Willingness to pay vs lottery equivalent to value the impact of alcohol misuse on quality of life.

OBJECTIVES: To estimate the impact of alcohol disorders using lottery equivalent (LE) and willingness to pay (WTP) methods and compute the WTP for a QALY (WTP-Q) derived from these values. METHODS: Two samples of 300 people valued nine states of alcohol misuse. LE and WTP were used in sample 1 and 2, respectively. The ability to discriminate between methods was tested. Regression models were performed to estimate the preference weights of dimensions. Several values of WTP-Q were obtained by combining the estimated values from both samples. RESULTS: LE and WTP produce the same ranking of states but LE is more sensitive. The estimated impact of the nine states ranges between 0.91 and 0.22 QALYs, and the WTP for avoiding them ranges between €10,444 and €4132. WTP-Q varies between €11,473 and €19,092 when the mean values of the states are used. The WTP-Q tends to decrease with the severity. CONCLUSIONS: Although LE and WTP provide values for cost-utility and cost-benefit analyses, respectively, LE seems to be preferable for measuring the impact of alcohol disorders. As the lower sensitivity of WTP seems to explain a WTP-Q decrease with severity, more research is needed before recommending the use of different WTP-Q values.

Determinants of caregiving burden among informal caregivers of adult care recipients with chronic illness.

AIMS AND OBJECTIVES: This study examined the predictors of caregiver burden based on patient and caregiver characteristics in a sample of Spanish caregivers looking after adult patients with chronic disease. The effect of task type and patient-caregiver interaction is also analysed. BACKGROUND: Specific predictors of caregiver burden have been widely examined in the literature. Few studies, however, jointly analyse a wide range of factors, including the effect of task type and patient-caregiver interaction. DESIGN: Correlational study. METHODS: One hundred and thirty five informal caregivers for 148 care recipients were recruited from primary health care centres. The caregivers responded to the short version of the Zarit Burden Interview (ZBI), the DEPendency index-6 Dimensions (DEP-6D), and reported how long they spent on caregiving on a daily basis. Sociodemographic and health characteristics were also recorded. Linear and logistic regression models were used to evaluate factors associated with ZBI scores and the likelihood of being severely burdened, respectively. This research complies with STROBE guidelines for observational studies. RESULTS: Severe burden was present in 62% of the caregivers. Regression analysis shows that burden severity increases significantly with the level of dependence when the latter is measured either by DEP-6D or by time spent on basic activities. Care related to incontinence and mobility has the greatest effect on burden, which is aggravated when the patient has behavioural problems. Poor caregiver health or not being retired also contributes to burden levels. CONCLUSIONS: These results establish that caregiver burden is related to characteristics of both the caregiver and the care recipient as well as to their interaction. RELEVANCE TO CLINICAL PRACTICE: The findings indicate that the socio-sanitary attention focused on reducing caregiver burden must address the caregiver and patient as a dyad. Identifying the dependence level and the patient's aggressive behaviour can be a good predictor of caregiver burden.

[Measurement of dependence based on the care time and the dependency assessment scale]. / La medición de la dependencia a partir del tiempo de cuidado y del baremo de valoración de dependencia.

AIMS: To assign care time to the activities collected in the Dependency Assessment Scale (BVD) and to analyse the relationship between care time and the score received on the BVD. METHODS: A cross-sectional observational study of 148 dependent persons was carried out. Socioeconomic and clinical data, the BVD, the 6-dimensional dependency indicator (DEP-6D), as well as data from a diary with the time of care received, were collected. The median time needed to carry out the activities included in the BVD was estimated from the diary. Following the BVD methodology, those who had their mental functions affected were separated. Each person was assigned two scores, one based on BVD and the other based on the time that the caregivers spent to care for them. The correlation between the two was estimated, and a regression was performed to identify the main explanatory factors for the disparity between the two indicators. RESULTS: BVD and hours of care show a moderate positive correlation. The mental impairment of the dependent person increased the time of care in most activities. The regression analysis suggests that while mental impairment is the main explanatory factor of obtaining a higher assessment with care time than with BVD, being bedridden is the main predictor of having a higher sore with the BVD. CONCLUSIONS: The construct that underlies BVD is moderately related to care time. Future research must contrast the robustness of these results and address whether the normative criteria that underlie the BVD is aligned with the weights that characterise it.

