Feasibility of a Health Utility Assessment Platform in a Hemodialysis Outpatient Setting (Preprint)

2021 ◽  
Author(s):  
Adeboye A Adejare Jr ◽  
Heather J Duncan ◽  
Geoffrey R. Motz ◽  
Silvi Shah ◽  
Charuhas V. Thakar ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Assessment Tool ◽  
Health Utility ◽  
Assessment Process ◽  
Health State ◽  
Post Intervention ◽  
Health States ◽  
General Group ◽  
Utility Assessment ◽  
Clinic Setting

BACKGROUND Background: Patients with End-Stage Kidney Disease (ESKD) wait roughly 4 years for a kidney transplant. A potential way to reduce wait times is through the use of Hepatitis-C Viremic (HCV) kidneys. OBJECTIVE Objective: As preparation for developing a shared decision-making tool to assist ESKD patients with the decision whether to accept an HCV-viremic kidney transplant, we first wanted to assess the feasibility of using the Gambler II, a health utility assessment tool, in an ambulatory dialysis clinic setting. Secondary goals were to collect ESKD patients’ utilities and to explore whether use of race-matched vs race-mismatched exemplars impacted knowledge gained during the assessment process. METHODS Methods: We used the Gambler II to elicit utilities for ESKD-related health states: hemodialysis, kidney transplant with HCV-unexposed kidney, and transplantation with HCV-viremic kidney. We created race exemplar video clips describing these health states and randomly assigned patients into the race-matched or race-mismatched video arms. We obtained utilities for these 3 health states from each patient, and we evaluated knowledge about ESKD and HCV-associated health conditions with pre- and post-intervention knowledge assessments. RESULTS Results: 63 hemodialysis patients from 4 outpatient Dialysis Center Inc. sites completed the study. Mean adjusted standard gamble utilities for hemodialysis, transplant with HCV-unexposed kidney, and transplantation with HCV-viremic kidney were 82.5, 89, and 75.5 respectively. General group knowledge assessment scores improved by 10 points (p < 0.05) following utility assessment process. CONCLUSIONS Conclusion: Using The Gambler II to collect ESKD patients’ utilities in an ambulatory dialysis clinic setting proved feasible. In addition, educational information about health states provided as part of the utility assessment process tool improved patients’ knowledge and understanding about ESKD-related health states and implications of organ transplantation with HCV-viremic kidneys. Wide variation in patient health state utilities reinforces the importance of incorporating patients’ preferences into decisions regarding use of HCV-viremic kidneys for transplantation

scholarly journals Automated Tool for Health Utility Assessments: The Gambler II

2020 ◽  
Vol 5 (1) ◽  
pp. 238146832091430
Author(s):  
Adeboye A. Adejare ◽  
Mark H. Eckman
Keyword(s):  
Assessment Tool ◽  
Health Utility ◽  
Assessment Process ◽  
Health State ◽  
Health States ◽  
Convenience Sample ◽  
Utility Assessment ◽  
Clinical Encounters ◽  
System Usability Scale ◽  
Before And After

Background. The Gambler II is a web-based utility assessment tool supporting visual analogue scale (VAS), standard gamble (SG), and time trade-off (TTO) utility assessments. It contains novel features, including an easy to use project development authoring tool and use of multimedia clips for health state descriptions. Objectives. Evaluate the usability and understandability of the patient-facing side of The Gambler. Investigate the feasibility of using The Gambler and evaluate its impact on patient knowledge regarding the relevant health states. Materials and Methods. We used The Gambler to assess utilities on a convenience sample of 55 users for common long-term complications of type 2 diabetes mellitus: diabetic neuropathy, diabetic retinopathy, and diabetic foot infection requiring transmetatarsal amputation. Using VAS, SG, and TTO, we collected metadata, such as time spent on each assessment and the entire assessment process. We evaluated usability with an adaptation of the System Usability Scale survey and understandability. We evaluated impact on knowledge gained through knowledge assessments about these complications before and after use of The Gambler. Results. Overall satisfaction with The Gambler was high, 4.02 on a 5-point scale. Usability rated highly at 84.93 on a normalized scale between 0 and 100. Knowledge scores increased significantly following use of The Gambler from pretest mean of 68% to posttest mean of 76% ( P < 0.01). Average time using the software: ∼7½ minutes. Conclusions. The Gambler is an easy to use and understand computer-based tool for utility assessment. It is feasible to use within clinical encounters to support shared decision making, and it has unique features that make it a powerful tool for investigators interested in research on health utilities.

