scholarly journals Use of temperature-controlled laminar airflow in the management of atopic asthma: clinical evidence and experience

2017 ◽  
Vol 11 (4) ◽  
pp. 181-188 ◽  
Author(s):  
John O. Warner
Keyword(s):  
Airway Inflammation ◽  
Quality Adjusted Life Year ◽  
Atopic Asthma ◽  
Severe Exacerbation ◽  
Asthmatic Patients ◽  
Cochrane Reviews ◽  
Temperature Controlled ◽  
Quality Adjusted Life ◽  
Health Service Costs

Avoidance of allergens in the treatment of asthma has hitherto not achieved significant benefit despite the strong evidence that allergy both increases severity and contributes to exacerbations of asthma. House dust mite, cat and dog allergens are the most common perennial allergic triggers and most avoidance strategies have focused on reducing exposures in bedrooms. Cochrane reviews have suggested that they neither significantly reduce allergen levels nor improve asthma. While the lack of efficacy may be assumed to be a consequence of exposures occurring outside the bedroom, prolonged sleep is associated with increased susceptibility to bronchospasm and airway inflammation. Thus, if efficient reductions in allergen exposure could be achieved during sleep, it might be expected that this would result in significant improvements in control of asthma. The temperature-controlled laminar airflow (TLA) is a system which can be employed over beds in a domestic environment and results in massive reductions in particulate exposure of recumbent subjects, including highly respirable allergens such as Fel. D1 from cats. Trials of TLA have demonstrated highly significant improvements in asthma quality of life and reductions on airway inflammation as monitored by exhaled nitric oxide levels. Furthermore, in patients with the worst disease, severe exacerbation frequency was significantly reduced. Based on UK health-service costs, the use of TLA falls well below the National Institute for Health and Care Excellence (NICE) threshold for the incremental cost effectiveness ratio (ICER) per quality adjusted life year (QALY). Indeed, for those with frequent exacerbations, it is cost saving and should be prescribed for such allergic asthmatic patients.

Quality of Life and Resource Allocation

1988 ◽  
Vol 23 ◽  
pp. 33-55 ◽  
Author(s):  
Michael Lockwood
Keyword(s):  
Quality Of Life ◽  
Resource Allocation ◽  
Quality Adjusted Life Year ◽  
Medical Resources ◽  
Medical Vocabulary ◽  
Quality Adjusted Life

A new word has recently entered the British medical vocabulary. What it stands for is neither a disease nor a cure. At least, it is not a cure for a disease in the medical sense. But it could, perhaps, be thought of as an intended cure for a medicosociological disease: namely that of haphazard or otherwise ethically inappropriate allocation of scarce medical resources. What I have in mind is the term ‘QALY’, which is an acronym standing for quality adjusted life year. Just what this means and what it is intended to do I shall explain in due course. Let me first, however, set the scene.

scholarly journals Cost-Effectiveness of Continuous Positive Airway Pressure Therapy in Patients with Obstructive Sleep Apnea-Hypopnea in British Columbia

2008 ◽  
Vol 15 (3) ◽  
pp. 159-165 ◽  
Author(s):  
MCY Tan ◽  
NT Ayas ◽  
A Mulgrew ◽  
L Cortes ◽  
JM FitzGerald ◽  
...  
Keyword(s):  
Quality Of Life ◽  
British Columbia ◽  
Cost Effectiveness ◽  
Quality Adjusted Life Year ◽  
Third Party ◽  
Cpap Therapy ◽  
Obstructive Sleep ◽  
The Cost ◽  
Quality Adjusted Life

