The impact of body weight on patient utilities with or without type 2 diabetes: a review of the medical literature.

BACKGROUND: Weight gain is a common side effect of many therapies for type 2 diabetes (T2DM). Selecting utility values for incorporation into cost-utility analyses (CUAs) of T2DM therapies is difficult because of variations in methodologies to elicit utilities and other study limitations. METHODS: A review of the medical literature was conducted to identify studies assessing the impact of body weight on patient utility. RESULTS: Eighteen articles presented either: 1) utility values by body-mass index (BMI) or body weight, or 2) the change in utility scores or quality-adjusted life-years based on unit changes in BMI or body weight. Regardless of the study population or methodology used to elicit utility scores, all studies reviewed found that as body weight increased, patient utility decreased. Utility scores obtained using standard gamble were generally higher than those using time trade-off(TTO) or the EQ-5D. Most studies reported utility scores stratified by BMI and used regression analyses to attribute the difference in utility scores to differences in weight while controlling for other factors. Studies generally assumed a constant change in utility occurs with a one unit change in BMI. Recent studies, however, demonstrate the magnitude of changes in utility may vary depending on 1) valuing weight loss versus weight gain; 2) valuing a small or large change in body weight; and 3) baseline BMI. CONCLUSIONS: Various utility values associated with body weight using different methodologies have been published. Careful consideration should be given to determine the most appropriate utility values to use in CUAs of T2DM therapies.

Clinical practice guidelines on the initial assessment and treatment of urinary incontinence in women: a US focused review.

OBJECTIVE: To identify clinical practice guidelines from prominent US organizations for the initial management of urinary incontinence (UI) in women and compare them with recommendations from the International Consultation on Incontinence (ICI). The challenge of implementing guidelines in the US was also identified. METHODS: The medical literature was reviewed to identify relevant practice guidelines on the initial management of UI in community-dwelling women according to specific inclusion and exclusion criteria. Guidelines were compared with the ICI international gold standard relating to patient identification, initial therapy, and recommendation for specialist referral. Literature on programs to implement guidelines into clinical practice was reviewed. RESULTS: There is general agreement on how females with UI should be initially managed based on guidelines, monographs, and technical bulletins from prominent US organizations. Though these recommendations are more than 5 years old, they are fairly similar to the latest guidelines developed by the ICI in 2001. Minor discrepancies are mainly related to the lack of updating US guidelines based on most recent knowledge. Implementing existing guidelines into clinical practice presents a challenge. CONCLUSION: No evidence-based practice guidelines from prominent US organizations on the initial management of UI in women exist that are less than 5 years old, but the latest versions are in alignment with recent ICI/WHO guidelines. Although optimization of UI management may be the goal of guidances, the debate remains over whether these recommendations are actually effective in modifying practice. Simplifying and updating guidelines regularly may enhance adaptation in the initial management of UI in women.

The impact of reducing dose frequency on health outcomes.

BACKGROUND: Dosing schedules may be one important factor determining whether patients take their prescribed medication. Schedules may influence whether a patient stays on the prescribed therapy and, if so, the degree to which the regimen is followed. Both factors are important determinants of health outcomes and health care costs. OBJECTIVE: The goal of this study was to investigate the impact of reducing dose frequency on health outcomes and health care costs. METHODS: Articles from peer-reviewed journals were identified from the medical literature databases MEDLINE, International Pharmaceutical Abstracts, and HealthSTAR for the years 1985 through 2002. The search included all references that reported on the impact of a change of dose frequency on chronic disease. Search terms used were combinations of dose frequency, dose schedule, and dosing and efficacy, safety, clinical effectiveness, preferences, adherence, compliance, persistence, health-related quality of life, patient satisfaction, resource use, and costs. RESULTS: Reducing the number of daily doses through extended-release formulations or newer drugs has frequently been shown to provide the patient with better symptom control in a number of disease states. Overall improvements were seen in adherence, patient quality of life, patient satisfaction, and costs. However, results of some studies indicate that not all patients, medications, or diseases may be candidates for reduced dosing due to the potential effects on symptom control, incidence of adverse events, and overcompensation for missed doses. CONCLUSION: Where feasible, reducing dose frequency may offer benefits for the patient in terms of health outcomes and for the health care budget holder in terms of costs.

Integer/linear mathematical programming models: a tool for allocating healthcare resources.

In today's environment, the demand for efficient healthcare resource allocation is increasing. As new technologies become available, allocation decisions become more complex and tools to assist decision makers in determining efficient allocations of healthcare resources are encouraged. Mathematical programs have multiple properties that are desirable for healthcare decision makers such as the simultaneous consideration of multiple constraints and a built-in sensitivity analysis. These models have been well researched and are considered invaluable in other industries. Mathematical programming has also become increasingly visible in facilitating the allocation of healthcare resources in the health services research sector. However, the use of mathematical programming tools has been limited in economic evaluations of new technologies. Budget allocations, such as formulary, drug development, and pricing decisions may benefit greatly from the use of mathematical programs. As an increasing number of expensive new technologies become available and pressure grows to contain healthcare costs, these tools may help guide a more efficient allocation of resources for technologies under budgetary and other constraints.