scholarly journals Estimating an EQ-5D-3L Value Set for Romania Using Time Trade-Off

2021 ◽  
Vol 18 (14) ◽  
pp. 7415
Author(s):  
Marian Sorin Paveliu ◽  
Elena Olariu ◽  
Raluca Caplescu ◽  
Yemi Oluboyede ◽  
Ileana-Gabriela Niculescu-Aron ◽  
...  
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Assessment Process ◽  
Computer Assisted ◽  
Health State ◽  
Health States ◽  
Value Set ◽  
Health Technologies ◽  
Related Quality

Objective: To provide health-related quality of life (HRQoL) data to support health technology assessment (HTA) and reimbursement decisions in Romania, by developing a country-specific value set for the EQ-5D-3L questionnaire. Methods: We used the cTTO method to elicit health state values using a computer-assisted personal interviewing approach. Interviews were standardized following the most recent version of the EQ-VT protocol developed by the EuroQoL Foundation. Thirty EQ-5D-3L health states were randomly assigned to respondents in blocks of three. Econometric modeling was used to estimate values for all 243 states described by the EQ-5D-3L. Results: Data from 1556 non-institutionalized adults aged 18 years and older, selected from a national representative sample, were used to build the value set. All tested models were logically consistent; the final model chosen to generate the value set was an interval regression model. The predicted EQ-5D-3L values ranged from 0.969 to 0.399, and the relative importance of EQ-5D-3L dimensions was in the following order: mobility, pain/discomfort, self-care, anxiety/depression, and usual activities. Conclusions: These results can support reimbursement decisions and allow regional cross-country comparisons between health technologies. This study lays a stepping stone in the development of a health technology assessment process more driven by locally relevant data in Romania.

Health Utility Measurement

2011 ◽  
pp. 787-813 ◽  
Author(s):  
Donna Rowen ◽  
John Brazier
Keyword(s):  
Economic Evaluation ◽  
Health Utility ◽  
Health State ◽  
Health States ◽  
Health State Description ◽  
Utility Measurement ◽  
Current State ◽  
Increasing Demand ◽  
Demand For Health

Measuring and valuing health is a major component of economic evaluation, meaning that health utility measurement has been growing in popularity in recent years due to the increasing demand for health state values in economic models and evaluations. The main issues in health utility measurement are how to describe health states, how to value the health state description and whose values should be used. This article briefly outlines these main issues and then focuses on recent methodological developments in health utility measurement. It assesses the current state of health utility measurement and discusses the question of assessment of a health state to be used in economic evaluation. The discussion whether experience utility should be used rather than conventional preference-based utility raises important issues about perspective and the role of various factors.

scholarly journals Setting Dead at Zero: Applying Scale Properties to the QALY Model

2018 ◽  
Vol 38 (6) ◽  
pp. 627-634 ◽  
Author(s):  
Bram Roudijk ◽  
A. Rogier T. Donders ◽  
Peep F.M. Stalmeier
Keyword(s):  
Decision Making ◽  
Research Question ◽  
Health Utility ◽  
Discrete Choice Experiments ◽  
Health State ◽  
Ratio Scale ◽  
Health States ◽  
A Value ◽  
Scale Properties ◽  
Utility Scale