Measuring health-related quality of life in patients treated for substance dependence: differences among instruments and methods of eliciting preferences.

BACKGROUND: Measuring the health-related quality of life is an essential estimation in cost-utility studies. In this research, we provide new evidence about comparing utility scores - in the field of substance dependence. Although the main objective is to compare the EQ-5D-5L and SF-6D with paired gamble, evidence about the SF-6D with standard gamble is also provided. METHODS: Ninety-four patients with substance dependence were recruited; the SF-6D and the EQ-5D-5L were administered at the beginning of treatment and 6 months thereafter. Differences in treatment effect were estimated by comparing utility gains. All analyses were reproduced for two subgroups of severity. RESULTS: Both the baseline scores and the treatment effect are sensitive to the instrument used. For severe states, the SF-6D with paired gamble (SF-6D with standard gamble) estimates the lowest (highest) utility. With regard to the impact of treatment, the EQ-5D-5L and SF-6D with paired gamble estimate strongly similar effects for severe states (and both estimate greater effects than does the SF-6D with standard gamble). CONCLUSIONS: These findings have implications for cost-utility analyses. The incremental cost-utility ratio of treatments intended for severe states is barely sensitive to the choice of EQ-5D-5L or SF-6D with paired gamble.

Necesidad y uso de productos de apoyo y facilitadores arquitectónicos en población dependiente / Need and use of assistive devices and architectural facilitators in a dependent population

OBJETIVO: Describir la utilización y percepción de la necesidad de productos de apoyo e identificar su asociación con instrumentos para medir la dependencia y la sobrecarga de cuidados. DISEÑO: Estudio transversal. Emplazamiento: Atención Primaria del área sur de Pontevedra. PARTICIPANTES: Un total de 112 personas cuidadoras informales que atienden a 125 personas dependientes. Mediciones principales: Mediante entrevista personal se recogen datos sobre la utilización y percepción de necesidad de estos productos. Además, se obtienen datos sociodemográficos e información referida al tiempo dedicado al cuidado diario, la sobrecarga del cuidador, el Baremo de Valoración de Dependencia y el indicador de dependencia DEP-6D. Se ha utilizado un contraste de medias para identificar si existen diferencias significativas en dichos indicadores en función de si utilizan o no los productos facilitadores. Se ha calculado una regresión logística para identificar aquellas variables asociadas con tener una necesidad no cubierta. RESULTADOS: Un 60% (IC 95%: 50,9-68,7) de las personas dependientes tienen necesidades no cubiertas de estos dispositivos. Estas necesidades se asocian, principalmente, con una renta familiar baja, un mayor grado de dependencia y una mejor salud del cuidador, aunque en situaciones de gran dependencia y muy mala salud del cuidador estas carencias se suavizan. CONCLUSIONES: Existe una fuerte asociación entre grado de dependencia y utilización de estos productos. Sin embargo, también hay un elevado porcentaje de la muestra con necesidades no cubiertas de estos productos que están asociadas tanto con la situación socioeconómica del hogar como con las características del dependiente y de la persona cuidadora

OBJECTIVE: To describe the use and perception of the need for assistive devices and identify their relationship with instruments to measure dependence and caregiver burden. DESIGN: Cross-sectional study. LOCATION: Primary Health Care in the southern area of Pontevedra. PARTICIPANTS: A total of 112 informal caregivers providing care to 125 dependent persons. Key measurements: Through a personal interview, data was collected on the use and perception of the need for these devices. In addition, sociodemographic data and information on the time dedicated to daily care, caregiver burden, the Dependency Rating Scale, and the DEP-6D dependency indicator were obtained. A contrast mean was used to identify whether there are significant differences in these indicators, depending on whether or not they use the facilitator devices. A logistic regression was performed to identify those variables most associated with not having a need covered. RESULTS: More than half (60%: 95% CI; 50.9-68.7) of dependent persons have unmet needs for these devices. These needs are mainly associated with a low family income, a high degree of dependence, and better health of the caregiver; although in extreme situations of greater dependence and worse health of the caregiver these deficiencies are smoothed out. CONCLUSIONS: There is a strong association between the level of dependence and the use of these devices. However, there is a high percentage of the sample that do not have the products that they need, which are associated with the socioeconomic situation of the household as well as with the characteristics of the dependent person and the caregiver

