Could the choice of patient versus proxy ratings for assessing quality of life in dementia affect resource allocation in health care?
DOI:
https://doi.org/10.7175/fe.v13i1.102Keywords:
Patient ratings, Proxy ratings, Dementia, Quality of Life, Resource allocationAbstract
OBJECTIVE: The aim of this paper is to demonstrate how the choice of patient versus proxy ratings of patient health-related quality of life (HRQoL) in dementia, for use in cost-effectiveness analyses (CEAs), could potentially affect resource allocation in health care.
METHODS:A model of Alzheimer’s disease (AD) based on cognitive ability was used to assess the consequences of using HRQoL ratings from either patients themselves or proxies if a new treatment was to be introduced. The model was based on previously published data on costs related to AD stages as well as HRQoL ratings from AD patients and from their caregivers as proxy raters.
RESULTS:The results show that there can be large differences in the results of the CEAs depending on whether the ratings of patients’ HRQoL were made by the patients themselves or by the proxy. When patient self-ratings of HRQoL were used, the cost/quality-adjusted life year (QALY) gained was much higher as compared to the scenario when proxy ratings were used for the same analysis.
CONCLUSIONS: The choice of patient self-ratings compared to proxy ratings of patients’ HRQoL can have a substantial effect on the results of CEAs. These differences in results may have an important impact on decision making and, ultimately, on resource allocation. In order to critically appraise the results of CEA studies in dementia we advise that both patient and proxy ratings are used in the CEA. To decide on methodology it is of great importance that focus is directed towards determining the most valid way to measure HRQoL in AD.
References
National Institute for Health and Clinical Excellence, Guide to the methods of technology appraisal. London: NICE, 2008. http://www.nice.org.uk/niceMedia/pdf/TAP_Methods.pdf
Hurley J. An overview of the normative economics of the health care sector. In: Culyer AJ and Newhouse J (ed). Handbook of health economics. Amsterdam: Elsevier Science, 2000
Gold MR, Patrick DL, Torrance GW, Fryback DG, Hadorn DC, Kamlet MS, et al. Indentifying and valuing outcomes. In: Gold M, et al. (ed). Cost-effectiveness in health and medicine. Oxford University Press, 1996
Dolan P, Whose preferences count? Med Decis Making 1999; 19(4): 482-6
Sands LP, Ferreira P, Stewart AL, Brod M, and Yaffe K, What explains differences between dementia patients' and their caregivers' ratings of patients' quality of life? Am J Geriatr Psychiatry 2004; 12(3): 272-80
Coucill W, Bryan S, Bentham P, Buckley A, and Laight A, EQ-5D in patients with dementia: an investigation of inter-rater agreement. Med Care 2001; 39(8): 760-71
Jönsson L, Andreasen N, Kilander L, Soininen H, Waldemar G, Nygaard H, et al., Patient- and proxy-reported utility in Alzheimer disease using the EuroQoL. Alzheimer Dis Assoc Disord 2006; 20(1): 49-55
Naglie G, Tomlinson G, Tansey C, Irvine J, Ritvo P, Black SE, et al., Utility-based quality of life measures in Alzheimer's disease. Qual Life Res 2006; 15: 631-643
Crespo M, Bernaldo de Quiros M, Gomez MM, and Hornillos C, Quality of Life of Nursing Home Residents With Dementia: A Comparison of Perspectives of Residents, Family, and Staff. Gerontologist 2011
Ready RE, Ott BR, and Grace J, Patient versus informant perspectives of quality of life in mild cognitive impairment and Alzheimer's disease. Int J Geriatr Psychiatry 2004; 19(3): 256-65
Folstein MF, Folstein SE, and McHugh PR, "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 1975; 12(3): 189-98
Svensk förening för Kognitiva sjukdomar (SKF), Mini Mental Test/MMT (test sheet, Swedish version. From Folstein MF et al, J Psychiatric Res 1975). 2000
Mendiondo MS, Ashford JW, Kryscio RJ, and Schmitt FA, Modelling mini mental state examination changes in Alzheimer's disease. Stat Med 2000; 19(11-12): 1607-16
Statistics Sweden. Life tables for 2006, divided into men and women. [Access Date: 2009]; Available at: www.ssd.scb.se.
Jönsson L, Eriksdotter Jönhagen M, Kilander L, Soininen H, Hallikainen M, Waldemar G, et al., Determinants of costs of care for patients with Alzheimer's disease. Int J Geriatr Psychiatry 2006; 21(5): 449-59
Jönsson L. Economic evaluation of treatments for Alzheimer's disease.Doctoral Thesis. Division of Geriatric Epidemiology, the Neurotec Department. Stockholm, Sweden: Karolinska Institutet, 2003
Pickard AS and Knight SJ, Proxy evaluation of health-related quality of life: a conceptual framework for understanding multiple proxy perspectives. Med Care 2005; 43(5): 493-9
Brooks R, EuroQol: the current state of play. Health Policy 1996; 37(1): 53-72
Dolan P, Modeling valuations for EuroQol health states. Med Care 1997; 35(11): 1095-108
Busschbach JJ, Brouwer WB, van der Donk A, Passchier J, and Rutten FF, An outline for a cost-effectiveness analysis of a drug for patients with Alzheimer's disease. PharmacoEconomics 1998; 13(1 Pt 1): 21-34
Burström K, Johannesson M, and Diderichsen F, Swedish population health-related quality of life results using the EQ-5D. Qual Life Res 2001; 10: 621-635
Jönsson L, Lindgren P, Wimo A, Jönsson B, and Winblad B, Costs of mini mental state examination-related cognitive impairment. PharmacoEconomics 1999; 16(4): 409-416
Green C, Modelling disease progression in Alzheimer's disease: a review of modelling methods used for cost-effectiveness analysis. PharmacoEconomics 2007; 25(9): 735-50
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