Heidi Brown

Quality of life associated with diabetes mellitus in an adult population

To ascertain the quality of life associated with the health state of diabetes mellitus using utility value analysis. Consecutive adult patients with diabetes mellitus for at least 1 year and a mean age of 61.7 years (range 21-85 years) were interviewed in a cross-sectional fashion using standardized research methodology. Utility analysis values were obtained employing the time tradeoff method and were correlated with clinical parameters of the sample group, as well as with co-morbidities using the heteroscedastic Students t-test and multivariate linear regression. The chi(2) distribution to test for independence was used to compare sample subgroups. With a sample of 292 patients, the mean, patient-preference-based, time tradeoff utility value associated with the health state of diabetes mellitus was 0.88 (standard deviation (SD)=0.17; 95% confidence interval (CI), 0.86-0.90). Repeat analysis confirmed the reproducibility of the data. Thus, the average diabetic was willing to trade away 12% of his or her remaining life in return for a diabetic-free health state. Factors associated with a significant decrease in diabetic-associated quality of life included: (1) the requirement for insulin (p=0.05), (2) the presence of depression (p=0.01), (3) the presence of diabetic retinopathy (p=0.03) and the presence of co-morbidities in general (p=0.01). The health state of diabetes mellitus has a significant effect upon patient, preference-based quality of life. The presence of diabetic co-morbidities and dependence upon insulin appear to decrease quality of life. The utility value associated with the health state of diabetes mellitus is of substantial importance for use in the calculation of cost-effective analyses.

Utility values associated with blindness in an adult population.

AIM To ascertain utility values associated with varying degrees of legal blindness. METHODS A cross sectional study on three group of patients. There were: (1) 15 patients with complete absence of vision (no light perception) in at least one eye who were asked to assume a scenario of no light perception in the second eye as well, (2) 17 patients with light perception to counting fingers in the better seeing eye, and (3) 33 patients with 20/200–20/400 vision in the better seeing eye. Utility values were measured using the time trade-off and standard gamble methods in each of the three groups. RESULTS The mean time trade-off utility value for the no light perception group with the theoretical scenario of bilateral absence of light perception was 0.26 (95% CI, 0.19–0.33). The mean utility value for the light perception to counting fingers group was 0.47 (95% CI, 0.33–0.61), and the mean utility value for the 20/200–20/400 group was 0.65 (95% CI, 0.58–0.72). Thus, patients with no light perception in one eye, who were presented with the same scenario in the second eye as well, were willing to trade almost 3 out of every 4 years of remaining life in return for perfect vision in each eye. Those with light perception to counting fingers would trade approximately 1 of 2 remaining years and those with 20/200–20/400 would trade approximately 1 of 3 remaining years. CONCLUSIONS There is a wide range of utility values associated with legal blindness. The utility value decreases dramatically with perceived total loss of vision (absence of light perception in each eye), compared with counting fingers to light perception vision, indicating that the preservation of even small amounts of vision in patients with legal blindness is critically important to their wellbeing and functioning in life.

Quality of life associated with unilateral and bilateral good vision

OBJECTIVE To ascertain with patient preference-based methodology whether individuals with good visual acuity (20/20-20/25) in one eye have the same quality of life as individuals with good vision in both eyes. DESIGN Cross-sectional comparative study. PARTICIPANTS Consecutive patients seen in comprehensive ophthalmic and vitreoretinal practices with known ocular disease and good visual acuity (20/20 or 20/25) in one or both eyes. METHODS Standardized patient interview. MAIN OUTCOME MEASURES Time tradeoff and utility analysis values. RESULTS The mean time tradeoff utility value in 81 patients with good visual acuity in one eye was 0.89 (standard deviation, 0.17; 95% confidence interval, 0.85-0.93), whereas the mean value in 66 patients with good vision in both eyes was 0.97 (standard deviation, 0.05; 95% confidence interval, 0.97-0.99). The difference between the means of the utility values in these two groups was significant using multiple linear regression (P = 0.001). CONCLUSIONS From the patient preference-based point of view, individuals with ocular disease and good visual acuity in both eyes appear to have a higher time tradeoff utility value, and thus a better associated quality of life, than those with good visual acuity in only one eye.

Incremental cost effectiveness of laser photocoagulation for subfoveal choroidal neovascularization

OBJECTIVE To perform a patient preference-based, incremental cost-effectiveness analysis for laser treatment of subfoveal choroidal neovascularization. DESIGN Computer-based econometric modeling. METHODS The cost effectiveness of laser photocoagulation therapy was compared with the natural course of subfoveal choroidal neovascularization. The model applied long-term visual data from previous clinical trials, utility analysis (which reflects patient perceptions of quality of life associated with a health state), decision analysis with Markov modeling, and the economic principles of present value analysis with discounting to account for the time value of money. DATABASE Data from patients eligible for treatment of subfoveal choroidal neovascularization obtained by researchers in the Macular Photocoagulation Study were used for the analysis. INTERVENTION Modeled laser therapy for subfoveal choroidal neovasacularization in patients with age-related macular degeneration. MAIN OUTCOME MEASURE Cost per quality-adjusted life-year (

Cost-Effectiveness of Treatment for Threshold Retinopathy of Prematurity

/QALY gained) associated with laser therapy. RESULTS Laser photocoagulation therapy for subfoveal choroidal neovascularization, as compared with no treatment, resulted in a mean gain of 0.257 QALYs per treated patient. Using a yearly discount rate of 3% to account for the time value of money and inflation, the resultant

Value-Based Medicine, Comparative Effectiveness, and Cost-effectiveness Analysis of Topical Cyclosporine for the Treatment of Dry Eye Syndrome

/QALY gained was

Incremental cost-effectiveness of laser therapy for choroidal neovascularization associated with histoplasmosis.

5629. Sensitivity analysis used in the cost-effectiveness analysis resulted in a

The effect of comorbidities upon ocular and systemic health-related quality of life

/QALY gained of

Incremental cost-effectiveness of laser therapy for visual loss secondary to branch retinal vein occlusion

4974 with no gained discount rate and

Patient perceptions of quality-of-life associated with bilateral visual loss.

11,633 with a yearly discount rate of 10%. CONCLUSIONS The incremental expense of laser therapy for the treatment of subfoveal choroidal neovascularization appears to be highly cost effective. The result, which takes into account patient preference-based utility data, compares quite favorably with other interventional therapies across different medical specialties.