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Int J Angiol 2012; 21(03): 139-146
DOI: 10.1055/s-0032-1324738
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Critical Limb Ischemia and Its Impact on Patient Health Preferences and Quality of Life—An International Study

Giovanni Pisa
1   Division of Healthcare, Department of Healthcare, Kantar Health GmbH, München, Germany
,
Thomas Reinhold
2   Department of Health Economics, Charité - Universitätsmedizin Berlin - Berlin, Germany
,
Eliot Obi-Tabot
3   Department of R&D, Medical Affairs, Sanofi - Bridgewater, New Jersey, USA
,
Maria Bodoria
4   Department of R&D, Sanofi - Paris, France
,
Bernd Brüggenjürgen
5   Department of Healthcare Management, Steinbeis-Hochschule - Berlin, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
24 August 2012 (online)

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Abstract

Critical limb ischemia (CLI) has a significant impact on patients' quality of life (QoL). Despite cost utility evaluations being required by different authorities, data on patient health preferences and utilities for CLI are scarce. Hence, the objective of this study was to assess the impact of CLI on health preferences and health status of affected patients, and to generate health state utilities. In the International Study, 200 patients with CLI (stages III and IV according to Fontaine scale) were interviewed by trained interviewers with a discrete choice instrument, a standard gamble (SG), and the EuroQol-five dimension (EQ-5D) questionnaires (Marten Meesweg, Rotterdam, Netherland). Conjoint analysis showed that a planned amputation (33%) was the most relevant health attribute followed by ambulatory function (25%) and chronic pain (15%). Non-dependence on caregiver impacted on patient health state preference considerably, whereas healing of ulcer/skin lesions had less impact. Preference values obtained from the SG were 0.84, for an amputation subpopulation arriving at 0.70. The EQ-5D index values as well as the EQ-5D visual analog scale for patients with CLI were 0.56. The QoL data of patients with CLI result in decreased QoL and preference values with a planned amputation.

Keywords

critical limb ischemia - peripheral artery disease - quality of life - utility - discrete choice model
 

