D Golicki

Valuation of EQ‐5D Health States in Poland: First TTO‐Based Social Value Set in Central and Eastern Europe

OBJECTIVE Currently, there is no EQ-5D value set for Poland. The primary objective of this study was to elicit EQ-5D Polish values using the time trade-off (TTO) method. METHODS Face-to-face interviews with visitors of inpatients in eight medical centers in Warsaw, Skierniewice, and Puławy were carried out by trained interviewers. Quota sampling was used to achieve a representative sample of the Polish population with regard to age and sex. Modified protocol from the Measurement and Value of Health study was used. Each respondent ranked 10 health states and valued 4 health states using the visual analog scale and 23 using the TTO. Mean and variance stability tests were performed to determine whether using a larger number of health states per respondent would yield credible results. Modeling included random effects and random parameters models. RESULTS Between February and May 2008, 321 interviews were performed. Modeling based on 6777 valuations resulted in an additive model with all coefficients statistically significant, R(2) equal to 0.45, and value -0.523 for the worst possible health state. Means and variance did not differ significantly for states valued in the middle and at the end of the TTO exercise. CONCLUSIONS This is the first EQ-5D value set based on TTO in Central and Eastern Europe so far. Because the values differ considerably from those elicited in Western European countries, its use should be recommended for studies in Poland. Increasing the number of health states that each respondent is asked to value using TTO seems feasible and justifiable.

Gender-related differences in outcomes and resource utilization in patients undergoing radiofrequency ablation of supraventricular tachycardia: results from Patients' Perspective on Radiofrequency Catheter Ablation of AVRT and AVNRT Study

AIMS The aim of this study was to describe gender-related differences in clinical presentation, radiofrequency ablation (RFA) outcomes, and healthcare resource utilization in a group of patients with atrioventricular nodal reciprocating tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT). METHODS AND RESULTS This was a single-centre, prospective, cohort study which enroled 82 patients undergoing RFA of AVNRT or AVRT. At baseline, all patients received a clinical assessment and completed questionnaires concerning: socioeconomic status, disease-specific symptoms (Patient Perception of Arrhythmia Questionnaire; PPAQ), health-related quality of life (HRQoL) (EQ-5D-3L), and healthcare resource utilization. Two months after RFA, the clinical assessment was repeated and subjects completed PPAQ and EQ-5D-3L. Follow-up was completed by 64 patients, 41 (64%) women. At baseline, there were no significant differences in baseline characteristics, except AVNRT prevalence, and HRQoL by gender but women reported higher severity of symptoms on PPAQ than men (2.8 vs. 2.4 points, P < 0.001). At 2 months after RFA, women still reported higher severity of symptoms (1.8 vs. 0 points; P = 0.02) on PPAQ and more heart skipping than men (54 vs. 13%; P = 0.0014); differences in EQ-5D-3L index and EQ-VAS were insignificant. There was no significant difference in healthcare resource utilization during the year preceding RFA, but antiarrhythmic drugs were significantly more often prescribed to women pre-procedure (30 vs. 8%; P = 0.022). CONCLUSION There is a small but significant gender-related difference in outcome of RFA in patients with AVNRT or AVRT measured with a disease-specific instrument. No significant difference in HRQoL or access to healthcare resources between women and men was found.