Introduction. Scaling severe states can be a difficult task. First, the method of measurement affects whether a health state is considered better or worse than dead. Second, in discrete choice experiments, different models to anchor health states on 0 (dead) and 1 (perfect health) produce varying amounts of health states worse than dead. Research Question. Within the context of the quality-adjusted life year (QALY) model, this article provides insight into the value assigned to dead and its consequences for decision making. Our research questions are 1) what are the arguments set forth to assign dead the number 0 on the health–utility scale? And 2) what are the effects of the position of dead on the health–utility scale on decision making? Methods. A literature review was conducted to explore the arguments set forth to assign dead a value of 0 in the QALY model. In addition, scale properties and transformations were considered. Results. The review uncovered several practical and theoretical considerations for setting dead at 0. In the QALY model, indifference between 2 health episodes is not preserved under changes of the origin of the duration scale. Ratio scale properties are needed for the duration scale to preserve indifferences. In combination with preferences and zero conditions for duration and health, it follows that dead should have a value of 0. Conclusions. The health–utility and duration scales have ratio scale properties, and dead should be assigned the number 0. Furthermore, the position of dead should be carefully established, because it determines how life-saving and life-improving values are weighed in cost–utility analysis.

scholarly journals Sagittal craniosynostosis: a utility outcomes study

2017 ◽  
Vol 20 (2) ◽  
pp. 113-118 ◽  
Author(s):  
Victoria Kuta ◽  
P. Daniel McNeely ◽  
Simon Walling ◽  
Michael Bezuhly
Keyword(s):  
Online Survey ◽  
Assessment Tools ◽  
Health State Utility ◽  
Health State ◽  
Or Education ◽  
Health States ◽  
Utility Assessment ◽  
Objective Health ◽  
Sagittal Craniosynostosis ◽  
Utility Scores

OBJECTIVESagittal craniosynostosis results in a characteristic scaphocephalic head shape that is typically corrected surgically during a child’s 1st year of life. The authors’ objective was to determine the potential impact of being born with sagittal craniosynostosis by using validated health state utility assessment measures.METHODSAn online utility assessment was designed to generate health utility scores for scaphocephaly, monocular blindness, and binocular blindness using standardized utility assessment tools, namely the visual analog scale (VAS) and the standard gamble (SG) and time trade-off (TTO) tests. Utility scores were compared between health states using the Wilcoxon and Kruskal-Wallis tests. Univariate regression was performed using age, sex, income, and education as independent predictors of utility scores.RESULTSOver a 2-month enrollment period, 122 participants completed the online survey. One hundred eighteen participants were eligible for analysis. Participants rated scaphocephaly due to sagittal craniosynostosis with significantly higher (p < 0.001) median utility scores (VAS 0.85, IQR 0.76–0.95; SG 0.92, IQR 0.84–0.98; TTO 0.91, IQR 0.84–0.95) than both monocular blindness (VAS 0.60, IQR 0.50–0.70; SG 0.84, IQR 0.68–0.94; TTO 0.84, IQR 0.67–0.91) and binocular blindness (VAS 0.25, IQR 0.20–0.40; SG 0.51, IQR 0.18–0.79; TTO 0.55, IQR 0.36–0.76). No differences were noted in utility scores based on participant age, sex, income, or education.CONCLUSIONSUsing objective health state utility scores, authors of the current study demonstrated that the preoperatively perceived burden of scaphocephaly in a child’s 1st year of life is less than that of monocular blindness. These relatively high utility scores for scaphocephaly suggest that the burden of disease as perceived by the general population is low and should inform surgeons’ discussions when offering morbid corrective surgery, particularly when driven by aesthetic concerns.

