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Aim: This study aimed to determine the utility of chronic kidney disease (CKD)‐related health states in the Korean general population by using the standard gamble (SG) method. Methods: Seven hypothetical CKD‐related health states were developed and revised based on previous publications. Data from 242 individuals from the Korean general population were obtained via computer‐assisted personal interviews and used to evaluate the CKD‐related health states by using the visual analogue scale (VAS) and SG methods. Mean and median utility values were calculated for each health state. To assess the reliability of the valuation, some samples were retested and evaluated using intraclass correlation coefficients (ICC). Results: In all health states, the utility weights from SG were higher than those from VAS. The difference in utility values between the two valuation methods ranged from 0.258 to 0.308. The utility value of CKD grade 3 was the highest and that of peritoneal dialysis (PD) was the lowest. The utility weights tended to decrease in accordance with the progression of CKD. CKD grade 3 was assigned a SG utility value of 0.878, whereas PD was assigned 0.507. The SG utility values of predialysis end‐stage renal disease, haemodialysis, kidney transplantation (KT), and post‐KT recovery states were 0.666, 0.547, 0.748 and 0.827, respectively. The mean ICC (SD) at the individual level was 0.746 (0.281) for the SG scores. Conclusion: Our results could be used to measure the burden of kidney disease or to evaluate the economic efficiency of CKD‐related interventions. SUMMARY AT A GLANCE: The authors estimated the utility of seven chronic kidney disease (CKD)‐related health states in the Korean general population. The estimated utility values could be used to measure the burden of kidney disease or to compare it with that of other diseases. These results have implications in the economic evaluation of CKD‐related interventions, including screening programs. [ABSTRACT FROM AUTHOR]

Purpose: The EQ-5D-5L was developed to compensate for a high ceiling effect and lack of descriptive richness of the EQ-5D-3L. We evaluated psychometric properties of EQ-5D-5L in the general population. Methods: Six hundred of adults were sampled from the general population in South Korea using a multistage stratified quota sampling method. Participants completed the EQ-5D-5L, EQ-5D-3L, and SF-36v2. One hundred participants were resurveyed for reliability evaluation. The ceiling effect, known-groups construct validity, convergent and discriminant validity, and reliability of EQ-5D-5L were evaluated. Results: A smaller proportion of participants answered ‘no problem’ to all dimensions of EQ-5D-5L (61.2 %) than EQ-5D-3L (65.7 %, p < 0.01), indicating a reduced ceiling effect. Female, elderly, low-educated, and low-income participants reported health problems more frequently, indicating known-groups construct validity. The mobility dimension of EQ-5D-5L was better correlated with the physical component score (| r| = 0.48) than the mental component score (| r| = 0.25) of the SF-36v2, and the anxiety/depression dimension was better correlated with mental component score (| r| = 0.45) than physical component score (| r| = 0.34), indicating convergent and discriminant validity. The intraclass correlation coefficient of EQ-5D-5L index was 0.75. Conclusions: The EQ-5D-5L has a smaller ceiling effect than the EQ-5D-3L and is a valid and reliable instrument to measure health-related quality of life in the general population. [ABSTRACT FROM AUTHOR]

Objective: To estimate quality weights of EQ-5D health states with the time trade-off (TTO) method in the general population of South Korea. Methods: A total of 500 respondents valued 42 hypothetical EQ-5D health states using the TTO and visual analog scale. The quality weights for all EQ-5D health states were estimated by a random effects model and compared with those from studies in other countries. Results: Overall estimated quality weights for all EQ-5D health states from this study were highly correlated with those from previous studies, but quality weights of individual states were substantially different from those of their corresponding states in other studies. Conclusions: The Korean value set differed from value sets from other countries. Special caution is needed when a value set from one country is applied to another with a different culture. [ABSTRACT FROM AUTHOR]