EQ-5D-5L Polish population norms

Introduction The new, five-level version of the EQ-5D (EQ-5D-5L) questionnaire has better psychometric properties than the standard three-level version (EQ-5D-3L), including a reduced ceiling effect. Currently, there are few existing population norms for the EQ-5D-5L. The aims of this study were to provide population norms for the EQ-5D-5L in Poland, based on a representative sample of adults, and to compare those with norms from other countries. Material and methods Members of the general public, selected through multistage stratified sampling, filled in paper-and-pencil EQ-5D-5L questionnaires in the presence of an interviewer. EQ-5D-5L index values were estimated using an interim value set, based on a crosswalk methodology. Descriptive statistics were calculated for the EQ-5D-5L index. The distribution of answers was obtained for the descriptive part of the EQ-5D-5L. Results The sample was representative of the Polish population in terms of age, gender, geographical region, education, and socio-professional group. Population norms were developed based on 3963 questionnaires with no missing data. At least one slight, moderate, severe, and extreme health limitation was reported by 61.5%, 31.1%, 12.4%, and 1.6% of the respondents, respectively. Polish society is characterized by poorer health, as compared to its direct neighbor, Germany, especially with regard to the individuals’ perception of pain, as well as anxiety and depression. Conclusions Polish population norms for the EQ-5D-5L should encourage clinicians, economists, and policymakers in Poland to use this questionnaire on a broader scale.

What Influences Recommendations Issued by the Agency for Health Technology Assessment in Poland? A Glimpse Into Decision Makers’ Preferences

OBJECTIVE This study aimed to evaluate the factors that are associated with positive (supporting public funding) and negative recommendations of the Agency for Health Technology Assessment in Poland. METHODS Two independent analysts reviewed all the recommendations publicly available online before October 7, 2011. For each recommendation, predefined decision rationales, that is, clinical efficacy, safety, cost-effectiveness, and formal aspects, were sought, either advocating or discouraging the public financing. In the analysis, we used descriptive statistics and a logistic regression model so as to identify the association between predefined criteria and the recommendation being positive. RESULTS We identified 344 recommendations-218 positive (62.8%) and 126 negative (37.2%). Negative recommendations were better justified and also the comments were less ambiguous in accordance with the recommendation (except for clinical efficacy). In general, the specified criteria supported the decision (either positive or negative) in 209 (60.8%), 107 (31.1%), 124 (36.0%), 96 (27.9%), and 61 (17.7%) recommendations, respectively, and ran contrary to the actual decision in the remaining ones. Threshold values for either cost-effectiveness or budget impact distinguishing positive from negative recommendations could not be specified. The following parameters reached statistical significance in logistic regression: clinical efficacy (both explicitly positive and explicitly negative evaluations impacted in opposite directions), lack of impact on hard end points, unfavorable safety profile, cost-effectiveness results, and formal shortcomings (all reduced the probability of a positive recommendation). CONCLUSIONS Decision making of the Agency for Health Technology Assessment in Poland is multicriterial, and its results cannot be easily decomposed into simple associations or easily predicted. Still, efficacy and safety seem to contribute most to final recommendations.

Quality of life among polish Fabry patients — a cross-sectional study quality of life among polish Fabry patients

This study sought to explore the following issues 1) health-related quality of life (HRQoL) in Fabry patients relative to the general population 2) the quality of life (QoL) level in heterozygous females as compared to hemizygous males and the general population. A prospective, cross-sectional study was performed in patients diagnosed with Fabry disease in Poland (n=33). HRQoL was assessed with two generic questionnaires: the Medical Outcomes Study Short Form-36 (SF-36) and EuroQol questionnaire (EQ-5D), which includes the EQ-5D descriptive system and the EQ-visual analogue scale (EQ VAS), as well as a disease-specific author’s questionnaire. When measured with EQ-VAS, the subjective perception of health status was significantly lower in Fabry patients than that of the general population. SF-36 norm-based scores showed that patients are disadvantaged mainly in social functioning, bodily pain, and mental health. Objective assessments of HRQoL according to the EQ-5D Index tend to be lower for males than for females. Only male patients experienced extreme problems identified by the EQ-5D descriptive system. HRQoL of Fabry patients, measured by EQ-5D and SF-36, is lower as compared with that of the general population. Fabry disease effects QoL in its physical, mental and social dimensions.

