| 1. |
- Nystrand, Camilla, et al.
(författare)
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Indicated Parenting Interventions and Long Term Outcomes : A Health Economic Modeling Study
- 2018
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Ingår i: Value in Health. - : Elsevier. - 1098-3015 .- 1524-4733. ; 21, s. S76-S76
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Konferensbidrag (refereegranskat)abstract
- Economic evaluations of early interventions for children are augmenting in numbers and a larger focus is put on the longer-term economic returns. However, little is known about the labour market returns from preventive parenting programs. This study estimates the benefits and costs of five parenting interventions: Comet, Connect, the Incredible Years (IY), Cope and bibliotherapy, compared to a waitlist control, for the prevention of persistent externalizing behavior problems in children.
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| 2. |
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| 3. |
- Berg, Jenny, et al.
(författare)
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Determinants of Utility Based on the EuroQol Five-Dimensional Questionnaire in Patients with Chronic Heart Failure and Their Change Over Time: Results from the Swedish Heart Failure Registry
- 2015
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Ingår i: Value in Health. - : Wiley: No OnlineOpen / Elsevier. - 1098-3015 .- 1524-4733. ; 18:4, s. 439-448
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is limited information on drivers of utilities in patients with chronic heart failure (CHF). Objectives: To analyze determinants of utility in CHF and drivers of change over 1 year in a large sample from clinical practice. Methods: We included 5334 patients from the Swedish Heart Failure Registry with EuroQol five-dimensional questionnaire information available following inpatient or outpatient care during 2008 to 2010; 3495 had 1-year follow-up data Utilities based on Swedish and UK value sets were derived. We applied ordinary least squares (OLS) and two-part models for utility at inclusion and OLS regression for change over 1 year, all with robust standard errors. We assessed the predictive accuracy of both models using cross-validation. Results: Patients mean age was 73 years, 65% were men, 19% had a left ventricular ejection fraction of 50% or more, 23% had 40% to 49%, 27% had 30% to 39%, and 31% had less than 30%. For both models and value sets, utility at inclusion was affected by sex, age, New York Heart Association class, ejection fraction, hemoglobin, blood pressure, lung disease, diabetes, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, nitrates, antiplatelets, and diuretics. The OLS model performed slightly better than did the two-part model on a population level and for capturing utility ranges. Change in utility over 1 year was influenced by age, sex, and (measured at inclusion) disease duration, New York Heart Association class, blood pressure, ischemic heart disease, lung disease, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and antiplatelets. Conclusions: Utilities in CHF and their change over time are influenced by diverse demographic and clinical factors. Our findings can be used to target clinical interventions and for economic evaluations of new therapies.
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| 4. |
- Bergthorsdottir, R, et al.
(författare)
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Health-Related Quality of Life In Patients With Adrenal Insufficiency Receiving Plenadren Compared With Immediate-Release Hydrocortisone
- 2015
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Ingår i: Value in Health. - : Elsevier. - 1098-3015 .- 1524-4733. ; 18:7
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPrevious studies in patients with primary adrenal insufficiency (PAI) on conventional replacement therapy suggest decreased health-related quality of life (HRQoL), and that patients report more frequently fatigue, increased anxiety and inability to work compared to background population.ObjectivesTo study self-reported health status with EQ-5D in patients with PAI. Patients treated with Plenadren (modified-release hydrocortisone) were compared with patients treated with immediate release hydrocortisone (IRHC) replacement therapy.MethodsThis was a cross-sectional, multi-centre, non-interventional survey of patients with PAI receiving Plenadren or immediate release hydrocortisone (IRHC) replacement.SubjectsOne hundred thirty-four adult patients with PAI of whom 36 (19 females [53%]) were treated with Plenadren and 98 (77 females [79%]) were treated with IRHC, were included.MAIN OUTCOME MEASUREHRQoL described by the EQ-5D, a generic preference-based measure of health.RESULTSPatients on Plenadren and on IRHC had a mean ± SD age of 53.1 ± 12.7 years and 48.0 ± 13.1 years, respectively (P=0.043). The majority of the patients were diagnosed more than 5 years ago (69%). The mean ± SD daily Plenadren and IRHC doses were 27.0 ± 6.8 mg and 26.6 ± 10.9 mg, respectively (P=0.807). 47% of the Plenadren patients had been receiving Plenadren and 82% of the IRHC patients had been receiving IRHC for more than 3 years. Patients receiving Plenadren had better HRQoL measured by the EQ-5D questionnaire compared to patients replaced with IRHC (0.76 ± 0.18 vs 0.68 ± 0.18, respectively [P=0.040]).CONCLUSIONSReplacement therapy with Plenadren in patients with PAI confers measurable benefit on HRQoL relative to IRHC as estimated by the EQ-5D questionnaire, and may therefore be advantageous when compared to IRHC substitution.
