 2022 as the WTP threshold； when 20 000 yuan （less than 3 times GDP per capita in China of 257 094 yuan） was used as the WTP threshold，the probability of sugemalimab consolidation therapy being cost-effective was greater than 98%. CONCLUSIONS The consolidation therapy with sugemalimab is cost-effective for stage Ⅲ NSCLC whose disease had not progressed after concurrent or sequential chemoradiotherapy.
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OBJECTIVE To study the cost-utility threshold （WTP/Q） based on the preference of the population in Liaoning province with willingness-to-pay（WTP） survey method， and to provide reference for decision-making. METHODS Using the method of questionnaire survey， quota sampling combined with snowball sampling were used to conduct telephone interviews with the general population in Liaoning province， collect data and analyze it. Probit regression combined with generalized linear model was used to analyze the relevant factors affecting WTP/Q. RESULTS A total of 755 general people were recruited. The WTP/Q of Liaoning population was 119 175 yuan，the average WTP/Q for improving the quality of life was 84 902 yuan， and the average WTP/Q for extending the survival period was 188 005 yuan. The analysis of influential factors showed that the older the age， the lower the probability of people purchasing medical interventions； the higher the education level and income， the greater the WTP/ Q； at the same time， the physical feelings of the interviewee， such as pain and depression， could also affect the WTP/Q results； compared with the scenario of improving quality of life， the WTP/Q for the extended survival period was higher. CONCLUSIONS The WTP/Q of Liaoning province based on the WTP survey method is about 2.07 times of the per capita gross domestic product of Liaoning province in the same period. The WTP/Q for extending survival period is about 2.21 times that of improving the quality of life. Therefore， interventions to improve quality of life and to extend the survival period need to be treated differently， in measurement or decision-making.
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ABSTRACT Objective: To study the feasibility of time trade-off (TTO) method in quantifying health utility ratings in different types of malocclusion. Material and Methods: In this cross-sectional study, 70 orthodontic patients aged 18 years or above, reporting for treatment/consultation, were included and interviewed. Malocclusion-related health utilities were assessed through the TTO method, and oral health-related quality of life was measured with the help of Orthognathic Quality of Life Questionnaire (OQLQ). Angle's classification of malocclusion was recorded. Bivariate analyses and multivariate Poisson's regression were done to find out an association between the oral health utility values, OQLQ and demographic and clinical characteristics. Results: Patients with skeletal Class III malocclusion had lower health utility values than those with Class I and Class II malocclusions (p=0.013). Poisson's regression showed that Angle's Class II division 1 (0.90, CI 0.84 to 0.97), Class III (0.68, CI 0.59 to 0.95) and Skeletal malocclusion (0.79, CI 0.71 to 0.87) and OQLQ scores (1.0, CI 1 to 1.003) were found to be significant predictors of TTO utility scores. Conclusions: TTO utilities were found to be valid and well correlated with clinical findings. Health utilities could serve as useful and reliable markers of health-related quality of life (HRQL) among individuals or communities and help cost-effective preventive or intervention programs planning.
RESUMO Objetivo: Estudar a viabilidade do método Time trade-off (TTO) para quantificar escores de valoração da saúde em diferentes tipos de má oclusão. Material e Métodos: Neste estudo transversal, foram incluídos e entrevistados 70 pacientes ortodônticos com idade igual ou superior a 18 anos, que compareceram para tratamento/consulta. A valoração da saúde em relação à má oclusão foi avaliada por meio do método TTO e a qualidade de vida relacionada à saúde bucal foi medida com a ajuda do Questionário de Qualidade de Vida Ortognática (Orthognathic Quality of Life Questionnaire, OQLQ). A classificação da má oclusão segundo Angle foi registrada, e análises bivariadas e regressão multivariada de Poisson foram feitas para verificar qualquer associação entre os escores de valoração da saúde bucal, OQLQ e características demográficas e clínicas. Resultados: Os pacientes com má oclusão esquelética de Classe III apresentaram escores de valoração da saúde mais baixos do que aqueles com má oclusão de Classe I e Classe II (p=0,013). A regressão de Poisson mostrou que a Classe II de Angle divisão 1 (0,90, IC 0,84 a 0,97), Classe III (0,68, IC 0,59 a 0,95), má oclusão esquelética (0,79, IC 0,71 a 0,87) e os escores do OQLQ (1,0, IC 1 a 1,003) foram considerados preditores significativos dos escores de valoração pelo método TTO. Conclusões: Os escores do TTO foram considerados válidos e bem correlacionados com os achados clínicos, e podem servir como marcadores úteis e confiáveis da qualidade de vida relacionada à saúde (health-related quality of life, HRQL) entre indivíduos ou comunidades, e ajudar no planejamento de programas de prevenção ou de intervenção, com uma boa relação custo-benefício.
