Consumer willingness to pay for pharmacy services: An updated review of the literature.

BACKGROUND: Quantifying the value of pharmacy services is imperative for the profession as it works to establish an expanded role within evolving health care systems. The literature documents the work that many have contributed toward meeting this goal. To date, however, the preponderance of evidence evaluates the value of pharmacist services to third-party payers; few published studies address the value that consumers place on these services. OBJECTIVES: In 1999, a review of studies that used the contingent valuation method to value pharmacy services was published. The objective of this manuscript is to provide an update of that review. METHODS: Relevant studies published in the English language were identified searching MEDLINE, ECONLIT and International Pharmaceutical Abstracts databases from January 1999 to November 2017. Only studies that specifically elicited willingness to pay for a community pharmacist provided service from actual or potential consumers were included. RESULTS: Thirty-one studies using the contingent valuation method to value pharmacy services were identified using the search strategy outlined. These studies included surveys in different demographic and geographic populations and valuing various pharmacy services. CONCLUSIONS: Improving the quality of studies using contingent valuation to value pharmacy services will aid the profession in marketing pharmacy services to consumers, and may assist practitioners who wish to implement various pharmacy services in their practice settings. A limited number of studies have been conducted, but the quality of contingent valuation studies valuing pharmacist services is improving. Understanding the pharmacy services that consumers value, and understanding the level of their monetary willingness to pay for those services will be crucial as the profession continues to work toward establishing a sustainable and economically viable role within the evolving health care systems.

Suspected Synthetic Cannabinomimetic Intoxication: Case Series and Review.

PURPOSE: The purpose of this work was to retrospectively review patient cases presenting to the University of Kentucky Chandler Medical Center (UKCMC) emergency department (ED) with symptoms of suspected synthetic cannabinomimetic (SC) intoxication. These drugs, currently undetected by standard urine drug screen tests, comprise a structurally diverse group of compounds designed to mimic the psychoactive effects of Δ9-tetrahydrocannabinol (Δ9-THC), the primary psychoactive cannabinoid in marijuana. SUMMARY: Fourteen cases of suspected SC intoxication were identified between July 1, 2015, through September 30, 2015. The median patient age was 25.5 years (range: 13-45 years), and most (64%) patients were males. The most common psychoactive symptom was agitation (n = 6, 42.9%), while the most common physical symptoms were altered level of consciousness (n = 9, 64.3%) and mydriasis (n = 3, 21.4%). Most cases resolved without complication in 24 hours; 2 patients required hospitalization. CONCLUSION: Recent legislation has failed to curb the public health concerns emanating from SC misuse. Education about the risks of SC use along with additional regulation may be required to remove the false sense of safety that some individuals, especially adolescents and young adults, may associate with these compounds, which are often misconstrued as "herbal marijuana." Clinicians need to be prepared to identify and treat symptoms of SC intoxication as incidents of toxicity continue to rise.

Quality of Life and Medication Adherence of Independently Living Older Adults Enrolled in a Pharmacist-Based Medication Management Program.

This study sought to understand the medication adherence and quality of life (QOL) of recipients of a pharmacist-based medication management program among independently living older adults. Using a cross-sectional, quasi-experimental study design, we compared older adults enrolled in the program to older adults not enrolled in the program. Data were collected via face-to-face interviews in independent-living facilities and in participants' homes. Independently living older adults who were enrolled in the medication management program (n = 38) were compared to older adults not enrolled in the program (control group (n = 41)). All participants were asked to complete questionnaires on health-related quality of life (QOL, using the SF-36) and medication adherence (using the four-item Morisky scale). The medication management program recipients reported significantly more prescribed medications (p < 0.0001) and were more likely to report living alone (p = 0.01) than the control group. The medication management program recipients had a significantly lower SF-36 physical functioning score (p = 0.03) compared to the control group, although other SF-36 domains and self-reported medication adherence were similar between the groups. Despite taking more medications and more commonly living alone, independent living older adults enrolled in a pharmacist-based medication management program had similar QOL and self-reported medication adherence when compared to older adults not enrolled in the program. This study provides initial evidence for the characteristics of older adults receiving a pharmacist-based medication management program, which may contribute to prolonged independent living and positive health outcomes.