From Clinical Outcomes to Health Utilities: The Role of Mapping to Bridge the Evidence Gap

2019 ◽  
Author(s):  
Mónica Hernández Alava
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Economic Evaluation ◽  
Health Utility ◽  
Health State ◽  
Health States ◽  
Descriptive System ◽  
Healthcare Technologies ◽  
Health State Utility Values

The assessment of health-related quality of life is crucially important in the evaluation of healthcare technologies and services. In many countries, economic evaluation plays a prominent role in informing decision making often requiring preference-based measures (PBMs) to assess quality of life. These measures comprise two aspects: a descriptive system where patients can indicate the impact of ill health, and a value set based on the preferences of individuals for each of the health states that can be described. These values are required for the calculation of quality adjusted life years (QALYs), the measure for health benefit used in the vast majority of economic evaluations. The National Institute for Health and Care Excellence (NICE) has used cost per QALY as its preferred framework for economic evaluation of healthcare technologies since its inception in 1999. However, there is often an evidence gap between the clinical measures that are available from clinical studies on the effect of a specific health technology and the PBMs needed to construct QALY measures. Instruments such as the EQ-5D have preference-based scoring systems and are favored by organizations such as NICE but are frequently absent from clinical studies of treatment effect. Even where a PBM is included this may still be insufficient for the needs of the economic evaluation. Trials may have insufficient follow-up, be underpowered to detect relevant events, or include the wrong PBM for the decision- making body. Often this gap is bridged by “mapping”—estimating a relationship between observed clinical outcomes and PBMs, using data from a reference dataset containing both types of information. The estimated statistical model can then be used to predict what the PBM would have been in the clinical study given the available information. There are two approaches to mapping linked to the structure of a PBM. The indirect approach (or response mapping) models the responses to the descriptive system using discrete data models. The expected health utility is calculated as a subsequent step using the estimated probability distribution of health states. The second approach (the direct approach) models the health state utility values directly. Statistical models routinely used in the past for mapping are unable to consider the idiosyncrasies of health utility data. Often they do not work well in practice and can give seriously biased estimates of the value of treatments. Although the bias could, in principle, go in any direction, in practice it tends to result in underestimation of cost effectiveness and consequently distorted funding decisions. This has real effects on patients, clinicians, industry, and the general public. These problems have led some analysts to mistakenly conclude that mapping always induces biases and should be avoided. However, the development and use of more appropriate models has refuted this claim. The need to improve the quality of mapping studies led to the formation of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Mapping to Estimate Health State Utility values from Non-Preference-Based Outcome Measures Task Force to develop good practice guidance in mapping.

Estimating Utility Values for Health States of DFU Patients Using EQ-5D-5L and cTTO

2021 ◽  
pp. 153473462110143
Author(s):  
Morteza Arab-Zozani ◽  
Hossein Safari ◽  
Zoha Dori ◽  
Somayeh Afshari ◽  
Hosein Ameri ◽  
...  
Keyword(s):  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Economic Modeling ◽  
Health State ◽  
Health States ◽  
Utility Values ◽  
The Mean ◽  
The Difference ◽  
Diabetes Center ◽  
Health State Utility Values

Health-state utility values of diabetic foot ulcer (DFU) patients are necessary for clinical praxis and economic modeling. The purpose of this study was to estimate utility values in DFU patients using the EuroQol-5-dimension-5-level (EQ-5D-5L) and composite time trade-off (cTTO). The EQ-5D-5L and cTTO were used for estimating utility values. Data were collected from 228 patients referred to the largest governmental diabetes center in the South of Iran, Yazd province. When appropriate, independent sample t-test or analysis of variance test was used to test the difference in the utility values in each of the demographic and clinical characteristics of the patients. Finally, the BetaMix was used to identify predictors of the utility values. The means of EQ-5D-5L and cTTO values were 0.55( SD 0.21) and 0.67( SD 0.23), respectively. Anxiety and pain were the most common problems reported by the patients. The difference between the mean EQ-5D-5L values was significant for age, grade of ulcer, number of comorbidities, and having complications. In addition, variables of gender, age, grade of ulcer, and having complications were significant predictors of the EQ-5D-5L. The difference between the mean cTTO values was significant for age, employment status, grade of ulcer, number of comorbidities, and having complications. Moreover, variables of gender, age, grade of ulcer, number of comorbidities, and developing complications were significant predictors of cTTO. The current study provided estimates of utility values for DFU patients for clinical praxis and economic modeling. These estimates, similar to utilities reported in other studies, were low. Identifying strategies to decrease anxiety/depression and pain in patients is important to improve the utility values.