South Korea has one of the highest suicide rates among countries. However, the prevalence of depression in South Korea has been reported to be much lower than in other countries. The current study aims to estimate the prevalence of major depressive disorder using a large representative sample of the South Korean population. The prevalence of depression in a sampled population of one million individuals increased from 2.8% in 2002 to 5.3% in 2013; it was found to increase with the age of the population, and was higher in females than in males for most age groups. A Cox's proportional hazard model showed that suicide risk was significantly higher in people with depression (hazard ratio [HR] 3.79, 95% CI 3.14–4.58) than those without depression. It was also significantly higher in older people (HR 1.52, 95% CI 1.36–1.70) than in younger people, and in males (HR 2.45, 95% CI 2.02–2.96) than in females. Furthermore, higher income groups were at lower suicide risk as compared to lower income groups (HR 0.88, 95% CI 0.80–0.95). This study using the large representative sample data provided evidence that increased prevalence of depression contributed to the increased risk of suicide in South Korea during the recent decade. [ABSTRACT FROM AUTHOR]

Background: Globally, allergic diseases are very common in childhood and may affect children's quality of life. This study aimed to explore health-related quality of life of elementary school students with allergy symptoms using the EQ-5D-Y and to examine the validity and feasibility of the EQ-5D-Y.Methods: The study subjects were the students within 50 elementary schools which voluntarily participated in research project. In this sample population, the EQ-5D-Y questionnaire was self-administered by the students, and demographic and health information were collected from the student's parents. The parents' information was used to investigate the proportion of students with allergic symptoms (wheezing, runny or blocked nose, and itchy rash) in the past 12 months. In addition, we analyzed the correlation of symptom reporting and EQ-5D-Y including EQ-VAS.Results: The overall return was 9117 responses, of which 198 (2.2%) lacked responses on the EQ-5D-Y dimension and 1258 (13.8%) on the VAS score. There were significant differences in symptom reporting in all EQ-5D-Y dimensions between groups with or without allergic symptoms. Particularly, there was a large difference in reporting rates in 'having pain or discomfort' and 'feeling worried, sad or unhappy' dimensions. As the number of allergic symptoms increased, in all dimensions also the problem reporting rate tended to increase.Conclusions: As expected, the presence of allergic symptoms is inversely correlated with the quality of life of children. The EQ-5D-Y instrument proved to be useful in terms of feasibility and construct validity in assessing the quality of life of Korean elementary school students. [ABSTRACT FROM AUTHOR]

Background: The burden of diabetes is considerable not only globally but also nationally within Korea. The Global Burden of Disease study derived the disability-adjusted life years (DALYs) of diabetes depending on its complications as individual severity using prevalence-based approach from 2017. Conversely, the Korean National Burden of Disease study based on an incidence-based approach does not incorporate the severity of diseases. This study aimed to simulate incidence-based DALYs of type 2 diabetes mellitus (T2DM), given diabetic complications as disease severity using a Markov model. Methods: We developed a model with six Markov states, including incident and existing prevalent cases of diabetes and its complications and death. We assumed that diabetes and its complications would not be cured. The cycle length was one year, and the endpoint of the simulation was 100 years. A 5% discount rate was adopted in the analysis. Transition cases were counted by 5-year age groups above 30 years of age. Age- and sex-specific transition probabilities were calculated based on the incident rate. Results: The total DALY estimates of T2DM were 5,417 and 3,934 per 100,000 population in men and women, respectively. The years of life lost in men were relatively higher than those in women in most age groups except the 80–84 age group. The distribution of years lived with disability by gender and age group showed a bell shape, peaking in the 55–59 age group in men and 65–69 age group in women. Conclusions: The burden of T2DM considering its complications was larger compared to the outcomes from previous studies, with more precise morbid duration using the Markov model. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to identify the best-fitting model in predicting the health gap of multimorbid status based on the health gap of uniconditional status.Methods: This study analyzed data of adults aged 50 years or older derived from the cross-sectional, nationally representative 6th Korean National Health and Nutrition Examination Survey (KNHANES). We translated the EQ-5D utility score assessed from the KNHANES using the Korean EQ-5D-3L into the health gap by subtracting the EQ-5D utility score from one. The predicted health gap of multimorbid status was calculated based on the health gap of uniconditional status using the additive, multiplicative, and maximum limit models. We assessed the performance of the multimorbidity adjustment models based on the root mean square error and mean absolute error. We also examined the impact of multimorbidity adjustment on the estimated disease burden in the best-fitting model.Results: Of the three approaches, the multiplicative adjustment model had the smallest root mean square error between the predicted and observed health gap of multimorbid status. The total number of prevalence-based years lived with the disability after adjusting for multimorbid status using the multiplicative model decreased compared to that without adjustment for multimorbid status.Conclusion: Using the appropriate methodology to adjust for multimorbidity in estimations of population health is becoming more important as the prevalence of multimorbidity increases, particularly in older populations. Further empirical research is required to develop additional general adjustment approaches that consider the independent co-occurrence of multiple diseases, and to understand how multimorbidity influences health gap. [ABSTRACT FROM AUTHOR]