National trends in off-label use of atypical antipsychotics in children and adolescents in the United States.

The objectives of the study were as follows: to examine the national trend of pediatric atypical antipsychotic (AAP) use in the United States; to identify primary mental disorders associated with AAPs; to estimate the strength of independent associations between patient/provider characteristics and AAP use. Data are from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. First, average AAP prescription rates among 4 and 18-year-old patients between 1993 and 2010 were estimated. Second, data from 2007 to 2010 were combined and analyzed to identify primary mental disorders related to AAP prescription. Third, a multivariate logistic regression model was developed having the presence of AAP prescription as the dependent variable and patient/provider characteristics as explanatory variables. Adjusted odds ratios (AORs) with associated 95% confidence intervals (CIs) were estimated. Outpatient visits including an AAP prescription among 4 to 18-year-old patients significantly increased between 1993 and 2010 in the United States, and over 65% of those visits did not have diagnoses for US Food and Drug Administration-approved AAP indications. During 2007 to 2010, the most common mental disorder was attention-deficit hyperactivity disorder, accounting for 24% of total pediatric AAP visits. Among visits with attention-deficit hyperactivity disorder diagnosis, those with Medicaid as payer (AOR 1.66, 95% CI 1.01-2.75), comorbid mental disorders (e.g., psychoses AOR 3.34, 95% CI 1.35-8.26), and multiple prescriptions (4 or more prescriptions AOR 4.48, 95% CI 2.08-9.64) were more likely to have an AAP prescription. The off-label use of AAPs in children and adolescents is prevalent in the United States. Our study raises questions about the potential misuse of AAPs in the population.

A cost-effectiveness analysis of off-label atypical antipsychotic treatment in children and adolescents with ADHD who have failed stimulant therapy.

The objectives of this study are: (1) to estimate the expected health outcomes of atypical antipsychotics (AAPs) and other non-stimulant attention-deficit/hyperactivity disorder (ADHD) medications and (2) to evaluate the cost-effectiveness of AAPs compared to other non-stimulant ADHD medications. We used decision analysis to compare three alternatives for treating children and adolescents with ADHD who failed initial stimulant treatment: (1) AAPs, (2) a selective norepinephrine reuptake inhibitor (atomoxetine), and (3) selective α2-adrenergic agonists (clonidine and guanfacine). Probability estimates and quality-adjusted life year (QALY) weights were derived from a literature review. Cost-effectiveness was estimated using the expected health outcomes derived from the decision analysis and expected costs from the literature. The study was conducted from the third-party payer perspective, and the study period was 1 year. One-way deterministic sensitivity analysis and a Monte Carlo simulation were performed. Over the course of 1 year of ADHD pharmacotherapy, the highest QALY was for clonidine/guanfacine (expected QALY = 0.95) followed by atomoxetine (expected QALY = 0.94). Atypical antipsychotics yielded the lowest health outcome with an expected QALY of 0.84. In the cost-effectiveness analysis, the AAP strategy was dominated as it was less effective and more costly than other two strategies. Compared to clonidine/guanfacine, AAPs provided lower QALYs (0.11 QALY lost) at an additional cost of $2186 on average. Compared to atomoxetine, AAPs resulted in 0.10 QALYs lost at an additional cost of $2186. In this decision analysis model, AAPs provide lower expected health outcomes than other ADHD medications in children and adolescents who failed prior stimulant therapy. Furthermore, AAPs were not a cost-effective option.

Prescription drug monitoring program utilization in Kentucky community pharmacies.

