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Indurkhya, A., Gardiner, J.C., and Luo, Z. (2001). "The effect of outliers on confidence interval procedures for cost-effectiveness ratios." (AHRQ grant HS09514). Statistics in Medicine 20, pp. 1469-1477.
Cost-effectiveness ratios (CERs) generally are used as summary statistics to compare competing health care programs relative to their cost and benefits. These authors describe methods used to obtain confidence intervals for CERs and discuss the effects of outliers in cost measures.
Ramsey, S.D., Sullivan, S.D., Kaplan, R.M., and others. (2001). "Economic analysis of lung volume reduction surgery as part of the National Emphysema Treatment Trial." Annals of Thoracic Surgery 71, pp. 995-1002.
Emphysema affects about 2 million Americans. Lung volume reduction surgery (LVRS), a promising new surgical therapy for patients with severe emphysema, is controversial, with some contending that the surgery is insufficiently safe and lacking evidence as to its efficacy. In October 1997, patients began enrolling in what is now the National Emphysema Treatment Trial (NETT). This is a multicenter, randomized controlled trial of LVRS plus medical therapy versus medical therapy for patients with severe emphysema. This paper describes the goal of a parallel cost-effectiveness analysis of LVRS versus medical therapy for those who are eligible for the procedure. The researchers describe the economic and quality of life data that are being collected alongside the clinical trial, their methods of analysis, and their approach to presenting the results. Their analysis should provide timely economic data that can be considered along with the clinical results of the NETT.
Verrips, G.H., Stuifbergen, M.C., den Ouden, A.L., and others. (2001). "Measuring health status using the Health Utilities Index: Agreement between raters and between modalities of administration." (AHRQ grant HS08385). Journal of Clinical Epidemiology 54, pp. 475-481.
The effects of prevention and therapy in medicine are conventionally measured in terms of mortality and morbidity. In chronic diseases, however, mortality and morbidity show little variance, and the patient's priorities may lie elsewhere. The aim of this study was to evaluate the Health Utilities Index (HUI) for assessing health status. The researchers invited a random sample from a group of 14-year-old very low birthweight Dutch children and their parents to participate in face-to-face or telephone interviews. All 300 participants were also sent a questionnaire by mail. Interrater and intermodality agreement were high for the physical HUI attributes, with little reported dysfunction, and poor for the psychological attributes, with more reported dysfunction. Children and parents reported more dysfunction in the psychological attributes when interviewed than when completing the mailed questionnaire. The authors conclude that HUI results and their interpretation vary with the source of information and modality of administration.
Wuerz, R.C., Milne, L.W., and Eitel, D.R. (2001). "Reliability and validity of a new five-level triage instrument." (AHRQ grant HS10381). Academic Emergency Medicine 7, pp. 236-242; Wuerz, R.C., Travers, D., Gilboy, N., and others. (2001). "Implementation and refinement of the emergency severity index." (AHRQ grant HS10381). Academic Emergency Medicine 8, pp. 170-176.
About 95 million people visited U.S. hospital emergency departments (EDs) in 1997. When patients arrive at the ED, a clinical assessment process known as triage is used to sort patients and treat those with high-acuity conditions first. Most U.S. hospitals use three triage categories, whereas five-level triage prevails in Canada, Australia, and England. These U.S. researchers developed a new five-level triage instrument, the Emergency Severity Index (ESI), which they validated against the clinical resource and hospitalization needs of adult patients triaged during 100 hours at two urban hospitals. Triage levels ranged from category 1, the most severe (for example, for patients who were intubated, did not have a pulse, or were unresponsive), and category 2 (for example, those in severe pain and distress) to those requiring no lab tests, x-rays, or procedures (category 5). The researchers implemented the ESI at two university hospital EDs in evaluation of 252 ED patients. Hospitalization was 28 percent overall and was strongly associated with triage level, decreasing from 92 percent of patients in triage category 1 to 2 percent of patients in triage category 5. The researchers conclude that the ESI is useful for stratifying patients into five groups with distinct clinical outcomes.
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Current as of July 2001
AHRQ Publication No. 01-0033