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| 7. |
- Caccamisi, Andrea, et al.
(författare)
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PRM92 - Automatic Extraction and Classification of Patients’ Smoking Status from Free Text Using Natural Language Processing
- 2016
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Ingår i: Value in Health. - : Elsevier BV. - 1098-3015 .- 1524-4733. ; 19:7
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo develop a machine learning algorithm for automatic classification of smoking status (smoker, ex-smoker, non-smoker and unknown status) in EMRs, and validate the predictive accuracy compared to a rule-based method. Smoking is a leading cause of death worldwide and may introduce confounding in research based on real world data (RWD). Information on smoking is often documented in free text fields in Electronic Medical Records (EMRs), but structured RWD on smoking is sparse.Methods32 predictive models were trained with the Weka machine learning suite, tweaking sentence frequency, classifier type, tokenization and attribute selection using a database of 85,000 classified sentences. The models were evaluated using F-Score and Accuracy based on out-of-sample test data including 8,500 sentences. The error weight matrix was used to select the best model, assigning a weight to each type of misclassification and applying it to the models confusion matrices.ResultsThe best performing model was based on the Support Vector Machine (SVM) Sequential Minimal Optimization (SMO) classifier using a polynomial kernel with parameter C equal to 6 and a combination of unigrams and bigrams as tokens. Sentence frequency and attributes selection did not improve model performance. SMO achieved 98.25% accuracy and 0.982 F-Score versus 79.32% and 0.756, respectively, for the rule-based model.ConclusionsA model using machine learning algorithms to automatically classify patients smoking status was successfully developed. This algorithm would enable automatic assessment of smoking status directly from EMRs, obviating the need to extract complete case notes and manual classification.
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| 8. |
- Chen, Gang, et al.
(författare)
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Assessing the Health-Related Quality of Life of Australian Adolescents : An Empirical Comparison of the Child Health Utility 9D and EQ-5D-Y Instruments
- 2015
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Ingår i: Value in Health. - : Elsevier BV. - 1098-3015 .- 1524-4733. ; 18:4, s. 432-438
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To examine the performance of two recently developed preference-based instruments-the Child Health Utility 9D (CHU9D) and the EuroQol five-dimensional questionnaire Youth version (EQ-5D-Y)-in assessing the health related quality of life (HRQOL) of Australian adolescents. Methods: An online survey including the CHU9D and the EQ-5D-Y, self-reported health status, and a series of sociodemographic questions was developed for administration to a community-based sample of adolescents (aged 11-17 years). Individual responses to both instruments were translated into utilities using scoring algorithms derived from the Australian adult general population. Results: A total of 2020 adolescents completed the online survey. The mean +/- SD utilities of the CHU9D and the EQ-5D-Y were very similar (0.82 +/- 0.13 and 0.83 +/- 0.19, respectively), and the intraclass correlation coefficient (0.80) suggested good levels of agreement. Both instruments were able to discriminate according to varying levels of self-reported health status (P < 0.001). Although exhibiting good levels of agreement overall, some wide divergences were apparent at an individual level. Conclusions: The study results are encouraging and illustrate the potential for both the CHU9D and the EQ-5D-Y to be more widely used for measuring and valuing the HRQOL of adolescent populations in Australia and internationally. Generating adolescent-specific scoring algorithms pertaining to each instrument and an empirical comparison of the resulting utilities is a natural next step. More evidence is required from the application of the CHU9D and the EQ-5D-Y in specific patient groups in adolescent health settings to inform the choice of instrument for measuring and valuing the HRQOL for the economic evaluation of adolescent health care treatments and services.
