Introduction Surgical site infections (SSIs) are among the most common and potentially serious complications after surgery. Staphylococcus aureus is a virulent pathogen frequently identified as a cause of SSI. As vaccines and other infection control measures are developed to reduce SSI risk, cost-utility analyses (CUA) of these interventions are needed to inform resource allocation decisions. A recent systematic review found that available SSI utilities are of “questionable quality.” Therefore, the purpose of this study was to estimate the disutility (i.e., utility decrease) associated with SSIs. Methods In time trade-off interviews, general population participants in the UK (London, Edinburgh) valued health states drafted based on literature and clinician interviews. Health states described either joint or spine surgery, with or without an SSI. The utility difference between otherwise identical health states with and without the SSI represented the disutility associated with the SSI. Results A total of 201 participants completed interviews (50.2% female; mean age = 46.2 years). Mean (SD) utilities of health states describing joint and spine surgery without infections were 0.79 (0.23) and 0.78 (0.23). Disutilities of SSIs ranged from − 0.03 to − 0.32, depending on severity of the infection and subsequent medical interventions. All differences between corresponding health with and without SSIs were statistically significant (all p < 0.001). Conclusion The preference-based SSI disutilities derived in this study may be used to represent mild and serious SSIs in CUAs assessing and comparing the value of vaccinations that may reduce the risk of SSIs. Electronic supplementary material The online version of this article (10.1007/s10198-019-01036-3) contains supplementary material, which is available to authorized users.
Declaration of funding This study and the resulting manuscript was funded by Amgen (Thousand Oaks, CA). Declaration of financial/other relationships Three of the authors were employed by Amgen at the time this study was initiated (Mutebi, Pinto, Viswanathan). Five of the authors were employed by Evidera, an independent company that received funding from Amgen for time spent conducting this study (Bender, Jordan, Kim, Matza, Stewart). The other authors received funding for time spent on this research (Brazier, Kircik, Menter). All aspects of the study design, interpretation, and decision to submit for publication were determined by the authors.
PurposeDespite benefits of antiretroviral therapies (ART), people with HIV infection have increased risk of cardiovascular disease, kidney disease, and low bone mineral density. Some ARTs increase risk of these events. The purpose of this study was to examine patients’ perspectives of these risks and estimate health state utilities associated with these risks for use in cost-utility models.MethodsQualitative thematic analysis was conducted to examine messages posted to the POZ/AIDSmeds Internet community forums, focusing on bone, kidney, and cardiovascular side effects and risks of HIV/AIDS medications. Then, health state vignettes were drafted based on this qualitative analysis, literature review, and clinician interviews. The health states (representing HIV, plus treatment-related risks) were valued in time trade-off interviews with general population participants in the UK.ResultsQualitative analysis of the Internet forums documented patient concerns about ART risks, as well as treatment decisions made because of these risks. A total of 208 participants completed utility interviews (51.4% female; mean age 44.6 years). The mean utility of the HIV health state (virologically suppressed, treated with ART) was 0.86. Adding a description of risk resulted in statistically significant disutility (i.e., utility decreases): renal risk (disutility = −0.02), bone risk (−0.03), and myocardial infarction risk (−0.05).ConclusionsPatient concerns and treatment decisions were documented via qualitative analysis of Internet forum discussions, and the impact of these concerns was quantified in terms of health state utilities. The resulting disutilities may be useful for differentiating among ARTs in economic modeling of treatment for patients with HIV.
ClinicalTrials.gov; No.: NCT01880177; URL: www.clinicaltrials.gov.
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