EVALUATING HEALTH RELATED
QUALITY OF LIFE OUTCOMES IN STUTTERING: A CRITIQUE
OF CONDITION SPECIFIC INSTRUMENTS Franic DM, Bothe AK, University of Georgia,
Athens, GA, USA
OBJECTIVE:
To
evaluate the psychometric properties of
disease-specific quality of life (QOL) instruments
in stuttering. METHODS:
A comprehensive search for
stuttering instruments was conducted using: a
literature review, web search engines, references,
and personal files. Instruments were included in
the study for evaluation if there was at least one
publication using the instrument including
psychometric data, in addition to instrument
availability. Instruments were, evaluated based on
criteria developed by McHorney and Tarlov (1995).
The eight domains considered in the evaluation
were: item information, versatility, practicality,
breadth (social, role, physical and mental
functioning), depth, reliability, validity and
responsiveness. RESULTS:
Of the 18 instruments
identified, adequate data was available to
evaluate eight based on study criteria. The eight
stuttering-specific metrics were Stutterer’s Self
Ratings of Reactions to Speech Situations (ARSF),
Erickson’s scale of communication attitudes
(S-scale), shortened S-scale (S-24), Communication
Attitude Test – English and revised (CAT and
CAT-R), Perceptions of Stuttering Inventory (PSI)
Speech Situations Checklist (SSC) and its
shortened version (Shortened-SSC). Item
information was only available for S-scale and
S-24. Only S-24 and the S scale satisfied breadth
criteria. Depth information was lacking for all
instruments evaluated. Of the eight instruments
S-24 fared the best being the most widely used and
satisfying six of eight criteria (omitting depth
and reliability), however due to inadequate
reliability (coefficients < 0.9) authors do not
recommend S-24 for individual decision-making.
CONLUSIONS:
None of the eight metrics satisfied
all the study criteria and as a result none can be
recommended for use in individual decision making.
However, if used for group level decision making
the authors recommend the use of S-24 which would
then meet most of the study criteria reporting
adequate or better performance on seven of the
eight criteria assessed (omitting instrument
depth), in conjunction with a generic QOL
instrument.
PNL3
A COST-EFFECTIVENESS
COMPARISON OF RASAGILINE WITH DOPAMINE AGONISTS
FOR DELAYING LEVODOPA USE IN EARLY PARKINSONIAN
PATIENTS IN THE UNITED KINGDOM Roch B, Eckert L, Guelfucci F, Cochran J,
François C, H. Lundbeck A/S, Paris, France
OBJECTIVE:
Assess the cost-effectiveness of
rasagiline, a potent, selective, and irreversible
monoamine oxidase-B inhibitor and
second-generation dopamine agonists ropinirole and
pramipexole (DAs) for delaying levodopa-related
motor complications (delaying levodopa start) in
patients with early Parkinson’s disease (PD) in
the UK. Development of motor complications is
related to duration under levodopa, and clinical
consensus in PD management advises postponing
levodopa treatment. METHODS:
We compared
costeffectiveness in starting treatment with
rasagiline versus second-generation DAs in early
patients. A 5-year probabilistic Markov model with
3 states: ‘under rasagiline’, ‘under DA’ and
‘levodopa start’ was used. Model inputs included
transition probabilities from randomised clinical
trials in early PD for rasagiline and DAs, and
costs and resources from an English
cost-of-illness study. Effectiveness measure was
number of years before levodopa request. Primary
analysis was performed from the NHS perspective.
Sensitivity analysis was performed varying
ropinirole dose. Prices for rasagiline,
pramipexole and ropinirole were obtained from the
NHS based on WHO-DDD. RESULTS:
Over five years,
time without levodopa was greater when early PD
patients’ treatment was initiated with rasagiline
compared with DAs (3.93 vs. 2.65 years). There was
a small increase in costs of £1807 compared with
DAs. Incremental cost effectiveness was £1411.7
per patient per year before levodopa compared with
DAs. Cost-effectiveness acceptability curve shows
that with a willingness to pay of £1704 per year
without levodopa, rasagiline has a 95% probability
of being cost-effective. Sensitivity analysis on
ropinirole dose confirmed that rasagiline was
cost-saving for a differential gain of 1.28 years
and dominates ropinirole. CONLUSIONS:
This
economic model demonstrates initiating treatment
with rasagiline is a cost-effective alternative
compared with initiating DAs in delaying time to
levodopa. Further studies are necessary to
evaluate if delaying motor complications in
advanced PD will offset the slight increases in
costs observed.
