Higher Utility Scores Research Articles

Determinants of Health Utility in Lung and Heart-Lung Transplant Recipients

Bronchiolitis obliterans syndrome (BOS) is associated with poor health-related quality of life (HRQL) following lung and heart-lung transplantation, but few other determinants of HRQL have been described. We performed a cross-sectional study of standard gamble utility, a preference-based measure of HRQL, in 90 stable lung and heart-lung transplant recipients. We used bivariate analyses and multiple linear regression to evaluate associations between utility scores and candidate predictor variables including age, sex, indication for transplant (obstructive, interstitial, suppurative and pulmonary vascular diseases), transplant type (bilateral, single and heart-lung), time since transplant, body mass index, arterial PO(2), creatinine clearance, number of medications, presence of BOS and risk-attitude score. The median utility was 0.88 (inter-quartile range: 0.50-0.99). Multivariable analysis showed that female sex, absence of BOS, better renal function and longer time since transplantation were associated with higher utility scores, and that there were utility differences across diagnostic groups. Although BOS is a major determinant of utility following lung and heart-lung transplantation, other demographic and clinical factors are also associated with significant differences in this measure of HRQL.

Intrapartum pain management at the Royal Hospital for Women.

To explore use of, and women's satisfaction with, intrapartum pain management at Royal Hospital for Women (RHW), Sydney, Australia. From October 2002 to January 2003 women aged over 16 who had been in labour at RHW were given a questionnaire to complete in the first week post-partum regarding their intrapartum pain management. Supplementary information was obtained from patient records. A total of 496 women participated (69% response rate), including 95 birth centre clients. The mean age was 32 years and 73% percent had a normal vaginal delivery. At least one form of pain management ('natural', nitrous oxide, pethidine, epidural, local infiltration of the perineum) was used by 463 (93%) women, with 74% using two or more methods. Labour pain was 'worse' or 'much worse' than expected for 55%. Seventy-two percent were 'very' or 'quite' satisfied with overall pain management. Epidural analgesia had the highest utility scores (89%'very useful') and likelihood of use in subsequent labours (67%), and pethidine the lowest. Factors affecting analgesic use included cervical dilation on admission, labour length, English-speaking background, delivery suite versus birth centre care, parity, and syntocinon use. Women at RHW use a variety of pain management methods in labour and most use multiple methods. Labour was rated more painful than expected by a majority; however, most were satisfied with their pain management. Labour length and cervical dilation on admission were most predictive of pain management use.

The quality of life and cost utility of home nocturnal and conventional in-center hemodialysis

Home nocturnal hemodialysis is an intensive form of hemodialysis, where patients perform their treatments at home for about 7 hours approximately 6 nights a week. Compared with in-center conventional hemodialysis, home nocturnal hemodialysis has been shown to improve physiologic parameters and reduce health care costs; however, the effects on quality of life and cost utility are less clear. We hypothesized that individuals performing home nocturnal hemodialysis would have a higher quality of life and superior cost utility than in-center hemodialysis patients. Home nocturnal hemodialysis patients and a demographically similar group of in-center hemodialysis patients from a hospital without a home hemodialysis program underwent computer-assisted interviews to assess their utility score for current health by the standard gamble method. Nineteen in-center hemodialysis and 24 home nocturnal hemodialysis patients were interviewed. Mean annual costs for home nocturnal hemodialysis were about 10,000 dollars lower for home nocturnal hemodialysis (55,139 dollars +/- 7651 dollars for home nocturnal hemodialysis vs. 66,367 dollars +/- 17,502 dollars for in-center hemodialysis, P = 0.03). Home nocturnal hemodialysis was associated with a higher utility score than in-center hemodialysis (0.77 +/- 0.23 vs. 0.53 +/- 0.35, P = 0.03). The cost utility for home nocturnal hemodialysis was 71,443 dollars/quality-adjusted life-year (QALY), while for in-center hemodialysis it was 125,845 dollars/QALY. Home nocturnal hemodialysis was the dominant strategy, with an incremental cost-effectiveness ratio (ICER) of -45,932 dollars. The 95% CI for the ICER, and 2500 bootstrap iterations of the ICER all fell below the cost-effectiveness ceiling of 50,000 dollars. The net monetary benefit of home nocturnal hemodialysis ranged from 11,227 dollars to 35,669 dollars. Home nocturnal hemodialysis is associated with a higher quality of life and a superior cost utility when compared to in-center hemodialysis.

Oseltamivir for Treatment of Influenza in Healthy Adults: Pooled Trial Evidence and Cost-Effectiveness Model for Canada