BACKGROUND: Obstructive sleep apnea-hypopnea (OSAH) is a common disorder characterized by recurrent collapse of the upper airway during sleep. Patients experience a reduced quality of life and an increased risk of motor vehicle crashes (MVCs). Continuous positive airway pressure (CPAP), which is the first-line therapy for OSAH, improves sleepiness, vigilance and quality of life.OBJECTIVE: To assess the cost-effectiveness of CPAP therapy versus no treatment for OSAH patients who are drivers.METHODS: A Markov decision analytical model with a five-year time horizon was used. The study population consisted of male and female patients, between 30 and 59 years of age, who were newly diagnosed with moderate to severe OSAH. The model evaluated the cost-effectiveness of CPAP therapy in reducing rates of MVCs and improving quality of life. Utility values were obtained from previously published studies. Rates of MVCs under the CPAP and no CPAP scenarios were calculated from Insurance Corporation of British Columbia data and a systematic review of published studies. MVCs, equipment and physician costs were obtained from the British Columbia Medical Association, published cost-of-illness studies and the price lists of established vendors of CPAP equipment in British Columbia. Findings were examined from the perspectives of a third-party payer and society.RESULTS: From the third-party payer perspective, CPAP therapy was more effective but more costly than no CPAP (incremental cost-effectiveness ratio [ICER] of $3,626 per quality-adjusted life year). From the societal perspective, the ICER was similar ($2,979 per quality-adjusted life year). The ICER was most dependent on preference elicitation method used to obtain utility values, varying almost sixfold under alternative assumptions from the base-case analysis.CONCLUSION: After considering costs and impact on quality of life, as well as the risk of MVCs in individuals with OSAH, CPAP therapy for OSAH patients is a highly efficient use of health care resources. Provincial governments who do not provide funding for CPAP therapy should reconsider.

scholarly journals A systematic review of economic evaluations of the use of memantine alone or combined with donepezil for moderate to severe Alzheimer’s disease

2019 ◽  
Vol 22 (4) ◽  
Author(s):  
Ione Ayala Gualandi de Oliveira ◽  
Rosângela Caetano ◽  
Ricardo Ewback Steffen ◽  
Aline Navega Biz
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Markov Models ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Decision Models ◽  
Economic Evaluations ◽  
Eligibility Criteria ◽  
Quality Adjusted Life

Abstract Objective: To synthesize the available evidence and state of the art of economic evaluations which evaluate the use of memantine, whether alone or combined with donepezil, for moderate to severe Alzheimer’s disease (AD), focusing on the analytical decision models built. Method: The electronic databases MEDLINE, EMBASE, NHS EED, CEA Registry and LILACS were searched for references. After duplicates were removed, two independent reviewers evaluated the titles and abstracts and subsequently the full texts. The Drummond M. tool was used to evaluate the quality of the studies. Results: After the application of the eligibility criteria, twelve complete economic evaluations were included. One evaluation was a clinical trial, two involved simulations and nine used Markov models. The main outcome measure adopted was dominated by cost per quality adjusted life year (QALY). The use of memantine was considered cost-effective and dominant in eight studies; while in a single study, its use was dominated when compared to donepezil for moderate AD. Sensitivity analyzes were systematically performed, with robust results. The quality assessment indicated that the methodological quality of the studies was good. Conclusion: Although there is some controversy regarding the benefits derived from the use of memantine, whether combined or not with donepezil, the evidence collected suggests that it is cost-effective in the countries where the studies were performed. However, local economic studies need to be performed, given the significant variability derived from the different parameters adopted in the evaluations.

Comparison of Hemodialysis and Peritoneal Dialysis — a Cost–Utility Analysis

2002 ◽  
Vol 22 (1) ◽  
pp. 39-47 ◽  
Author(s):  
Karin Sennfält ◽  
Martin Magnusson ◽  
Per Carlsson
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Peritoneal Dialysis ◽  
Kidney Failure ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Age Group ◽  
The Cost ◽  
Quality Adjusted Life