Measuring intangible cost-of-morbidity due to substance dependence: implications of using alternative preference-based instruments.

OBJECTIVE: Drug and/or alcohol dependence (DAD) generates substantial costs to society. One of the main consequences of DAD is its negative impact on health-related quality of life (HRQoL). The main objective of this study is to analyse the impact of using EQ-5D-5L, SF-6DSG (SF-6D using standard-gamble as the preference-eliciting method) and SF-6DPG (SF-6D using a paired-gamble method), to estimate the HRQoL burden, attributable to DAD, within the cost-of-illness framework. METHODS: A convenience sample of 109 patients with a diagnosis of substance use disorder was recruited. SF-6D and EQ-5D-5L were administered and then the utility scores were computed. The impact of employing different instruments to estimate the HRQoL burden was assessed by comparing the utility scores of patients and general population after controlling for sex and age through regression analysis. The analysis was reproduced for two subgroups of severity. RESULTS: All instruments detect that DAD significantly affects the HRQoL. However, the estimated impact changes, according to the instrument used, whose pattern varies by severity group. Nonetheless, regardless of severity, SF-6DPG always estimates a higher or equal DAD burden than the other instruments considered. These results are compatible with the presence of the floor effect in SF-6DSG, the ceiling effect in EQ-ED-5L, and a smaller presence of both biases in SF-6DPG. CONCLUSIONS: The SF-6DPG instrument emerges as a good candidate to avoid under-estimating intangible costs within the cost-of-illness framework. However, further research is needed to assess the validity of our results in the context of other health problems.

[Need and use of assistive devices and architectural facilitators in a dependent population]. / Necesidad y uso de productos de apoyo y facilitadores arquitectónicos en población dependiente.

OBJECTIVE: To describe the use and perception of the need for assistive devices and identify their relationship with instruments to measure dependence and caregiver burden. DESIGN: Cross-sectional study. LOCATION: Primary Health Care in the southern area of Pontevedra. PARTICIPANTS: A total of 112 informal caregivers providing care to 125 dependent persons. KEY MEASUREMENTS: Through a personal interview, data was collected on the use and perception of the need for these devices. In addition, sociodemographic data and information on the time dedicated to daily care, caregiver burden, the Dependency Rating Scale, and the DEP-6D dependency indicator were obtained. A contrast mean was used to identify whether there are significant differences in these indicators, depending on whether or not they use the facilitator devices. A logistic regression was performed to identify those variables most associated with not having a need covered. RESULTS: More than half (60%: 95% CI; 50.9-68.7) of dependent persons have unmet needs for these devices. These needs are mainly associated with a low family income, a high degree of dependence, and better health of the caregiver; although in extreme situations of greater dependence and worse health of the caregiver these deficiencies are smoothed out. CONCLUSIONS: There is a strong association between the level of dependence and the use of these devices. However, there is a high percentage of the sample that do not have the products that they need, which are associated with the socioeconomic situation of the household as well as with the characteristics of the dependent person and the caregiver.

A meta-analysis of the association between caregiver burden and the dependent's illness.

The caregiver burden is frequently used to refer to the physical and psychological problems that may arise from caring for a dependent relative. We conducted a meta-analysis to see whether Zarit Burden Interview (ZBI) scores differed by dependent's pathology. Results from 125 studies showed that caregivers of individuals with a physical disability have an estimated mean ZBI score (±SE) of 27 ± 2.6 - a score significantly lower than for caregivers of persons with dementia or cognitive impairment (34.1 ± 1.1), mental illness (32.6 ± 1.7), or Alzheimer's (32.5 ± 1). Our analysis of Alzheimer's revealed differences among cases of mildly (25.8 ± 5.2), moderately (35.6 ± 7.8), and severely (42.6 ± 7.9) afflicted dependents.

