Utility weights study in TOP 5 diseases in Thailand. W. Thanawat MD.,M.P.A.

1. Utility weights study in TOP 5 diseases in Thailand. W. Thanawat MD.,M.P.A.

3. II. Quality of life measurement Quality of life was measured by using the EuroQol (EQ-5D) in Thai version (see appendix). The descriptive system of the EQ-5D recorded quality of life in five dimensions: mobility, self-care, usual activities (such as work, study, housework, and family or leisure activities), pain or discomfort, and anxiety-depression. Each dimension is divided into three response levels: no problems, some or moderate problems, and extreme problems or inability to perform the activity. The responses on these five dimensions are weighted on a scale where 0.0 = death and 1.0 = perfect health. Interviewing technique was used by our trained staffs to accommodate patients to complete this questionnaire.

4. ?????????????????HIV ????????. ?????????????????????????(Anti Retro Viral drug) ??????????? ????????????????????????????????????? ??????????? ????????????????? CD 4+ lymphocyte ,??????????????????? ?????????????????????(Plasma Viral Load) Cunningham WE et al(2005)[i] ?????????????????????????????? HIV ???????????????? ????? CD4 ????????????????????????????? ?????? HR-QOL ????????????????? William C Mathews and Susanne May(2007)[ii] ?????????? EQ-5D ????????????????????????????????????????????????? ??????????? ????????? ???????????? ??????????????? ?????????????? ????????????????????????????????????? ???????????????????????????????????????????????????????????????????????? ??????????????? [i] Cunningham WE ,Crystal S, Bozzette S, Hays RD: The association of health-related quality of life with survival among persons with HIV infection in the United States. J Gen Intern Med 2005, 20(1):21-27. [ii] William C Mathews and Susanne May: EuroQol (EQ-5D) measure of quality of life predicts mortality,emergency department utilization, and hospital discharge rates in HIV-infected adults under care,Biomed Central 2007

5. ?????????????????HIV ????????.(2) ????????????????????????????????????????????????????????? HIV/ADIS ??????????????????????? Medical Outcomes Study HIV Health Survey (MOS-HIV) ?????????????? SF-20[i] ??????????????? 30 ??????????????[ii] ??????????????????????????????????? HIV[iii] ????????????????????????????????????? MOS-HIV ??? EQ-5D,EQ-5D-VAS,HUI3 ??? 0.6-0.75 ???????? EQ-5d ??? HUI3 ???????????? 0.73[iv] [i] Stewart AL, Hays RD, Ware JE ,Jr. (1988) The MOS short-form general health survey: reliability and validity in a patient population. Medical Care; 26:724-735. [ii] Wu AW, Rubin HR, Mathews WC, et al. (1991). A health status questionnaire using 30 items from the Medical Outcomes Study: preliminary validation in persons with early HIV infection. Medical Care; 29:786-798. [iii]Albert W. Wu MOS-HIV Health Survey Users Manual 1999 http://chipts.ucla.edu/assessment/pdf/assessments/MOS-HIV%20Users%20Manual%20%20Draft.pdf [iv] Joyce, Vilija R MS*; Barnett, Paul G PhD*; Bayoumi, Ahmed M MD, et al. Health-Related Quality of Life in a Randomized Trial of Antiretroviral Therapy for Advanced HIV Disease JAIDS Journal of Acquired Immune Deficiency Syndromes:Volume 50(1)1 January 2009pp 27-36

6. ?????????????????HIV ????????.(3) ????????????????????????????????????? HIV ??????????????? ????????????????????? MOS-HIV ??????? ????????????????????????? ?????????????? ???? internal consistency and discriminant validity ??????? 93.8 and 97.4% ????????????????????????????? ?????????? 50.7 - 61.5[i] [i] Masao Ichikawa1, Chawalit Natpratan Quality of life among people living with HIV/AIDS in northern Thailand: MOS-HIV Health Survey Quality of Life Research 13: 601�610, 2004.

