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Could the choice of patient versus proxy ratings for assessing quality of life in dementia affect resource allocation in health care?
Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
ResearchTriangle Institute (RTI) Health Solutions, Lund.
2012 (English)In: Farmeconomia: Health economics and therapeutic pathways, ISSN 1721-6915, Vol. 13, no 1, 25-31 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this paper is to demonstrate how the choice of patient versus proxy ratings of patient health-related quality of life (HRQoL) in dementia, for use in cost-effectiveness analyses (CEAs), could potentially affect resource allocation in health care.

METHODS:A model of Alzheimer’s disease (AD) based on cognitive ability was used to assess the consequences of using HRQoL ratings from either patients themselves or proxies if a new treatment was to be introduced. The model was based on previously published data on costs related to AD stages as well as HRQoL ratings from AD patients and from their caregivers as proxy raters.

RESULTS:The results show that there can be large differences in the results of the CEAs depending on whether the ratings of patients’ HRQoL were made by the patients themselves or by the proxy. When patient self-ratings of HRQoL were used, the cost/quality-adjusted life year (QALY) gained was much higher as compared to the scenario when proxy ratings were used for the same analysis.

CONCLUSIONS: The choice of patient self-ratings compared to proxy ratings of patients’ HRQoL can have a substantial effect on the results of CEAs. These differences in results may have an important impact on decision making and, ultimately, on resource allocation. In order to critically appraise the results of CEA studies in dementia we advise that both patient and proxy ratings are used in the CEA. To decide on methodology it is of great importance that focus is directed towards determining the most valid way to measure HRQoL in AD.

Place, publisher, year, edition, pages
SEEd , 2012. Vol. 13, no 1, 25-31 p.
Keyword [en]
Patient ratings; Proxy ratings; Dementia; Quality of Life; Resource allocation
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-80152DOI: 10.7175/fe.v13i1.102OAI: oai:DiVA.org:liu-80152DiVA: diva2:545911
Note

The previous status of this article was Manuscript.

Available from: 2012-08-21 Created: 2012-08-21 Last updated: 2017-02-09Bibliographically approved
In thesis
1. Assessment of Support Interventions in Dementia: Methodological and Empirical Studies
Open this publication in new window or tab >>Assessment of Support Interventions in Dementia: Methodological and Empirical Studies
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Dementia means a continuous deterioration of abilities and has a large impact on the persons affected as well as on family members and others close to the persons with dementia. Interventions aimed at this population in order to support and alleviate the often straining situation may be of great importance. There is a need to increase the knowledge and understanding of the impact and consequences of these interventions, both at an individual level and at a societal level. The demand for information concerning, e.g., economic and medical impact of technologies and interventions within health care is increasing. Assessment of technologies and interventions in dementia is related to certain methodological issues. The overall aim of this thesis is to contribute to the development of methodological knowledge concerning assessment studies and understanding of support interventions in dementia.

This thesis work includes four studies that examine methodological aspects of assessment of support interventions in dementia and also report empirical research on the perception of support interventions from the perspectives of family caregivers of persons with dementia. In study I, an assessment model for assistive technology (AT) interventions in dementia was developed. In study II, part of the assessment model is applied, and a process evaluation of the AT intervention is presented. Study III examines family caregivers’ perception of the importance of different types of support and services. In the final study, study IV, a well‐acknowledged methodological challenge within the field of assessment in dementia is addressed: measuring health‐related quality of life (HRQoL). The studies are based on different data materials.

An assessment model of AT interventions was developed that includes health economic evaluation from a societal perspective as well as evaluation of the intervention process. The perspectives of both persons with dementia and their relatives were incorporated in the model. The process evaluation was applied in study II in order to study the relatives’ perception of an AT intervention process. Assistive technology interventions in dementia may be of great significance for the relatives. By performing the process evaluation, several important aspects that need to be acknowledged in AT intervention processes in dementia were identified.

Family caregivers of persons with dementia perceived different types of support/services within the comprehensive areas of counselling, relief and information as very important. Knowledge of the caregivers’ preferences is significant so that more directed support interventions may be provided.

One specific methodological issue was addressed in study IV. The results of study IV showed that there were large differences in the results of cost‐effectiveness analyses depending on whether patient self‐ratings or proxy ratings (ratings of persons close to the patient) of patient HRQoL were used for the same analysis. These differences in the results could ultimately have an important impact on decision making and resource allocation.

Support interventions aimed at persons with dementia and their relatives may be of great value. Conducting assessment studies of technologies and interventions within health care is important in order to increase the knowledge concerning, e.g., economic and medical impact. Assessment studies of support interventions dementia entails methodological issues that need to be addressed. There is a need for increased knowledge within this field and suggestions on methodology are made.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2010. 68 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1170
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-54312 (URN)978-91-7393-434-3 (ISBN)
Public defence
2010-04-09, Berzeliussalen, Universitetssjukhuset, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2010-03-09 Created: 2010-03-09 Last updated: 2017-07-06Bibliographically approved

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Alwin, JennyBrodtkorb, Thor-Henrik

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