  • References

  • 1 Minar E. Critical limb ischaemia. Hamostaseologie 2009; 29 (1) 102-109
    PubMedGoogle Scholar
  • 2 Sprengers RW, Teraa M, Moll FL, de Wit GA, van der Graaf Y, Verhaar MC ; JUVENTAS Study Group; SMART Study Group. Quality of life in patients with no-option critical limb ischemia underlines the need for new effective treatment. J VascSurg 2010; 52 (4) 843-849, 849, e1
    PubMedGoogle Scholar
  • 3 Drummond MF, O'Brien BJ, Stoddart GL, Torrance GW. Methods for Economic Evaluation of Health Care Programmes. 2nd ed. Oxford: Oxford University Press; 1997
    Google Scholar
  • 4 Torrance GW. Measurement of health state utilities for economic appraisal. J Health Econ 1986; 5 (1) 1-30
    CrossrefPubMedGoogle Scholar
  • 5 Szende A, Schaefer C. A taxonomy of health utility assessment methods and the role for uncertainty analysis. Eur J Health Econ 2006; 7 (2) 147-151
    CrossrefPubMedGoogle Scholar
  • 6 de Bekker-Grob EW, Ryan M, Gerard K. Discrete choice experiments in health economics: a review of the literature. Health Econ 2012; 21 (2) 145-172 10.1002/hec.1697
    CrossrefPubMedGoogle Scholar
  • 7 Orme B “Sample Size Issues for Conjoint Analysis Studies,” in Sawtooth Software Technical Papers, http://www.sawtoothsoftware.com/download/techpap/samplesz.pdf (Reprinted Version), 1998
    PubMed
  • 8 Herdman M, Gudex C, Lloyd A , et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 2011; 20 (10) 1727-1736
    CrossrefPubMedGoogle Scholar
  • 9 Brooks R. EuroQol: the current state of play. Health Policy 1996; 37 (1) 53-72
    CrossrefPubMedGoogle Scholar
  • 10 Littenberg B, Partilo S, Licata A, Kattan MW. Paper Standard Gamble: the reliability of a paper questionnaire to assess utility. Med Decis Making 2003; 23 (6) 480-488
    CrossrefPubMedGoogle Scholar
  • 11 Bult JR, Bosch JL, Hunink MG. Heterogeneity in the relationship between the standard-gamble utility measure and health-status dimensions. Med Decis Making 1996; 16 (3) 226-233
    CrossrefPubMedGoogle Scholar
  • 12 Michaels J, Brazier J, Palfreyman S, Shackley P, Slack R. Cost and outcome implications of the organisation of vascular services. Health Technol Assess 2000; 4 (11) i-iv , 1–191
    PubMedGoogle Scholar
  • 13 McFadden D, Train K. Mixed MNL models for discrete response. J Appl Econ 2000; 15 (5) 447-470
    CrossrefPubMedGoogle Scholar
  • 14 Holler D, Claes C, von der Schulenburg JM. Treatment costs and quality of life of patients with peripheral arterial occlusive disease—the German perspective. Vasa 2004; 33 (3) 145-153
    CrossrefPubMedGoogle Scholar
  • 15 Shackley P, Slack R, Michaels J. Vascular patients' preferences for local treatment: an application of conjoint analysis. J Health Serv Res Policy 2001; 6 (3) 151-157
    CrossrefPubMedGoogle Scholar
  • 16 Hurst NP, Jobanputra P, Hunter M, Lambert M, Lochhead A, Brown H ; Economic and Health Outcomes Research Group. Validity of Euroqol—a generic health status instrument—in patients with rheumatoid arthritis. Br J Rheumatol 1994; 33 (7) 655-662
    CrossrefPubMedGoogle Scholar
  • 17 Ubel PA, Loewenstein G, Jepson C. Whose quality of life? A commentary exploring discrepancies between health state evaluations of patients and the general public. Qual Life Res 2003; 12 (6) 599-607
    CrossrefPubMedGoogle Scholar
  • 18 Lenert LA, Sturley AE. Acceptability of computerized visual analog scale, time trade-off and standard gamble rating methods in patients and the public. Proc AMIA Symp 2001; •••: 364-368
    PubMedGoogle Scholar
  • 19 Szabo SM, Levy AR, Davis C, Holyoake TL, Cortes J. A multinational study of health state preference values associated with chronic myelogenous leukemia. Value Health 2010; 13 (1) 103-111
    CrossrefPubMedGoogle Scholar
  • 20 Lipscomb J, Drummond M, Fryback D, Gold M, Revicki D. Retaining, and enhancing, the QALY. Value Health 2009; 12 (Suppl. 01) S18-S26
    PubMedGoogle Scholar
  • 21 Abellán-Perpiñán JM, Pinto-Prades JL, Méndez-Martínez I, Badía-Llach X. Towards a better QALY model. Health Econ 2006; 15 (7) 665-676
    CrossrefPubMedGoogle Scholar
  • 22 Fitzpatrick E, Coyle DE, Durieux-Smith A, Graham ID, Angus DE, Gaboury I. Parents' preferences for services for children with hearing loss: a conjoint analysis study. Ear Hear 2007; 28 (6) 842-849
    PubMedGoogle Scholar
  • 23 Waltzman JT, Scholz T, Evans GR. What patients look for when choosing a plastic surgeon: an assessment of patient preference by conjoint analysis. Ann Plast Surg 2011; 66 (6) 643-647
    CrossrefPubMedGoogle Scholar
  • 24 Bederman SS, Mahomed NN, Kreder HJ, McIsaac WJ, Coyte PC, Wright JG. In the eye of the beholder: preferences of patients, family physicians, and surgeons for lumbar spinal surgery. Spine 2010; 35 (1) 108-115
    CrossrefPubMedGoogle Scholar
  • 25 Hong SH, Liu J, Wang J, Brown L, White-Means S. Conjoint analysis of patient preferences on Medicare medication therapy management. J Am Pharm Assoc (2003) 2011; 51 (3) 378-387
    CrossrefPubMedGoogle Scholar
  • 26 Flynn TN. Using conjoint analysis and choice experiments to estimate QALY values: issues to consider. Pharmacoeconomics 2010; 28 (9) 711-722
    CrossrefPubMedGoogle Scholar