Eliciting Health State Utilities Using Paired-Gamble Methods: The Role of the Starting Point.

BACKGROUND: Paired-gamble methods have been proposed to avoid the "certainty effect" associated with standard gamble methods. OBJECTIVE: This study examines the role of starting-point effects in paired-gamble methods. In particular, it examines how the utilities so derived vary as a function of the probabilities of the stimulus lottery. METHODS: A sample of 455 members of the Spanish general population valued 9 health states via face-to-face interviews. Subjects were randomly placed into 3 subgroups, which differed in terms of the stimulus gamble's probability. Nonparametric tests and an interval regression model were used to test if utilities change when the probability distribution is modified. RESULTS: Nonparametric tests showed that the probability of a health state being considered worse than death did not differ among subgroups. Nevertheless, changes in the stimulus gamble did produce significant differences in the distribution of utilities: the higher the probability of full health in the stimulus, the higher the utility elicited. Regression estimates support the existence of starting-point effects when the utilities are obtained under expected utility. According to the prospect theory, the conclusions depend on the reference point considered. When the reference points used are death or the health state evaluated, we observe differences among these groups. Nevertheless, when full health is used, these differences disappear. CONCLUSION: This research suggests that paired-gamble methods may also be susceptible to starting-point effects. Yet the differences are small, and they disappear when the data are analyzed using prospect theory with full health as the reference point.

Intangible costs of alcohol dependence from the perspective of patients and their relatives: A contingent valuation study. / Costes intangibles de la dependencia alcohólica desde la perspectiva de los pacientes y sus familiares: un estudio de valoración contingente.

Alcohol dependence causes multiple problems not only for the person suffering dependence but also for others. In this study, the contingent valuation method is proposed to measure the intangible effects of alcohol dependence from the perspective of the persons directly involved: the patients and their relatives. Interviews were conducted with 145 patients and 61 relatives. Intangible effects of alcohol dependence were determined based on willingness to pay for a hypothetical treatment for dependence, with different success scenarios (100% and 50%). The mean monthly willingness to pay among the alcohol-dependent population was €129 and €168, respectively, for the treatments with 100% and 50% success. The willingness to pay of relatives was greater in both scenarios (€307 and €420, respectively), which could be explained by their greater perception of the family, labour, and health problems resulting from alcohol dependence. Regression analysis showed that patients' willingness to pay is positively related to treatment efficacy, personal income and moderate health deterioration, and negatively related to feeling discouraged and depressed. The results from this study can be applied to economic valuation studies that aim to measure the benefits of programs intended to reduce the prevalence of alcohol dependence. The intangible costs estimated can be added to the direct and indirect costs commonly used.

La dependencia alcohólica produce múltiples problemas no sólo a la persona que la padece sino también a su entorno. En este estudio se utiliza la valoración contingente para valorar los efectos intangibles de la dependencia alcohólica, desde la perspectiva de las personas directamente implicadas: pacientes y familiares. Se ha entrevistado a 145 pacientes y 61 familiares. Los efectos intangibles de la dependencia alcohólica se obtienen a partir de la disponibilidad a pagar por un hipotético tratamiento para la dependencia, ante dos escenarios de éxito (50% y 100%). La disponibilidad a pagar media mensual de la población alcohólica es de 129€ y 168€, respectivamente, por los tratamientos con un 50% y un 100% de éxito. La disponibilidad de los familiares es mayor en ambos escenarios (307€ y 420€, respectivamente), lo cual podría ser explicado por su mayor percepción de los problemas familiares, laborales y de salud generados por la dependencia alcohólica. El análisis de regresión realizado muestra que la eficacia del tratamiento, la renta personal y tener un deterioro moderado de la salud influyen positivamente en la disponibilidad a pagar de los pacientes, e influye negativamente estar desanimado y deprimido. Los resultados de este estudio pueden ser aplicados a estudios de evaluación económica cuyo objetivo es medir los beneficios de programas destinados a reducir la prevalencia de la dependencia alcohólica. Los costes intangibles estimados pueden ser añadidos a los costes directos e indirectos habitualmente utilizados.

