Quality of Life and Financial Measures in Surgical and Non-Surgical Treatments in Emphysema

Miller, J. D.; Altaf, F.

doi:10.1007/978-0-387-78665-0_137

Quality of Life and Financial Measures in Surgical and Non-Surgical Treatments in Emphysema

J. D. Miller &
F. Altaf

Reference work entry

183 Accesses

Abstract:

The cost of health care is continuing to escalate world wide. More people are living longer and often with more challenging medical conditions. The personal and societal cost for survival is growing yearly.

Medical and surgical advances, unfortunately, have not been able to stop this growing financial burden. Occasionally new surgical interventions can favorably affect the overall health care cost. If an intervention can create a healthier patient with fewer health care needs, society may experience an overall saving. Such was the early hope for Lung Volume Reduction Surgery (LVRS).

If LVRS can save productive lives and reduce a patients’ ongoing need for medicines, such as oxygen therapy, there may be an overall financial gain to society. If, however, LVRS differs costs into the future as well as add the new surgical costs clearly there will be no overall saving. In this later instance the gain to a patients’ well being must be weighed against the cost of the intervention. Lastly when there is no overall gain for the patient and no saving to society it is clear that we should not invest in the intervention.

This chapter reviews the tools used to evaluate a patients health-related quality of life (HRQOL) and reviews the world literature evaluating health gains and losses following LVRS. The cost of LVRS to society will be reviewed and compared with other medical and surgical interventions with an emphasis on other treatments for advanced emphysema.

We begin with a general outline of the definition of Quality of Life (QOL), and a review of the research tools in use to evaluate QOL. These tools can be designed to assess a patients’ quality of life specifically as it related to a particular disease state such as chronic obstructive lung disease (COPD) (a disease specific QOL measure), or it can be designed as a broader tool assessing QOL as ones’ general health impacts on their perception of well being.

The two major short-comings of a QOL measure is its subjective nature (individual preference based) and its inability to include one of the worst health related outcomes, death. Traditionally a subject who has died is not able to report on their QOL and is omitted from further assessment and is not included in the group assessment. Only patients who are able to complete the questionnaire at the give time are included in that time’s overall group score. Health Utilities, however, is a societal preference based score and ascribes the value zero for death. It therefore can be used as a tool to follow a group of patients over time and include loss of life in the overall scoring of health quality for that group.

Healthcare economists can use health utility (HU) scores of a study group over time as a measure of that groups’ overall health for that time period. It is reported in units called Quality Adjusted Life Years (QALYs). A comparison between research groups allows the investigator an opportunity to assess the gain or loss of health. This difference is also reported in quality adjusted life years (QALYs). Knowing the gain or loss in QALYs and the cost difference between two groups allows the economist to report the cost per QALY. The cost per QALY is a value of a very general nature and allows for comparison of interventions of various types to one and other.

This chapter will outline in more detail each of these measures and tools and discuss their application to the financial assessment of LVRS.

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Abbreviations

COPD:: chronic obstructive pulmonary disease
CRDQ:: Chronic Respiratory Disease Questionnaire
CUA:: cost utility assessment
CUI:: cost utility index
DLCO:: Carbon monoxide diffusion capacity
FEV1:: forced expiratory volume in one second
HRQOL:: health-related quality of life
HUI:: health utility index
ICER:: The incremental cost-utility ratio
ISOLDE:: inhaled steroid in obstructive lung disease
LTOT:: long-term oxygen therapy
LVRS:: lung volume reduction surgery
MICD:: minimal important clinical difference
MRC:: Modified Medical Research Council Dyspnea Index
NETT:: National Emphysema Treatment Trial
NHP:: Nottingham Health Profile
Pao2:: peripheral arterial oxygen content
PFSDQ:: Pulmonary Function Status and Dyspnea Questionnaire
PFSS:: pulmonary function status scale
PR:: pulmonary rehabilitation
QALYs:: quality adjusted life years
QOL:: quality of life
QWB:: Quality of Well-Being Questionnaire
SF-36:: Short Form 36 questionnaire
SGRQ:: St. George’s Respiratory Questionnaire
SIP:: sickness impact profile
SOLQ:: Seattle Obstructive Lung Disease Questionnaire

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Authors

J. D. Miller
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F. Altaf
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Editors and Affiliations

Dept. Nutrition and Dietetics Nutritional Sciences Research Division School of Biomedical & Health Sciences, King's College London, Franklin‐Wilkins Building 150 Stamford Street, SE1 9NH, London, UK
Victor R. Preedy (Prof.) (Prof.)
Mel and Enid Zuckerman College of Public Health, University of Arizona, Health Science Center 1295 N. Martin, P.O. Box 245155, 85724-5155, Tucson, AZ
Ronald R. Watson (Prof.) (Prof.)

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Miller, J.D., Altaf, F. (2010). Quality of Life and Financial Measures in Surgical and Non-Surgical Treatments in Emphysema. In: Preedy, V.R., Watson, R.R. (eds) Handbook of Disease Burdens and Quality of Life Measures. Springer, New York, NY. https://doi.org/10.1007/978-0-387-78665-0_137

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DOI: https://doi.org/10.1007/978-0-387-78665-0_137
Publisher Name: Springer, New York, NY
Print ISBN: 978-0-387-78664-3
Online ISBN: 978-0-387-78665-0
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