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Milton C Weinstein

Publications and source records attributed to Milton C Weinstein.

61 records · Page 4Linked to original sources
PubMedDate not supplied

Comparison of health state utilities using community and patient preference weights derived from a survey of patients with HIV/AIDS.

OBJECTIVES: The authors compare health state utilities derived from a national survey of patients with HIV/AIDS to represent community-based preferences with utilities derived from the same survey representing patient preferences; explore the relationships between these utilities and the dimensions of the SF-6D health state classification; and examine the implications of differences in the source of utilities for a cost-effectiveness analysis of early treatment of patients with HIV/AIDS. METHODS: The authors derived community-based standard gamble (SG) utilities using an algorithm developed for the SF-6D health state classification system. The authors derived patient SG utilities from HIV/AIDS patient rating scale self-assessments using a power transformation. Data were from the HIV Cost and Services Utilization Study, a probability sample of 2864 HIV-infected adults receiving care in the United States in 1996. RESULTS: Patient SG utilities were higher than community SG utilities by 4% to 9% (0.979 vs. 0.937, 0.910 vs. 0.841, and 0.845 vs. 0.778; P < 0.001 for all comparisons). In regression analyses, patient SG utilities were less influenced by physical functioning, pain, and mental health dimensions of the SF-6D. The base case results of a cost-effectiveness analysis comparing early antiretroviral therapy to deferred therapy were unaffected by the choice between community ($20,100 per quality-adjusted life year) and patient ($18,400 per quality-adjusted life year) perspectives. The impact of the choice of utilities remained small in sensitivity analyses that varied the influence of treatment side effects on utilities and the initial symptom status of patients. CONCLUSION: There are differences between community and patient utilities for HIV/AIDS health states, although even when treatment side effects are important, these differences may not affect cost-effectiveness ratios.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The relationship between risk attitude and treatment choice in patients with relapsing-remitting multiple sclerosis.

BACKGROUND: Many patients with multiple sclerosis (MS) eligible for beta-interferons or glatiramer acetate have chosen to forgo or discontinue treatment The objective of this study was to evaluate risk attitude as a patient characteristic related to treatment choice for patients with MS. METHODS: Sixty-two MS patients completed a survey on treatment history, risk preference, and socioeconomic and clinical variables. Multinomial logistic regression was used to assess the relationship between treatment choice and risk attitude. Risk attitude was measured using a standard gamble question on short-term health outcomes. RESULTS: More risk-seeking patients were less likely to choose treatment compared with more risk-averse patients (P < 0.01). Forpatients who discontinued treatment, the explanatory variable of significance was severity of side effects (P < 0.05). CONCLUSIONS: Risk attitude is a patient characteristic related to treatment initiation in patients with MS. This could be an important factor to consider when identifying optimal treatment decisions for individual patients.

Adjuvants, Immunologic↗
PubMedDate not supplied

Can we better prioritize resources for cost-utility research?

PURPOSE: We examined 512 published cost-utility analyses (CUAs) in the U.S. and other developed countries from 1976 through 2001 to determine: 1) the types of interventions studied; 2) whether they cover diseases and conditions with the highest burden; and, 3) to what extent they have covered leading health concerns defined by the Healthy People 2010 report. DATA AND METHODS: We compared rankings of the most common diseases covered by the CUAs to rankings of U.S. disease burden. We also examined the extent to which CUAs covered key Healthy People 2010 priorities. RESULTS: CUAs have focused mostly on pharmaceuticals (40%) and surgical procedures (16%). When compared to leading causes of DALYs, the data show overrepresentation of CUAs in cerebrovascular disease, diabetes, breast cancer, and HIV/AIDS, and underrepresentation in depression and bipolar disorder, injuries, and substance abuse disorders. Few CUAs have targeted Healthy People 2010 areas, such as physical activity. CONCLUSIONS: Published CUAs are associated with burden measures, but have not covered certain important health problems. These discrepancies do not alone indicate that society has been targeting resources for research inefficiently, but they do suggest the need to formalize the question of where each CUA research dollar might do the most good.

Cost-Benefit Analysis↗
PubMedDate not supplied

Optimal allocation of testing dollars: the example of HIV counseling, testing, and referral.

BACKGROUND: Health screening programs can be represented as a pathway of sequential processes: offering a test, obtaining consent, conducting the test, providing results, and linking to appropriate care. Using the example of HIV testing, the authors explore the optimal targeting of funds within this pathway. METHODS: The authors develop a microsimulation of HIV testing services and decompose the likelihood that an unidentified HIV-infected person will receive care into the probability of testing [P(test)] and the probability of follow-up [P(follow)] defined as returning for results and linking to care. The authors examine the clinical impact and cost-effectiveness of alternative investments in these component probabilities. RESULTS: At 1% undiagnosed HIV prevalence, cost-effectiveness ratios for HIV testing cluster around $33,000/QALY (quality-adjusted life year) gained. A program with a yield of 0.16 via P(test)=0.20 and P(follow)=0.80 has a cost-effectiveness ratio of $32,900/QALY compared with $36,300/QALY for a program where P(test)=0.80 and P(follow)=0.20. Interventions that improve the probability of success in later stages in the testing pathway [P(follow)] are more cost-effective than investments devoted to earlier stages [P(test)]. CONCLUSIONS: Equivalent pathway outcomes in a screening program do not confer equal value. Limited screening resources are best targeted toward returning for results and linkage among those already identified with disease rather than offering testing to additional people.

AIDS Serodiagnosis↗
PubMedDate not supplied

Estimation of mortality rates for disease simulation models using Bayesian evidence synthesis.

PURPOSE: The authors propose a Bayesian approach for estimating competing risks for inputs to disease simulation models. This approach is suggested when modeling a disease that causes a large proportion of all-cause mortality, particularly when mortality from the disease of interest and other-cause mortality are both affected by the same risk factor. METHODS: The authors demonstrate a Bayesian evidence synthesis by estimating other-cause mortality, stratified by smoking status, for use in a simulation model of lung cancer. National (US) survey data linked to death registries (National Health Interview Survey [NHIS]--Multiple Cause of Death files) were used to fit cause-specific hazard models for 3 causes of death (lung cancer, heart disease, and all other causes), controlling for age, sex, race, and smoking status. Synthesis of NHIS data with national vital statistics data on numbers and causes of deaths was performed in WinBUGS (version 1.4.1, MRC Biostatistics Unit, UK). Correction for inconsistencies between the NHIS and vital statistics data is described. A published cohort study was a source of prior information for smoking-related mortality. RESULTS: Marginal posterior densities of annual mortality rates for lung cancer and other-cause death (further divided into heart disease and all other causes), stratified by 5-year age interval, race (white and black), gender, and smoking status (current, former, never), were estimated, specific to a time period (1987-1995). Overall, black current smokers experienced the highest mortality rates. CONCLUSIONS: Bayesian evidence synthesis is an effective method for estimation of cause-specific mortality rates, stratified by demographic factors.

Adult↗
PubMedDate not supplied

Comparative effectiveness: asking the right questions, choosing the right method.

The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 has placed renewed focus on assessing the comparative effectiveness of various therapeutic options. Unfortunately, all of the evidence needed to fully assess these options is rarely available to drug formulary decisionmakers. Comparative randomized trials frequently fail to find differences when there indeed are some, while decision-modeling approaches are more likely to identify differences where there are none. We consider the consequences of these strategies. This paper proposes a framework for using different methods to assess available evidence. We contend that choosing the appropriate method can occur only when there are clear policy goals.

Decision Making↗