Handbook of Disease Burdens and Quality of Life Measures pp 2335-2352 | Cite as
Quality of Life and Financial Measures in Surgical and Non-Surgical Treatments in Emphysema
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.
KeywordsChronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Patient Minimally Important Clinical Difference Pulmonary Rehabilitation Health Utility Index
List of Abbreviations:
chronic obstructive pulmonary disease
Chronic Respiratory Disease Questionnaire
cost utility assessment
cost utility index
Carbon monoxide diffusion capacity
forced expiratory volume in one second
health-related quality of life
The incremental cost-utility ratio
inhaled steroid in obstructive lung disease
long-term oxygen therapy
lung volume reduction surgery
minimal important clinical difference
Modified Medical Research Council Dyspnea Index
National Emphysema Treatment Trial
Nottingham Health Profile
peripheral arterial oxygen content
Pulmonary Function Status and Dyspnea Questionnaire
pulmonary function status scale
quality adjusted life years
quality of life
Quality of Well-Being Questionnaire
Short Form 36 questionnaire
St. George’s Respiratory Questionnaire
sickness impact profile
Seattle Obstructive Lung Disease Questionnaire
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