Background and Aims: To assess whether predictors of success in stopping smoking vary as a function of income level in Korean smoking cessation services. Design Prospective study of predictors of smoking cessation up to 6 months' follow up. Participants: A sample of 954 people (mean age 49.13 ± 10.69 years; 863 [90.5%] men) enrolled in the Korean National Health Insurance Service smoking cessation programme in 2015. Measures: The outcome measure was self‐reported continuous abstinence up to 6‐month follow up. Predictors were income and other sociodemographic variables as well as smoking‐related variables measured at baseline. Results: The continuous 6‐month abstinence rate was 30.5%. The adjusted odds of 6‐month continuous abstinence were lower among low‐income versus the middle‐ or high‐income smokers (OR, 0.54; 95% CI, 0.35–0.84), those with severe versus light/moderate cigarette dependence (OR, 0.72; 95% CI, 0.52–0.98), and use of bupropion versus varenicline (OR, 0.60; 95% CI, 0.39–0.91). The association between cigarette dependence and outcome was only present among low‐income smokers. Conclusions: Lower income, higher cigarette dependence, and choice of bupropion versus varenicline are associated with lower chances of stopping smoking in Korean smoking cessation services, but the association with cigarette dependence is only found in low‐income smokers. [ABSTRACT FROM AUTHOR]

Existing epidemiologic reports or studies of cancer statistics in Korea lack sufficient data on cancer severity distributions and observed survival rates. This study analyzed trends in major cancer statistics according to sex and severity levels in Korea from 2006 to 2013. We included eight cancers (hepatocellular carcinoma, and thyroid, colorectal, gastric, lung, prostate, breast, and cervical cancer), using Korea Central Cancer Registry data. Severity level was classified by Surveillance, Epidemiology, and End Results (SEER) stage as follows: localized, regional, distant, or unknown. Numbers of incident cancer cases from 2006 to 2013 were described by sex and SEER stage. We estimated up to 8-year observed survival rates of major cancers by sex and SEER stage, and provided prevalence rates by sex and SEER stage in 2011, 2012, and 2013. Although increases in new cancer cases are slowing and the total number of incident cancer cases in 2013 decreased for the first time since 2006, the number of prevalent cancer cases was 663,530 in 2013, an increase of 13.3% compared to 2011. Among the five cancers affecting both sexes, sex-related differences in 5-year observed survival rates for lung cancer were greatest in the localized stage (men, 31.9%; women, 48.1%), regional stage (men, 20.0%; women, 31.3%), and unknown stage (men, 24.3%; women, 37.5%). The sum of the proportions of localized and regional stages for thyroid and breast cancer was over 90% in 2013, while the sum of the proportions of localized and regional stages for lung cancer was only 56.7% in 2013. Differences in observed survival rates between men and women were prominent in lung cancer for all SEER stages. The reported epidemiologic data from this study can be used to obtain a more valid measure of cancer burden using a summary measure of population health. [ABSTRACT FROM AUTHOR]

