Paul Grootendorst

Health Utilities Index Mark 3 : Evidence of Construct validity for stroke and arthritis in a population health survey

BACKGROUND The Health Utilities Index Mark 3 (HUI3) is a comprehensive, compact health status classification and health state preference system. The HUI3 system has been included in 4 Canadian population health surveys and numerous clinical trials. OBJECTIVES To evaluate the construct validity of the HUI3 for the measurement of health-related quality of life (HRQL) and attribute-specific morbidity in respondents to the 1990 Ontario Health Survey reported to have arthritis or stroke. The authors assessed (1) whether those with stroke, arthritis, and both conditions had lower HRQL scores than those with neither condition and (2) whether HUI3 detects morbidity in specific health attributes affected by arthritis and stroke. Stroke (but not arthritis) were expected to affect speech and cognition; arthritis (but not stroke) to affect pain; both to affect mobility, dexterity, and emotion; and neither to affect vision and hearing. RESEARCH DESIGN Linear regression models of HRQL and attribute-specific utilities were estimated as a function of 3 indicator variables of health problem (stroke only, arthritis only, both) and variables included to reduce confounding. RESULTS Subjects with stroke, arthritis, and both conditions had substantially lower HRQL than those with neither condition. Stroke subjects had greater morbidity in speech and cognition than arthritis subjects; somewhat surprisingly, pain morbidity was only slightly higher among arthritis subjects; neither condition affected vision or hearing. These associations were robust to various model specifications. CONCLUSIONS The HUI3 system appears valid for measuring health status and HRQL for stroke and arthritis in the context of a noninstitutionalized population health survey.

The cost of drug development: a systematic review

OBJECTIVES We aimed to systematically review and assess published estimates of the cost of developing new drugs. METHODS We sought English language research articles containing original estimates of the cost of drug development that were published from 1980 to 2009, inclusive. We searched seven databases and used citation tracing and expert referral to identify studies. We abstracted qualifying studies for information about methods, data sources, study samples, and key results. RESULTS Thirteen articles were found to meet our inclusion criteria. Estimates of the cost of drug development ranged more than 9-fold, from USD

Effects of Prescription Drug User Fees on Drug and Health Services Use and on Health Status in Vulnerable Populations: A Systematic Review of the Evidence

92 million cash (USD

Does It Matter Whom and How You Ask? Inter and Intra-rater Agreement in the Ontario Health Survey

161 million capitalized) to USD

Net health plan savings from reference pricing for angiotensin-converting enzyme inhibitors in elderly British Columbia residents.

883.6 million cash (USD

A review of instrumental variables estimation of treatment effects in the applied health sciences

1.8 billion capitalized). Differences in methods, data sources, and time periods explain some of the variation in estimates. Lack of transparency limits many studies. Confidential information provided by unnamed companies about unspecified products forms all or part of the data underlying 10 of the 13 studies. CONCLUSIONS Despite three decades of research in this area, no published estimate of the cost of developing a drug can be considered a gold standard. Studies on this topic should be subjected to reasonable audit and disclosure of - at the very least - the drugs which authors purport to provide development cost estimates for.

On Becoming 65 in Ontario: Effects of Drug Plan Eligibility on Use of Prescription Medicines

Rising pharmaceutical expenditures have led to the use of cost-sharing measures. The authors undertook a systematic review of the effects of cost sharing on vulnerable populations (the poor and those with chronic illnesses). Virtually every article reviewed supports the view that cost sharing decreases the use of prescription drugs in these populations. Copayments or a cap on the monthly number of subsidized prescriptions lower drug costs for the payer, but any savings may be offset by increases in other health care areas. Cost sharing also leads to patients foregoing essential medications and to a decline in health care status.

Equity in dental care among Canadian households

A large amount of information in the 1990 Ontario Health Survey (OHS) was collected from proxy respondents using questions administered in face-to-face interviews. Can this type of information represent candid self-reported measures of health status? Inter-rater agreement was assessed using Cohens kappa statistic for responses to questions that were answered both by individuals about themselves and by proxies on their behalf. Intra-rater agreement, assessing the effect of mode of survey administration (in-person interviews versus self-completed written questionnaires) on the responses, was also investigated using the kappa statistic. We conclude that: (1) proxy responses in the OHS for impairments of emotion and pain are not reliable indicators of self-response (kappa < 0.32) because proxy respondents consistently under-report the burden of morbidity; (2) levels of morbidity reported by subjects to interviewer-administered questionnaires may underestimate morbidity, relative to morbidity reported by subjects using self-administered questionnaires completed in privacy. We also hypothesize that the relative magnitudes of inaccuracy introduced by interviewer administration relative to proxy reporting depends on the phenomenon being measured. When assessing pain, mode of administration is quantitatively a more important source of disagreement than type of respondent.

Effect of the Low Risk Ankle Rule on the frequency of radiography in children with ankle injuries

Background:Reference drug pricing (RP) is a cost-sharing strategy commonly used to control drug expenditures. Under RP, a benefit plan fully reimburses medications that are equally or less expensive than the reference price, and requires patients to pay the extra cost of therapeutically equivalent but higher priced drugs. Critics argued that drug plan savings are offset by administrative costs and increased spending on other health services. Objective:We evaluated net healthcare savings in beneficiaries ≥65 years from the perspective of the British Columbia provincial health insurance system after it applied RP to angiotensin-converting enzyme (ACE) inhibitors in 1997. Methods:We estimated savings in new users of antihypertensives after the start of RP plus associated administrative costs and savings from reductions in retail drug prices. Findings were integrated with earlier results on the consequences of RP on expenditures for drugs, physicians, and hospitalizations among all seniors who used ACE inhibitors before the introduction of RP. Results:During the first year after the implementation of RP, savings for continuous users were CAN

Hospitalization and surgical rates in patients with Crohn's disease treated with infliximab: a matched analysis

6.0 million. Savings for new users were