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Bundorf, M.K., Singer, S.J., Wagner, T.H., and Baker, L. (2004, September). "Consumers' use of the Internet for health insurance." (AHRQ grant HS11668). American Journal of Managed Care 10(9), pp. 609-616.

The Internet is an important source of health insurance information, according to this survey of 4,500 adults. The survey asked adults about their use of the Internet to search for information about health insurance plans and manage health benefits in three health insurance markets: Medicare, individual or nongroup, and employer-sponsored group. The Internet seemed to be a more important information source for those purchasing coverage individually in the nongroup and Medicare markets than those obtaining coverage from an employer. Although many individuals were unaware of whether their employer or health plan maintained a Web site to manage health benefits, those who used the sites gave them a favorable evaluation.

Carey, E.C., Walter, L.C., Lindquist, K., and Covinsky, K.E. (2004, October). "Development and validation of a functional morbidity index to predict mortality in community-dwelling elders." (AHRQ grant HS00006). Journal of General Internal Medicine 19, pp. 1027-1033.

These researchers developed and validated a prognostic index for 2-year mortality for community-dwelling elders based solely on self-reported functional status, age, and sex. The researchers developed the index in 4,516 participants (mean age 78 years) and validated it in 2,877 different same-aged participants. They calculated risk scores with male sex, 2 points; age (76 to 80, 1 point; greater than 80, 2 points); dependence in bathing, 1 point; dependence in shopping, 2 points; difficulty walking several blocks, 2 points; and difficulty pulling or pushing heavy objects, 1 point. In the development and validation groups respectively, 2-year mortality was 3 percent and 5 percent in the lowest risk group (0 to 2 points); 11 percent and 12 percent in the middle risk group (3 to 6 points); and 34 percent and 36 percent in the highest risk group (more than 7 points).

Godder, K., Eapen, M., Laver, J.H., and others (2004, September). "Autologous hematopoietic stem-cell transplantation for children with acute myeloid leukemia in first or second complete remission: A prognostic factor analysis." (Cosponsored by AHRQ, NCI, NIAID, and NHLBI). Journal of Clinical Oncology 22(18), pp. 3798-3804.

Among children with acute myeloid leukemia (AML), leukemia relapse is common, whether treatment is with intensive chemotherapy alone or in combination with allogeneic (from a genetically matched relative or unrelated person) or autologous (from the patient) hematopoietic stem-cell transplantation (HSCT). This study found that a substantial proportion of children who underwent transplantation in second complete remission (CR) achieved long-term leukemia-free survival (LFS), especially those who were experiencing relapse after a long first CR. Patients in second CR after a short first CR were more likely to experience relapse and had higher treatment failure and mortality. Results in children who experience treatment failure with conventional chemotherapy support the use of autologous transplantation as salvage therapy if such patients achieve a subsequent CR, conclude the researchers. They correlated prognostic factors with outcomes among 219 children who received autologous HSCT for AML in first CR and 73 children in second CR.

Kane, R.L., Johnson, P.E., Town, R.J., and Butler, M. (2004). "A structured review of the effect of economic incentives on consumers' preventive behavior." (AHRQ contract 290-02-0009). American Journal of Preventive Medicine 27(4), pp. 327-352.

These researchers reviewed 47 trials to assess the effects of economic incentives on consumers' preventive health behaviors. They classified a study as complex preventive health if a sustained behavior change was required of the consumer; if it could be accomplished directly (for example, immunizations), it was considered simple. Economic incentives worked 73 percent of the time, but rates varied by the goal of the incentive. Incentives that increased the ability to purchase the preventive service worked better than more diffuse incentives, but the type mattered less than the nature of the incentive. Economic incentives were effective in the short run for simple preventive care and distinct, well-defined behavioral goals. The authors conclude that small incentives can produce finite changes, but it is not clear what size of incentive is needed to yield a major sustained effect.

Kaplan, R.M., Ries, A.L., Reilly, J., and others (2004, September). "Measurement of health-related quality of life in the National Emphysema Treatment Trial." (Cosponsored by AHRQ, NHLBI, and CMS). Chest 126(3), pp. 781-789.

This study evaluated two generic and two disease-specific measures of health-related quality of life (QOL) using data from the National Emphysema Treatment Trial (NETT). Patients completed evaluations before and after completion of the prerandomization phase of the NETT pulmonary rehabilitation program. The researchers evaluated QOL measures against physiologic criteria that included measures of emphysema severity (for example, FEV1, volume of gas expired after one second) and functional criteria, (the 6-minute walk distance [6MWD], maximum work, and hospitalizations in the prior 3 months). Compared with normative samples, scores on general QOL measures were low, suggesting that the NETT participants were quite ill. All QOL measures were modestly but significantly correlated with FEV1, maximum work, and 6MWD. There were significant improvements for all QOL measures following the rehabilitation program, and improvements in QOL were correlated with improvements in 6MWD.

Plunkett, B.A. and Grobman, W.A. (2004, September). "Elective cesarean delivery to prevent perinatal transmission of hepatitis C virus: A cost-effectiveness analysis." (AHRQ grant T32 HS00078). American Journal of Obstetrics and Gynecology 191, pp. 998-1003.

The goal of this study was to determine the cost-effectiveness of elective cesarean delivery to avert perinatal hepatitis C virus (HCV) transmission. The researchers compared two approaches in terms of the lifetime cost and quality-adjusted life years (QALYs) for neonates: one, offering elective cesarean delivery to pregnant women infected with HCV, and two, performing a cesarean delivery only for obstetric indications (emergent cesarean delivery). The researchers calculated that when elective cesarean delivery prevented all perinatal HCV transmission, 18 elective cesareans were necessary to avert one neonatal infection with a cost-effectiveness ratio of $34,812 per QALY. This is similar or less than other accepted therapies considered to be cost effective. If rates of perinatal transmission with emergent cesarean or vaginal delivery were relative low (6 percent or less), elective cesarean was not cost effective even if it prevented all perinatal HCV transmission. If HCV transmission rates were high (12 percent) with emergent cesarean and vaginal delivery, elective cesarean delivery became cost effective when transmission rates were reduced by only 50 percent. The researchers conclude that cesarean delivery is cost effective only if it substantially reduces the risk of perinatal HCV transmission.

AHRQ Publication No. 05-0045
Current as of January 2005

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