Impact of long-acting growth factors on practice dynamics and patient satisfaction.

OBJECTIVE: To quantify time expended, patient satisfaction, and econometrics associated with short-acting (sargramostim, epoetin alfa) and long-acting (darbepoetin alfa, pegfilgrastim) growth factors. DESIGN: Retrospective resource utilization and prospective two-phase observational study. METHODS: During week 1, time-motion measurements related to patient treatment and drug preparation were collected for scheduling; check-in; phlebotomy; laboratory; and drug preparation, administration, and recording. Drug utilization for one chemotherapy cycle during weeks 2 and 3 was assessed for sargramostim, pegfilgrastim, epoetin alfa, darbepoetin alfa, sargramostim plus epoetin alfa, and pegfilgrastim plus darbepoetin alfa. Patients completed a satisfaction survey. RESULTS: Among 140 patients (mean age 58 yrs), mean chemotherapy cycle duration was 19 days. A total of 268 events were observed. Mean total staff time/patient visit for drug administration was 22.1 minutes, with most time spent on scheduling (5.5 min) and drug preparation, administration, recording (5.2 min). For sargramostim only versus pegfilgrastim only, pegfilgrastim resulted in a 37% reduction (p < 0.01) in all visits and an 85% reduction (p < 0.01) in mean number of doses. For epoetin alfa only versus darbepoetin alfa only, darbepoetin alfa resulted in a 48% reduction (p < 0.01) in mean number of doses. The most common dosage of epoetin alfa was 40,000 U/week (63.6%) and that of darbepoetin alfa was 200 microg every other week (92%), but complete blood counts were obtained weekly. For pegfilgrastim plus darbepoetin alfa versus sargramostim plus epoetin alfa, a 45% reduction (p < 0.01) in total visits and a 77% reduction (p < 0.01) in mean number of doses were noted in the former group. In 69 patients converted to long-acting drugs, 65 actual hours for a single treatment cycle were saved. For patients receiving pegfilgrastim plus darbepoetin alfa, there was a 45% reduction in total clinic visits, 77% reduction in doses, and staff time savings of 1.9 hours/patient/cycle of chemotherapy. Fifty-four patients completed the survey and trended toward neutral in their responses, with moderate disagreement that receiving injections is painful. CONCLUSION: Long-acting growth factors resulted in significant time savings for staff and providers by reducing the number of necessary office visits for drug administration. These time savings can significantly improve the quality of life for patients, as well as nurses, physicians, and caregivers.

Valuation of symptomatic hepatitis a in adults: estimates based on time trade-off and willingness-to-pay measurement.

BACKGROUND: The cost effectiveness of hepatitis A prevention is typically assessed by comparing vaccination costs with the number of life-years saved. This endpoint does not consider the benefits of preventing nonfatal yet symptomatic infections. Nearly as many days of healthy life are lost to hepatitis A morbidity as mortality. OBJECTIVE: To investigate the value American adults place on preventing hepatitis A symptoms by using the willingness-to-pay and time trade-off metrics. METHODS: We provided a written description of hepatitis A symptoms to 181 American adults, who judged the amounts of money and lifespan they would forego to avoid them. The description made no reference to the possibility of fatality, and respondents were asked not to consider costs of medical care and work loss. We investigated relationships between demographic characteristics and each metric, the relationship between the two metrics, and the test/re-test reliability of the metrics. RESULTS: Respondents would pay a median of dollars US 2000 (inter-quartile range, dollars US 500 to 5000; 2001 values) for risk-free prevention of hepatitis A symptoms. Alternatively, they would forego a median of 28 days survival (inter-quartile range, 6 to 40 days) for cost-free prevention. There was modest correlation between willingness-to-pay and time trade-off responses (r = 0.24, p < 0.01), suggesting these metrics measure independent aspects of preference. Strong correlations between measures obtained 30 days apart support the test/re-test reliability of willingness to pay (r = 0.70, p < 0.01) and time trade-off (r = 0.73, p < 0.01) metrics. In multivariate analyses, higher household income (p = 0.02) predicted greater willingness to pay in dollars. Male gender (p < 0.01) predicted greater willingness to forego life expectancy for better health. CONCLUSION: In our study population of US adults, most were willing to pay or trade life expectancy for a hypothetical preventative drug for hepatitis A symptoms. The amount respondents were willing to pay appears dependent on their income level while males are willing to trade more life expectancy than female respondents. The values expressed should be considered in assessments of hepatitis A prevention.