OBJECTIVE: Identify characteristics of Kentucky community pharmacists and community pharmacists' practice environment associated with utilization of the Kentucky All Schedule Prescription Electronic Reporting Program (KASPER). METHODS: Surveys were mailed to all 1,018 Kentucky pharmacists with a KASPER account and an additional 1,000 licensed pharmacists without an account. Bivariate analyses examined the association between KASPER utilization and practice type (independent or chain) and practice location (rural or urban). A multivariate Poisson regression model with robust error variance estimated risk ratios (RR) of KASPER utilization by characteristics of pharmacists' practice environment. RESULTS: Responses were received from 563 pharmacists (response rate 27.9%). Of these, 402 responses from community pharmacists were included in the analyses. A majority of responding pharmacists (84%) indicated they or someone in their pharmacy had requested a patient's controlled substance history since KASPER's inception. Bivariate results showed that pharmacists who practiced in independent pharmacies reported greater KASPER utilization (94%) than pharmacists in chain pharmacies (75%; p<0.001). Multivariate regression results found utilization of KASPER varied significantly among practice environments of community pharmacists with those who practiced in an urban location (RR: 1.11; [1.01-1.21]) or at an independent pharmacy (RR: 1.27; [1.14-1.40]) having an increased likelihood of KASPER utilization. CONCLUSION: Utilization of KASPER differs by community pharmacists' practice environment, predominantly by practice type and location. Understanding characteristics of community pharmacists and community pharmacists' practice environment associated with PDMP use is necessary to remove barriers to access and increase utilization thereby increasing PDMP effectiveness.

Prescription drug monitoring program utilization in Kentucky community pharmacies / Utilización del programa de monitorización de la prescripción de medicamentos en las farmacias comunitarias de Kentucky

Objective: Identify characteristics of Kentucky community pharmacists and community pharmacists' practice environment associated with utilization of the Kentucky All Schedule Prescription Electronic Reporting Program (KASPER). Methods: Surveys were mailed to all 1,018 Kentucky pharmacists with a KASPER account and an additional 1,000 licensed pharmacists without an account. Bivariate analyses examined the association between KASPER utilization and practice type (independent or chain) and practice location (rural or urban). A multivariate Poisson regression model with robust error variance estimated risk ratios (RR) of KASPER utilization by characteristics of pharmacists' practice environment. Results: Responses were received from 563 pharmacists (response rate 27.9%). Of these, 402 responses from community pharmacists were included in the analyses. A majority of responding pharmacists (84%) indicated they or someone in their pharmacy had requested a patient's controlled substance history since KASPER's inception. Bivariate results showed that pharmacists who practiced in independent pharmacies reported greater KASPER utilization (94%) than pharmacists in chain pharmacies (75%; p<0.001). Multivariate regression results found utilization of KASPER varied significantly among practice environments of community pharmacists with those who practiced in an urban location (RR: 1.11; [1.01-1.21]) or at an independent pharmacy (RR: 1.27; [1.14-1.40]) having an increased likelihood of KASPER utilization. Conclusion: Utilization of KASPER differs by community pharmacists' practice environment, predominantly by practice type and location. Understanding characteristics of community pharmacists and community pharmacists' practice environment associated with PDMP use is necessary to remove barriers to access and increase utilization thereby increasing PDMP effectiveness (AU)

Objetivo: Identificar las características de las farmacias comunitarias y del entorno de práctica de las farmacias comunitarias relacionadas con la utilización del Kentucky All Schedule Prescription Electronic Reporting Program (KASPER). Métodos: Se enviaron cuestionarios a todos los 1.018 farmacéuticos con cuenta en el KASPER y a un total adicional de 1.000 farmacéuticos sin cuenta. Se examinó la asociación entre la utilización de KASPER y el tipo de ejercicio (independiente o de cadena) la localidad (rural o urbana) con análisis bivariado. Mediante un modelo de regresión multivariada de Poisson con varianza de error robusta se estimaron los ratios de riesgo (RR) de la utilización de KASPER con las características del entorno de práctica de los farmacéuticos. Resultados: Se recibieron respuestas de 563 farmacéuticos (tasa de respuesta 27,9%). De esos, 402 respuestas de farmacéuticos comunitarios se incluyeron en el análisis. La mayoría de los respondentes (84%) indicó que ellos o alguien de su farmacia habían solicitado una historia de substancias controladas de un paciente desde que se creó KASPER. El análisis bivariado demostró que los farmacéuticos que ejercían en farmacias independientes comunicaban una mayor utilización de KASPER (94%) que los farmacéuticos de cadenas (75%; p<0,001). Los resultados de la regresión multivariada encontraron que la utilización de KASPER variaba significativamente entre los entornos de práctica de los farmacéuticos comunitarios que trabajaban en localidades urbanas (RR: 1,11; [1,01-1,21]) o los de farmacias independientes (RR: 1,27; [1,14-1,40]) que tenían una mayor probabilidad de utilización de KASPER. Conclusión: La utilización de KASPER difiere en los ambientes de práctica de los farmacéuticos comunitarios, principalmente por tipo de establecimiento y localización. Es necesario entender las características de los farmacéuticos comunitarios y de los entornos de práctica de las farmacias comunitarias asociadas con el uso de programas de monitorización de la prescripción (PDMP) para eliminar las barreras de acceso y aumentar la utilización incrementando así la efectividad del PDMP (AU)

