Effects of health-related quality of life on health service utilisation in patients with colorectal neoplasms.

This study was to assess the impact of HRQOL on health service utilisation using four different count data models. The HRQOL was measured using the Short-Form Six-Dimension instrument and the functional assessment of cancer therapy-colorectal whereas health service utilisation was measured by the number of monthly clinical consultations and the number of monthly hospitalisation. Different count data models (Poisson's regression, negative binomial regression, zero-inflated Poisson's regression and zero-inflated negative binomial regression) were used to assess the association between HRQOL and health service utilisation. A performance comparison was made between the models. Goodness-of-fit statistics (the Pearson's chi-squared test statistic, the Akaike and Bayesian information criteria) were used to determine the best-fitting model. The negative binomial model performed the best in assessing the association between HRQOL measures and health service utilisation in patients with colorectal neoplasm and thus recommended. Physical well-being of patients was negatively and significantly associated with the monthly rate of health service utilisation after controlling for patient demographics. Both physical and function well-beings of patients were negatively and significantly associated with the number of monthly hospitalisations. If the data for the condition-specific FACT-C are not available, SF-6D showed a very strong negative relationship with health service utilisation. Such models can be used to guide the allocation of clinical resources and funding for the care of colorectal cancer patients.

Methodological and Reporting Quality of Comparative Studies Evaluating Health-Related Quality of Life of Colorectal Cancer Patients and Controls: A Systematic Review.

BACKGROUND: Health-related quality of life is an important outcome measure in patients with colorectal cancer. Comparison with normative data has been increasingly undertaken to assess the additional impact of colorectal cancer on health-related quality of life. OBJECTIVE: This review aimed to critically appraise the methodological details and reporting characteristics of comparative studies evaluating differences in health-related quality of life between patients and controls. DATA SOURCES: A systematic search of English-language literature published between January 1985 and May 2014 was conducted through a database search of PubMed, Web of Science, Embase, and Medline. STUDY SELECTION: Comparative studies reporting health-related quality-of-life outcomes among patients who have colorectal cancer and controls were selected. MAIN OUTCOME MEASURES: Methodological and reporting quality per comparison study was evaluated based on a 11-item methodological checklist proposed by Efficace in 2003 and a set of criteria predetermined by reviewers. RESULTS: Thirty-one comparative studies involving >10,000 patients and >10,000 controls were included. Twenty-three studies (74.2%) originated from European countries, with the largest number from the Netherlands (n = 6). Twenty-eight studies (90.3%) compared the health-related quality of life of patients with normative data published elsewhere, whereas the remaining studies recruited a group of patients who had colorectal cancer and a group of control patients within the same studies. The European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30 was the most extensively used instrument (n = 16; 51.6%). Eight studies (25.8%) were classified as "probably robust" for clinical decision making according to the Efficace standard methodological checklist. Our further quality assessment revealed the lack of score differences reported (61.3%), contemporary comparisons (36.7%), statistical significance tested (38.7%), and matching of control group (58.1%), possibly leading to inappropriate control groups for fair comparisons. LIMITATIONS: Meta-analysis of differences between the 2 groups was not available. CONCLUSIONS: In general, one-fourth of comparative studies that evaluated health-related quality of life of patients who had colorectal cancer achieved high quality in reporting characteristics and methodological details. Future studies are encouraged to undertake health-related quality-of-life measurement and adhere to a methodological checklist in comparison with controls.

Spillover Effects of Maternal Chronic Disease on Children's Quality of Life and Behaviors Among Low-Income Families.

BACKGROUND: Mothers with chronic diseases may have spillover effects on their children. OBJECTIVE: The aim of this study was to estimate the spillover effects of mothers with chronic disease on their children's health-related quality of life (HRQOL) and behavior. METHOD: A cross-sectional study was conducted on 255 mother-child pairs (130 boys and 125 girls, mean age 8.4 years) from low-income Chinese families. We asked the mothers to self-report any doctor-diagnosed chronic diseases, and evaluate their children's HRQOL and behaviors with the Child Health Questionnaire-Parent Form-50 (CHQ-PF50) and the Strengths and Difficulties Questionnaire (SDQ), respectively. Multiple linear regression analysis was conducted to assess the independent spillover effect of maternal chronic disease on children's HRQOL and behaviors, with adjustment for confounders. The differential impact of maternal physical and mental diseases was also investigated. RESULTS: Over one-third of mothers (n = 88, 34.5%) reported one or more doctor-diagnosed chronic diseases. Multiple linear regression analysis showed that children of mothers with chronic diseases had significantly lower CHQ-PF50 scores in the parental impact-time, parental impact-emotional, and family activities subscales and psychosocial summary scores, as well as more hyperactive and inattentive problems measured by SDQ after adjustment for confounders. Maternal mental and physical disease showed a differential impact on children's HRQOL and behavior. CONCLUSIONS: Chronic disease in mothers might exert adverse effects on their children's HRQOL and behaviors. The effects could differ by maternal physical or mental disease status. Special attention and support should be paid to children of mothers with chronic disease as these children are at an increased risk of poor HRQOL and problematic behaviors.