EQ1 PSYCHOMETRIC COMPARISON OF EQ-5D AND EQ-5D-5L IN STUDENT POPULATION

EQ1 PSYCHOMETRIC COMPARISON OF EQ-5D AND EQ-5D-5L IN STUDENT POPULATION Golicki D, Zawodnik S, Janssen MF, Kiljan A, Hermanowski T Department of Pharmacoeconomics, Medical University of Warsaw, Warsaw, Poland; EuroQol Group, Rotterdam, The Netherlands OBJECTIVES: The new fi ve-level version of the EQ-5D is now offi cially available. a pilot fi ve-level version of EQ-5D questionnaire was successfully tested in patients with cancer. Other studies, using the offi cial EQ-5D-5L, in moderately or severely disabled populations of patients with stroke, diabetes, injury, or psychiatric conditions are under way. Nothing is known about how EQ-5D-5L performs in relatively young and healthy populations. Aim of the study was to compare a polish version of the threelevel EQ-5D questionnaire (3L) with the fi ve-level version (5L) in a student population. METHODS: In March 2010, all students from the Faculty of Pharmacy, Medical University of Warsaw were surveyed with a set of HRQoL questionnaires (5L, EQ-VAS, SF-36, and 3L). We examined percentage of reported problems, proportion and size of logical inconsistencies, ceiling effect, redistribution properties, convergent validity with SF-36 domains, and discriminatory power using Shannon’s indices. RESULTS: Four hundred eighty-fi ve students were approached and 443 responded to all questionnaires (5L, SF-36, and 3L). The domains with the highest and the lowest proportion of reported problems by 5L were Anxiety/Depression (57.1%) and SelfCare (0.2%), respectively. 3L and 5L responses were highly correlated in Pain/Discomfort (Pearsons’s Rho = 0.71), Usual Activities (0.64), and Anxiety/Depression domains (0.64). Mean rate of logical inconsistencies was 3.02%, with 93% of them being level 1 (according to Janssen et al., 2008). The ceiling effect was indentifi ed in 47% of 3L questionnaires and 34% of 5L questionnaires. Absolute informativity was higher for 5L, with similar relative informativity for both instruments. CONCLUSIONS: Results obtained in students support introduction of new 5-level version of EQ-5D in young and healthy populations. EQ-5D-5L appears to be more favorable in terms of ceiling effect and absolute informativity.

PMC24 SELF-ASSESSED HEALTH STATUS IN POLAND: EQ-5D FINDINGS FROM POLISH VALUATION STUDY

PMC22 THE IMPACT OF COMORBIDITY BURDEN ANDAGE ON PREFERENCE-BASED HRQL INTHE UNITED STATES Sullivan PW, Ghushchyan VH University of Colorado Denver, Aurora, CO, USA OBJECTIVES: Gains in life expectancy have lead to aging populations with more chronic comorbidity. This study aims to examine the impact of age and comorbidity on EQ-5D index scores in a nationally representative sample of the U.S. METHODS: The pooled 2001 and 2003 Medical Expenditure Panel Survey (MEPS) was used. MEPS is a nationally representative survey of the U.S. civilian, noninstitutionalized population based on self-report which collects detailed information on sociodemographic characteristics, medical conditions and HRQL. The total number of chronic conditions for each individual was calculated based on ICD-9 codes. Spline regression was used to allow for nonlinear age effects: individuals were separated into 4 quartiles based on age: 18–31; 32–44; 45–58; and >58 years. Censored least absolute deviations (CLAD), Tobit and OLS methods were used to regress EQ-5D index scores on age and chronic comorbidity, controlling for income, gender, race, ethnicity, education, physical activity and smoking status. Interactions between age and chronic conditions were also explored. RESULTS: After controlling for chronic comorbidities and other confounders, age was not statistically significant except for those >58 years and the magnitude of this coefficient was very small (coefficient age >58 years = -0.0006). However, the coefficients for chronic comorbidities were highly statistically significant with large magnitudes for those with 2 chronic conditions (coefficient 2 chronic conditions = -0.16; coefficient 9 chronic conditions = -0.28). Having only one chronic condition was not statistically significant. The interaction between age and chronic comorbidity was significant, but the deleterious impact of their interaction was largely dominated by the existence and number of chronic conditions. CONCLUSIONS: Chronic conditions have a significant deleterious impact on EQ-5D index scores regardless of age. The negative impact of age on EQ-5D index scores may be due to the existence and degree of chronic comorbidity.

