Synthesis of results
We conducted meta-analyses of EQ-5D utilities across different GOLD levels, based on an inverse-variance approach. The pooled estimates for EQ-5D measurements of mild, moderate, severe, and very severe COPD are 0.821 (95% CI: 0.814-0.828), 0.760 (95% CI: 0.756-0.765), 0.727 (95% CI: 0.722-0.732), and 0.681 (95% CI: 0.675-0.686). Results based on visual analogue scale demonstrated a similar trend. There was insufficient data for meta-analysis on the utilities across different disease severity levels according to time trade off and standard gamble.
Discrete choice
In addition to utility of outcomes ranging from 0 to 1, we also included other reports on the importance of outcomes. Willingness to pay is another indication of utility by monetary values. Researchers also used forced choice techniques, discrete choice exercise/conjoint analysis, or probability trade off to elicit the outcome importance information. Additionally, some studies were based on research self-developed scales or questionnaires. In total, we identified 74 reports to suggest outcome importance information other than utility of outcomes ranging from 0 to 1.
Forced choice and Preference trials
Of all the 74 reports, 39 of them used a “forced choice” question. By forced choice, we mean the researcher provided a set of options to ask the participants to choose from, or to indicate they would accept or reject one option. Of all these 39 studies, 35 studies were on treatment itself or
In a world of increasing competition for health resources economic evaluations are essential to provide evidence to decision makers that allows them to make appropriate decisions regarding the best use of those resources (Cohen and Reynolds, 2008; Williams et al., 2008). Critical appraisal is the means by which the validity of this research is assessed and is essential for true evidence based practice, and decision-making (Burls, 2009; Ciliska, Thomas and Buffett, 2008).
nutrition, hydration and pain relief? Advance decisions to refuse treatment are not as yet widespread in medical care, but are undoubtedly encountered more frequently (Cowan 2007).
The study began with 32 patients having stages II to IV COPD. They had to meet the criteria pertaining to the Global Initiative for Chronic Obstructive Pulmonary Disease; total lung capacity >120%, (FEV1/FVC) <70%, FEV1 <80%, RV/TLC >140% and >40% of predicted values in stable conditions. Patients were removed from the study if they had asthma, heart failure, orthopedic impairments of the shoulder girdle, recent surgery, past thoracic fractures, pneumothorax, and claustrophobia.
The study included 100 patients with COPD. All patients fulfilled the inclusion and exclusion criteria. According to its demographic and clinical parameters and treatment groups differ among themselves. Completed the study, all patients included in the study. The therapy in all patients with a clinically meaningful improvement of symptoms was observed.
The article’s researchers believed that it is necessary to research the efficacy of these claimed evidence based interventions.
SAS University Edition English Version (Cary, NC, USA) was used for statistical analysis and data management. All analyses excluded- refused, inapplicable, don’t know, and missing values. The outcome variable “asthma episodes/asthma attacks” (AB41) was categorized in to three levels: (-1) “inapplicable” (1) “yes” and (2) “no”. This variable was renamed “ABSH” with two categories (1) “yes” and (2) “no”. The predictor variable was “current smoker” (SMKCUR) and was categorized in to two levels: (1) “current smoker”, (2) “not current
must be on the patient rather than on an assumption about the nature of the patient’s problem and on arbitrary decisions about actions to be undertaken (Alligood, 2010).
Objective: To identify quality indicators with the largest potential to improve health outcomes in the Ontario COPD patient population.
Patient's decision-making is influenced by several factors. Patients may change their decisions, from accepting or refusing treatment depending on the available treatment options. The capacity of the individual to make informed medical decisions can differ as the patient's status changes cognitively, emotionally, and/or physically and as the proposed treatment interventions change. Treatment refusal is a common situation faced by clinicians. Patients do not usually refuse the medical advice if the advice is of good intention. When patients refuse an advice, it indicates some underlying reasons related to the patients or family, factors associated with the physician as well as social and organizational issues.
Farrar S., Ryan M., Ross D., Ludbrook A. 2000. Using discrete choice modelling in priority setting: an application to clinical service developments. Social Science and Medicine (50) 63-75.
Interested participants were issue a questionnaire for completion and following a six Week intervention, each participant patients
Two completely different viewpoints of randomized clinical trials are given, article one is against the idea and article two is for it. Article one argues that when a patient sees a physician; the physician has the duty to provide the best treatment for that
All over the world, chronic obstructive pulmonary disease (COPD) is a very significant and prevalent cause of morbidity and mortality, and it is increasing with time (Hurd, 2000; Pauwels, 2000; Petty, 2000). Due to the factor of COPD being an underdiagnosed and undertreated disease, the epidemiology (Pauwels, Rabe, 2004) is about 60 to 85 % with mild or moderate COPD remaining undiagnosed (Miravitlles et al., 2009; Hvidsten et al., 2010).
Patients in the United States have a right to refuse care if treatment is being recommended for non-life-threatening illnesses according to the Washington School of Medicine (2012). The simple task of refilling a prescription, or choosing to not get a flu shot are all acts of not following through with treatment mechanisms. Patients often times refuse medical treatment for far more reasons than just religious beliefs. Subconscious emotion reasons about side effects, pain, healing time, and the procedure itself scares patient’s away (Washington School of Medicine, 2012).
Cost-benefit, cost-effectiveness and cost-utility analyses are forms of economic evaluation which are useful in health economics for comparing costs and allocating resources. Health economics is widely relevant to governments and the health sector in implementation of new policy, as it concerns the allocation of resources in the context of a limited budget, or 'scarcity'. Economic evaluation is a potential tool for setting priorities in health, though it is only one of many potential criteria, including overall budget and public attitudes and wants. Economic evaluation is already in use in some settings, such as in pharmaceutical company proposals for government subsidisation, but there is room for expansion across the field of