Value Judgment in the Oregon Medicaid Experiment

Kaplan, Robert M.

doi:10.1097/00005650-199410000-00001

Cited by 54 publications

(26 citation statements)

References 20 publications

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“…The QWB is a generic quality of life instrument that has been widely used in clinical trials to evaluate medical and surgical therapies (9)(10)(11)(12)(13)(14). The QWB-SA was administered to DPP participants annually.…”

Section: Health Utilitiesmentioning

confidence: 99%

Within-Trial Cost-Effectiveness of Lifestyle Intervention or Metformin for the Primary Prevention of Type 2 Diabetes

2003

Diabetes Care

233

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OBJECTIVE-The Diabetes PreventionProgram (DPP) demonstrated that intensive lifestyle and metformin interventions reduced the incidence of type 2 diabetes compared with a placebo intervention. The aim of this study was to assess the cost-effectiveness of the lifestyle and metformin interventions relative to the placebo intervention.RESEARCH DESIGN AND METHODS-Analyses were performed from a health system perspective that considered direct medical costs only and a societal perspective that considered direct medical costs, direct nonmedical costs, and indirect costs. Analyses were performed with the interventions as implemented in the DPP and as they might be implemented in clinical practice. RESULTS-The lifestyle and metformin interventions required more resources than the placebo intervention from a health system perspective, and over 3 years they cost approximately $2,250 more per participant. As implemented in the DPP and from a societal perspective, the lifestyle and metformin interventions cost $24,400 and $34,500, respectively, per case of diabetes delayed or prevented and $51,600 and $99,200 per quality-adjusted life-year (QALY) gained. As the interventions might be implemented in routine clinical practice and from a societal perspective, the lifestyle and metformin interventions cost $13,200 and $14,300, respectively, per case of diabetes delayed or prevented and $27,100 and $35,000 per QALY gained. From a health system perspective, costs per case of diabetes delayed or prevented and costs per QALY gained tended to be lower. CONCLUSIONS-Over 3 years, the lifestyle and metformin interventions were effective and were cost-effective from the perspective of a health system and society. Both interventions are likely to be affordable in routine clinical practice, especially if implemented in a group format and with generic medication pricing.Intensive lifestyle and medication interventions can delay or prevent progression from impaired glucose tolerance (IGT) to type 2 diabetes (1-3). The Diabetes Prevention Program (DPP) demonstrated that compared with the placebo intervention, the intensive lifestyle intervention reduced the incidence of type 2 diabetes by 58%, and the metformin intervention reduced the incidence of type 2 diabetes by 31% over 2.8 years (3).

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Section: Health Utilitiesmentioning

confidence: 99%

Within-Trial Cost-Effectiveness of Lifestyle Intervention or Metformin for the Primary Prevention of Type 2 Diabetes

2003

Diabetes Care

233

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“…21 Further, the method has been used for health resource allocation modeling and has served as the basis for an innovative experiment on rationing of health care by the state of Oregon. 22,23 Studies have also demonstrated that the QWB is responsive to clinical change derived from surgery 14 or medical conditions such as rheumatoid arthritis, 24 AIDS, 10 and cystic fibrosis. 11 Th e QWB was developed more recently.…”

Section: Qol Measurement: Self-administered Quality Of Well-being Scalementioning

confidence: 99%

Quality of Well-being Outcomes in the National Emphysema Treatment Trial

Kaplan

Sun

Ries

2015

Chest

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“…The QWB has been used in numerous clinical trials and studies to evaluate medical and surgical therapies in conditions such as COPD (21) and several other conditions, (35)(36)(37)(38)(39). Furthermore, the method has been used for health resource allocation modeling and has served as the basis for an innovative experiment on rationing of health care by the state of Oregon (36,37).…”

Section: Quality Of Well-being Scalementioning

confidence: 99%

“…Furthermore, the method has been used for health resource allocation modeling and has served as the basis for an innovative experiment on rationing of health care by the state of Oregon (36,37). A self-administered form of the QWB (QWB-SA) is available and it now the most commonly used form of the QWB.…”

Section: Quality Of Well-being Scalementioning

confidence: 99%

“…Because the objective of all programs is to produce QALYs, the cost-QALY ratio can be used to show the relative health benefits from investing in different programs (35). Several different governments have proposed allocating resources based on systematic data (37). For example, the Australian government now requires evidence of effectiveness, as do a variety of European governments.…”

Section: Integrating Cost With Outcome Datamentioning

confidence: 99%

See 1 more Smart Citation

Health-related Quality of Life in Emphysema

Kaplan

Ries²

2008

Proceedings of the American Thoracic Society

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Patients with emphysema may experience reduced health-related quality of life (HRQOL). HRQOL measures have evolved from two different measurement traditions: psychometric theory and decision theory. Psychometric methods typically create a profile of outcomes, whereas decision theory methods offer a summary score on a continuum ranging from 0.0 (for death or worst possible health) to 1.0 (for best possible health). Decision theory methods are better suited for cost-effectiveness studies. Generic HRQOL measures can be applied to any disease population, whereas disease-targeted measures are tailored to a specific clinical condition. Disease-targeted measures are typically more sensitive to clinical change, but cannot offer a comparison basis for different clinical conditions. This article reviews the measurement of HRQOL in patients with emphysema. The National Emphysema Treatment Trial (NETT) offers an example of the application of both generic and disease-targeted, as well as profile and decision theory, methods. The NETT illustrates how HRQOL measures can be used to assess outcomes and estimate cost-effectiveness in a major clinical trial.Keywords: health-related quality of life; emphysema; outcomes assessment; quality-of-life measurement Patients with emphysema experience significant limitations in daily activities and reduced quality of life. Evidence supports the value of medical management and pulmonary rehabilitation for emphysema. Despite important advances in medical management, the promise of medical therapy is limited. Lung volume reduction surgery (LVRS) offers the potential to enhance quality of life for selected patients who have completed pulmonary rehabilitation.The goals of surgical and medical treatments for emphysema are to extend life expectancy and to improve quality of life. Medicines have side effects and surgery is associated with operative and perioperative risks. Recovery from surgery necessarily reduces quality of life and functioning in the short term. These effects are important, but often are difficult to quantify. Healthrelated quality of life (HRQOL) measures attempt to characterize the negative and positive effects of a disease as well as its effect on quality of life.

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Value Judgment in the Oregon Medicaid Experiment

Cited by 54 publications

References 20 publications

Within-Trial Cost-Effectiveness of Lifestyle Intervention or Metformin for the Primary Prevention of Type 2 Diabetes

Within-Trial Cost-Effectiveness of Lifestyle Intervention or Metformin for the Primary Prevention of Type 2 Diabetes

Quality of Well-being Outcomes in the National Emphysema Treatment Trial

Health-related Quality of Life in Emphysema

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