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: 7296905
• 负责人: ROBERT T RUSSELL
• 金额: $ 5.03万
• 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 2008-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7296905
• 关键词: Achievement; Adult; Age; Anxiety; Ascites; Characteristics; Clinical; Complication; Data; Decision Making; Demographic Factors; Deterioration; Effectiveness of Interventions; Event; Floor; Functional disorder; Goals; Graft Rejection; Health; Health Status; Hepatic; Hepatitis C virus; Individual; Intervention; Ischemia; Kidney Failure; Length of Stay; Life; Liver diseases; Living Costs; Measures; Mental Depression; Mental Health; Modeling; Nature; Outcome; Outcome Measure; Pathway interactions; Patient Care; Patients; Performance; Perioperative; Policy Maker; Postoperative Period; Procedures; Psyche structure; Publishing; Quality of life; Quality-of-Life Assessment; Rate; Recording of previous events; Recurrence; Renal Glycosuria; Research; Research Project Grants; Resources; Risk Factors; Severity of illness; Survival Rate; Symptoms; Testing; Time; Transplant Recipients; Transplantation; base; cognitive function; cost; cost utility analysis; graft function; health related quality of life; improved; indexing; liver transplantation; mortality; preference; programs; response; time interval

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成果和可接受的长期生存。既然肝移植是一种相对常见的手术，可以为受者提供多年的生命，因此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。由于存活率的“天花板效应”和移植物排斥的“地板效应”，必须利用肝移植的额外结果指标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于实现这一目标至关重要。本研究项目的具体目的是：（1）前瞻性评估移植前后的认知功能以及肝移植后认知功能变化的临床相关性； (2) 测试移植前和移植后人口统计特征、危险因素和临床事件之间关系的性质和强度，以影响成年肝移植受者的功能表现、健康相关的生活质量、焦虑和抑郁症状以及整体健康状况； (3) 在肝移植环境中前瞻性评估和验证可用于成本效用分析的移植前和移植后健康状况测量。肝移植候选者和接受者将被要求填写一系列与健康相关的生活质量评估表，并在不同的时间间隔进行认知功能测试，以测量随时间变化的轨迹及其与多种术前临床危险因素、围手术期因素和术后事件的关系。这项研究的意义在于最终确定干预措施，以改善结果并协助临床医生做出决策，就像目前使用的影响生存和并发症的因素的数据一样。这些分析的结果将表明患者护理途径和资源应用的变化，以有利地影响这些重要的结果变量，就像过去患者管理策略根据并发症发生率和死亡原因而改变一样。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相关的个人和患者群体的预期结果。