Evaluating Cognitive Function Cost Utility and Outcomes after Liver Transplant

评估肝移植后的认知功能成本效用和结果

• 批准号: 7221361
• 负责人: ROBERT T RUSSELL
• 金额: $ 5.89万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-23 至 2008-09-22
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7221361
• 关键词: anxiety; behavioral /social science research tag; clinical research; cognition; cost effectiveness; depression; disease /disorder proneness /risk; functional ability; human subject; liver transplantation; neuropsychological tests; outcomes research; patient oriented research; postdoctoral investigator; postoperative state; quality of life; questionnaires; sign /symptom

DESCRIPTION (provided by applicant): The initial challenges in liver transplantation were to demonstrate successful technical outcomes and acceptable long term survival. Now that liver transplantation is a relatively common procedure that provides many life years to the recipient, there must be an intense focus on improvements in cognitive function, health-related quality of life, and cost-utility following transplantation. Due to the achievement of a "ceiling effect" for survival rates and a "floor effect" for graft rejections, additional outcomes measures for liver transplantation must be utilized to measure the effects of interventions. The identification of factors that influence cognitive function, quality of life, and cost-utility is essential to accomplish this goal. The specific aims of this research project are: (1) to prospectively evaluate pre- and post transplant cognitive function and clinical correlates of change in cognitive function following liver transplantation; (2) to test the nature and strength of relationships among pre- and post transplant demographic characteristics, risk factors, and clinical events on functional performance, health-related quality of life, symptoms of anxiety and depression, and overall health in adult liver transplant recipients; and (3) to prospectively assess, and validate in the liver transplantation setting, pre- and post-transplant measures of health status that can be employed in cost- utility analyses. Liver transplant candidates and recipients will be asked to complete a battery of health- related quality of life assessment forms and undergo cognitive function testing at various time intervals to measure the trajectory of change over time and its relationship to multiple pre-operative clinical risk factors, perioperative factors, and post-operative events. The relevance of this research will be the eventual identification of interventions to improve outcomes and to assist clinicians in decision making, much as data on factors that influence survival and complications are employed currently. Findings from these analyses will suggest changes in patient care pathways and the application of resources to influence favorably these important outcome variables, much as patient management strategies have shifted in response to complication rates and causes of mortality in the past. Additionally, this information is likely to influence policy maker and payer decisions, as it will give a more complete picture of anticipated outcomes for individual and groups of patients in relation to this expensive treatment.

描述（由申请人提供）：肝移植的最初挑战是证明成功的技术结局和可接受的长期生存率。既然肝移植是一种相对常见的手术，为接受者提供了许多生命年，那么必须高度关注移植后认知功能，健康相关生活质量和成本效益的改善。由于生存率的“天花板效应”和移植物排斥的“地板效应”的实现，肝移植的额外结果的措施，必须利用来衡量干预措施的效果。识别影响认知功能、生活质量和成本效用的因素对实现这一目标至关重要。本研究的具体目的是：（1）前瞻性评估肝移植前后认知功能的变化及其临床相关性;（2）测试移植前和移植后人口统计学特征、风险因素和临床事件对功能表现、健康相关生活质量之间的关系的性质和强度，焦虑和抑郁症状，以及成年肝移植受者的总体健康状况;（3）前瞻性评估，并在肝移植环境中验证，移植前和移植后健康状况的测量可用于成本效用分析。将要求肝移植候选人和受者填写一系列健康相关生活质量评估表，并在不同时间间隔接受认知功能测试，以测量随时间变化的轨迹及其与多种术前临床风险因素、围手术期因素和术后事件的关系。这项研究的相关性将是最终确定干预措施，以改善结果，并协助临床医生决策，就像目前采用的影响生存和并发症的因素的数据一样。这些分析的结果将提示患者护理途径的变化和资源的应用，以有利地影响这些重要的结局变量，就像过去患者管理策略已根据并发症发生率和死亡原因发生变化一样。此外，这些信息可能会影响政策制定者和付款人的决定，因为它将更全面地了解与这种昂贵的治疗有关的个人和患者群体的预期结果。