7. ?????????????????HIV ????????.(4) ????????????????????? ??????????????? ?????????????????? ????????????????? HIV ??? CD4<100 ?????????????????? EQ-5D score ??? HIV-MOS ??????????? ??????? 0.45 (??????????) to 0.63 (???????????) ??? EQ-VAS ?????????????????????? 0.33 (?????????) ??? 0.66 (???????????????).[i] ???????????????????? EQ-5D ?????????? HIV ,?????????????????????????????????[ii] [i] Wu A W; Jacobson K L; Frick K D Validity and responsiveness of the euroqol as a measure of health-related quality of life in people enrolled in an AIDS clinical trial. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation�2002;11(3):273-82. [ii] Kind P. Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1997; 13: 81. http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102233086.html

8. ?????????????????HIV ????????.(5) ????????????????????????????? 3 ????????????????????????? WHO ?????? 1. HIV ???????????????????????? AIDs 2. AIDs ???????????????????? 3. AIDs ??????????????????????? ??????????????????????????? Center of Disease Control(CDC) 1993

9. ?????????????????HIV ????????.(6) ?????????????????????????? ??? EQ-5D ?????????????????????????????????????????????? HIV ??? AIDs[i],[ii],[iii] ??????????????????????????????? ?????????????????????????????????????????????????????????????????????? ?????????  [i] Delate T, Coons SJ. The use of 2 health-related quality-of life measures in a sample of persons infected with human immunodeficiency virus. Clin Infect Dis 32: E47�E52. [ii] Wu AW, Jacobson KD, Frick DL, et al. Validity and responsiveness of the Euroqol as a measure of health-related quality of life in people enrolled in an AIDS clinical trial. Qual Life Res 2002; 11: 273�282. [iii] Knut Stavem et al. Comparison of preference-based utilities of the 15D, EQ-5D and SF-6D in patients with HIV/AIDS. Quality of Life Research (2005) 14: 971�980

10. ?????????????????HIV ????????.(7) 1. ???????????????????[i],10. 2. ???????? CD4+ lymphocyte3,7. 3. ????? Plasma viral load3. 4. ?????????????????????????[ii] ???????????????????????????????????????????????? ??????????????????????????????????????? ?????????????????? HRQOL[iii]. [i] BARRY D. ROSENFELD, MARY WHITE et al. Making Treatment with HIV Infection.: Decisions A Pilot Study of Patient Preferences. http://umg.umdnj.edu/smdm/pdf/17-03-307.pdf [ii] Alexander H. Miners, Caroline A. Sabin et al. Health-Related Quality of Life in Individuals Infected with HIV in the Era of HAART HIV Clin Trials 2001;2(6):484�492 [iii] Diane Franchi and Richard P. Wenzel. Measuring Health-Related Quality of Life Among Patients Infected with Human Immunodeficiency Virus. Clinical Infectious Diseases 1998;26:20�6

11. ???????????????????????? ?????????????????????????????????????? ?????? ? ???????????????????????????????????????????????????? ??????????????????????????????????? ???? ???????????????????? 3-5 ?????????? EQ-5D ??????????? 0.792 ???????? ????????????????????? 0-2 ?????????? EQ-5D ??????????? 0.870[i] [i] Susan Grandy and Kathleen M Fox EQ-5D visual analog scale and utility index values in individuals with diabetes and at risk for diabetes: Findings from the Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD) Health and Quality of Life Outcomes 2008, 6:18