Costes intangibles de la dependencia alcohólica desde la perspectiva de los pacientes y sus familiares: un estudio de valoración contingente / Intangible costs of alcohol dependence from the perspective of patients and their relatives: A contingent valuation study

La dependencia alcohólica produce múltiples problemas no sólo a la persona que la padece sino también a su entorno. En este estudio se utiliza la valoración contingente para valorar los efectos intangibles de la dependencia alcohólica, desde la perspectiva de las personas directamente implicadas: pacientes y familiares. Se ha entrevistado a 145 pacientes y 61 familiares. Los efectos intangibles de la dependencia alcohólica se obtienen a partir de la disponibilidad a pagar por un hipotético tratamiento para la dependencia, ante dos escenarios de éxito (50% y 100%). La disponibilidad a pagar media mensual de la población alcohólica es de 129€ y 168€, respectivamente, por los tratamientos con un 50% y un 100% de éxito. La disponibilidad de los familiares es mayor en ambos escenarios (307€ y 420€, respectivamente), lo cual podría ser explicado por su mayor percepción de los problemas familiares, laborales y de salud generados por la dependencia alcohólica. El análisis de regresión realizado muestra que la eficacia del tratamiento, la renta personal y tener un deterioro moderado de la salud influyen positivamente en la disponibilidad a pagar de los pacientes, e influye negativamente estar desanimado y deprimido. Los resultados de este estudio pueden ser aplicados a estudios de evaluación económica cuyo objetivo es medir los beneficios de programas destinados a reducir la prevalencia de la dependencia alcohólica. Los costes intangibles estimados pueden ser añadidos a los costes directos e indirectos habitualmente utilizados

Alcohol dependence causes multiple problems not only for the person suffering dependence but also for others. In this study, the contingent valuation method is proposed to measure the intangible effects of alcohol dependence from the perspective of the persons directly involved: the patients and their relatives. Interviews were conducted with 145 patients and 61 relatives. Intangible effects of alcohol dependence were determined based on willingness to pay for a hypothetical treatment for dependence, with different success scenarios (50% and 100%). The mean monthly willingness to pay among the alcohol-dependent population was €129 and €168, respectively, for the treatments with 50% and 100% success. The willingness to pay of relatives was greater in both scenarios (€307 and €420, respectively), which could be explained by their greater perception of the family, labour, and health problems resulting from alcohol dependence. Regression analysis showed that patients' willingness to pay is positively related to treatment efficacy, personal income and moderate health deterioration, and negatively related to feeling discouraged and depressed. The results from this study can be applied to economic valuation studies that aim to measure the benefits of programs intended to reduce the prevalence of alcohol dependence. The intangible costs estimated can be added to the direct and indirect costs commonly used

Measuring the impact of alcohol-related disorders on quality of life through general population preferences / Medición del impacto de los trastornos relacionados con el alcohol en la calidad de vida a partir de las preferencias sociales

Objective: To estimate the intangible effects of alcohol misuse on the drinker's quality of life, based on general population preferences Methods: The most important effects (dimensions) were identified by means of two focus groups conducted with patients and specialists. The levels of these dimensions were combined to yield different scenarios. A sample of 300 people taken from the general Spanish population evaluated a subset of these scenarios, selected by using a fractional factorial design. We used the probability lottery equivalent method to derive the utility score for the evaluated scenarios, and the random-effects regression model to estimate the relative importance of each dimension and to derive the utility score for the rest of scenarios not directly evaluated. Results: Four main dimensions were identified (family, physical health, psychological health and social) and divided into three levels of intensity. We found a wide variation in the utilities associated with the scenarios directly evaluated (ranging from 0.09 to 0.78). The dimensions with the greatest relative importance were physical health (36.4%) and family consequences (31.3%), followed by psychological (20.5%) and social consequences (11.8%). Conclusions: Our findings confirm the benefits of adopting a heterogeneous approach to measure the effects of alcohol misuse. The estimated utilities could have both clinical and economic applications (AU)

