Jeffrey Vietri

The burden of hepatitis C in Europe from the patients’ perspective: a survey in 5 countries

BackgroundFew studies have examined the impact of Hepatitis C virus (HCV) infection on patient reported outcomes in Europe. This study was conducted to assess the burden of HCV infection in terms of work productivity loss, activity impairment, health-related quality of life, healthcare resource utilization, and associated costs.MethodsThe 2010 European National Health and Wellness Survey (n = 57,805) provided data. Patients reporting HCV infection in France, Germany, the UK, Italy, and Spain were matched to respondents without HCV using propensity scores. Outcome measures included the Work Productivity and Activity Impairment (WPAI) questionnaire and the Medical Outcomes Study Short Form-12 (SF-12v2) questionnaire. Subgroup analyses focused on treatment-naïve patients.ResultsHCV Patients (n = 286) had more work impairment (30% vs. 18%, p < .001), more impairment in non-work activities (34% vs. 28%, p < .05), and more annual physician visits per patient (19.8 vs. 13.3, p < .001). Estimated indirect and direct costs were €2,956 (p < .01) and €495 (p < .001) higher than in matched controls, respectively. Health-related quality of life was also lower among HCV patients. Treatment-naïve HCV patients (n = 139) also reported higher work impairment (29% vs. 15%, p < .01), as well as more frequent physician visits (19.5 vs. 12.1, p < .01) than matched controls. Each treatment-naïve HCV infected patient incurred €934 in direct costs vs. €508 (p < .01 in matched controls. Employed treatment-naïve patients reported higher productivity loss per year compared to matched controls (€6,414 vs. €3,642, p < .05).ConclusionHCV infection in Europe is associated with considerable economic and humanistic burden. This is also true of diagnosed patients who have never been treated for HCV.

Using Game Theory to Examine Incentives in Influenza Vaccination Behavior

The social good often depends on the altruistic behavior of specific individuals. For example, epidemiological studies of influenza indicate that elderly individuals, who face the highest mortality risk, are best protected by vaccination of young individuals, who contribute most to disease transmission. To examine the conditions under which young people would get vaccinated to protect elderly people, we conducted a game-theory experiment that mirrored real-world influenza transmission, with “young” players contributing more than “elderly” players to herd immunity. Participants could spend points to get vaccinated and reduce the risk of influenza. When players were paid according to individual point totals, more elderly than young players got vaccinated, a finding consistent with the Nash equilibrium predicting self-interested behavior. When players were paid according to group point totals, however, more young than elderly players got vaccinated—a finding consistent with the utilitarian equilibrium predicting group-optimal behavior—which resulted in higher point totals than when players were paid for their individual totals. Thus, payout structure affected whether individuals got vaccinated for self-interest or group benefit.

Vaccinating to Help Ourselves and Others

Background. Many behaviors affect not only the self but also others. The utility of a vaccination to each individual depends on population immunity, the cumulative result of individual vaccination decisions. However, little is known about how the benefit to others influences vaccination decisions. Methods. In a series of 3 experiments (N = 292, 316, and 299) using hypothetical scenarios and college student respondents, we tested whether the vaccination decisions of individuals were sensitive to the level of immunity in the population when it had implications for either altruistic or free-riding vaccination behavior. Results. Our findings indicate that decisions of individuals were sensitive to opportunities both to free ride by refusing vaccination and to vaccinate altruistically. Although individuals were most willing to get vaccinated when they were at risk themselves, they were also sensitive to the amount of good they could do for others. This altruistic sensitivity was strongest when individuals were not vulnerable to the disease themselves. Conclusions. The most effective vaccination strategies, from a public health perspective, often entail vaccinating the disease transmitters rather than those who are most vulnerable. Consequently, those who bear the burden of vaccination and those who benefit are not the same individuals. Thus, effective vaccination campaigns require that disease transmitters vaccinate even when it is not in their self-interest to do so. Our results suggest that it may be possible to encourage vaccination by appealing to altruistic motives.