12. ?????????? ? ?????????????????????????????????????????????? ????????????????????????????[i],[ii] ????????????????? 9. ?????????????????????????????????[iii],[iv]. ???????????????????????????(Fasting blood sugar)[v]. ??????????????HbA1C13. ???????????? ?????????????????? [vi] [i] Paul Glasziou*1, Jan Alexander2, Elaine Beller2, Philip Clarke3 and the ADVANCE Collaborative Group. Which health-related quality of life score? A comparison of alternative utility measures in patients with Type 2 diabetes in the ADVANCE trial. Health and Quality of Life Outcomes 2007, 5:21 doi:10.1186/1477-7525-5-21 [ii] Adrian Bagust and Sophie Beale Modelling EuroQol health-related utility values for diabetic complications fromCODE-2 data Health Econ. 14: 217�230 (2005). [iii] Louis S. Matza ? Kristina S. Boye ? Nicole Yurgin Jessica Brewster-Jordan ? Sally Mannix ? Jodi M. Shorr ? Beth L. Barber Utilities and disutilities for type 2 diabetes treatment-related Attributes Qual Life Res (2007) 16:1251�1265 [iv] Murali Sundaram1, Jan Kavookjian1, Julie Hicks Patrick2, Lesley-Ann Miller1, S. Suresh Madhavan1 & Virginia (Ginger) Scott Quality of life, health status and clinical outcomes in Type 2 diabetes patients Quality of Life Research (2007) 16: 165�177 [v] W. KEN REDEKOP, PHD et al. Health-Related Quality of Life and Treatment Satisfaction in Dutch Patients With Type 2 Diabetes Diabetes Care 25:458�463, 2002 [vi] James E Graham*1, Diane G Stoebner-May2, Glenn V Ostir3,4, Soham Al Snih1,3, M Kristen Peek3,5, Kyriakos Markides3,5 and Kenneth J Ottenbacher1,3 Health related quality of life in older Mexican Americans with diabetes: A cross-sectional study. Published: 12 July 2007 Health and Quality of Life Outcomes 2007, 5:39

13. 3. ????????????????????????????????? ???????????????????????????????????????????????????? 286,681 ???20 ??? ??????????????????????????????????????????????????????? ???????????????????????? ? ???????? ???????????????????????????????????? ?????????????????????????????? ? ????????????? ????????????????????????????????????????????????????????????????????????????????????????

14. ?????????????????????????????????????????????????????????????????????? ??????????? ???????????????????????[i] ?????????????????[ii]. ????????????[iii]. ??????????????????[iv],[v]. [i] Caroline Haacke, Astrid Althaus, Annika Spottke, Uwe Siebert, Tobias Back and Richard Dodel Stroke 2006;37;193-198; originally published online Dec 8, 2005; [ii] A. Simon Pickard, Jeffrey A. Johnson, David H. Feeny, Ashfaq Shuaib, K.C. Carriere and Abdul M. Nasser. Agreement Between Patient and Proxy Assessments of Health-Related Quality of Life After Stroke Using the EQ-5D and Health Utilities Index Stroke 2004;35;607-612; originally published online Jan 15, 2004; [iii] Jonathan W. Sturm, Geoffrey A. Donnan, Helen M. Dewey, Richard A. L. Macdonell, Amanda K. Gilligan, Velandai Srikanth and Amanda G. Thrift Quality of Life After Stroke: The North East Melbourne Stroke Incidence Study(NEMESIS). Stroke 2004;35;2340-2345; originally published online Aug 26, 2004; [iv] Gage BF, Cardinalli AB, Albers GW, Owens DK. Cost-effectiveness of warfarin and aspirin for prophylaxis of stroke in patients with nonvalvular atrial fibrillation. JAMA. 1995;274:1839 �1845. [v] Marc�Fisher, Antithrombotic and Thrombolytic Therapy for Ischemic Stroke. Journal of Thrombosis and Thrombolysis Volume 7, Number 2 / April, 1999

15. ??????????????????????? WHO ???? ????????????????????????????????????????????????????????? ????????? Transient Ischemic Attack (TIA) Reversible Ischemic Neurological Deficit (RIND) ????????????????????????????????????????????? ???????????

16. 4. ????????????????????????????? ?????????????? Global Burden Of Disease(GBD) ???????????????????????????????????? ? ???? ??????????????????????? ???????????????????????? ??????? ? ??????? ?????????????????????????????????????? GBD ????????????????????????? ??????????????????????????????????? ????????????????? ? ??????????????????????????????????? ?????????????????? ?????????????????????????????????????????????????????????????????????????????? ???????

17. ????????????????????????????????????????????????? 1 ???? ??????????????????????????????????????????????????????????????????????????? ????????????????????

18. 5. ?????????????????????????? ???????????????????????????????????????????????? ??????????????????????????????????????????????????????????????????? ??????????????????????????????????????????? ????????? ???????????????????????? ??????????????????????????????????????? ??????????????????????????? ?????????????????????????????????? GBD ??????? 2 ???????? ??????????????????? :????????????????????????(metastatic) ??????????? :????????????????? ??????????????????????????????????????????? ??? ?????????????????????