Objective Our aim was to compare both health-related quality of life and costs for hemodialysis (HD) and peritoneal dialysis (PD) in a defined population. Design Decision-tree modeling to estimate total costs and effects for two treatment strategies, HD and PD, among patients with chronic kidney failure, for 5 years following the start of treatment. Courses of events and health-care consumption were mapped in a retrospective matched-record study. Data on health status were obtained from a matched population by a quality-of-life questionnaire (EuroQol). The study has a societal perspective. Setting All dialysis departments in the southeastern health-care region of Sweden. Patients 136 patients with kidney failure, comprising 68 matched pairs, were included in a retrospective record study; 81 patients with kidney failure, comprising 27 matched triplets, were included in a prospective questionnaire study. Main Outcome Measures Cost per life year and cost per quality-adjusted life year. Results The cost per quality-adjusted life year for PD was lower in all analyzed age groups. There was a 12% difference in the age group 21 – 40 years, a 31% difference in the age group 41 – 60 years, and an 11% difference in the age group 61+ years. Peritoneal dialysis and HD resulted in similar frequencies of transplantation (50% and 41%, respectively) and expected survival (3.58 years and 3.56 years, respectively) during the first 5 years after the initiation of treatment. Conclusion The cost–utility ratio is most favorable for PD as the primary method of treatment for patients eligible for both PD and HD.

Economic Evaluation of A Support Program for Caregivers of Demented Elderly

1991 ◽  
Vol 7 (2) ◽  
pp. 209-219 ◽  
Author(s):  
Michael F. Drummond ◽  
E. Ann Mohide ◽  
Michelle Tew ◽  
David L. Streiner ◽  
Dorothy M. Pringle ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Economic Evaluation ◽  
Statistical Significance ◽  
Quality Adjusted Life Year ◽  
Support Program ◽  
Caregiver Support ◽  
Health Care Interventions ◽  
Caregiver Quality ◽  
Quality Adjusted Life

AbstractAn economic evaluation was undertaken concurrently with a randomized trial comparing a Caregiver Support Program (CSP) with existing conventional community nursing care for those caring for elderly relatives at home. The differences in resource consumption were compared with changes in caregiver quality of life, as measured by the Caregiver Quality of Life Instrument (CQLI). A 20% difference from baseline in the CQLI favored the experimental (CSP) group, although this did not reach conventional levels of statistical significance. A comparison of improvement in quality of life with costs implies an incremental cost per quality-adjusted life year gained of Canadian $20,000 for the CSP, which compares favorably with other health care interventions. Further, larger studies are required to confirm this result.

scholarly journals Modern aspects of the study of the quality of life in children with cystic fibrosis

2019 ◽  
Vol 19 (1) ◽  
pp. 43-48
Author(s):  
M. S. Samsonova ◽  
O. I. Simonova ◽  
Irina V. Vinyarskaya
Keyword(s):  
Quality Of Life ◽  
Cystic Fibrosis ◽  
Pharmacoeconomic Analysis ◽  
Quality Adjusted Life Year ◽  
Therapeutic Approaches ◽  
Health Related ◽  
The One ◽  
Practice Methods ◽  
Quality Adjusted Life

There is presented a review of recent data on the changes in quality of life (QL) in children suffering from cystic fibrosis (CF). The recurrence of acute pulmonary infections was shown to significantly reduce health-related QL. In this aggressive treatment of exacerbations ofpulmonary infection leads to a significant improvement in QL, and to gain in the life expectancy ofpatients with CF. Used in clinical practice methods demonstrate the effectiveness in the short term period, but their impact on health-related QL has not yet been studied. The use of the concept of Quality adjusted life year (QALY) in conjunction with the pharmacoeconomic analysis is the one out of promising directions, which allows in the comparative plan to determine the ratio between cost and effectiveness, safety and QL in alternative schemes of treatment of the disease. The use of the QALY index in the analysis of the CF will allow to execute the cumulative determination as the ratio of "cost-effectiveness", and the influence of the conducted therapy on health-related QL ofpatients, which is an inherent component of the evaluation of the estimation of usefulness of specific therapeutic approaches.

