Nyman John A, Barleen Nathan A, Kirdruang Phatta
Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55455-0392, USA.
Med Decis Making. 2008 Nov-Dec;28(6):819-28. doi: 10.1177/0272989X08318463. Epub 2008 Nov 17.
A number of studies have estimated the quality-adjusted life years (QALYs) lost from nonfatal motor vehicle accident injuries, but these estimates have a number of limitations.
The goal of this study is to estimate the QALYs lost from the typical motor vehicle accident injury based on 1) data obtained through a standard preference elicitation procedure, 2) both permanent and nonpermanent injuries, and 3) a more realistic baseline quality-of-life level from which to determine the QALY decrement. This study also intends to demonstrate the advantages of using self-reported health status as the basis for determining a change in QALYs.
Ordered probit equations were estimated to determine the change in self-reported health status associated with 3 categories of injuries. These results were next converted to their marginal effects and weighted by the quality-of-life estimates for self-reported health status found in Nyman and others (2007). The quality-of-life decrements for the 3 categories of injury were then converted to QALY decrements by applying estimates of the duration of that injury type.
The data came from 8 years of the Medical Expenditure Panel Survey (MEPS), from 1997 to 2004.
Self-reported health status categories were excellent, very good, good, fair, or poor.
The reference case decrement for an average motor vehicle accident injury is 0.0612 QALYs or 0.0360 QALYs, if discounted at 3%.
Quality-of-life weights for self-reported health status can be used to exploit the data in large national surveys.
多项研究估算了非致命机动车事故伤害导致的质量调整生命年(QALY)损失,但这些估算存在一些局限性。
本研究的目标是基于以下几点估算典型机动车事故伤害导致的QALY损失:1)通过标准偏好诱导程序获得的数据;2)永久性和非永久性伤害;3)用于确定QALY减少量的更现实的基线生活质量水平。本研究还旨在证明将自我报告的健康状况作为确定QALY变化依据的优势。
估计有序概率方程以确定与3类伤害相关的自我报告健康状况的变化。接下来将这些结果转换为边际效应,并根据Nyman等人(2007年)发现的自我报告健康状况的生活质量估算值进行加权。然后,通过应用该伤害类型持续时间的估算值,将3类伤害的生活质量下降转换为QALY下降。
数据来自1997年至2004年的8年医疗支出面板调查(MEPS)。
自我报告的健康状况类别为优秀、非常好、良好、一般或差。
如果按3%进行贴现,平均机动车事故伤害的参考案例下降量为0.0612个QALY或0.0360个QALY。
自我报告健康状况的生活质量权重可用于利用大型全国性调查中的数据。