Fann Ching-Yuan, Huang Po-Chien, Yen Amy Ming-Fang, Chen Hsiu-Hsi
Department of Nutrition and Health Sciences, School of Healthcare Management, Kainan University, Taoyuan, Taiwan.
Division of Urology, Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan.
Value Health Reg Issues. 2012 May;1(1):87-92. doi: 10.1016/j.vhri.2012.03.004. Epub 2012 May 25.
To measure the utility of patients with ureteral stones under various medical regimes and to identify significant factors affecting utility for various health states.
A cross-sectional survey was conducted to measure the utility of 89 patients on each health state related to the clinical management of ureteral stones. Health states with respect to intervention and treatment modalities were classified into the acute phase (including medication, extracorporeal shock wave lithotripsy, ureterorenoscopic lithotripsy, and surgery) and the chronic phase (no specific intervention, lifestyle modification, maintenance with surveillance, and continued medication). Utility was measured by using the modified standard gamble. Demographic data and relevant history of treatment modalities and interventions for ureteral stones were collected by using a questionnaire.
Utility scores of health states in the acute phase (ranging from 0.914 [surgery] to 0.967 [extracorporeal shock wave lithotripsy]) were lower than those in the chronic phase (ranging from 0.955 [maintenance with surveillance] to 0.974 [lifestyle modification]). Utility for surgery was lower than for nonsurgical methods. Utilities for the two lithotripsy modalities were close to that for medication. The utility figures for health states in the chronic phase were the highest for lifestyle modification, but the differences across health states were trivial. Sex, history of ureterorenoscopic lithotripsy, education level, and employment were significant covariates in the final multiple linear regression model.
A modified standard gamble chained method was applied to measure the utility for health states in relation to the clinical management of ureteral stones. Patients preferred nonsurgical treatment over surgical treatment and hemodialysis regardless of health states. We also found that sex, a history of ureterorenoscopic lithotripsy, education level, and employment affected utility for health states related to clinical management. Our findings provide an insight into patient preference for the choice of treatment of ureteral stones.
评估输尿管结石患者在不同医疗方案下的效用值，并确定影响不同健康状态效用值的显著因素。
进行了一项横断面调查，以测量89例患者在与输尿管结石临床管理相关的每种健康状态下的效用值。将干预和治疗方式的健康状态分为急性期（包括药物治疗、体外冲击波碎石术、输尿管镜碎石术和手术）和慢性期（无特定干预、生活方式改变、监测维持和持续药物治疗）。采用改良标准博弈法测量效用值。通过问卷调查收集输尿管结石患者的人口统计学数据以及治疗方式和干预措施的相关病史。
急性期健康状态的效用得分（范围从0.914[手术]至0.967[体外冲击波碎石术]）低于慢性期（范围从0.955[监测维持]至0.974[生活方式改变]）。手术的效用低于非手术方法。两种碎石术方式的效用值与药物治疗相近。慢性期健康状态的效用值在生活方式改变时最高，但不同健康状态之间的差异很小。性别、输尿管镜碎石术病史、教育水平和就业情况是最终多元线性回归模型中的显著协变量。
采用改良标准博弈连锁法测量与输尿管结石临床管理相关的健康状态的效用值。无论健康状态如何，患者都更倾向于非手术治疗而非手术治疗和血液透析。我们还发现，性别、输尿管镜碎石术病史、教育水平和就业情况会影响与临床管理相关的健康状态的效用值。我们的研究结果为了解患者对输尿管结石治疗选择的偏好提供了依据。