To introduce disclosure of patient safety incidents (DPSI) into a specific country, evidence of the effectiveness of DPSI is essential. Since such a disclosure policy has not been adopted in South Korea, hypothetical cases can be used to measure the effectiveness of DPSI. We evaluated the effectiveness of DPSI using hypothetical cases in a survey with a sample of the Korean general public. We used 8 hypothetical cases reflecting 3 conditions: the clarity of medical errors, the severity of harm, and conducting DPSI. Face-to-face interviews with 700 people using structured questionnaires were conducted. Participants were asked to read each hypothetical case and give remarks on the following: their judgment of a situation as a medical error and of the requirement for an apology, the willingness to revisit or recommend physicians, the intention to file a medical lawsuit and commence criminal proceedings against physicians, the level of trust in physicians, and the expected amount of compensation. The results indicated favorable findings in support of DPSI; DPSI reduced the likelihood of perceiving a situation as a medical error, promoted willingness to revisit and recommend physicians, and discouraged the intention to file a medical lawsuit and take commence criminal proceedings against physicians. Furthermore, DPSI increased patients’ trust scores in physicians and reduced the expected amount of compensation. The general public had positive attitudes towards DPSI in South Korea. This result provides empirical evidence for reducing the psychological burden that the introduction of DPSI may have on health professionals. [ABSTRACT FROM AUTHOR]

Background: The recent rising health spending intrigued efficiency and cost-based performance measures. However, mortality risk adjustment methods are still under consideration in cost estimation, though methods specific to cost estimate have been developed. Therefore, we aimed to compare the performance of diagnosis-based risk adjustment methods based on the episode-based cost to utilize in efficiency measurement. Methods: We used the Health Insurance Review and Assessment Service–National Patient Sample as the data source. A separate linear regression model was constructed within each Major Diagnostic Category (MDC). Individual models included explanatory (demographics, insurance type, institutional type, Adjacent Diagnosis Related Group [ADRG], diagnosis-based risk adjustment methods) and response variables (episode-based costs). The following risk adjustment methods were used: Refined Diagnosis Related Group (RDRG), Charlson Comorbidity Index (CCI), National Health Insurance Service Hierarchical Condition Categories (NHIS-HCC), and Department of Health and Human Service-HCC (HHS-HCC). The model accuracy was compared using R-squared (R2), mean absolute error, and predictive ratio. For external validity, we used the 2017 dataset. Results: The model including RDRG improved the mean adjusted R2 from 40.8% to 45.8% compared to the adjacent DRG. RDRG was inferior to both HCCs (RDRG adjusted R2 45.8%, NHIS-HCC adjusted R2 46.3%, HHS-HCC adjusted R2 45.9%) but superior to CCI (adjusted R2 42.7%). Model performance varied depending on the MDC groups. While both HCCs had the highest explanatory power in 12 MDCs, including MDC P (Newborns), RDRG showed the highest adjusted R2 in 6 MDCs, such as MDC O (pregnancy, childbirth, and puerperium). The overall mean absolute errors were the lowest in the model with RDRG ($1,099). The predictive ratios showed similar patterns among the models regardless of the subgroups according to age, sex, insurance type, institutional type, and the upper and lower 10th percentiles of actual costs. External validity also showed a similar pattern in the model performance. Conclusions: Our research showed that either NHIS-HCC or HHS-HCC can be useful in adjusting comorbidities for episode-based costs in the process of efficiency measurement. [ABSTRACT FROM AUTHOR]