Atypical antipsychotic initiation and the risk of type II diabetes in children and adolescents.

PURPOSE: To estimate the risk of type II diabetes (T2DM) in children and adolescents initiating atypical antipsychotic (AAP) therapy. METHODS: We conducted a retrospective cohort study using a new user design approach. Medical and pharmacy claims data between 1 January 2007 and 31 December 2009 for dependents ages 4 to 18 from an employed, commercially insured population from across the USA were included. AAP exposure was defined in the presence of a pharmacy claim preceded by at least six months of AAP-free history. We used propensity score (PS) methodology to identify and match incident AAP users and non-users. New-onset T2DM, was defined based on medical and pharmacy claims. Follow-up was extended until the date of new-onset T2DM or the end of the study period. The risk of T2DM was evaluated in an intent to treat fashion using the Kaplan-Meier estimator and Cox proportional hazard regression that provided hazard ratio (HR) and associated 95% confidence interval (CI). RESULTS: Our study population included 6236 new AAP users and 22 080 non-users. In this PS-matched sample, the estimated risk of T2DM was twice as high in AAP users as non-users (HR 2.18, 95% CI 1.45-3.29). Noticeable risk differences between AAP-treated and control groups materialized within four months of AAP initiation and became constant after six months until the end of the follow-up. CONCLUSIONS: Children and adolescents who were prescribed an AAP medication had a two times higher risk of developing T2DM; our study raises questions about continued AAP use in children and adolescents.

Kentucky pharmacists' opinions of the potential reclassification of pseudoephedrine as a legend drug.

OBJECTIVES: To collect and analyze Kentucky pharmacists' opinions of the effectiveness of current methamphetamine precursor controls, to analyze proposed legislation to make pseudoephedrine (PSE) a legend drug, and to analyze the potential impact of such legislation on pharmacy practice and patients. DESIGN: Descriptive, nonexperimental survey study. SETTING: Kentucky; June through October 2012. PARTICIPANTS: 431 Kentucky community pharmacists. INTERVENTION: Mailed survey. MAIN OUTCOME MEASURES: Perceived efficacy of current methamphetamine precursor controls, anticipated impact on individual pharmacy practices and patients of proposed legislation to make PSE available by prescription only, and current opinions about the proposed legislation. RESULTS: Analysis of 431 community pharmacists showed that approximately 77% believed proposed legislation to make PSE available by prescription only would be effective in reducing methamphetamine abuse and methamphetamine-related laboratory incidents, with 56.2% indicating support for the proposed legislation. Pharmacists practicing in chain pharmacies were 2.9 times more likely to support the legislation than pharmacists practicing in independent pharmacies. Additional factors influencing pharmacist support included Kentucky region of practice, anticipated impact on time spent on PSE activities, pharmacy profit, methamphetamine abuse, and methamphetamine-related laboratory incidents. Pharmacists practicing in regions of Kentucky associated with higher methamphetamine abuse appear to more strongly support the proposed legislation. CONCLUSION: Pharmacists are at the frontline of PSE distribution. Gaining a better understanding of issues surrounding the distribution of PSE will enhance the likelihood that future legislation may be crafted to reduce methamphetamine production, laboratory incidents, and abuse while minimizing inconvenience and cost.

