Priority setting in the German healthcare system: results from a discrete choice experiment.

Worldwide, social healthcare systems must face the challenges of a growing scarcity of resources and of its inevitable distributional effects. Explicit criteria are needed to define the boundaries of public reimbursement decisions. As Germany stands at the beginning of such a discussion, more formalised priority setting procedures seem in order. Recent research identified multi-criteria decision analysis (MCDA) as a promising approach to inform and to guide decision-making in healthcare systems. In that regard, this paper aims to analyse the relative weight assigned to various criteria in setting priority interventions in Germany. A discrete choice experiment (DCE) was employed in 2015 to elicit equity and efficiency preferences of 263 decision makers, through six attributes. The experiment allowed us to rate different policy interventions based on their features in a composite league table (CLT). As number of potential beneficiaries, severity of disease, individual health benefits and cost-effectiveness are the most relevant criteria for German decision makers within the sample population, the results display an overall higher preference towards efficiency criteria. Specific high priority interventions are mental disorders and cardiovascular diseases.

Valuation of pemphigus vulgaris and pemphigus foliaceus health states: a convenience sample experiment.

BACKGROUND: Health-related quality of life (HRQoL) in pemphigus has been widely investigated; nevertheless, utility values for economic evaluations are still lacking. OBJECTIVES: To estimate health utilities for hypothetical pemphigus vulgaris (PV) and pemphigus foliaceus (PF) health states in a general population sample. METHODS: Three health states (uncontrolled PV, uncontrolled PF and controlled pemphigus) were developed based on a systematic literature review of HRQoL studies in pemphigus. Utilities were obtained from a convenience sample of 108 adults using a visual analogue scale (VAS) and 10-year time trade-off (TTO). Lead-time TTO was applied for health states regarded as worse than dead with a lead time to disease time ratio of 1 : 1. RESULTS: The mean VAS utility scores for PV, PF and controlled pemphigus were 0·25 ± 0·15, 0·37 ± 0·17 and 0·63 ± 0·16, respectively. Corresponding TTO utilities were as follows: 0·34 ± 0·38, 0·51 ± 0·32 and 0·75 ± 0·31. Overall, 14% and 6% judged PV and PF as being worse than dead. For both VAS and TTO values, significant differences were observed between all health states (P < 0·001). VAS utilities were rated significantly lower compared with TTO in each health state (P < 0·001). CONCLUSIONS: This is the first study that reports health utility values for PV and PF. Successful treatment of pemphigus might result in significant utility gain (0·24-0·41). These empirical findings with respect to three health states in pemphigus may serve as anchor points for further utility studies and cost-effectiveness analyses.

Alopecia areata and health-related quality of life: a systematic review and meta-analysis.

BACKGROUND: No systematic review has yet evaluated the available evidence on health-related quality of life (HRQOL) in alopecia areata (AA). OBJECTIVES: To conduct a systematic review and meta-analysis of HRQOL studies among patients diagnosed with AA. METHODS: A systematic search was performed for papers published between 1946 and 15 December 2014 in Medline, Embase, Web of Science, CINAHL, PsycINFO and the Cochrane Library. Random-effects meta-analyses were conducted to pool data. RESULTS: Twenty-one studies were included, representing a total of 2530 adult patients with AA. Of the 14 different HRQOL measures used in the studies, Dermatology Life Quality Index (DLQI; n = 8) and SF-36 (n = 7) were the most common. Three AA-specific HRQOL instruments were identified: Alopecia Areata Quality of Life Index, Alopecia Areata Quality of Life and Alopecia Areata Symptom Impact Scale. The mean pooled DLQI score of patients with AA was 6·3 (95% confidence interval 5·6-7·1). Comparing age- and sex-matched controls, the meta-analysis of SF-36 studies revealed significantly reduced HRQOL across the role-emotional, mental health and vitality domains (P < 0·001). Wearing a wig had a positive impact, while scalp involvement, anxiety and depression had a negative impact on HRQOL. Conflicting results were found regarding the association between HRQOL and age, sex, marital status and disease duration. CONCLUSIONS: Patients with AA experience significant impairment in HRQOL, especially in the area of mental health. Several generic and dermatology-specific HRQOL instruments have been used, but no validation studies have confirmed their applicability in AA. The newly developed AA-specific measures seem very promising; however, a more extensive assessment of validity and reliability is needed.

Serum lipoproteins in lepromatous leprosy.

Serum total cholesterol and the lipoprotein fractions were studied in forty subjects of lepromatous leprosy and age matched controls. The study revealed a significant decrease in serum cholesterol in the disease group as compared to control group. The decrease in cholesterol was 28.76% An alteration in serum lipoprotein fractions was observed in disease group. The beta-lipoprotein fraction showed a significant decrease along with a rise in alpha-lipoprotein fraction. A positive correlation was also observed between total cholesterol and beta-lipoproteins. The significance of the above findings are discussed.

Electrophoretic pattern of proteins in lepromatous leprosy.

Serum total proteins and the various protein fractions were studied in fifty cases of lepromatous leprosy and in eleven cases of lepromatous leprosy with lepra reaction. The study revealed a significant increase in serum total proteins in both lepromatous leprosy and lepra reaction groups, when compared with normal healthy subjects. The percentage rise was found to be 14.5% and 22.95% for lepromatous leprosy and lepra reaction respectively. The globulin fraction showed a significant elevation, while albumin showed a decrease. Thus a reversal of A/G ratio was observed in both the disease groups. Alpha-1 and Alpha-2 globulins were found to be significantly increased in both the disease groups. Beta globulins did not reveal any significant alteration. It was interesting to note the presence of an additional globulin fraction in seventeen patients of lepromatous leprosy and two cases of lepra reaction. Gammaglobulin showed a significant rise in lepromatous leprosy (56.16%) and in lepra reaction (60.72%). The significance of the above findings are discussed in the light of available literature.