Objetivo: Estimar los efectos intangibles del consumo abusivo de alcohol en la calidad de vida del bebedor, según las preferencias sociales. Métodos: Los efectos más relevantes se identificaron mediante dos grupos focales realizados con pacientes y especialistas. Los niveles de estas dimensiones se combinaron para producir diferentes escenarios. Una muestra de 300 personas de la población general española evaluó un subconjunto de estos escenarios, seleccionados mediante un diseño factorial fraccional. Se utilizó el método de lotería equivalente para obtener la utilidad asociada a cada uno de los escenarios evaluados. Para estimar la importancia relativa de cada dimensión y obtener la utilidad para el resto de escenarios no evaluados se estimó una regresión con efectos aleatorios. Resultados: Se identificaron cuatro efectos intangibles relevantes (familia, salud física, salud psicológica y social) con tres niveles de intensidad. Las utilidades asociadas a cada uno de los escenarios evaluados presentan una amplia variación (entre 0,09 y 0,78). La dimensión con mayor importancia relativa son las consecuencias en la salud física (36,4%) y las consecuencias en la familia (31,3%), seguidas de las consecuencias psicológicas (20,5%) y las sociales (11,8%). Conclusiones: Nuestros resultados confirman la conveniencia de adoptar un enfoque heterogéneo para medir los efectos del abuso del alcohol. Las utilidades estimadas podrían tener aplicaciones tanto clínicas como económicas (AU)

Estudio observacional transversal de la sobrecarga en cuidadoras informales y los determinantes relacionados con la atención a las personas dependientes / Cross-sectional study of informal caregiver burden and the determinants related to the care of dependent persons

OBJETIVO: Describir la sobrecarga de las cuidadoras informales de personas dependientes e identificar las variables relacionadas. DISEÑO: Estudio transversal descriptivo observacional. Emplazamiento: Atención Primaria del área sur de Pontevedra. PARTICIPANTES: Un total de 97 cuidadoras/es de dependientes. Mediciones principales: Mediante una entrevista personal se recogen datos socioeconómicos y del estado de salud de la cuidadora y del dependiente, el tiempo dedicado al cuidado y la carga del cuidador (Zarit abreviada). Además de una descripción de la muestra -incluyendo su nivel de sobrecarga-, se ha utilizado un contraste de medias para identificar aquellas características que inciden en la puntuación de la escala Zarit y una regresión logística para analizar aquellas que inciden en la probabilidad de experimentar sobrecarga. RESULTADOS: Un 61,9% de las cuidadoras están sometidas a sobrecarga intensa. El ítem de la escala que más contribuye a la sobrecarga es la falta de tiempo para uno mismo, seguida de los efectos negativos en las relaciones interpersonales. El contraste de medias muestra que el grado de parentesco, el número de horas de cuidado, la salud de la cuidadora y la agresividad del dependiente producen diferencias significativas en la escala Zarit. La salud física y psicológica de la cuidadora, y la agresividad del dependiente, se asocian a la probabilidad de padecer sobrecarga. CONCLUSIONES: Las cuidadoras informales de personas dependientes presentan un alto nivel de sobrecarga, que se relaciona tanto con sus características, como con las del dependiente. La sobrecarga replantea la necesidad de que las políticas públicas enfocadas en la dependencia adopten una visión integradora cuidadora-dependiente