Purpose: The standard gamble (SG) method is the gold standard for valuing health states as a utility, although it is accepted that it is difficult to valuate health states. This study was conducted in order to compare the SG with the rating scale (RS) and time trade-off (TTO) techniques in terms of their feasibility, comparability, and reliability in a valuation survey of the general Korean population.Methods: Five-hundred members of the general Korean population were recruited using a multi-stage quota sampling method in Seoul and its surrounding areas, Korea. Respondents evaluated 9 EQ-5D-5L health states using a visual analogue scale (VAS), SG, and TTO during a personal interview. Feasibility was assessed in aspects of the level of difficulty, administration time, and inconsistent responses. Comparability was evaluated using intraclass correlation coefficient (ICC) and the Bland-Altman approach. Test-retest reliability was analyzed using the ICC.Results: Of the three methods, VAS was the easiest and quickest method to respond. The SG method did not differ significantly compared to the TTO method in administration time as well as the level of difficulty. The SG and TTO values were highly correlated (r = 0.992), and the average mean difference between the SG and the TTO values was 0.034. The ICCs of the VAS, SG, and TTO scores were 0.906, 0.841, and 0.827, respectively.Conclusions: This study suggests that the SG method compared with the VAS and TTO method was feasible and offered a reliable tool for population-based, health state valuation studies in Korea. [ABSTRACT FROM AUTHOR]

Background: The psychometric properties of the Korean Short Form-12 Health Survey, version 2 (SF-12 v2) have not been assessed in the general population. Therefore, the aim of our study was to evaluate the psychometric properties of the Korean version of the SF-12 v2 in the general population and to provide SF-12 v2 domain scores according to the general characteristics of the study population.Methods: A total of 1,000 participants from the general Korean population were recruited using a multistage quota sampling method. Psychometric properties were evaluated by descriptive statistics, validity, reliability, and exploratory factor analysis.Results: Item convergent and discriminant validity met the criteria established by the instrument developer. In the known-group comparison, male gender, age <60 years, high educational status, and absence of any comorbidity were significantly associated with high scale scores. The reliability of all SF-12 v2 items was 0.88.Conclusions: The findings of this study generally support the idea that the Korean SF-12 v2 is a feasible, valid, and reliable instrument for assessing health-related quality of life in the general population. The SF-12 v2 seems to be a viable alternative health-related quality of life instrument for the Korean population. [ABSTRACT FROM AUTHOR]

Background: In intensive care unit (ICU) settings, the transmission risk of carbapenem-resistant, gram-negative bacteria (CRGNB) is high. There is a paucity of data regarding the effectiveness of interventions, including active screening, preemptive isolation, and contact precautions, to reduce transmission of CRGNB. Methods: We conducted a pragmatic, cluster-randomized, non-blinded cross-over study in 6 adult ICUs in a tertiary care center in Seoul, South Korea. ICUs were randomly assigned to perform active surveillance testing with preemptive isolation and contact precautions (intervention) or standard precautions (control) during the initial 6-month study period, followed by a 1-month washout period. During a subsequent 6-month period, departments that used standard precautions switched to using interventional precautions and vice versa. The incidence rates of CRGNB were compared between the two periods using Poisson regression analysis. Results: During the study period, there were 2268 and 2224 ICU admissions during the intervention and control periods, respectively. Because a carbapenemase-producing Enterobacterales outbreak occurred in a surgical ICU (SICU), we excluded admissions to the SICU during both the intervention and control periods and performed a modified intention-to-treat (mITT) analysis. In mITT analysis, a total of 1314 patients were included. The acquisition rate of CRGNB was 1.75 cases per 1000 person-days during the intervention period versus 3.33 cases per 1000 person-days during the control period (IRR, 0.53 [95% confidence interval (CI) 0.23–1.11]; P = 0.07). Conclusions: Although this study was underpowered and showed borderline significance, active surveillance testing and preemptive isolation could be considered in settings with high baseline prevalence of CRGNB. Trial registration Clinicaltrials.gov Identifier: NCT03980197. [ABSTRACT FROM AUTHOR]

