Utilities for treatment-related adverse events in type 2 diabetes.

OBJECTIVES: The impact of Type 2 diabetes mellitus (T2DM) on health-related quality-of-life (HRQoL) is complex due to the burden of disease, lifelong treatment requirements, and comorbidities. This study aimed to capture UK societal utility values for health states associated with T2DM and treatment-related adverse events (AEs) to assess the burden of the disease and common AEs. METHODS: Nine health state descriptions were developed (from a literature review and patient and clinician qualitative input) depicting the burden associated with T2DM and treatment-related AEs. These were mild/moderate urinary tract infection (UTI); severe UTI; mycotic infection; moderate hypoglycemic events; severe hypoglycemic events; fear of hypoglycemia; gastrointestinal symptoms; and hypovolemic events. Members of the UK general public (n = 100) valued these states using the time trade-off (TTO) methodology to elicit utility values (between 0 = dead, 1 = full health). Regression analysis was conducted to understand the influence of age and gender. RESULTS: All treatment-related AEs were found to have a significant effect on utility. From the T2DM baseline state (0.92), the experience of AEs was associated with the following disutility: T2DM with hypovolemic events (0.08); T2DM with mild/moderate UTIs (0.09); T2DM with moderate hypoglycemic events (0.11); T2DM with severe hypoglycemic events (0.15); T2DM with fear of hypoglycemia (0.15); T2DM with severe UTIs (0.19); T2DM with GI symptoms (0.24); and T2DM with mycotic infection (0.25); Males consistently scored the states with significantly lower utility values, but no significant age effects emerged. CONCLUSIONS: Findings suggest that adverse events in T2DM can be a burden for some individuals. The study indicates the potential importance of including information regarding AEs in economic evaluations. Although some states were rated severely in terms of utility; in reality, many of these only last a few days, therefore having a minimal quality-adjusted life year (QALY) impact.

A pilot study examining mindfulness-based cognitive therapy in psoriasis.

A sub-population of people with psoriasis have strong causal beliefs about stress, high levels of emotional distress (anxiety and depression) and an impaired quality of life (QoL). Mindfulness-based cognitive therapy has been found to reduce levels of stress and distress and to improve QoL. This pilot study in people with psoriasis aimed to test the hypothesis that mindfulness could reduce stress and thereby lessen psoriasis severity, improve QoL and reduce distress. Twenty-nine people with psoriasis (22-70-years old; 16 females; 13 males) were randomised to an eight-week mindfulness treatment as an adjunct to their usual psoriasis therapy or to a control group which continued with usual psoriasis therapy alone. All subjects completed self-reported measurements of psoriasis severity, perceived stress, distress and QoL, at baseline and again post-intervention. The mindfulness group reported statistically lower psoriasis severity (Self-Assessed Psoriasis Area Severity Index; z = 1.96, p = .05) and QoL impairment scores (Dermatology Life Quality Index; z = 2.30, p = .02) than the control group. There was no significant difference between groups on perceived stress (Perceived Stress Scale; z = .07, p = .94) or distress scores (Hospital Anxiety Depression Scale; z = 1.60, p = .11). People with psoriasis who received mindfulness as an adjunct to their usual therapy reported a significant improvement in both psoriasis severity and QoL. These pilot results suggest that a full randomised control trial is justified to examine the effectiveness of mindfulness as an adjunctive treatment for people with psoriasis.