Consumer/patient encounters with prescription drug monitoring programs: evidence from a Medicaid population.

BACKGROUND: Prescription drug monitoring programs issue reports about a patient's controlled substance prescription history upon request to physicians, law enforcement officials, and pharmacists. The dual purposes of these programs are to reduce the abuse and diversion of controlled substances while not preventing access to these medications for legitimate medical need. OBJECTIVE: The purpose of this study was to examine the experiences of Medicaid patients with Kentucky's Prescription Drug Monitoring Program (PDMP). STUDY DESIGN: A random sample of Medicaid patients was surveyed in 2010; respondents were matched with patient retrospective claims data from 6 months prior to the survey's administration. SETTING: Kentucky Medicaid patients from across the state. METHODS: A combination of patient surveys and Medicaid claims data was used to test the relationship between patient characteristics and patient-reported interactions with physicians regarding their PDMP reports and whether they experienced difficulty obtaining or filling a prescription for a controlled substance due to a PDMP report. RESULTS: Most Medicaid patients are unaffected by the PDMP; however, patients diagnosed with chronic non-cancer pain conditions and patients reporting a Hispanic ethnicity are significantly more likely to have a physician discuss their PDMP report with them. Patients diagnosed with chronic non-cancer pain conditions are also significantly more likely to report difficulty obtaining a prescription for a controlled substance than patients that have not been diagnosed with chronic non-cancer pain conditions. Patients living in rural areas are significantly less likely than patients in urban areas to report difficulty obtaining a prescription for a controlled substance. LIMITATIONS: The utilization of controlled substance prescriptions by respondents was not measured or monitored. The Medicaid population examined in this study may not be representative of the population as a whole. CONCLUSIONS: These results suggest that more attention to the consumer/patient perspective is warranted in maintaining a balanced approach to decreasing drug abuse and diversion while not limiting access to controlled substances in cases of legitimate medical need.

Independent community pharmacist interest in participating in community pharmacy research networks.

OBJECTIVES: To assess the interest of American Pharmacy Services Corporation (APSC) independent community pharmacists in participating in a community pharmacy research network (CPRN) and to identify perceived barriers to participation in a CPRN. DESIGN: Descriptive, exploratory, nonexperimental study. SETTING: University of Kentucky and APSC during 2009-10. PARTICIPANTS: 65 APSC independent community pharmacists in Kentucky. INTERVENTION: Single-mode survey. MAIN OUTCOME MEASURE: Independent community pharmacists' willingness to participate in community-based research and perceived barriers to participation. RESULTS: A total of 65 independent community pharmacists from 191 pharmacies returned the survey. The majority of independent community pharmacists were "interested" or "very interested" (83.8%) in participating in a CPRN. Respondents were willing to participate for a mean (±SD) of 6.5 ± 5.8 hours per week. However, they reported only being able participate in a CPRN for 5.2 ± 4.1 hours per week, with time being the greatest limitation to participation. An overwhelming percentage of respondents (92.1%) were interested in learning more about opportunities to participate in a CPRN in the future. CONCLUSION: CPRNs are an emerging interest in community pharmacy practice. A CPRN is an opportunity for independent community pharmacies to collaborate and use resources as a group to conduct research to solve issues in the community pharmacy setting.

Patient interpretations of prescription order quantitative statements.