Highlights: [•] Utility of epilepsy with partial seizure was measured by TTO, VAS and EQ-5D in general population. [•] Seizure-free (0.899, 0.959 measured by TTO, EQ-5D respectively) had higher utility scores than seizure reduction (0.493, 0.645) and withdrawal (0.303, 0.261). [•] Mean utilities from EQ-5D were greater than those from TTO for the seizure reduction and the seizure-free state. [ABSTRACT FROM AUTHOR]

Introduction: Many countries have established their own EQ-5D value sets proceeding on the basis that health preferences differ among countries/populations. So far, published studies focused on comparing value set using TTO data. This study aims to compare the health preferences among 11 Asian populations using the DCE data collected in their EQ-5D-5L valuation studies. Methods: In the EQ-VT protocol, 196 pairs of EQ-5D-5L health states were valued by a general population sample using DCE method for all studies. DCE data were obtained from the study PI. To understand how the health preferences are different/similar with each other, the following analyses were done: (1) the statistical difference between the coefficients; (2) the relative importance of the five EQ-5D dimensions; (3) the relative importance of the response levels. Results: The number of statistically differed coefficients between two studies ranged from 2 to 16 (mean: 9.3), out of 20 main effects coefficients. For the relative importance, there is not a universal preference pattern that fits all studies, but with some common characteristics, e.g. mobility is considered the most important; the relative importance of levels are approximately 20% for level 2, 30% for level 3, 70% for level 4 for all studies. Discussion: Following a standardized study protocol, there are still considerable differences in the modeling and relative importance results in the EQ-5D-5L DCE data among 11 Asian studies. These findings advocate the use of local value set for calculating health state utility. [ABSTRACT FROM AUTHOR]

Background: In South Korea, there is currently no syndromic surveillance system using internet search data, including Google Flu Trends. The purpose of this study was to investigate the correlation between national influenza surveillance data and Google Trends in South Korea. Methods: Our study was based on a publicly available search engine database, Google Trends, using 12 influenza-related queries, from September 9, 2007 to September 8, 2012. National surveillance data were obtained from the Korea Centers for Disease Control and Prevention (KCDC) influenza-like illness (ILI) and virologic surveillance system. Pearson's correlation coefficients were calculated to compare the national surveillance and the Google Trends data for the overall period and for 5 influenza seasons. Results: The correlation coefficient between the KCDC ILI and virologic surveillance data was 0.72 (p<0.05). The highest correlation was between the Google Trends query of H1N1 and the ILI data, with a correlation coefficient of 0.53 (p<0.05), for the overall study period. When compared with the KCDC virologic data, the Google Trends query of bird flu had the highest correlation with a correlation coefficient of 0.93 (p<0.05) in the 2010-11 season. The following queries showed a statistically significant correlation coefficient compared with ILI data for three consecutive seasons: Tamiflu (r = 0.59, 0.86, 0.90, p<0.05), new flu (r = 0.64, 0.43, 0.70, p<0.05) and flu (r = 0.68, 0.43, 0.77, p<0.05). Conclusions: In our study, we found that the Google Trends for certain queries using the survey on influenza correlated with national surveillance data in South Korea. The results of this study showed that Google Trends in the Korean language can be used as complementary data for influenza surveillance but was insufficient for the use of predictive models, such as Google Flu Trends. [ABSTRACT FROM AUTHOR]