Measuring the Value of Prescription Drugs

2021 ◽  
pp. 62-92
Author(s):  
Neumann Peter J. ◽  
Cohen Joshua T. ◽  
Ollendorf Daniel A
Keyword(s):  
Cost Effectiveness ◽  
Prescription Drugs ◽  
Quality Adjusted Life Year ◽  
Costs And Benefits ◽  
Purchasing Decisions ◽  
A Value ◽  
Near Term ◽  
Productive Output ◽  
Quality Adjusted Life

This chapter recounts the evolution of methods to put a value on health benefits, a step crucial to appropriately pricing drugs. Early efforts valued life based on a worker’s productive output. “Willingness-to-pay” methods use surveys and examine real-world purchasing decisions to value life beyond productivity considerations. Cost-effectiveness analysis sidesteps explicitly pricing life by instead measuring an intervention’s cost per unit of health gained. A common currency for benefits called the quality-adjusted life year (QALY) facilitates cost-effectiveness ratio comparisons across diseases. Although controversial, the QALY packs information about longevity and quality of life, making it popular. Next, this chapter explains that economists down-weight (“discount”) future costs and benefits as less important than near term impacts. Finally, it explores the question of perspective—that is, whether an analysis should, for example, reflect only costs and benefits pertinent to health system payers or whether it should take a broader, “societal” perspective.

Benefits from improved health

2017 ◽  
Author(s):  
Jan Abel Olsen
Keyword(s):  
Quality Adjusted Life Year ◽  
Health State ◽  
Important Distinction ◽  
Equity Issues ◽  
Related Quality ◽  
Health Related ◽  
Returning To Work ◽  
Productivity Gains ◽  
Quality Adjusted Life

This chapter starts with an inquiry into the nature of different outcome measures that are being used in the medical literature, emphasizing an important distinction between incommensurable versus commensurable measures. The quality-adjusted life year (QALY) represents the most widely used commensurable metric. A key issue is how to value health-related quality of life (HRQoL) on a [0–1] scale by the use of health-state utility instruments. In addition to the health outcomes that are accounted for in the QALY measure, productivity gains might occur as a result of previously sick people returning to work. The chapter discusses the methodological and the equity issues involved when determining the extent to which production gains should be included in an economic evaluation. Finally, the theory behind the willingness-to-pay method is briefly explained, and contrasted with some measurement problems when applied as a way to value health benefits.

An approach to estimating the intangible costs of multiple sclerosis according to disability in Catalonia, Spain

2007 ◽  
Vol 13 (6) ◽  
pp. 800-804 ◽  
Author(s):  
V. Casado ◽  
L. Romero ◽  
L. Gubieras ◽  
L. Alonso ◽  
E. Moral ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Demyelinating Disease ◽  
Quality Adjusted Life Year ◽  
Expanded Disability Status Scale ◽  
Pain Anxiety ◽  
Disability Status ◽  
Intangible Costs ◽  
Edss Score ◽  
Quality Adjusted Life

Multiple sclerosis (MS) is a chronic demyelinating disease, which represents a great economic burden to society. Cost-of-illness studies of MS tend to underestimate the intangible costs related to pain, anxiety and helplessness. The purpose of this study was to estimate the intangible costs of MS, and determine whether these costs increase as disability progresses. We studied 211 consecutive patients with MS who attended our MS unit. Patients mean age was 41.6 (SD: 10.7) years, 69% were female, and their mean Expanded Disability Status Scale (EDSS) score was 2.47 (SD: 2.05). Quality-of-life was measured with the EuroQoL visual analogue scale. Quality-adjusted life year (QALY) was calculated for each patient. Patients were grouped into five disability stages according to their EDSS, and QALY was compared between patients and a group of healthy controls matched by age and sex. A benchmark value was ascribed to each QALY lost, and the intangible costs per patient-year were calculated as 0 (EDSS =0), 1100 (EDSS =1-3), 8250 (EDSS =3.5-5.5), 9900 (EDSS =6-7) and 11 000 (EDSS >7.5). Sensitivity analysis showed a similar progression of costs. We conclude that intangible costs are relevant in MS, especially when disability increases. Although the method to calculate the costs remains controversial, we consider that they should be included in cost analysis of MS. Multiple Sclerosis 2007; 13: 800-804. http://msj.sagepub.com

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