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Background: Immunization programs may collect numerator data for the estimation of pneumococcal vaccine coverage, but program evaluators do not have appropriate denominator data for estimation of pneumococcal vaccine coverage, particularly among those eligible for vaccine on the grounds of having chronic health conditions. Methods: We partitioned the Alberta population into 6 mutually exclusive groups, all but one of which met Canadian recommendations for pneumococcal vaccination. Age-sex specific prevalence rates for each group were estimated using data on chronic health conditions from the Alberta over-sample of the 1996 Household component of the National Population Health Survey, from Alberta Health and Wellness rosters of nursing home residents, and from the Alberta Health Care Insurance Plan Stakeholder Registry. We applied these to Alberta Population Projections to estimate the numbers of persons who should be vaccinated. Results:The proportion of persons recommended for vaccination on the grounds of chronic health condition ranged from 1.5% among those aged less than 12 years to 36% among persons aged 80 years or older. The total number of persons recommended for vaccination at mid-year 2000 is estimated to be 638,561 (21.5% of the Alberta population).Interpretation: This methodology provides denominators for the estimation of pneumococcal vaccine coverage and permits monitoring of local and regional progress towards national goals.La traduction du résumé se trouve à la fin de l'article.
Background: Immunization programs may collect numerator data for the estimation of pneumococcal vaccine coverage, but program evaluators do not have appropriate denominator data for estimation of pneumococcal vaccine coverage, particularly among those eligible for vaccine on the grounds of having chronic health conditions. Methods: We partitioned the Alberta population into 6 mutually exclusive groups, all but one of which met Canadian recommendations for pneumococcal vaccination. Age-sex specific prevalence rates for each group were estimated using data on chronic health conditions from the Alberta over-sample of the 1996 Household component of the National Population Health Survey, from Alberta Health and Wellness rosters of nursing home residents, and from the Alberta Health Care Insurance Plan Stakeholder Registry. We applied these to Alberta Population Projections to estimate the numbers of persons who should be vaccinated. Results:The proportion of persons recommended for vaccination on the grounds of chronic health condition ranged from 1.5% among those aged less than 12 years to 36% among persons aged 80 years or older. The total number of persons recommended for vaccination at mid-year 2000 is estimated to be 638,561 (21.5% of the Alberta population).Interpretation: This methodology provides denominators for the estimation of pneumococcal vaccine coverage and permits monitoring of local and regional progress towards national goals.La traduction du résumé se trouve à la fin de l'article.
An important weakness of economic models in the field of osteoporosis has been the dependence on assumptions or expert judgements rather than empirical estimates for the utility values of key health events associated with osteoporosis such as hip, vertebral, wrist fracture and established osteoporosis. This paper seeks to identify the best available utility estimates for health states associated with osteoporosis and make recommendations about their use. It is based on a systematic search of the main literature databases. Studies meeting inclusion criteria have been reviewed in terms of the appropriateness of the valuation technique, the validity of the descriptive system (if one was used), the number and type of respondents, and overall quality of the study. Twenty three estimates of health state values (HSVs) were found across the four conditions from five studies. These empirical estimates were found to differ significantly from the commonly used assumptions in economic evaluation, but with a wide variation between estimates for the same state (0.32 to 0.80 for vertebral fracture states). This variation can be partly explained by the valuation technique, health state description and the background and perspective of respondent, and leaves scope for considerable discretion that could be abused. There are also problems in using values obtained from the study populations to those in economic models and the difficulty of predicting health state values in those who avoid a fracture. The review recommends a set of health state values as part of a "reference case" for use in economic models. Due to the paucity of good quality of estimates in this area, further recommendations are made regarding the design of future studies to collect HSVs relevant to economic models.
It seems generally believed that the HUI3 is a more responsive utility measure than the EQ-5D because of the crude level structure of the EQ-5D compared to the HUI3.As empirical evidence to support this hypothesis is lacking, we undertook a study to compare the construct validity of the utility indices of the EQ-5D index and the HUI3 index in 135 patients treated for congenital anorectal malformation and 57 patients treated for congenital diaphragmatic hernia.Discriminant validity was tested by the ability of the HUI3 index and EQ-5D index to distinguish clinically relevant subgroups in the patient populations.Convergent validity was tested using Pearson correlations of the HUI3 index and the EQ-5D index with the symptom scores.In general the index scores were in line with expectations: the higher the level of symptomaticity, the lower the indices.The HUI3 classified patients in more health states than the EQ-5D and classified a smaller percentage in the best health state.Nevertheless, the EQ-5D index distinguished more clinically relevant subgroups than the HUI3 index . The two indices were correlated weakly to moderately with the symptom scores, which was expected given the relatively good quality of life of the patients.Despite the higher number of health states of the HUI, the EQ-5D index discriminated more clinically relevant subgroups than the HUI3 index .This means that discriminative power of the utility indices is not determined merely by the number of health states of the underlying classification system.Differences in the description of the health states might explain this finding.
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