Prostate cancer treatment ascertained from several sources: analysis of disagreement and error.

BACKGROUND: Treatment data for prostate cancer can be obtained from a variety of sources. Each of these sources has its own strengths and weaknesses and is subject to error. MATERIALS AND METHODS: In a population-based cohort of 319 prostate cancer patients, data on treatment were obtained from five sources: two patient interviews at 6 and 12 months after diagnosis, primary caregiver interviews, physician questionnaires, and medical records. Inter-reporting agreement and accuracy of reporting (compared with medical records) were assessed. Multivariate analyses examined patient, caregiver, and physician characteristics as determinants of reporting error. RESULTS: The agreement among different reporting methods was generally good to excellent for prostatectomy and brachytherapy (kappa range 0.70-0.90) and fair to good (kappa range 0.35-0.75) for external beam radiation and hormonal treatment. Compared with medical records, the interview- and questionnaire-based data collection methods were more accurate for prostatectomy and brachytherapy than for external beam radiation and hormonal therapy. Using medical records as the 'gold standard', patient and caregiver interviews at 6 months after the diagnosis had higher sensitivity and specificity than other reporting sources. CONCLUSION: Interviews of prostate cancer patients and caregivers are useful alternatives to medical record abstraction, particularly if carried out during, or soon after, treatment.

Economic evaluation of use of diphtheria, tetanus, and acellular pertussis vaccine or diphtheria, tetanus, and whole-cell pertussis vaccine in the United States, 1997.

OBJECTIVE: To compare the economic costs and benefits associated with using either diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) or diphtheria and tetanus toxoids and whole-cell pertussis vaccine (DTwP) in the United States in 1997. DESIGN: Standard cost-benefit analysis, from both the societal and health care system perspectives, was performed for each combination vaccine as well as for the pertussis components singly. SETTING: A simulated cohort of 4.1 million children from birth to age 15 years. MAIN OUTCOME MEASURES: Net costs (savings) and benefit-cost ratios (BCRs) RESULTS: Without a vaccination program, diphtheria, tetanus, and pertussis disease caused more than 3 million cases and more than 28,000 deaths, at a cost of $23.6 billion. From the societal perspective, net savings because of the use of DTaP and DTwP were $22.510 million and $22.623 million, respectively. The net savings from the acellular pertussis component and the whole-cell pertussis component only were $4.362 million and $4.474 million, respectively. Benefit-cost ratios for DTaP from a societal and health care system perspective were 27:1 and 9:1, respectively. Sensitivity analyses of key variables did not result in appreciable changes in results. CONCLUSIONS: Compared with no program, vaccination with DTaP or DTwP resulted in substantial savings, regardless of the perspective taken and for all sensitivity analyses conducted. Compared with DTwP, use of DTaP generated a small cost increase that might be offset by the value of other factors, such as increased confidence in pertussis vaccination resulting from reduced adverse events. Arch Pediatr Adolesc Med. 2000;154:797-803