OBJECTIVES: To characterize the variability in patient understanding and interpretation of quantitative statements from prescription orders and to evaluate the influence of sociodemographic characteristics on how patients interpret quantitative statements. METHODS: Participants were recruited in both a clinic and pharmacy setting in Kentucky. Patients were given a survey that asked for general background information and two questions pertaining to their experience with topical products. Then, patients were read a scenario and asked to use a provided tube of cream and squeeze out what they considered a small amount. RESULTS: 100 eligible patients participated in the study, with the majority having previous counseling on the use of topical products. The mean (±SD) cream weight representing a small amount was 0.36 ± 0.50 g. Regression analysis demonstrated a significant nonlinear relationship for two of the patient characteristics, age and body mass index (BMI), with the greatest effect in the middle of age and BMI distributions (at approximately age 50 years and BMI 30 kg/m²). No evidence indicated that gender, race, education, or previous experience with or education about topical products had any effect on cream weight perception. CONCLUSION: Patients demonstrated tremendous variability in the interpretation of a small amount of topical product cream. Further research should be conducted to determine whether policy changes are warranted to require more specific prescription order instructions in the outpatient setting.

Outcomes from DiabetesCARE: a pharmacist-provided diabetes management service.

OBJECTIVE: To describe outcomes attained by the DiabetesCARE component of the PharmacistCARE program, which is an innovative pharmacy practice model implemented within a self-insured employer. DESIGN: Descriptive nonexperimental study. SETTING: University of Kentucky (UK), from March 2003 through December 2006. PATIENTS: 236 patients with diabetes (95% with type 2 diabetes). INTERVENTION: Three clinical pharmacists provided UK Health Plan (UKHP) members with diabetes with comprehensive disease state and medication therapy management. MAIN OUTCOME MEASURES: Clinical outcomes included glycosylated hemoglobin (A1C), fasting lipid panels, blood pressure, weight, vaccination rates, and aspirin use. Humanistic outcomes included the mental and physical components of the 12-Item Short-Form Health Survey (SF-12) and patient satisfaction with health services related to their diabetes care. Screening parameters included the proportion of patients meeting Healthcare Effectiveness Data and Information Set expectations for patients with diabetes. Productivity and health resource use were also assessed based on patient responses to survey questions. RESULTS: After 1 year of enrollment, patients in the DiabetesCARE program achieved improved clinical outcomes compared with baseline, as evidenced by statistically significant reductions in A1C, low-density lipoprotein cholesterol, triglycerides, and total cholesterol. Statistically significant increases were seen in high-density lipoprotein cholesterol and the proportion of patients obtaining influenza vaccine, yearly screenings for lipid level assessment, screenings for kidney disease, and eye examinations. The mental component score of the SF-12 was significantly increased. Patients were highly satisfied with the DiabetesCARE service, and satisfaction with their overall diabetes care within UKHP was significantly enhanced. Based on the patient provided survey data analyzed here, productivity and health resource use were unchanged; however, additional analyses using UKHP claims data are ongoing. CONCLUSION: The DiabetesCARE program is a unique pharmacist-provided service delivered in a freestanding pharmacist clinic that enhances health outcomes for adult members with diabetes in a self-insured employer group.

PharmacistCARE: description of a pharmacist care service and lessons learned along the way.

OBJECTIVE: To describe the PharmacistCARE program, an innovative pharmacy practice model implemented within a self-insured employer and to describe lessons learned by the authors in implementing and maintaining the program. SETTING: University of Kentucky (UK), March 2003 to present. PRACTICE DESCRIPTION: A free-standing pharmacist clinic located within an ambulatory care facility owned by UK HealthCare. PRACTICE INNOVATION: PharmacistCARE, a pharmacist-provided patient care service for UK Health Plan members that includes comprehensive disease and medication therapy management. MAIN OUTCOME MEASURES: Various lessons learned by the authors during development, implementation, and maintenance of the program. RESULTS: The program has been recognized by the university as a positive contribution to health plan service enhancement and cost savings and has documented enhanced patient care outcomes. CONCLUSION: The PharmacistCARE program is a unique pharmacist-provided service delivered in a free-standing pharmacist clinic that enhances health outcomes for adult members in a self-insured employer group.

Dual degree programs at the University of Kentucky College of Pharmacy.

