Quantifying patient centered outcomes associated with the use of bilateral endobronchial coil treatment in patients with severe emphysema.

OBJECTIVE: To determine the impact of endobronchial coils on health-related quality-of-life (HRQoL). This paper utilizes trial data to identify the predictors of HRQoL in patients with severe emphysema, and subsequently estimates the impact of a new treatment on HRQoL (measured by utilities). These utility estimates are used to generate indicative long-term QALY estimates for a range of clinically plausible scenarios as a precursor to cost-effectiveness analyses. METHODS: Patient level HRQoL data from RENEW and the National Emphysema Treatment Trial (NETT) were combined and mapped to generic EuroQol 5-dimension health utility questionnaire (EQ-5D) values using a published algorithm. Multilevel statistical models were developed using treatment, time, response, and baseline characteristics (EQ-5D, age, gender, FEV1, lung RV) to predict EQ-5D over time. Lifetime QALY estimates were generated using published survival data from NETT (assuming no impact of treatment on mortality) and four clinically plausible response profiles. Each response profile was combined with assumptions around treatment impact (constant or time varying). RESULTS: After controlling for baseline characteristics, both treatment and response had a statistically significant impact (p < .001) on utility (+0.101 and +0.061, respectively). When combined with selected baseline characteristics and time, Coils and Standard of Care (SoC) generated more QALYs than SoC alone in all scenarios, with incremental lifetime benefit ranging from 0.29-0.55 QALYs. CONCLUSIONS: Coils and SoC resulted in statistically significant improvements in HRQoL compared to SoC alone in patients with severe emphysema.

Economic Burden of Chronic Conditions Among Survivors of Cancer in the United States.

Purpose The prevalence of cancer survivorship and chronic health conditions is increasing. Limited information exists on the economic burden of chronic conditions among survivors of cancer. This study examines the prevalence and economic effect of chronic conditions among survivors of cancer. Methods Using the 2008 to 2013 Medical Expenditure Panel Survey, we present nationally representative estimates of the prevalence of chronic conditions (heart disease, high blood pressure, stroke, emphysema, high cholesterol, diabetes, arthritis, and asthma) and multiple chronic conditions (MCCs) and the incremental annual health care use, medical expenditures, and lost productivity for survivors of cancer attributed to individual chronic conditions and MCCs. Incremental use, expenditures, and lost productivity were evaluated with multivariable regression. Results Survivors of cancer were more likely to have chronic conditions and MCCs compared with adults without a history of cancer. The presence of chronic conditions among survivors of cancer was associated with substantially higher annual medical expenditures, especially for heart disease ($4,595; 95% CI, $3,262 to $5,927) and stroke ($3,843; 95% CI, $1,983 to $5,704). The presence of four or more chronic conditions was associated with increased annual expenditures of $10,280 (95% CI, $7,435 to $13,125) per survivor of cancer. Annual lost productivity was higher among survivors of cancer with other chronic conditions, especially stroke ($4,325; 95% CI, $2,687 to $5,964), and arthritis ($3,534; 95% CI, $2,475 to $4,593). Having four or more chronic conditions was associated with increased annual lost productivity of $9,099 (95% CI, $7,224 to $10,973) per survivor of cancer. The economic impact of chronic conditions was similar among survivors of cancer and individuals without a history of cancer. Conclusion These results highlight the importance of ensuring access to lifelong personalized screening, surveillance, and chronic disease management to help manage chronic conditions, reduce disruptions in employment, and reduce medical expenditures among survivors of cancer.

Burden of smoking on quality of life in patients with chronic obstructive pulmonary disease.

The objective of this study was to assess the impact of smoking on health-related quality of life, Work Productivity and Activity Impairment (WPAI) in chronic obstructive pulmonary disease (COPD) patients. Respondents of the 2009/2010 US National Health and Wellness Survey (NHWS), aged ≥ 40 years, with COPD, chronic bronchitis or emphysema, were included in the study. Current and former (had not smoked for ≥ 11 years) smokers were compared. Physical component summary (PCS) and mental component summary (MCS) scores from the Short Form-12 version 2 (SF-12v2), health utilities (SF-6D) and WPAI were evaluated. Differences between current (n = 1685) and former (n = 1932) smokers were revealed: MCS (44.80, 46.73; p < 0.01); PCS (35.12, 35.79; p < 0.1); SF-6D (0.63, 0.65; p < 0.05). WPAI: presenteeism (23%, 18%; p < 0.05); work impairment (25%, 21%; p < 0.05); activity impairment (52%, 49%; p < 0.01). In conclusion, COPD patients who smoke have poorer health-related quality of life, impaired productivity and higher healthcare costs than former smokers.

