12 I NTE R NA TI ONA L R ESEARC H & OP I N I ON

Is lCU treabnent cost effective? It would seem that ICU treatment is cost effective.

according to the findings of an Australian study. The data showed thai the cost/quality-adjusted life-year (QALY) associated with treatment at a general hospital intensive care unit (leU) in Sydney, Australia. was 'less than 10% o/that/or som~ commonly accepted medical interventions ',

The study authors investigated 248 leu admissions at the hospital during a 6-month period in 1986. Patients were followed for 3 years and they completed a health questionnaire and the YorkfRosser Index quality-or-life (QOL) questionnaire.·

During the 3-year period. 63% of patients were readmitted to hospital and 79% received medication. Personal health status was described as 'excellent' by 4% of patients. 'good' by 27%. 'satisfactory' by 25%, 'fair' by 29%, 'poor' by 12% and 'terrible • by 3%. QOL for long-term survivors was 'genuaJ/y good', with little difference between diagnostic groups. After 3 years 150 patients were still alive,

Outcomes and costs for each leU diagnostic group _ ..... P """""""' .,..,

"'*' OALT, lIdm'lI'!H,' OALr ...... 11 .4 "" '" T ....... 12.8 .... no --- ••• "" "" -......, ••• 83M " .. ea..... ...... .. "" 1215

-......, ,. .,,' "" p......",.. ........ 2.7 "" 2323

• 1986 AuIIr'-.IIIn 00I&ta

Treatment costs during initial hospitalisation had no correlation with long-term outcome, as measured by quality-adjusted life-years (QALYs). Also, costs and outcomes 'varied markedly' between diagnostic groups. Treatment was most cost effective in patients with asthma and least cost effective in those with pulmonary oedema (su table) . The costlQALY associated with ICU treatment compared favourably with the range of cost-effectiveness ratios seen for some commonly accepted interventions; e.g. from SA4596 for renal transplantation to SA 130 000 for zidovudine therapy in patients with AIDS.

Using QALYs to assess patient outcome was feasible at this general hospitai lCU, comment the study authors. • TM YorkIRosser /ntkx QOL questionnairr enabled assessment of patient disability and distrrss. KaridlC' RK, Glasnou f'I>. Hillman KM. The lise of quality-adjll5tCd life yan (QALV.) lOeval~ IJ'UImaiI in intensive care. AnIIesthc:sia and Ip",nsiveCare 2). )22-))I,JIIII 1995 _

Drugs Evaluations of

Drugs and Drug Thera py

~i!i

22 Ju, 1l1li5 PHARMACORESOURCES

Quality of Life Aspects

When to use specific vs generic QOL measures

Disease-specific quality-of-life (QOL) instruments are of greatest interest to patients and physicians. while generic QOL instruments are more useful to policy- or decision-makers, according to Dr Gordon Guyatt from McMaster University. Hamilton, Canada.

He suggests that researchers should depend on disease-specific QOL measures during the early stages of drug development. Disease-specific QOL questionnaires are 'clinically sensible' and the QOL items in such measures arc particularly relevant to patients and physicians.

Several disease-specific measures can be combined in a QOL battery to gain a complete picture of the QOL impact of various treatments. However, this can lead to problems with interpretation as multiple comparisons are made in the absence of a overall QOL score, he notes.

In studies that involve patients with a proven clinical outcome (e.g. myocardial infarction). generic QOL questionnaires can provide complementary information about treatment effects on QOL. says Dr Guyatt. Also. previously undetocted drug-related adverse effects may be uncovered, Generic QOL measures are particularly relevant if the economic impact of an intervention is a primary focus of the study, he comments. Qllyan QH. A iUnnomy 0( hulih SUlWS insmlmcnlS- Journal of RhaimatoloJy 22: 1188-1190. JuP 199$ _ ,

News in brief . .. • Pret reatment health-related QOL predicts anti­neoplastic therapy-induced emesis, suggest Canadian study find ings .• 535 patients received 5HT3-antagonists for the first 24 hours after mooera1ely 10 highly emcto­genic antineoplastic therapy; 75% continued antiemetic therapy for an additional 4-6 days. Patients completed a quality-of-life (QOL) questionnaire·· before the first cycle of antineoplastic therapy and I week after therapy. Pretreatment scores for physical, role and social functioning and global QOL were significantly better in emesis-free patients than those who had ~ I episode of emesis, Emesis-free patients also had less fatigue and anorexia before antineoplastic therapy than those with emesis. One week after antineoplastic therapy. cognitive functioning, global QOL, fatigue . anorexia. insomnia and dyspepsia were significantly worse among patients with. than those without, emesis. • TM study was sUPlJOned by Glaxo Ctlnada. SmithKline Beecham and the NCIC. •• Euro,nan Organization/or Research and Treatment ofCanur Corr Quality 0/ U/e QuestionlUlirr (QLQ-C30) Choba D. ct aI. Pn:tl'CatmcPt health ·related qllalily-of-life WitUS predicu chel!lOlhuapy·indllCCd emesis. J>mo;ecdin81 of the Americ&n Society of Clinical OrcolOSY )4: 497.199$ [Sumnwised from an abstnlC'l[ _ .....

• There is no question that Q O L is 'vitally important ' to patients with cystic fib rosis (CF), say Drs D Elizabeth Thllis and Gordon Guyan from the University of Toronto and McMaster University,

Iln~I2JSOI.Off'AdItl~UmIMod111115.Allrlgl'rUo~