The rapid growth and evolution of the pharmacy profession has created a wide array of opportunities for graduating pharmacists beyond traditional community pharmacy or hospital practice. Management and leadership positions in federal and state healthcare agencies, pharmaceutical companies, hospitals, retail pharmacies, academia and managed care organizations increasingly require the pharmaceutical knowledge obtained through a doctor of pharmacy (PharmD) degree combined with financial, organizational, and management skills. In these innovative positions, pharmacists are being called upon to assume responsibilities as executives and administrators in systems providing pharmacist care services to patients. To endow students with knowledge and skills required to perform the duties required in these decision-making positions, the University of Kentucky College of Pharmacy has established 3 joint degree programs: the PharmD/Master of Business Administration (PharmD/MBA), PharmD/Master of Public Administration (PharmD/MPA), and PharmD/Master of Science in Economics (PharmD/MS). This paper describes these joint degree programs.

Association between preference-based health-related quality of life and asthma severity.

BACKGROUND: Preference-based measures of health-related quality of life (HRQL) focus on choice and strength of preference for health outcomes. If the value people attach to the health improvement they receive from medical treatments for asthma is known, preference-based measures can be used in cost-effectiveness analyses to aid resource allocation decisions. International guidelines have been developed to guide medical management according to asthma severity defined by lung function and symptom frequency. OBJECTIVE: To test the hypothesis that preferences correlate with asthma severity and that the relationships vary among the preference instruments used and the components of asthma severity studied. METHODS: Preferences for subjects' health states were measured using (1) a rating scale (RS), (2) standard gamble (SG), (3) time tradeoff (TTO), (4) Health Utilities Index 3 (HUI3), and (5) Asthma Symptom Utility Index (ASUI). We measured level of airways obstruction by forced expiratory volume in 1 second (FEV1) and symptom frequency of cough, wheeze, dyspnea, and nighttime awakening. Asthma severity was defined by either percentage of predicted FEV1 or symptom frequency. RESULTS: One hundred adults with asthma were studied. Preference scores were lowest for the HUI3 (mean, 0.57) and highest for the SG (mean, 0.91). Spearman correlations showed that the strength of the relationship between preference scores and percentage of predicted FEV1 was weak to moderate (r = 0.14-0.36). One-way analysis of variance showed that RS, TTO, and ASUI scores were significantly associated with the percentage of predicted FEV1 (P < or = .01). Both RS and HUI3 scores were significantly associated with frequency of all symptoms (P < .05). CONCLUSIONS: Preference-based measures of HRQL are correlated with asthma severity defined by lung function or symptoms. The RS was significantly associated with level of airways obstruction and all 4 symptoms evaluated, whereas the SG was not correlated with either marker of asthma severity.

Assessment of the relationship between measures of disease severity, quality of life, and willingness to pay in asthma.

OBJECTIVE: The primary objective was to evaluate the relationship between willingness-to-pay (WTP), quality-of-life (QOL), and disease-severity measures in patients with asthma. The hypothesis studied was that patients with asthma with more severe disease are willing to pay more for a hypothetical cure of asthma than those with less severe disease. DESIGN SETTING/PATIENTS AND PARTICIPANTS: One hundred patients with asthma were recruited from community pharmacies in Kentucky for 30-minute face-to-face interviews. INTERVENTIONS: Spirometry assessed objective disease severity in terms of pulmonary function, while a multiple choice question measured subjective disease severity. The Medical Outcomes Study 36-item Short Form (SF-36) health survey and Asthma Technology of Patient Experience (Asthma TyPE) measured quality of life. WTP was obtained via a dichotomous choice contingent valuation question. RESULTS: In this exploratory evaluation, WTP was significantly related to both objective disease severity (p = 0.02) and subjectively assessed disease severity (p = 0.01). For objective disease severity the mean monthly WTP was dollars US90 for mild asthma, dollars US131 for moderate asthma and dollars US331 for severe asthma and for subjective disease severity the mean monthly WTP was dollars US48 for mild asthma, dollars US166 for moderate asthma and dollars US241 for severe asthma. CONCLUSIONS: The results suggest that the WTP for a cure from asthma is related to both objective and subjective disease severity. These findings contribute to the case for construct validity of the dichotomous choice contingent valuation method in the healthcare sector.