Cost-effectiveness analysis of vaccinations and decision makings on vaccination programmes in Hong Kong: A systematic review.

OBJECTIVES: To describe and systematically review the modelling and reporting of cost-effectiveness analysis of vaccination in Hong Kong, and to identify areas for quality enhancement in future cost-effectiveness analyses. METHODS: We conducted a comprehensive and systematic review of cost-effectiveness studies related to vaccination and government immunisation programmes in Hong Kong published from 1990 to 2015, through database search of Pubmed, Web of Science, Embase, and OVID Medline. Methodological quality of selected studies was assessed using Consolidated Health Economic Evaluation Reporting Standards checklist (CHEERS). Decision making of vaccination was obtained from Scientific Committee on Vaccine Preventable Diseases (SCVPD) and Department of Health in Hong Kong. RESULTS: Nine eligible studies reporting twelve comparative cost-effectiveness comparisons of vaccination programme for influenza (n=2), pneumococcal disease (n=3), influenza plus pneumococcal disease (n=1), chickenpox (n=2), Haemophilus influenzae b (n=1), hepatitis A (n=1), cervical cancer (n=1) and rotavirus (n=1) were identified. Ten comparisons (83.3%) calculated the incremental cost-effectiveness ratio (ICER) of a vaccination strategy versus status quo as outcomes in terms of cost in USD per life-years, cost per quality-adjusted life-years, or cost per disability-adjusted life-years. Among those 10 comparisons in base-case scenario, 4 evaluated interventions were cost-saving relative to status quo while the ICER estimates in 3 of the 6 remaining comparisons were far below commonly accepted threshold and WHO willingness-to-pay threshold, suggestive of very cost-effective. Seven studies were of good quality based on the CHEERS checklist; one was of moderate quality; and one was of excellent quality. The common methodological problems were characterisation of heterogeneity and reporting of study parameters. CONCLUSIONS: There was a paucity of cost-effectiveness models evaluating vaccination targeted to the Hong Kong population. All evaluated vaccinations and immunisation interventions in Hong Kong, except for Haemophilus influenzae b, hepatitis A and HPV vaccinations, were considered either cost-saving or very cost-effective when compared to status quo.

Possible Impact of Incremental Cost-Effectiveness Ratio (ICER) on Decision Making for Cancer Screening in Hong Kong: A Systematic Review.

OBJECTIVES: The aim of this paper was to critically review the literature on the cost effectiveness of cancer screening interventions, and examine the incremental cost-effectiveness ratios (ICERs) that may influence government recommendations on cancer screening strategies and funding for mass implementation in the Hong Kong healthcare system. METHODS: We conducted a literature review of cost-effectiveness studies in the Hong Kong population related to cancer screening published up to 2015, through a hand search and database search of PubMed, Web of Science, Embase, and OVID Medline. Binary data on the government's decisions were obtained from the Cancer Expert Working Group, Department of Health. Mixed-effect logistic regression analysis was used to examine the impact of ICERs on decision making. Using Youden's index, an optimal ICER threshold value for positive decisions was examined by area under receiver operating characteristic curve (AUC). RESULTS: Eight studies reporting 30 cost-effectiveness pairwise comparisons of population-based cancer screening were identified. Most studies reported an ICER for a cancer screening strategy versus a comparator with outcomes in terms of cost per life-years (55.6 %), or cost per quality-adjusted life-years (55.6 %). Among comparisons with a mean ICER of US$102,931 (range 800-715,137), the increase in ICER value by 1000 was associated with decreased odds (odds ratio 0.990, 0.981-0.999; p = 0.033) of a positive recommendation. An optimal ICER value of US$61,600 per effectiveness unit yielded a high sensitivity of 90 % and specificity of 85 % for a positive recommendation. A lower ICER threshold value of below US$8044 per effectiveness unit was detected for a positive funding decision. CONCLUSIONS: Linking published evidence to Government recommendations and practice on cancer screening, ICERs influence decisions on the adoption of health technologies in Hong Kong. The potential ICER threshold for recommendation in Hong Kong may be higher than those of developed countries.