Free-Riding Behavior in Vaccination Decisions: An Experimental Study

Individual decision-making regarding vaccination may be affected by the vaccination choices of others. As vaccination produces externalities reducing transmission of a disease, it can provide an incentive for individuals to be free-riders who benefit from the vaccination of others while avoiding the cost of vaccination. This study examined an individuals decision about vaccination in a group setting for a hypothetical disease that is called “influenza” using a computerized experimental game. In the game, interactions with others are allowed. We found that higher observed vaccination rate within the group during the previous round of the game decreased the likelihood of an individuals vaccination acceptance, indicating the existence of free-riding behavior. The free-riding behavior was observed regardless of parameter conditions on the characteristics of the influenza and vaccine. We also found that other predictors of vaccination uptake included an individuals own influenza exposure in previous rounds increasing the likelihood of vaccination acceptance, consistent with existing empirical studies. Influenza prevalence among other group members during the previous round did not have a statistically significant effect on vaccination acceptance in the current round once vaccination rate in the previous round was controlled for.

How Do People Value Life

Who should be saved when health resources are limited? Although bioethicists and policymakers continue to debate which metric should be used to evaluate health interventions, public policy is also subject to public opinion. We investigated how the public values life when evaluating vaccine-allocation policies during a flu epidemic. We found that people’s ratings of the acceptability of policies were dramatically influenced by question framing. When policies were described in terms of lives saved, people judged them on the basis of the number of life years gained. In contrast, when the policies were described in terms of lives lost, people considered the age of the policy’s beneficiaries, taking into account the number of years lived to prioritize young targets for the health intervention. In addition, young targets were judged as more valuable in general, but young participants valued young targets even more than older participants did.

Symptoms and Association with Health Outcomes in Relapsing-Remitting Multiple Sclerosis: Results of a US Patient Survey

Background. A variety of symptoms have been reported, but the prevalence of specific symptoms in relapsing-remitting multiple sclerosis (RRMS), how they are related to one another, and their impact on patient reported outcomes is not well understood. Objective. To describe how symptoms of RRMS cooccur and their impact on patient-reported outcomes. Methods. Individuals who reported a physician diagnosis of RRMS in a large general health survey in the United States indicated the symptoms they experience because of RRMS and completed validated scales, including the work productivity and activity impairment questionnaire and either the SF-12v2 or SF-36v2. Symptom clusters were identified through hierarchical cluster analysis, and the relationship between clusters and outcomes was assessed through regression. Results. Fatigue, difficulty walking, and numbness were the most commonly reported symptoms. Seven symptom clusters were identified, and several were significantly related to patient reported outcomes. Pain, muscle spasms, and stiffness formed a cluster strongly related to physical quality of life; depression was strongly related to mental quality of life and cognitive difficulty was associated with work impairment. Conclusions. Symptoms in RRMS show a strong relationship with quality of life and should be taken into consideration in treatment decisions and evaluation of treatment success.

Patient-reported impact of chronic urticaria compared with psoriasis in theUnited States

Abstract Purpose: Data are lacking on the burden of chronic idiopathic urticaria (CIU) versus other dermatologic conditions. This analysis compared the burden of chronic urticaria (CU, proxy for CIU) with psoriasis. Methods: Data from CU (N = 747) and psoriasis patients (N = 5107) came from 2010 to 2012 US National Health and Wellness Surveys. Outcomes included SF-12v2/SF-36v2 mental and physical component summary scores (MCS and PCS, respectively) and other health/activity-related measures. Results: MCS score was 44.7 for CU, and 48.2, 44.7 and 44.3 for mild/moderate/severe psoriasis, respectively (US norm = 50). PCS score was 43.8 for CU, and 46.5, 44.1 and 40.3 for mild/moderate/severe psoriasis. Health utility score was 0.67 for CU, and 0.72, 0.67 and 0.65 for mild/moderate/severe psoriasis. More CU patients reported depression (39%), anxiety (42%) and sleep difficulties (50%) than psoriasis patients (any severity). Overall work impairment was 29% for CU, and 19%, 26% and 31% for mild/moderate/severe psoriasis. Activities impairment was 39% for CU, and 28%, 37% and 43% for mild/moderate/severe psoriasis. CU and psoriasis patients had frequent healthcare visits. Conclusions: Patients with CU had impaired mental/physical health and work/non-work activities, similar to moderate-to-severe psoriasis patients. Results suggest that better disease management of CU is needed. This analysis should also reflect the significant burden of CIU.

