A cost analysis of gastro-oesophageal reflux disease and dyspepsia in Iran.

BACKGROUND AND AIM: To provide a first-time report on the health care utilization and costs of gastro-oesophageal reflux disease and dyspepsia in Iran. METHODS: A consecutive sample of 501 patients referred for upper endoscopy to an outpatient gastroenterology clinic in central Tehran (May 2005 to January 2006) was investigated using two interview-assisted questionnaires for gastro-oesophageal reflux disease (i.e. heartburn or regurgitation on a weekly basis for at least the past 3 months, and symptom onset at least 12 months prior to the study) or dyspepsia symptom (based on Rome II criteria). The frequency of health resource utilization (i.e. physician visit, hospitalization, laboratory tests, instrumental studies, and medications) and productivity loss (days off work) due to gastro-oesophageal reflux disease/dyspepsia-related symptoms in the past 12 months were recorded. Societal perspective was used, and cost of illness per person per year was estimated in purchasing power parity dollars (PPP$). RESULTS: The cost of illness per person per year for patients with gastro-oesophageal reflux disease, and dyspepsia alone were around PPP$195 and PPP$215, respectively. There was no statistically significant difference in the cost of illness between the two patient groups. The direct costs of disease comprised 88%, and 82% of the total costs in gastro-oesophageal reflux disease and dyspepsia patients, respectively with the costs of medications being the dominant component. There was also no statistically significant difference in the cost of disease between the gastro-oesophageal reflux disease patients with and without oesophagitis (based on Los Angeles criteria). CONCLUSION: As drugs cost was found to be a dominant cost component, cost-minimization studies to find the best medication therapy strategies considering the regional factors is suggested.

A logistic regression model for predicting health-related quality of life in kidney transplant recipients.

BACKGROUND: To develop a logistic regression model capable of predicting health-related quality of life (HRQOL) among kidney transplant recipients and determine its accuracy. METHODS: Three groups of patients were selected: 70 healthy controls, 136 kidney transplant patients as a derivation set, and another 110 kidney transplant patients as a validation set. SF-36 score was used for HRQOL measurement. A cutoff point to define poor versus good HRQOL was calculated using the SF-36 scores of healthy controls. A logistic regression model was used to derive predictive parameters from the derivation set. The derived model was then tested among the validation set. HRQOL predictions made by the model for the patients in the validation set and the SF-36 scores were compared. We calculated sensitivity, specificity, positive and negative predictive values, and model accuracy. RESULTS: SF-36 scores below 58.8 were defined as an indication of poor HRQOL. The regression model suggested that poor HRQOL was positively associated with lower education (below high school diploma), being single or widowed, and diabetes/hypertension as etiology. It was negatively associated with younger age (<45 years) at the time of transplantation. Optimal sensitivity and specificity were achieved at a cutoff value of 0.74 for the estimated probability of poor HRQOL. Sensitivity, specificity, positive and negative predictive values, and accuracy of the model were 73%, 70%, 80%, 60%, and 72%, respectively. CONCLUSION: The suggested model can be used to predict poor posttransplant HRQOL among renal graft recipients using simple variables with acceptable accuracy. This modal can be of use in decision making in the recipients for whom achieving good HRQOL is the main aim of transplantation, to select high-risk patients and to start interventional programs to prevent a poor HRQOL.