Patient perceptions of quality of life with diabetes-related complications and treatments
Patient perceptions of quality of life with diabetes-related complications and treatments
复制标题
DOI：
10.2337/dc07-0499
复制
发表时间：
2007-10-01
期刊：
影响因子：
16.2
通讯作者：
Meltzer, David O.
中科院分区：
文献类型：
--
作者：
Huang, Elbert S.;Brown, Sydney F. S.;Meltzer, David O.
目的：了解个体如何权衡与并发症和治疗相关的生活质量对评估糖尿病护理的经济价值很重要，并可能为治疗依从性提供见解。我们量化了患者对糖尿病相关并发症和治疗的效用（一种偏好度量）。研究设计和方法：我们对在芝加哥地区诊所就诊的701名成年糖尿病患者进行了访谈。我们通过使用时间权衡问题得出假设健康状态的效用（0-1等级的评分，其中0代表死亡，I代表完美健康）。我们评估了9种并发症状态（如糖尿病视网膜病变和失明）和10种治疗状态（如强化血糖控制与常规血糖控制和糖尿病综合护理[即强化控制多种危险因素]）。结果：终末期并发症的平均效用低于中期并发症（例如，失明0.38 [SD 0.35] vs视网膜病变0.53 [0.36],P < 0.01），终末期并发症在所有健康状态中评分最低。强化治疗的平均效用低于常规治疗（例如，强化血糖控制为0.67[0.34]，常规血糖控制为0.76 [0.311,P < 0.0]），评分最低的治疗状态是糖尿病综合护理（0.64[0.34]）。患者对综合治疗状态的评价与中间并发症状态相似。结论：终末期并发症对生活质量的影响最大；然而，综合糖尿病治疗也会对生活质量产生显著的负面影响。认识到糖尿病护理的这些影响对于未来对新型药物联合疗法和药物传递创新的经济评估将是重要的。
OBJECTIVE - Understanding how individuals weigh the quality of life associated With complications and treatments is important in assessing the economic value of diabetes care and may provide insight into treatment adherence. We quantify patients' utilities (a measure of preference) for the full array of diabetes-related complications and treatments.RESEARCH DESIGN AND METHODS - We conducted interviews with a multiethnic sample of 701 adult patients living with diabetes who were attending Chicago area clinics. We elicited utilities (ratings on a 0-1 scale, where 0 represents death and I represents perfect health) for hypothetical health states by using time-tradeoff questions. We evaluated 9 complication states (e.g., diabetic retinopathy and blindness) and 10 treatment states (e.g., intensive glucose control vs. conventional glucose control and comprehensive diabetes care [i.e., intensive control of multiple risk factors]).RESULTS - End-stage complications had lower mean utilities than intermediate complications (e.g., blindness 0.38 [SD 0.35] vs. retinopathy 0.53 [0.36], P < 0.01), and end-stage complications had the lowest ratings among all health states. Intensive treatments had lower mean utilities than conventional treatments (e.g., intensive glucose control 0.67 [0.34] vs. conventional glucose control 0.76 [0.311, P < 0.0]), and the lowest rated treatment state was comprehensive diabetes care (0.64 [0.34]). Patients rated comprehensive treatment states similarly to intermediate complication states.CONCLUSIONS - End-stage complications have the greatest perceived burden on quality of life; however, comprehensive diabetes treatments also have significant negative quality-of-life effects. Acknowledging these effects of diabetes care will be important for future economic evaluations of novel drug combination therapies and innovations in drug delivery.