A number of studies have estimated the quality-adjusted life years (QALYs) lost from nonfatal motor vehicle accident injuries, but these estimates have a number of limitations.
The goal of this study is to estimate the QALYs lost from the typical motor vehicle accident injury based on 1) data obtained through a standard preference elicitation procedure, 2) both permanent and nonpermanent injuries, and 3) a more realistic baseline quality-of-life level from which to determine the QALY decrement. This study also intends to demonstrate the advantages of using self-reported health status as the basis for determining a change in QALYs.
Ordered probit equations were estimated to determine the change in self-reported health status associated with 3 categories of injuries. These results were next converted to their marginal effects and weighted by the quality-of-life estimates for self-reported health status found in Nyman and others (2007). The quality-of-life decrements for the 3 categories of injury were then converted to QALY decrements by applying estimates of the duration of that injury type.
The data came from 8 years of the Medical Expenditure Panel Survey (MEPS), from 1997 to 2004.
Self-reported health status categories were excellent, very good, good, fair, or poor.
The reference case decrement for an average motor vehicle accident injury is 0.0612 QALYs or 0.0360 QALYs, if discounted at 3%.
Quality-of-life weights for self-reported health status can be used to exploit the data in large national surveys.
"Moreover, they fail to express the result in preference-based metrics, so that it cannot be extended to a policy or social framework. Nyman et al. (2008) make a …rst attempt to outperform the previous studies. Nonethless, there are some weak points in their approach: on the one hand, they use scaling methods with a lack of theoretical support; on the other hand, they consider road crashes as purely stochastic occurences. "
[Show abstract][Hide abstract] ABSTRACT: The objective of this paper is to evaluate the effect of a non-fatal road crash on the health-related quality of life of injured people. A new approach based on the cardinalization of categorical Self-Assessed Health valuations is suggested. Health losses have been estimated by using different Time Trade-off and Visual Analogue Scale tariffs, in order to assess the robustness of the results. The methodology is based on the existing literature about treatment effects. Our main contribution focuses on evaluating the loss of health up to 1 year after the non-fatal accident, for those who are non-institutionalized, which aids the appropriate estimation of the aggregated health losses in quality-of-life terms.
Health Economics 05/2012; 21(5):528-50. DOI:10.1002/hec.1729 · 2.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Obstructive sleep apnea (OSA) is a common disorder associated with substantially increased cardiovascular risks, reduced quality of life, and increased risk of motor vehicle collisions due to daytime sleepiness. This study evaluates the cost-effectiveness of three commonly used diagnostic strategies (full-night polysomnography, split-night polysomnography, unattended portable home-monitoring) in conjunction with continuous positive airway pressure (CPAP) therapy in patients with moderate-to-severe OSA.
A Markov model was created to compare costs and effectiveness of different diagnostic and therapeutic strategies over a 10-year interval and the expected lifetime of the patient. The primary measure of cost-effectiveness was incremental cost per quality-adjusted life year (QALY) gained.
Baseline computations were performed for a hypothetical average cohort of 50-year-old males with a 50% pretest probability of having moderate-to-severe OSA (apnea-hypopnea index [AHI] ≥ 15 events per hour).
For a patient with moderate-to-severe OSA, CPAP therapy has an incremental cost-effectiveness ratio (ICER) of $15,915 per QALY gained for the lifetime horizon. Over the lifetime horizon in a population with 50% prevalence of OSA, full-night polysomnography in conjunction with CPAP therapy is the most economically efficient strategy at any willingness-to-pay greater than $17,131 per-QALY gained because it dominates all other strategies in comparative analysis.
Full-night polysomnography (PSG) is cost-effective and is the preferred diagnostic strategy for adults suspected to have moderate-to-severe OSA when all diagnostic options are available. Split-night PSG and unattended home monitoring can be considered cost-effective alternatives when full-night PSG is not available.
[Show abstract][Hide abstract] ABSTRACT: The objective of this paper is to evaluate the effect of a nonfatal road crash on the health-related quality of life of injured people. A new approach is suggested, based on the cardinalization of categorical Self-Assessed Health valuations. Health losses have been estimated by using different Time Tradeoff and Visual Analogue Scale tariffs, in order to assess the robustness of the results. The methodology is based on the existing literature about treatment effects. Our main contribution focuses on evaluating the loss of health up to one year after the non-fatal accident, for those who are noninstitutionalized, which aids the appropriate estimation of the aggregated health losses in quality-of-life terms.
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