Burden of smoking on quality of life in patients with chronic obstructive pulmonary disease

The objective of this study was to assess the impact of smoking on health-related quality of life, Work Productivity and Activity Impairment (WPAI) in chronic obstructive pulmonary disease (COPD) patients. Respondents of the 2009/2010 US National Health and Wellness Survey (NHWS), aged ≥40 years, with COPD, chronic bronchitis or emphysema, were included in the study. Current and former (had not smoked for ≥11 years) smokers were compared. Physical component summary (PCS) and mental component summary (MCS) scores from the Short Form-12 version 2 (SF-12v2), health utilities (SF-6D) and WPAI were evaluated. Differences between current (n = 1685) and former (n = 1932) smokers were revealed: MCS (44.80, 46.73; p < 0.01); PCS (35.12, 35.79; p < 0.1); SF-6D (0.63, 0.65; p < 0.05). WPAI: presenteeism (23%, 18%; p < 0.05); work impairment (25%, 21%; p < 0.05); activity impairment (52%, 49%; p < 0.01). In conclusion, COPD patients who smoke have poorer health-related quality of life, impaired productivity and higher healthcare costs than former smokers.

Actor–observer differences in frequency-of-use estimates: Sometimes strangers know us better than ourselves

People make optimistic predictions about themselves; they expect relationships to last longer, tasks to take less time, and things to turn out generally better than they will. In contrast, predictions about others are more realistic, but lack discriminatory power. We investigated first- and third-party predictions for holiday gifts, and how the actors own prediction influences the observers prediction. As expected, actors’ predictions were optimistic but showed discrimination, while observer accuracy depended on access to the actors prediction. Observers who saw the actors prediction showed no optimism but similar discrimination, while other observers showed an optimistic bias but no discrimination. These results suggest that predictions allow efficient use of an anchor-and-adjust strategy, while their absence leads observers to use projection.

The Burden of Bladder Pain in Five European Countries: A Cross-sectional Study

OBJECTIVE To estimate the burden of illness associated with bladder pain in 5 European countries: France, Germany, Italy, Spain, and the United Kingdom. PATIENTS AND METHODS Patients with a diagnosis of bladder pain (ie, unpleasant sensation, pain, pressure, or discomfort related to the urinary bladder) were identified from data collected by the cross-sectional National Health and Wellness Survey performed in 2013. Propensity score matching was used to construct a comparator group without bladder pain (1 case: 2 controls). Assessments were performed for several outcomes including health-related quality of life (HRQoL; 36-item Short-Form, version 2), work-related function (Work Productivity and Activity Impairment questionnaire), employment status, and all-cause healthcare resource use. RESULTS We identified 275 patients with a physician diagnosis of bladder pain, 274 of whom were successfully matched to 548 controls without bladder pain. Compared with matched controls, patients with bladder pain had significantly impaired HRQoL (mental component summary: 38.5 vs 44.5; physical component summary: 38.9 vs 47.8; P <.001). Overall work productivity loss was significantly greater in patients with bladder pain compared with matched controls (41.7% vs 21.5%; P <.001). Patients with bladder pain were also significantly more likely to use all-cause healthcare resources and make more visits to healthcare providers in the previous 6 months than matched controls (P <.001 for all outcomes). CONCLUSION Bladder pain is associated with a considerable burden in Europe in terms of impaired HRQoL and work productivity, and increased healthcare resource use.