Tobacco-related chronic illnesses: a public health concern for Jamaica.

BACKGROUND: Tobacco use is a leading cause of preventable morbidity and mortality from non-communicable diseases. The objectives of the study were to determine the percentage of annual income used to purchase tobacco-related products and treat tobacco-related illnesses, and assess the characteristics of smokers and their awareness of the health-related risks of smoking. METHOD: Stratified and snowball sampling methods were used to obtain information (via a 17-item, close-ended questionnaire) from 85 adult respondents (49 males and 36 females). The instrument comprised of demographic characteristics, smoking behavioural/lifestyle, health, and micro socio-economics. RESULTS: There were no significant differences between individuals who were affected by chronic obstructive pulmonary disorder (COPD) (14.1%) and cardiovascular disease (18.8%). It was found that respondents spend 30-39% of their annual income on tobacco-related products. Forty percent (40.0%) and 41.7% of respondents with lung cancer and COPD respectively spend more than 50% of their annual income to treat these diseases. The majority (80%) of those who continues to consume tobacco-related products were uncertain as to why they were doing it. Not all the smokers were aware of the dangers of tobacco consumption despite their level of education. CONCLUSION: The majority of the respondents who had tobacco-related illnesses such as lung cancer and COPD spend a significant amount of their income on their health care. Not all the smokers were aware of the dangers of tobacco consumption despite their level of education. This suggests the need for increase public awareness where both smokers and non smokers are being fully or adequately informed about the dangers or health risks of tobacco consumption.

[Silicosis or chronical obstructive bronchitis/emphysema as compensatory occupational disease]. / Silikose oder chronische obstruktive Bronchitis/Emphysem als entschädigungspflichtige Berufskrankheit?

We report on a 73-year-old man, who developed chronical bronchitis after 15 years of working as a coal miner. About 3 decades later a manifest COPD, and additionally a silicosis, were diagnosed. The silicosis was rated as an accepted case for the hazard insurance, but not as a reason for pension. The reasoning for the declining of pension for the applicant is refuted by the literature which defines occupational diseases and is generally accepted by the legislation. In this case the insurance argued that in low- to medium-grade spread of silicosis functional deficits of the lung and/or the cardio-vascular system are not to be expected. Thus the recognition and recompensation of a BK 4101 (grinders' disease, silicosis) was proposed, in contrast to the social court which demanded an expert's opinion on causality.

Evidence, economics, and emphysema: Medicare's long journey with lung volume reduction surgery.

Use of lung volume reduction surgery (LVRS) increased in the mid-1990s as a palliative therapy for severe emphysema. Rapid growth in procedure volume despite little evidence supporting its safety and effectiveness prompted the Centers for Medicare and Medicaid Services (CMS) to suspend payments and cosponsor a nationwide randomized controlled trial to evaluate the procedure. In this paper we describe the trial and its influence on the CMS's recent coverage decision for LVRS. We describe the implications of this study for evidence-based evaluation of surgical procedures and Medicare's potential role in evaluating experimental treatments that affect its beneficiaries.

[Recent results in emphysema research]. / Neue Ergebnisse der Emphysemforschung.

The incidence as well as the medical, social and economic importance of lung emphysema are evaluated. Results of experimental emphysema research, including the author's own investigations on rats are discussed. Inhalation of tobacco smoke is one of the most important etiologic factors. The pathogenetic role of endogenous enzymes, in particular protease-antiprotease imbalance, is elaborated. The survey is completed with the reference of prophylactic investigations and with an outlook on the main points of future research.

Maintaining the lung disease patient at home.

A pilot home care program for lung disease patients has been set up by a lung association, in conjunction with local hospitals and home care agencies. The emphasis is on long-term care and support of services for which home care agencies would not ordinarily be reimbursed.