Nelson Caleb P, Routh Jonathan C, Logvinenko Tanya, Rosoklija Ilina, Kokorowski Paul J, Prosser Lisa A, Schuster Mark A
Department of Urology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Division of Urology, Duke University Medical Center, Durham, NC, USA.
J Pediatr Urol. 2015 Aug;11(4):177-82. doi: 10.1016/j.jpurol.2015.03.008. Epub 2015 Apr 30.
Management of vesicoureteral reflux (VUR) continues to be controversial. In conditions of uncertainty, decision analytic techniques such as cost-utility analysis (CUA) can help to structure the decision-making process. However, CUA analyses require a "utility," a value between 0 (death) and 1 (perfect health) corresponding to the quality of life associated with a health state. Ideally, utility values are elicited directly from representative community samples, but utilities have not been rigorously measured for pediatric urology conditions.
To elicit utility scores for VUR and open anti-reflux surgery (ARS) from a representative, well-characterized community sample of adults who have been parents.
Cross-sectional survey of nationally representative adults who had ever been parents. Each respondent saw one of four descriptions of VUR, with or without continuous antibiotic prophylaxis (CAP) and occurrence of febrile urinary tract infection (UTI). A 6-week postoperative health state following ARS was also assessed. We used the time trade-off (TTO) method to elicit utility scores. Factors associated with utility score were assessed with a multivariate linear regression model.
The survey was completed by 1200 individuals. Data were weighted to adjust for demographic differences between responders and non-responders. Mean age was 52 ± 15 years, 44% were male, and 68% were White. In terms of education, 29% had a college degree or higher. The mean utility score for VUR overall was 0.82 ± 0.28. VUR utility scores did not differ significantly based on inclusion of CAP or UTI in the health state description (p = 0.21). The 6-week postoperative period garnered a utility of 0.71 ± 0.43.
Our results showed that VUR has a mean utility score of 0.82, which indicates that the community perceives this condition to be a substantial burden. For comparison, conditions with similar utility scores include compensated hepatitis B-related cirrhosis (0.80) and glaucoma (0.82); conditions with higher utilities include neonatal jaundice (0.99) and transient neonatal neurological symptoms (0.95); and conditions with lower utility scores include severe depression (0.43) and major stroke (0.30). Our results suggest that parents consider the burden associated with VUR to be significant, and that the impact of the condition on families and children is substantial.
VUR is perceived as having a substantial impact on health-related quality of life, with a utility value of 0.82. However, use of CAP and occurrence of UTI do not seem to affect significantly the community perspective on HRQOL associated with living with VUR.
膀胱输尿管反流（VUR）的管理仍存在争议。在存在不确定性的情况下，成本效用分析（CUA）等决策分析技术有助于构建决策过程。然而，CUA分析需要一个“效用值”，即介于0（死亡）和1（完全健康）之间的数值，该数值对应于与某种健康状态相关的生活质量。理想情况下，效用值应直接从具有代表性的社区样本中获取，但尚未对儿科泌尿外科疾病的效用值进行严格测量。
从具有代表性、特征明确的曾为人父母的成年人群体样本中获取VUR和开放性抗反流手术（ARS）的效用评分。
对具有全国代表性的曾为人父母的成年人进行横断面调查。每位受访者阅读VUR的四种描述之一，描述内容包括是否进行持续抗生素预防（CAP）以及是否发生发热性尿路感染（UTI）。同时还评估了ARS术后6周的健康状态。我们使用时间权衡（TTO）方法来获取效用评分。通过多元线性回归模型评估与效用评分相关的因素。
1200人完成了调查。对数据进行加权处理，以调整应答者和非应答者之间的人口统计学差异。平均年龄为52±15岁，44%为男性，68%为白人。在教育程度方面，29%拥有大学学位或更高学历。VUR总体的平均效用评分为0.82±0.28。根据健康状态描述中是否包含CAP或UTI，VUR的效用评分无显著差异（p = 0.21）。术后6周的效用值为0.71±0.43。
我们的结果表明，VUR的平均效用评分为0.82，这表明社区认为这种疾病是一个相当大的负担。相比之下，效用评分相似的疾病包括代偿期乙型肝炎相关肝硬化（0.80）和青光眼（0.82）；效用值较高的疾病包括新生儿黄疸（0.99）和短暂性新生儿神经症状（0.95）；效用评分较低的疾病包括重度抑郁症（0.43）和大面积中风（0.30）。我们的结果表明，父母认为与VUR相关的负担很大，并且这种疾病对家庭和儿童的影响很大。
VUR被认为对健康相关生活质量有重大影响，效用值为0.82。然而，使用CAP和UTI的发生似乎并未显著影响社区对与VUR共存相关的健康相关生活质量的看法。