OBJECTIVE: To describe the burden of informal carers of dependent people and to identify related variables. DESIGN: Descriptive observational cross-sectional study. LOCATION: Primary Health Care in the southern area of Pontevedra. PARTICIPANTS: 97 caregivers of dependent persons. Key measurements: We collected socioeconomic data and health conditions from caregivers and dependent persons, time spent on the daily care and caregiver burden (Zarit abbreviate) through a personal interview. Besides the description of the sample-including their burden level-, a contrast mean was used to identify characteristics that influenced in punctuation of Zarit scale. A logistic regression was used to analyse characteristics that increase the likelihood to experiment burden. RESULTS: 61.9% of caregivers are subject to intense burden. The item on the scale which contributes most to the caregiver burden is the lack of time for oneself, followed by the negative effects of interpersonal relationships. Contrast means shows that degree of relationship, number of care hours, caregiver health and aggressiveness of dependent persons produce significant differences in Zarit scale. Physic and psychological health of caregivers and aggressiveness of dependent persons is associated with the likelihood of developing caregiver burden. CONCLUSIONS: Informal caregivers of dependent persons show a high level of burden, both related to their characteristics and those of the dependent persons. Caregiver burden rethinks the need for public policies focused on dependence to adopt an integrative caregiver-dependent vision

[Cross-sectional study of informal caregiver burden and the determinants related to the care of dependent persons]. / Estudio observacional transversal de la sobrecarga en cuidadoras informales y los determinantes relacionados con la atención a las personas dependientes.

OBJECTIVE: To describe the burden of informal carers of dependent people and to identify related variables. DESIGN: Descriptive observational cross-sectional study. LOCATION: Primary Health Care in the southern area of Pontevedra. PARTICIPANTS: 97 caregivers of dependent persons. KEY MEASUREMENTS: We collected socioeconomic data and health conditions from caregivers and dependent persons, time spent on the daily care and caregiver burden (Zarit abbreviate) through a personal interview. Besides the description of the sample-including their burden level-, a contrast mean was used to identify characteristics that influenced in punctuation of Zarit scale. A logistic regression was used to analyse characteristics that increase the likelihood to experiment burden. RESULTS: 61.9% of caregivers are subject to intense burden. The item on the scale which contributes most to the caregiver burden is the lack of time for oneself, followed by the negative effects of interpersonal relationships. Contrast means shows that degree of relationship, number of care hours, caregiver health and aggressiveness of dependent persons produce significant differences in Zarit scale. Physic and psychological health of caregivers and aggressiveness of dependent persons is associated with the likelihood of developing caregiver burden. CONCLUSIONS: Informal caregivers of dependent persons show a high level of burden, both related to their characteristics and those of the dependent persons. Caregiver burden rethinks the need for public policies focused on dependence to adopt an integrative caregiver-dependent vision.

Measuring the impact of alcohol-related disorders on quality of life through general population preferences.

OBJECTIVE: To estimate the intangible effects of alcohol misuse on the drinker's quality of life, based on general population preferences METHODS: The most important effects (dimensions) were identified by means of two focus groups conducted with patients and specialists. The levels of these dimensions were combined to yield different scenarios. A sample of 300 people taken from the general Spanish population evaluated a subset of these scenarios, selected by using a fractional factorial design. We used the probability lottery equivalent method to derive the utility score for the evaluated scenarios, and the random-effects regression model to estimate the relative importance of each dimension and to derive the utility score for the rest of scenarios not directly evaluated. RESULTS: Four main dimensions were identified (family, physical health, psychological health and social) and divided into three levels of intensity. We found a wide variation in the utilities associated with the scenarios directly evaluated (ranging from 0.09 to 0.78). The dimensions with the greatest relative importance were physical health (36.4%) and family consequences (31.3%), followed by psychological (20.5%) and social consequences (11.8%). CONCLUSIONS: Our findings confirm the benefits of adopting a heterogeneous approach to measure the effects of alcohol misuse. The estimated utilities could have both clinical and economic applications.

Using the SF-6D to measure the impact of alcohol dependence on health-related quality of life.