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| 9. |
- Coyne, Karin S, et al.
(författare)
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Development and Validation of the AFImpact: An Atrial Fibrillation-Specific Measure of Patient-Reported Health-Related Quality of Life.
- 2017
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Ingår i: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research. - : Elsevier BV. - 1524-4733. ; 20:10, s. 1355-1361
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Tidskriftsartikel (refereegranskat)abstract
- Improvement in health-related quality of life is a key therapeutic goal of disease management in atrial fibrillation (AF).To describe the development of the AFImpact, an AF-specific health-related quality-of-life patient-reported outcome measure.Development and validation of the AFImpact comprised a qualitative stage, consisting of a literature review and concept elicitation interviews (91 patients with AF), item generation, and cognitive debriefing (30 patients with AF), and a quantitative stage, consisting of evaluation of the instrument's psychometric properties (313 patients with AF). Preliminary responsiveness to change was assessed in 118 patients undergoing cardioversion.On the basis of the literature review and concept elicitation interviews, 75 items were generated. Factor analyses guided a reduction to 18 items. Three domains were confirmed: vitality (7 items), emotional distress (8 items), and sleep (3 items). The 18-item AFImpact demonstrated high item convergent and discriminant validity. Cronbach α coefficients showed high internal consistency reliability. Test-retest reliability of individual items in stable patients (n = 33) was satisfactory, with intraclass correlation coefficients ranging from 0.61 to 0.86. All three AFImpact domain scores differentiated patients who reported different levels of overall health, thereby supporting known-groups validity. Scores for each item improved after cardioversion, with effect sizes ranging from -0.19 to -0.65.Psychometric evaluations support the reliability and validity of the AFImpact as a patient-reported outcome instrument to measure the impact of AF, with preliminary results in patients undergoing cardioversion supporting responsiveness to change.
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| 10. |
- Denoncourt, R. N., et al.
(författare)
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Burden of Illness for Patients with Hereditary Attr Amyloidosis with Polyneuropathy Begins with Symptom Onset and Increases with Disease Progression
- 2016
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Ingår i: Value in Health. - : Elsevier. - 1098-3015 .- 1524-4733. ; 19:7, s. A436-A436
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Hereditary ATTR amyloidosis with polyneuropathy (hATTR-PN), also known as familial amyloidotic polyneuropathy (FAP), is an inherited, progressive disease leading to death within 5-15 years. hATTR-PN is due to a mutation in the transthyretin (TTR) gene. Patisiran is an investigational, RNA interference (RNAi) therapeutic targeting TTR. This abstract aims to further characterize hATTR-PN burden of illness.Methods: The ongoing, patisiran Phase 3 APOLLO trial was utilized to collect patient-reported EQ-5D, Norfolk-DN, Rasch-built Overall Disability Scale (R-ODS), and healthcare resource utilization from hATTR-PN patients with symptomatic disease.Results: APOLLO included 225 patients; median age of 62 years (range: 24-82), median neurological impairment score (NIS) of 6-141.6 and representative of the global patient population (19 countries) with a broad range of mutations and disease severities. At baseline, 57 patients had a Polyneuropathy Disability (PND) Score I and 168 patients had a PND Score ≥ II. By FAP Stage, 104 were FAP Stage 1 and 121 were FAP Stage 2. 41 patients (PND Score ≥ II) reported ≥1 hospitalization of ≥3 nights in duration due to hATTR-PN in the 12 months prior to enrollment. Mean EQ-5D scores were 0.76 (PND Score I) and 0.59 (PND Score ≥ II). Patients reported perceived health status on the EQ-VAS with mean scores of 66.9 (PND Score I) and 51.3 (PND Score ≥ II). Mean Norfolk-QoL-DN scores were 35.5 (PND Score I) and 66.0 (PND Score ≥ II). 145 patients (131 PND Score ≥ II) reported they cannot work because of hATTR-PN. Mean R-ODS scores were 40.9 and 25.9 for PND Score I and PND Score ≥ II, respectively.Conclusions: These data, from the largest controlled study of patients with hATTR-PN to date, further demonstrate that patients experience considerable burden of illness early in the course of disease and this burden increases with disease progression.
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