EQ-5D studies in cardiovascular diseases in eight Central and Eastern European countries: a systematic review of the literature

BACKGROUND The measurement of health-related quality of life (HRQoL) by validated generic instruments, such as EQ-5D, has become an increasingly important tool for the assessment of health care in a wide range of diagnoses. AIM We aimed to systematically review EQ-5D literature on cardiovascular diseases in eight Central and Eastern European (CEE) countries. METHODS A structured literature search was conducted in MEDLINE, EMBASE, Web of Science, CINAHL, PsycINFO, Cochrane Library, and the EuroQol website up to November 2016. Original cardiovascular-related studies that reported EQ-5D results were included. RESULTS Of the 36 papers, 17 reported EQ-5D index scores. Most studies were performed in Poland (n = 24, 67%). The most common diagnosis regarding the number of publications and population size was ischaemic heart disease (n = 13, N = 6394), followed by atrial fibrillation (n = 4, N = 1052). The average EQ-5D index scores ranged from 0.61 to 0.88 and from 0.66 to 0.95 for patients before and after cardiac procedure/surgery, respectively (including angioplasty, coronary artery bypass grafting, ablation, surgical correction of septal defects, transcatheter aortic valve implantation [TAVI]). In all studies baseline scores were lower than the repeated assessments after the procedure, with the most substantial improvement of 0.24 in high-risk elderly patients after TAVI. Studies which did not assess invasive treatment reported mean EQ-5D index scores ranging from 0.18 to 0.80. CONCLUSIONS The number of cardiovascular-related studies reporting HRQoL using EQ-5D has consistently increased in CEE countries over the past decade and is outstanding compared with other clinical fields. The EQ-5D index and EQ VAS scores varied based on the disease severity, patient characteristics, and treatment protocol.

Estimating the Fuzzy Trade-Offs Between Health Dimensions with Standard Time Trade-Off Data

Optimizing health provision requires measuring health, best using societal preferences. Health-related quality of life is evaluated with multiple criteria (e.g. feeling pain or being depressed), and their importance must be quantified. In a time trade-off (TTO) elicitation method, worsening in various attributes is compared with shortening the duration of life—a task unlike everyday experience. Therefore, we claim the trade-off coefficients should be treated as fuzzy numbers to allow imprecision. Additionally, a typical TTO protocol allows only limited number of final outcomes, enforcing approximate answers. In our model, we assume the respondent terminates TTO when the implied utility falls within the 1-cut of the true fuzzy disutility (normal and rectangular, simplifying). We show how to estimate such disutilities with standard TTO data (existing datasets can be used) in the hierarchical Bayesian setting. We test our approach on data collected in Poland with EQ-5D-3L descriptive system. For example, the disutility of worsening mobility to level 2 or 3 results (on average) in a disutility with 1-cut equal to [0.076–0.089] or [0.398–0.483], respectively. Standard errors of interval bounds estimates amount to ca. 5%–15% of their values. We construct a fuzzy value set assigning fuzzy utilities to all 243 EQ-5D-3L health states. The fuzzy disutilities tend to be larger than the standard, crisp ones (e.g. the crisp parameters for mobility amount to 0.056 and 0.313, respectively), and the resulting fuzzy value set assigns lower values to utilities than the crisp one.

Annual Cost Of Conservative Treatment Of Supraventricular Tachycardias In Poland.

ID#: 53361 Password: 222756 Submitters E-mail Address: mfarkowski@gmail.com Program Selection: Research Preferred Presentation Format: Either poster or podium Topic: Cost Studies (CS) Topic Subcategories: Cost of Treatment (CoT) Disease/Disorder: Cardiovascular Disease-Arrhythmia Health Care Treatment: