Background-The Panel on Cost-Effectiveness in Health and Medicine has called for an "off-theshelf" catalogue of nationally representative, community-based preference scores for health states, illnesses, and conditions. A previous review of cost-effectiveness analyses found that 77% did not incorporate community-based preferences, and 33% used arbitrary expert or author judgment. These results highlight the necessity of making a wide array of appropriate, community-based estimates more accessible to cost-effectiveness researchers.

OBJECTIVE -Given the risk of obesity and diabetes in the U.S., and clear benefit of exercise in disease prevention and management, this study aimed to determine the prevalence of physical activity among adults with and at risk for diabetes.RESEARCH DESIGN AND METHODS -The Medical Expenditure Panel Survey is a nationally representative survey of the U.S. population. In the 2003 survey, 23,283 adults responded when asked about whether they were physically active (moderate or vigorous activity, Ն30 min, three times per week). Information on sociodemographic characteristics and health conditions were self-reported. Additional type 2 diabetes risk factors examined were age Ն45 years, non-Caucasian ethnicity, BMI Ն25 kg/m 2 , hypertension, and cardiovascular disease.RESULTS -A total of 39% of adults with diabetes were physically active versus 58% of adults without diabetes. The proportion of active adults without diabetes declined as the number of risk factors increased until dropping to similar rates as people with diabetes. After adjustment for sociodemographic and clinical factors, the strongest correlates of being physically active were income level, limitations in physical function, depression, and severe obesity (BMI Ն40 kg/m 2 ). Several traditional predictors of activity (sex, education level, and having received past advice from a health professional to exercise more) were not evident among respondents with diabetes.CONCLUSIONS -The majority of patients with diabetes or at highest risk for developing type 2 diabetes do not engage in regular physical activity, with a rate significantly below national norms. There is a great need for efforts to target interventions to increase physical activity in these individuals.

The preference-based chronic condition scores reported in this research are nationally representative and may be useful to researchers to calculate quality-adjusted life-years for cost-effectiveness analyses and population-based burden of illness studies without the difficulty of primary data collection. Further research is necessary to validate these scores in condition-specific studies.

. This research provides community-based EQ-5D index scores for a wide variety of chronic conditions that can be used to estimate QALYs in cost-effectiveness analyses in the UK. Although using EQ-5D questionnaire responses from the US-based MEPS is less than ideal, the estimates approximate HRQL guidelines by NICE and provide an easily accessible"off-the-shelf" resource for cost-effectiveness and public-health applications.

OBJECTIVE -Obesity and physical inactivity are established risk factors for type 2 diabetes and cardiovascular comorbidities. Whether adiposity or fitness level is more important to health is controversial. The objective of this research is to determine the relative associations of physical activity and BMI with the prevalence of diabetes and diabetes-related cardiovascular comorbidities in the U.S. RESULTS -The likelihood of having diabetes and diabetes-related cardiovascular comorbidities increased with BMI regardless of physical activity and increased with physical inactivity regardless of BMI. Compared with normal-weight active adults, the multivariate-adjusted odds ratio (OR) for diabetes was 1.52 (95% CI 1.25-1.86) for normal-weight inactive adults and 1.65 (1.40 -1.96) for overweight inactive adults; the OR for diabetes and comorbid hypertension was 1.71 (1.32-2.19) for normal-weight inactive adults and 1.84 (1.47-2.32) for overweight inactive adults. RESEARCH DESIGN AND METHODSCONCLUSIONS -Both physical inactivity and obesity seem to be strongly and independently associated with diabetes and diabetes-related comorbidities. These results support continued research investigating the independent causal nature of these factors. Diabetes Care 28:1599 -1603, 2005T he prevalence of diabetes has been significantly increasing in the U.S.(1). Current estimates suggest that 6 -8% of adults have diabetes, with the true prevalence likely closer to 10% when undiagnosed diabetes is also considered (2-4). Importantly, the prevalence of diabetes has increased nearly 50% over the last decade; Ͼ5 million U.S. adults are newly suffering from the disease (1,3). The burden of diabetes is significant in terms of human and economic costs and is expected to increase in the future (2,5,6).Obesity and physical inactivity are well-established risk factors for the development of type 2 diabetes (7-11). It is estimated that for every 1-kg increase in weight, the prevalence of diabetes increases by 9% (1). Physical inactivity is associated with increased insulin resistance and poorer glycemic control independent of body weight (12).Evidence from randomized controlled trials on three continents has clearly demonstrated that maintenance of modest weight loss through diet and physical activity reduces the incidence of type 2 diabetes in high-risk individuals by ϳ40 -60% over 3-4 years (13-16). Lifestyle improvements, including weight control and increased physical activity, are also the cornerstone of diabetes management (11,12).However, despite the known association of obesity and inactivity with diabetes-related morbidity and mortality, there is limited national data reporting the independent association of each risk factor with the prevalence of diabetes and related cardiovascular comorbidities in the U.S. population. The objective of this study was to determine the relative prevalence of diabetes and related cardiovascular comorbidities among overweight and inactive adults in a nationally representative population. RESEARCH DESIGN AN...

Although previous research has documented the deleterious effect of continuous OCS exposure in patients with severe asthma, our results suggest that each OCS prescription might result in a cumulative burden on current and future health regardless of dose and duration. OCS-sparing strategies are extremely important to improve patient outcomes.

Background-Previous mapping algorithms estimating EQ-5D index scores from the SF-12 were based on preferences from a UK community sample. However, preferences based on the general US population are most appropriate for cost-effectiveness analyses done from the societal perspective in the United States.

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