Evaluation of quality of life and priorities of patients with glaucoma.

PURPOSE: To investigate the quality of life and priorities of patients with glaucoma. METHODS: Patients diagnosed with glaucoma and no other ocular comorbidity were consecutively recruited. Clinical information was collected. Participants were asked to complete three questionnaires: EuroQuol (EQ-5D), time tradeoff (TTO), and choice-based conjoint analysis. The latter used five-attribute outcomes: (1) reading and seeing detail, (2) peripheral vision, (3) darkness and glare, (4) household chores, and (5) outdoor mobility. Visual field loss was estimated by using binocular integrated visual fields (IVFs). RESULTS: Of 84 patients invited to participate, 72 were enrolled in the study. The conjoint utilities showed that the two main priorities were "reading and seeing detail" and "outdoor mobility." This rank order was stable across all segmentations of the data by demographic or visual state. However, the relative emphasis of these priorities changed with increasing visual field loss, with concerns for central vision increasing, whereas those for outdoor mobility decreased. Two subgroups of patients with differing priorities on the two main attributes were identified. Only 17% of patients (those with poorer visual acuity) were prepared to consider TTO. A principal component analysis revealed relatively independent components (i.e., low correlations) between the three different methodologies for assessing quality of life. CONCLUSIONS: Assessments of quality of life using different methodologies have been shown to produce different outcomes with low intercorrelations between them. Only a minority of patients were prepared to trade time for a return to normal vision. Conjoint analysis showed two subgroups with different priorities. Severity of glaucoma influenced the relative importance of priorities.

Conjoint analysis of French and German parents' willingness to pay for meningococcal vaccine.

OBJECTIVE: To estimate the willingness of parents in France and Germany to pay for meningococcal conjugate vaccines for their teenage children. METHODS: A conjoint analysis survey was administered to parents who had received counselling on the nature and risks of meningococcal disease in young people. In each country, half were randomly assigned to view a video with graphical depictions of the effects of meningococcaemia. Subjects were then shown a series of 18 sets of three vaccine descriptions. Each description listed the price of a hypothetical vaccine (range 15-304 euro; 2001 values), the duration of protection, and the number of serogroups of the bacteria covered. The survey asked which vaccine they preferred and whether they would buy it. Conditional logit and generalised linear-random effects logit models assessed the effect of product attributes, personal background and video viewership on the probability of indicating a purchase. RESULTS: 92.6% of subjects would purchase at least one of the vaccines they encountered. Price elasticity ranged from -1.20 (France) to -2.48 (Germany). Exposure to graphical depictions of disease consequences negligibly increased the overall willingness to purchase vaccine in French participants, but lowered the overall willingness in German participants. CONCLUSION: In Germany and France, where there is still limited out-of-pocket health spending, the majority of sampled respondents stated that they would purchase meningococcal vaccines with their own money.

Features of asthma management: quantifying the patient perspective.

BACKGROUND: In the management of asthma, features of care important to patients may not be fully appreciated. This study quantifies the importance of different features of asthma management from the patient perspective. This may assist in the development of personalised management strategies. METHODS: We used the technique of discrete choice experiment (DCE). Patients over 18 years of age with asthma, prescribed and taking medicine at step 3 of the UK guidelines were recruited from 15 general (family) practices in three areas of the UK. 147 evaluable questionnaires were returned from a total of 348 sent out. The outcome measures were the relative importance to patients of features of asthma management and the impact of changes in asthma management, as measured by utility shift between the features tested. RESULTS: The largest shift in mean utility values was recorded in "number of inhalers" and "use of inhaled steroid". Use of a personal asthma action plan was ranked next highest. CONCLUSION: This study suggests that adults with moderate or severe asthma would trade some improvements in symptom relief in favour of, for example, simpler treatment regimens that use as few inhalers as possible and a lower dose of inhaled steroid.