Self vs. other, child vs. adult. An experimental comparison of valuation perspectives for valuation of EQ-5D-Y-3L health states.

OBJECTIVES: EQ-5D-Y-3L health states are valued by adults taking the perspective of a 10-year-old child. Compared to valuation of adult EQ-5D instruments, this entails two changes to the perspective: (i) child health states are valued instead of adult health states and: (ii) health states are valued for someone else instead of for oneself. Although earlier work has shown that these combined changes yield different values for child and adult health states that are otherwise equal, it currently remains unclear why. Hence, we aimed to disentangle the effects of both changes. METHODS: A sample of 205 students (mean age: 19.48) was surveyed. Each respondent completed visual analogue scale (VAS) and time trade-off (TTO) tasks for five EQ-5D-Y-3L states, using four randomly ordered perspectives: (i) self-adult (themselves), (ii) other-adult (someone their age), (iii) self-child (themselves as a 10-year-old), (iv) other-child (a child of 10 years old). We compared how each perspective impacted outcomes, precision and quality of EQ-5D-Y-3L valuation. RESULTS: Overall, differences between perspectives were consistent, with their direction being dependent on the health states and respondents. For VAS, the effect on outcomes of valuation depended on severity, but variance was higher in valuation with child perspectives. For TTO, we observed that EQ-5D-Y-3L states valued on behalf of others (i.e., children or adults) received higher valuations, but lower variances. CONCLUSION: The use of a different perspective appears to yield systematic differences in EQ-5D-Y-3L valuation, with considerable heterogeneity between health states and respondents. This may explain mixed findings in earlier work.

Analysis of the upper gastrointestinal tract bleeding prevalence in patients treated due ischaemic heart disease.

PURPOSE: The analysis concerning the frequency of bleedings from the upper part of the gastrointestinal tract in group of patients suffering from ischaemic heart disease (IHD) treated and not treated with coronaroplasty. The other aim of the study was to analyse the incidence of using particular groups of drugs. MATERIAL AND METHODS: 150 patients were included in the study, aged from 17 to 86. They were divided into three groups: I group--patients treated with coronaroplasty (n=50), II group--patients who were not treated with coronaroplasty (n=50), III control group (n=50). The patients filled in a questionnaire (among other things the questions concerned methods and period of treating heart ischaemia and stomach complaints. The documentation of the keyhole examinations of the upper part of the digestive tract was analysed in flashback). RESULTS: Bleeding from the upper part of the gastrointestinal tract (only single episode) was noticed in 5 patients (treated with IHD) (3.33%). All these patients belonged to the group II. Endoscopic examination of the upper part of gastrointestinal tract was carried out in 4 of these patients and haemorrhagic gastritis has been found. The following drugs were more frequently used in patients treated with coronaroplasty: acetylsalicylic acid, clopidogrel, ticlopidine. Acenocoumarol was more frequently used in patients not treated with coronaroplasty. The differences were not significant and concerned the usage frequency of the following drugs: beta-blockers, calcium canal blockers, ACE, systemic nitrates and statins. CONCLUSIONS: Bleeding from the upper part of gastrointestinal tract occurred more frequently among patients not treated with coronaroplasty. The following drugs were used more frequently in the group of patients treated with coronaroplasty: acetylsalicylic acid, ticlopidine and clopidogrel, but acenocoumarol was used more frequently in the group of patients treated only pharmacologically.