Background Influenza is a common viral respiratory infection that is associated with significant morbidity. Oseltamivir (Tamiflu) is a neuraminidase inhibitor—a new class of antiviral treatment for influenza where efficacy and safety has been established but cost-effectiveness is unknown. Methods A decision analytic model was used to estimate the costs and effectiveness of two treatment scenarios for empiric management of otherwise healthy nonelderly patients, presenting with influenza-like illness (ILI) to primary care physicians in Canada: 1) where oseltamivir is reimbursed and on formulary for prescription; and 2) where oseltamivir is not on formulary. Outcomes are influenza-days averted and quality-adjusted life-years (QALYs) gained. Effectiveness, utility, and pneumonia complication risk estimates are by pooled analysis of patient-level data from four clinical trials. Unit cost information (Canadian dollars) was obtained from published sources in Ontario. Probabilistic sensitivity analysis was conducted using Monte Carlo simulation. Results Of 2288 patients randomized, influenza was confirmed in 1575 (69%) and oseltamivir treatment reduced the mean time to symptom alleviation by 1.08 days (95% confidence interval CI] 0.58–1.59). Infected patients treated with oseltamivir had higher utility scores (quality of life) than placebo patients over the 7 days of follow-up ( P < .05). Cost per influenza-day averted with oseltamivir on formulary is $49 (95% CI 31–107) and the cost per QALY is $57,863 (95% CI $48,919– $70,149). Results are sensitive to the percentage of patients presenting to their physician beyond 48 hours from symptom onset who get oseltamivir and the prevalence of influenza among patients presenting with ILI. Conclusions Oseltamivir for treatment of patients with ILI is potentially cost-effective if clinical diagnostic specificity for influenza observed in clinical trials is applicable to routine practice. More population-based information on the prevalence of influenza among early (<48 hours) presenters with ILI would be valuable.

A possibilistic approach to selecting portfolios with highest utility score

The mean–variance methodology for the portfolio selection problem, originally proposed by Markowitz, has been one of the most important research fields in modern finance. In this paper we will assume that: (i) each investor can assign a welfare, or utility, score to competing investment portfolios based on the expected return and risk of the portfolios; and (ii) the rates of return on securities are modelled by possibility distributions rather than probability distributions. We will present an algorithm of complexity o( n 3) for finding an exact optimal solution (in the sense of utility scores) to the n-asset portfolio selection problem under possibility distributions.

Patient Preferences Regarding Possible Outcomes of Lung Resection

Lung resection can lead to significant postoperative complications: Although many reports describe the likelihood of postoperative problems, such as atelectasis, pneumonia, and prolonged ventilator dependence, it is unclear whether patients perceive these outcomes as sufficiently severe to influence their decisions about surgery. To assess patients' preferences regarding possible outcomes of lung resection, including traditional complications reported in the lung surgery literature and outcomes that describe functional limitation. Utility analysis. A community hospital internal medicine clinic, a private internal medicine practice, and a private pulmonary practice. Sixty-four patients, aged 50 to 75 years, who were awaiting appointments at the designated clinic sites. Patients' strength of preference regarding potential outcomes of lung resection as derived from health utility scores. Common postoperative complications were assigned high utility scores by patients. On a scale for which 1.0 represents perfect health and 0 represents death, postoperative atelectasis, pneumonia, and 3 days of mechanical ventilation were all rated >0.75. Scores describing limited physical function were strikingly low. Specifically, activity limited to bed to chair movement and the need for complete assistance with activities of daily living were all assigned utility scores <0.2. Twenty-four-hour oxygen dependence was scored at 0.33. Presence or absence of pulmonary illness did not predict scores for any outcome. Whether patients suffer from chronic lung disease or not, they do not regard the postoperative outcomes reported in the lung surgery literature as sufficiently morbid to forego important surgery. However, physical debility is perceived as extremely undesirable, and anticipation of its occurrence could deter surgery. Therefore, identification of preoperative predictors of postoperative physical debility would be invaluable for counseling patients who face difficult decisions about lung resection.

Applying conjoint analysis in economic evaluations: an application to menorrhagia

The increased demand for health care, coupled with limited resources, means that decisions have to be made concerning the allocation of scarce health care resources. This paper considers how conjoint analysis (CA) can be used to aid this decision making process. It is shown how the technique can be used to estimate marginal rates of substitution between attributes, willingness to pay (WTP) if cost is included as an attribute and overall utility scores for different ways of providing a service. The technique is applied to consider women's preferences for two surgical procedures in the treatment of menorrhagia: hysterectomy and conservative surgery. The results suggest conservative surgery is preferred to hysterectomy, as indicated by higher utility scores for the former and a marginal WTP of 7593 to have conservative surgery rather than hysterectomy. The internal validity of CA was also shown. It is concluded that CA is a potentially useful instrument for policy makers. However, numerous methodological issues need addressing before the technique becomes an established instrument within economic evaluations.

GENIE: A decision support system for crisis negotiations

Decision support systems can play a role in improving the ability of decision makers to act as utility maximizers in crisis situations. This paper demonstrates the ability of one such decision support system, GENIE, to help decision makers maximize their objectives in a crisis negotiation. GENIE is described in detail, followed by the presentation of preliminary experimental results evaluating its effectiveness in crisis management and abatement. The experimental results show that GENIE users, as compared to non-users, are more likely to identify utility maximization as their primary objective and to achieve high utility scores. Experiments in which GENIE users participate are also more likely to end in agreement among the parties, rather than in an outcome in which one of the parties opts out of the negotiation.

Use and Utility of Alternative Information Sources about PCS: A Disk-Based Survey of PC User Group Members

A disk-based interviewing techmque is used to conduct an extensive survey among members of a large PC user group The survey includes a series of questions on the sources of technical knowledge used by these PC users to gain information about software and hardware. The extent of use and the relative utility of 11 alternative sources of information are assessed. Data on the information source attributes and on the end-user characteristics that might affect the use and utility of the information sources are also analyzed. We conclude that PC magazine articles and friends and colleagues are the most frequently used sources and that these 2 sources and user group members are attributed the greatest utility. In general, whereas accessibility is the most important factor in determining the level of use of an information source, those sources that are less biased and more interpersonal receive the highest utility scores from end users. Keywords personal computers, information utility, information use, user groups, disk-based surveys, opinion leaders, end users.