PubMed · 9781221
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J P Martin. 1998-01-15. [Centenarians: exceptional elderly?].. https://pubmed.ncbi.nlm.nih.gov/9781221/
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BACKGROUND: The purpose of this study was to assess the relative importance on patients' lives of multiple outcomes resulting from the management of head and neck cancer (HNC). METHODS: HNC patients filled out a disease-specific quality of life (QOL) survey covering 5 domains (speech, eating, aesthetics, pain/discomfort, and social/role functioning). Logistic regression was used to determine which of these domains best predicted the patients' response to a single, overall QOL assessment. RESULTS: In univariate analyses, all 5 domains were significantly correlated to QOL (p<.0001), with correlation coefficients ranging from.48 for eating to.64 for social/role functioning. Logistic regression indicated that speech and eating best predicted QOL (R(2) =.4647), with odds-ratios of 2. 96 for speech and 2.49 for eating. CONCLUSIONS: These data demonstrated that, for this group of patients, speech has the most impact on well-being, whereas eating has a substantial, unrelated influence. This is important information in counseling patients about treatment plans that have different levels of impairment.
OBJECTIVE: To evaluate the cost utility of interferon beta-1b in secondary progressive multiple sclerosis. DESIGN: Population based cost utility model (healthcare perspective). Data on use of health services were obtained from case records and routine morbidity data and utility values from a EuroQol survey. Local and published costs were used. Effectiveness was modelled using data on relative risk reductions from a randomised trial of interferon beta-1b. SETTING: Tayside region, 1993-5. SUBJECTS: 132 ambulatory people with secondary progressive multiple sclerosis. MAIN OUTCOME MEASURES: Cost per quality adjusted life year (QALY) gained. Rate of relapse and proportion becoming wheelchair dependent over three years. RESULTS: The number needed to treat for 30 months to delay time to wheelchair dependence in one person by nine months was 18 (95% confidence interval 5 to 26). For every 18 people treated for 30 months, six relapses would be prevented, gaining 0.397 discounted QALYs. The cost per QALY gained was 1 024 667 pounds sterling (276 466 pounds sterling to 485 499 pound sterling). If treatment was restricted to patients attending neurology services, the number needed to treat was 14 (cost per QALY gained 833 pounds sterling 514 (161 358 pounds sterling to infinity)). The cost per QALY gained was not sensitive to changes in cost which took account of a societal perspective. CONCLUSIONS: The cost per QALY gained from interferon beta is high because of the high drug cost and modest clinical effect. Resources could be used more efficiently elsewhere.
Increasingly in biomedical studies, health status is inferred through a series of questionnaire item responses. Challenges for analyzing associations between such responses and risk factors include multiplicity-many indicators must be combined to derive summary statements about health status, and measurement error-persons' self-report fluctuates due to causes other than substantive health changes. In order to deal with these challenges, the authors propose a strategy which comprises three methods: 1) score the item responses, then regress the score on predictors; 2) regress each item response on predictors, accounting for within-person associations; and 3) summarize and analyze the item responses jointly, using a latent variable model. The authors develop modeling and diagnostic procedures for method 3. They then show how the three-method analytic strategy can be used to solve the problem of determining which aspects of vision are associated with self-reported functioning in activities that require seeing at a distance. They demonstrate that methods 2 and 3 illuminate basic findings from method 1 by adding specificity, describing patterns as well as severities of health impairments, and identifying isolated items that relate to risk factors differentially than others. They conclude that the three-method strategy specifies how risk factors determine questionnaire-based health outcomes substantially better than any of the methods in isolation.