Biomedical subjects

Tracey H Sach

Publications and source records attributed to Tracey H Sach.

4 recordsLinked to original sources

PubMed2006

Interpreting parental proxy reports of (health-related) quality of life for children with unilateral cochlear implants.

OBJECTIVE: To examine what factors are associated with EuroQol EQ-5D scores in children after unilateral cochlear implantation and to explore parental conceptualisations of health-related quality of life (HRQL) and quality of life (QoL). METHODS: Face to face interviews were conducted with the parents of 222 implanted children, in an attempt to elicit information on their child's HRQL and QoL. Post-implant, the child's HRQL was measured using the EQ-5D, completed by parental proxy. Regression analysis was undertaken in order to estimate the association between the child EQ-5D score and child characteristics, child performance, and parental characteristics, in order to assess the construct validity of the EQ-5D. HRQL was also measured using the EuroQol visual analogue scale (VAS), where the endpoints were the best and worst imaginable health state, and a VAS was also used to measure QoL (endpoints: best/worst imaginable QoL). Parents were asked to estimate scores on both these VAS measures both post-implantation and (retrospectively) pre-implantation. Throughout the HRQL and QoL elicitation process, subjects' comments, and observations were noted. RESULTS: Children who had an additional disability (p<0.001), were male (p<0.05) or had a lower level of auditory perception (p<0.001) were estimated to have lower EQ-5D scores, as were children whose parents who left school before age 18 years (p<0.05). According to the EuroQol VAS the mean difference between pre- and post-implantation score was 0.14, compared to 0.35 for the QoL VAS, demonstrating that parents tended not to see HRQL and QoL as equivalent. As 67% of parents deemed there to be no difference between the pre- and post-implant EuroQol VAS scores we also infer that the majority of parents rejected the notion of deafness being a HRQL issue. CONCLUSION: The evidence relating to the construct validity of the EQ-5D is variable-though it was able to discriminate between children with certain levels of auditory performance, it could not discriminate between children who differed in other ways. By limiting outcome from cochlear implantation to HRQL, as opposed to QoL, the benefits of cochlear implants are likely to be underestimated.

Child↗

PubMed2005

Paediatric cochlear implantation: the views of parents.

The purpose of this study was to understand the parental perspective on paediatric cochlear implantation over time. Face-to-face semi-structured interviews were conducted with 216 families of children who were implanted at the Nottingham Paediatric Cochlear Implant Programme between 1989 and 2002, and who were attending an appointment during the study period (July 2001 August 2002). The qualitative data revealed that time played an important role in family experiences of paediatric cochlear implantation. Expectations were continually revised throughout the process, as a result of new knowledge and new technological developments. The results show that outcomes are highly individualistic although parents had a shared hope of the implant enabling the child to function in a "hearing world"; that the biggest area of contention is in respect of their child's education; and that parents talked openly about constraints imposed on them by implantation. The vast majority of parents did not regret their decision to proceed with implantation.

Adult↗

PubMed2003

Measuring indirect costs: is there a problem?

It is generally accepted that, in order to appraise from a societal perspective, indirect costs should be included in economic evaluations. What is less generally accepted, however, is the method by which such indirect costs should be calculated. Different methods and assumptions can, in theory, produce different results. Previous studies have commented on this variability, and most suggest a need for consensus. This having been said, no previous study appears to have demonstrated that variability in method is actually a practical problem, in the sense that the use of different costing methods would lead to different policy conclusions. In this paper, we examine this issue with respect to a specific intervention, namely, paediatric cochlear implantation (PCI). Based on questionnaire data, we estimate the indirect costs of PCI using a variety of methods. Thereafter, we integrate these indirect costs into a cost-utility analysis of PCI, and demonstrate that the variability in methods can significantly affect the outcome of a cost-effectiveness study. Therefore, in this case at least, the measurement of indirect cost is indeed a problem.

Child↗

PubMedDate not supplied

Assessing progressivity of out-of-pocket payment: with illustration to Malaysia.

Throughout the world, policy makers are considering or implementing financing strategies that are likely to have a substantial impact on the equity of health financing. The assessment of the equity implication is clearly important, given the potential impact that alternative finance sources have on households. Households incur out-of-pocket payment directly from their budget, apart from their public or private insurance. Out-of-pocket payment is the primary concern, given their undesirable impact on households. Progressivity measures departures from proportionality in the relationship between out-of-pocket payment and ability to pay. It is the most frequently used yardstick to assess the equity of out-of-pocket payments in empirical studies. This paper provides an evaluation of such progressivity measures, undertaken using four approaches (proportion approach, tabulation approach, concentration curve and Kakwani's index), in order to reveal their usefulness and underlying notion. It is illustrated empirically with data on out-of-pocket payment for health care in Malaysia for 1998/ 1999, based on the nationally representative Household Expenditure Survey. Results indicate that out-of-pocket payments are mildly progressive, whilst the four approaches have their benefits and limitations in assessing equity implications. This analysis is of interest from a policy perspective, given Malaysia's heavy reliance on out-of-pocket payments to finance health care.

Cost Sharing↗