UBC Faculty Research and Publications

Evaluating preferences for long term wheeze following RSV infection using TTO and best-worst scaling Roy, Lilla M; Bansback, Nick; Marra, Carlo; Carr, Roxane; Chilvers, Mark; Lynd, Larry D Mar 3, 2014

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MEETING ABSTRACT Open AccessEvaluating preferences for long term wheezefollowing RSV infection using TTO andbest-worst scalingLilla MC Roy1*, Nick Bansback2, Carlo Marra1, Roxane Carr3, Mark Chilvers3, Larry D Lynd1From Canadian Society of Allergy and Clinical Immunology Annual Scientific Meeting 2013Toronto, Canada. 3-6 October 2013BackgroundRespiratory Syncytial Virus (RSV) infects 70% of infantsunder one year, and is a leading cause of infant bronchioli-tis-related hospitalizations [1,2]. RSV is a relatively benign,temporary condition, and therefore likely to have limitedimpact on quality adjusted life years, however, it haspotential for long-term consequences such as asthma andwheeze [3,4]. Preferences related to the trade-offs betweendifferent long and short term aspects of RSV have notbeen explored previously, however, deriving preferencesfor infant health states is very challenging as infantsrequire proxy elicitation of preferences [5-8].MethodsThe objectives of this study were to explore preferencessurrounding attributes of RSV using proxy- and self-perspectives. Time trade-off (TTO) and best-worst scalingwere used to derive utilities for health states of RSV anddetermine relative preferences for different levels ofdisease attributes. Vignettes were constructed from focusgroup data and expert opinion. Respondents were rando-mized to either a child perspective (“imagine that yourchild has RSV”), or an adult perspective (“imagine that youhave RSV”). Experimental design for the BWS was devel-oped using Sawtooth Software. 1000 Canadians wererecruited through a market research panel facilitatinga societal perspective. Five attributes were used – hospita-lization status, oxygen support, presence of tubes (IV/NG),breathing symptom severity, and risk of long term wheeze.Ethics approval was obtained from the UBC BREB.Respondents completed both TTO and BWS tasks.ResultsDisutility associated with the short term health state ofRSV was significant. Disutility followed an expected gra-dient, with more time traded for more severe RSV, andless time traded for less severe RSV (mean range: 0.57 –0.14). Utilities were lower in the child perspective thanthe adult perspective. 0% risk of long term risk ofwheeze was most preferred over all other attributes, andrespiratory failure was least preferred (-4.7). Strongnegative preferences were similar for IV/NG (-3.3), ICUadmission (-3.5), mechanical ventilation (-3.6), andsevere breathing problems (-3.6). Utility associated withrisk of wheeze became lower as risk increased, with arelative preference for 80% risk of wheeze (-2.8) betweenmoderate (-1.5) and severe (-3.7) breathing problems.ConclusionsPreferences indicate societal willingness to acceptimmediate, short term, potentially clinically significantconsequences to avoid long term risk of wheeze. Thisstudy provides utilities that can be utilized for the evalua-tion of any potential or proposed treatment of RSV inchildren, and is important to understanding and applyingpriorities in health care.AcknowledgmentsThis study is funded by Abbott Laboratories and AllerGen NCE Canada.Authors’ details1Faculty of Pharmaceutical Sciences, University of British Columbia,Vancouver, Canada, V6T 1Z3. 2School of Population and Public Health,University of British Columbia, Vancouver, Canada, V6T 1Z3. 3British ColumbiaChildren’s Hospital, Vancouver, Canada, V6H 3E8.* Correspondence: lillaroy@mail.ubc.ca1Faculty of Pharmaceutical Sciences, University of British Columbia,Vancouver, Canada, V6T 1Z3Full list of author information is available at the end of the articleRoy et al. Allergy, Asthma & Clinical Immunology 2014, 10(Suppl 1):A64http://www.aacijournal.com/content/10/S1/A64 ALLERGY, ASTHMA & CLINICAL IMMUNOLOGY© 2014 Roy et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproductionin any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Published: 3 March 2014References1. Chidgey SM, Broadley KJ: Respiratory syncytial virus infections:characteristics and treatment. J Pharm Pharmacol 2005, 57:1371-1381.2. Holberg CJ, Wright AL, Martinez FD, Ray CG, Taussig LM, Lebowitz MD: Riskfactors for respiratory syncytial virus-associated lower respiratoryillnesses in the first year of life. Am J Epidemiol 1991, 133:1135-1151.3. Stensballe LG, Ravn H, Kristensen K, Agerskov K, Meakins T, Aaby P,Simões EAF: Respiratory syncytial virus neutralizing antibodies in cordblood, respiratory syncytial virus hospitalization, and recurrent wheeze.J Allergy Clin Immunol 2009, 123:398-403.4. Bont L, Steijn M, van Aalderen WMC, Kimpen JLL: Impact of WheezingAfter Respiratory Syncytial Virus Infection on Health-Related Quality ofLife. Pediatr Infect Dis J 2004, 23:414-417.5. Prosser LA: Current Challenges and Future Research in MeasuringPreferences for Pediatric Health Outcomes. J Pediatr 2009, 155:7-9.6. Griebsch I: Quality-Adjusted Life-Years Lack Quality in Pediatric Care:A Critical Review of Published Cost-Utility Studies in Child Health.PEDIATRICS 2005, 115:e600-e614.7. Petrou S: Methodological issues raised by preference-based approachesto measuring the health status of children. Health Econ 2003, 12:697-702.8. Ungar WJ: Challenges in health state valuation in paediatric economicevaluation: are QALYs contraindicated? Pharmacoeconomics 2011,29:641-652.doi:10.1186/1710-1492-10-S1-A64Cite this article as: Roy et al.: Evaluating preferences for long termwheeze following RSV infection using TTO and best-worst scaling.Allergy, Asthma & Clinical Immunology 2014 10(Suppl 1):A64.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitRoy et al. Allergy, Asthma & Clinical Immunology 2014, 10(Suppl 1):A64http://www.aacijournal.com/content/10/S1/A64Page 2 of 2


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