scholarly journals NCOG-36. FIRST HEALTH UTILITIES OF GLIOBLASTOMA PATIENTS USING TTFIELDS TREATMENT

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii137-ii137
Author(s):  
Gordon Chavez ◽  
Christina Proescholdt
Keyword(s):  
Population Sample ◽  
National Health System ◽  
Medical Decision ◽  
Economic Evaluations ◽  
Health State ◽  
High Quality ◽  
Health States ◽  
Tumor Treating Fields ◽  
Health State Utilities ◽  
The Uk

Abstract BACKGROUND Despite the importance of Health State Utilities for health policy and medical decision making, there are no publications that provide high quality utility values estimated from glioblastoma multiforme (GBM) patients. Published health economic evaluations for GBM treatments rely on utilities determined by Garside et al. (2007), which used the standard gamble method in healthy panel members of the UK National Health System. There are no published utilities for GBM estimated from a general population sample, and there are no utility estimates whatsoever for Tumor Treating Fields (TTFields) users. METHODS We designed a study to remedy this major deficit by eliciting utilities directly from GBM patients using the EuroQol 5-Dimension (EQ-5D) survey. The EQ-5D is a widely used and NICE-recommended tool for the estimation of health state utilities. The survey is composed of a questionnaire that asks patients to specify their health state along 5 dimensions: Mobility, Self-Care, Usual Activities, Pain/Discomfort, and Anxiety/Depression. Statistical models provided by EuroQol’s network of researchers convert this data into health state utility estimates. RESULTS The EQ-5D questionnaire is administered to active patients using TTFields treatment during the study duration, allowing the elicitation of health preference measures for different glioblastoma health states based on: progression status (progressed vs. non-progressed), current treatments (TTFields only vs. TTFields + others) and time-from-diagnosis (0-12 months vs. &gt; 12 months) CONCLUSION These results are important for understanding the patient preferences using TTFields treatment and communicating these preferences to decision makers. This study is the first to provide direct, high quality utility measures in glioblastoma patients using TTFields treatment.

scholarly journals A role-play assessment tool and drama-based social skills intervention for adults with autism or related social communication difficulties

Dramatherapy ◽  
2019 ◽  
Vol 40 (1) ◽  
pp. 41-60
Author(s):  
Céliane Trudel ◽  
Aparna Nadig
Keyword(s):  
Social Skills ◽  
Social Communication ◽  
Assessment Tool ◽  
Role Play ◽  
Autism Spectrum ◽  
Social Skills Intervention ◽  
Post Intervention ◽  
Adults With Autism ◽  
Play Assessment ◽  
Communication Difficulties

This study adds to a small literature on social skills measures and interventions for adults with autism spectrum disorder (ASD) or related social communication difficulties (SCD) without intellectual disability (ID). In study 1, a new multimodal assessment tool, the role-play assessment of social skills (R-PASS), was used to measure real-time application of social skills. The scores of adults with ASD/SCD were marginally lower than those of neurotypical adults, with a large effect size, suggesting that the measure can identify differences between the two groups. Therefore, the R-PASS shows potential as an objective tool to assess dynamic and naturalistic social skills. In Study 2, a pre–post single-group design study, we measured the effectiveness of a drama-based social skills intervention for seven participants who self-identified as having ASD/SCD. The R-PASS was used by external raters blind to diagnosis and intervention status to compare the performance of intervention participants to that of neurotypical adults. R-PASS scores suggested substantial improvement of social skills in the majority of participants post-intervention. Furthermore, relatives’ and participants’ perception of their social communication and self-regulation skills improved from pre- to post-intervention. These results suggest that the intervention may have helped the participants improve their social skills.

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