Alcohol dependence not only reduces life expectancy, but also causes considerable loss of quality of life of the dependents of and persons around those with alcohol dependence. This article presents new evidence on the impact of alcohol dependence on health-related quality of life in Spain. Three samples were recruited: 150 alcoholics and 64 family members of alcoholics, with both samples taken from an alcoholism treatment unit, and 600 persons from the general population. We used the short form 6D, a preference-based generic instrument, applying the utility scores estimated for Spain. It was found that the annual mean loss of quality-adjusted life years associated with alcohol dependence was 0.144 and 0.083 for the alcoholics and their close family members, respectively. This impact becomes more notable after controlling for socio economic variables and was higher than that estimated in similar studies. Possible explanations for these differences are discussed. The results from this work can be applied to economic evaluation studies measuring benefits from policies targeted at reducing the prevalence of alcohol dependence.

The lead time tradeoff: the case of health states better than dead.

BACKGROUND: Lead time tradeoff (L-TTO) is a variant of the time tradeoff (TTO). L-TTO introduces a lead period in full health before illness onset, avoiding the need to use 2 different procedures for states better and worse than dead. To estimate utilities, additive separability is assumed. We tested to what extent violations of this assumption can bias utilities estimated with L-TTO. METHODS: A sample of 500 members of the Spanish general population evaluated 24 health states, using face-to-face interviews. A total of 188 subjects were interviewed with L-TTO and the rest with TTO. Both samples evaluated the same set of 24 health states, divided into 4 groups with 6 health states per set. Each subject evaluated 1 of the sets. A random effects regression model was fitted to our data. Only health states better than dead were included in the regression since it is in this subset where additive separability can be tested clearly. RESULTS: Utilities were higher in L-TTO in relation to TTO (on average L-TTO adds about 0.2 points to the utility of health states), suggesting that additive separability is violated. The difference between methods increased with the severity of the health state. Thus, L-TTO adds about 0.14 points to the average utility of the less severe states, 0.23 to the intermediate states, and 0.28 points to the more severe estates. CONCLUSIONS: L-TTO produced higher utilities than TTO. Health problems are perceived as less severe if a lead period in full health is added upfront, implying that there are interactions between disjointed time periods. The advantages of this method have to be compared with the cost of modeling the interaction between periods.

Patients' self-interested preferences: empirical evidence from a priority setting experiment.

This paper explores whether patients act according to self-interest in priority setting experiments. The analysis is based on a ranking experiment, conducted in Galicia (Spain), to elicit preferences regarding the prioritization of patients on a waiting list for an elective surgical intervention (prostatectomy for benign prostatic hyperplasia). Participants were patients awaiting a similar intervention and members of the general populations. All of them were asked to rank hypothetical patients on a waiting list. A rank-ordered logit was then applied to their responses in order to obtain a prioritization scoring system. Using these estimations, we first test for differences in preferences between patients and general population. Second, we implement a procedure based on the similarity between respondents (true patients) and the hypothetical scenarios they evaluate (hypothetical patients) to analyze whether patients provide self-interested rankings. Our results show that patient preferences differ significantly from general population preferences. The findings also indicate that, when patients rank the hypothetical scenarios on the waiting list, they consider not only the explicit attributes but also the similarity of each scenario to their own. In particular, they assign a higher priority to scenarios that more closely match their own states. We also find that such a preference structure increases their likelihood of reporting "irrational" answers.

Using a point system in the management of waiting lists: the case of cataracts.

In the management of waiting lists, point systems could be a useful mechanism to establish priorities amongst patients. In this paper we explore the possibility of using Conjoint Analysis (CA) in order to implement a point system based on social preferences. We conducted an experiment for the specific case of cataract extraction. In spite of the pilot nature of the study the results seems to suggest that CA is a feasible method in order to estimate a point system.

Measuring the social importance of concentration or dispersion of individual health benefits.

In this paper we address the importance of distributive preferences in the social valuation of quality-adjusted life years (QALYs). We propose a social welfare function that generalises the functions traditionally used in the health economic literature. The novelty is that, depending on the individual health gains, this function can represent either preferences for concentrating or preferences for spreading total gain or both together, an issue which has not been addressed until now. Based on an experiment, we observe that this generalisation provides a suitable approximation to the sampled social preferences.