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Background: Health-related quality of life (HRQOL) is a construct that focuses on the capacity for living afforded by the health status of a patient. Measurement of HRQOL allows a composite estimation of the capacity for living of a patient and can help capture the suffering experienced by the patient due to adverse effects of therapeutic interventions. This study was conducted to understand the health-related quality of life of cancer patients undergoing various modalities of treatment to generate evidence source for need-based intervention, to assess patients diagnosed with cancers, using Health Utilities Index - 3 (HUI-3?) and assign them single-score values to gauge HRQOL and to measure the various domains of HRQOL and change in HRQOL after a period of three months of treatment. Methods: A descriptive, longitudinal study was conducted amongst patients aged more than 18 years, who were diagnosed with cancer at a tertiary care multispecialty hospital in New Delhi. They were administered a standardized HUI-3 Questionnaire? and their responses were recorded, simultaneously. Statistical significance for change in HRQOL score was assessed with paired t-test. Multivariate linear regression was used to identify the various correlates of HRQOL. Results: The mean (± standard deviation) overall HRQOL score for all participants was 0.71 (± 0.262) [range=-0.09 to 1.00]. A follow-up assessment was carried out after three months and changes in health scores were subsequently recorded. A significant decrease in mean overall HRQOL score was seen for the entire group after three months of having been administered treatment. Single-attributes of emotion and ambulation were maximally affected amongst cancer patients after three months of treatment. On linear regression analyses, baseline HRQOL was a significant correlate of HRQOL at follow-up after three months. Conclusion: Addressing the HRQOL of a cancer patient before starting treatment would address morbidity that might be present even after three months.
ABSTRACT
RESUMEN Los sistemas de clasificación diagnóstica categorizan la psicopatología en trastornos mentales. Aunque estas entidades son constructos clínicos elaborados por consenso, se ha señalado que en la práctica se suele tratarlas como entidades naturales y sin valorar aspectos relacionados con su construcción nosológica. Los objetivos del estudio son revisar: a) la conceptualización de los trastornos mentales; b) los indicadores de validez, confiabilidad y utilidad clínica, y c) los valores de estos indicadores en la esquizofrenia de la CIE-11. Los resultados muestran que los trastornos mentales están conceptualizados como entidades discretas, al igual que las enfermedades de otras áreas de la medicina; sin embargo, se observan diferencias entre ambas categorías diagnósticas en la práctica clínica. La confiabilidad y la utilidad clínica de los trastornos mentales son adecuadas; no obstante, la validez aún no está esclarecida. De modo similar, la esquizofrenia de la CIE-11 presenta adecuadas confiabilidad y utilidad clínica, pero su validez permanece incierta. La conceptualización de la psicopatología mental en entidades discretas puede resultar inadecuada para su estudio, por lo que se han propuesto modelos dimensionales y mixtos. Los indicadores de validez, confiabilidad y utilidad clínica permiten tener una visión precisa del estado nosológico de los trastornos mentales al valorar distintos aspectos de su construcción nosológica.
ABSTRACT Diagnostic classification systems categorize mental psychopathology in mental disorders. Although these entities are clinical constructs developed by consensus, it has been pointed out that in practice they are usually managed as natural entities and without evaluating aspects related to their nosological construction. The objectives of the study are to review a) the conceptualization of mental disorders, b) the indicators of validity, reliability and clinical utility, and c) the values of these indicators in ICD-11 schizophrenia. The results show that mental disorders are conceptualized as discrete entities, like the diseases of other areas of medicine; however, differences are observed between these diagnostic categories in clinical practice. The reliability and clinical utility of mental disorders are adequate; however, the validity is not yet clarified. Similarly, ICD-11 schizophrenia demonstrates adequate reliability and clinical utility, but its validity remains uncertain. The conceptualization of psychopathology in discrete entities may be inadequate for its study, therefore dimensional and mixed models have been proposed. The indicators of validity, reliability and clinical utility enable us to obtain an accurate view of the nosological state of mental disorders when evaluating different aspects of their nosological construction.