19. Study design This study is a cross-sectional study with one-time assessment of quality of life in patients with the conditions of interest.

20. III. Study population Population in this study was Thai patients with the following health conditions; Four chronic diseases; HIV, stroke, liver cancer, diabetes mellitus, Any health condition affected from the traffic accident. Total population in each health condition was estimated based on data from recent report on burden of disease in Thailand[i]. These data showed that; [i] MOPH. Burden of Disease Report, Thailand. Ministry of Public Health. Nonthaburi, 2004.

21. Prevalence of patients. Number of HIV patients number in Thailand was 572,482, Number of patients with traffic accidents was 232,447, Number of patients with stroke was 286,681, Number of patients with diabetes was 3,315,156, and Number of patients with liver cancer was 17,466.

22. Sample Size Calculation Method. The sample was obtained by using the formula of Taro Yamane as we shown below Sample size(n) = N -------------- 1 + N(e)2 Figure 3.1: Illustrate the Yamane�s sample size calculation equation. Source: Taro Yamane. 1967. Elementary Sampling Theory. Prentice Hall.

23. Number of sample size. At the confidence level = 95% and error = 0.05, sample sizes are as following; 400 patient with HIV diseases, 392 patient with Traffic accidents, 400 patients with Stroke, 400 patients with Diabetes, and 392 patients with Liver cancer.

24. Eligible criteria for patients to be included in the analysis are as following. Patients with HIV Aged = 15 years Have been clinically diagnosed having HIV or AIDS May or may not be treated with anti-retroviral therapy Patients who have Traffic accidents Aged =15 years Visited and received care in emergency unit in the studied hospitals after having accidents Patients with Stoke: Aged =15 years Have been clinically diagnosed having any type of stroke: TIA, RIND, Cerebral infraction, Cerebral hemorrhage Regularly received care and medicine in the studied hospitals

25. Patients with Diabetes Mellitus Age = 15 years Have been clinically diagnosed having any type of DM Regularly received care and medicine in the studied hospitals Patients with Liver Cancer Age = 15 years Have been clinically diagnosed having Liver Cancer in any stage Regularly received care and medicine in the studied hospitals

26. IV. Sampling technique and data collection ???????????????????????????????????? ????????????????????????????????????????????????????? ???????????????????????????????????????????? ???????????????????????? ??????????????????????????????????????????????????????????????????????????????????????????????????????????? ?????????????????????????????????????????????

27. (1) ????????????????? HIV/AIDs 1.??????????????: ???????????????? ?.??????? ?.??????? 2.???????????????: ??????????????????? ?.?????????? ?.??????? 3. ??????????????: ????????????????????? ?.????? ?.??????? 4. ?????????????????????? ????????? ??????????? ?.???????

28. (2) ???????????????????????? 1.??????????????: ???????????????? ?.??????? ?.??????? 2.???????????????: ??????????????????? ?.?????????? ?. ??????? 3. ??????????????: ????????????????????? ?.????? ?.??????? 4. ???????????????????? ?????????????????? ?. ?????????????

29. (3) ????????????????????????????????? ??????????????: ????????????????????? ?.??????? ????????????????????:??????????????????? ?. ????????????? ????????????????????:?????????????????????? ?. ????????????? ????????????????????:?????????????????? ?. ?????????????

30. (4) ???????????????????????????????????????? ? ???????????????: ??????????????????? ?.??????? ??????????????: ????????????????????? ?.??????? ??????????????????????: ???????????????? ?. ????????????? ????????????????????: ?????????????????? ?. ?????????????

31. (5) ?????????????????????????? ??????????????: ????????????????????? ?.??????? ??????????????????????: ???????????????????? ?. ????????????? ????????????????????: ??????????????????? ?.????????????? ????????????????????: ?????????????????????? ?. ????????????? ????????????????????: ?????????????????? ?. ?????????????

32. V. Statistical analysis ????? utility weight ??? EQ-5D, EQ-VAS along with Dolan Algorithms.[i] [i] Dolan, P. Modeling Valuations for EuroQol Health States. Med Care. 1997;35:1095�1108.