Although integrated home internet of things (IoT) services can be beneficial, especially for vulnerable older adults, the hurdle of usability hinders implementation of the technology. This study aimed to evaluate the practical usability of home IoT services in older adults, by frailty status, and to determine the potential obstacles. From August 2019 to July 2020, we randomly selected 20 vulnerable older adults (prefrailty group [n = 11], and frailty group [n = 9]) who had already been identified as needing home IoT services in a community-based prospective cohort study, the Aging Study of the Pyeongchang Rural Area. Integrated home IoT services were provided for 1 year, and a face-to-face survey evaluating usability and satisfaction of each service was conducted. The usability of the integrated home IoT services declined gradually throughout the study. However, prefrail participants showed higher usability than frail older adults (difference-in-difference = − 19.431, p = 0.012). According to the frailty status, the change in usability for each service type also showed a different pattern. During the 12-month study period, the service with the highest satisfaction converged from various service needs to light control by remote control (77.8%) in the prefrailty group and automatic gas circuit breaker (72.7%) in the frailty group. For wider implementation of home IoT services, organizing services expected to have high usability and satisfaction based on user's frailty status is crucial. Also, providing education before service implementation might help older adults coping with digital literacy. [ABSTRACT FROM AUTHOR]

• HAdV leads to ARD outbreaks among military recruits. • Current vaccine fails against HAdV in Korean military; targeted vaccine needed. • Vaccine benefit-cost ratio: 0.71 in the sixth year, increasing to 1.32 thereafter. • The cumulative benefit-cost ratio over 10 years was 2.72. Human adenovirus (HAdV) is a prevalent causative agent of acute respiratory disease (ARD) and is frequently responsible for outbreaks, particularly in military environments. Current vaccines do not effectively cover HAdV subtypes commonly found among Korean military personnel, highlighting the need for a new targeted vaccine. This study presents a cost-benefit analysis to evaluate the economic viability of developing and implementing such a vaccine within a military context. We adopted a societal perspective for this cost-benefit analysis, which included estimating costs associated with vaccine development, production, and distribution over a projected timeline. We assumed a development period of five years, after which vaccine production and administration were initiated in the sixth year. The cost associated with vaccine development, production, and dispensation was considered. The benefits were calculated based on both direct and indirect cost savings from preventing HAdV infections through vaccination. All financial figures were expressed in 2023 US dollars. A sensitivity analysis was conducted to explore the impact of varying factors such as vaccination rate, incidence of infection, vaccine efficacy, and discount rate. For the base case scenario, we assumed a vaccination rate of 100 %, an incidence rate of 0.02, and a vaccine efficacy of 95 %, applying a 3 % discount rate. Initially, in the sixth year, the benefit-cost ratio stood at 0.71, suggesting a cost disadvantage at the onset of vaccination. However, this ratio improved to 1.32 in the following years, indicating a cost benefit from the seventh year onward. The cumulative benefit-cost ratio over a decade reached 2.72. The outcomes from the sensitivity analysis were consistent with these findings. Our cost-benefit analysis demonstrates that the introduction of an HAdV vaccine for the Korean military is economically advantageous, with substantial cost benefits accruing from the seventh year after the commencement of vaccination. [ABSTRACT FROM AUTHOR]

Aim: Although a National Health Screening Program (NHSP) for chronic kidney disease (CKD) has been implemented in Korea since 2002, its cost‐effectiveness has never been determined. This study aimed to estimate the cost‐utility of NHSP for CKD in Korea. Methods: A Markov decision analytic model was constructed to compare CKD screening strategies of the NHSP with no screening. We developed a model that simulated disease progression in a cohort aged 20–120 years or death from the societal perspective. Results: Biannual screening starting at age 40 for CKD by proteinuria (dipstick) and estimated glomerular filtration ratio had an ICUR of $66 874/QALY relative to no screening. The targeted screening strategy had an ICUR of $37 812/QALY and $40 787/QALY for persons with diabetes and hypertension, respectively. ICURs improved with lower cost strategies. The most influential parameter that might make screening more cost‐effective was the effectiveness of treatment on CKD to decrease disease progression and mortality. Conclusions: The Korean NHSP for CKD is more cost‐effective for patients with diabetes or hypertension than the general population, consistent with prior studies. Although it is too early to conclude the cost‐effectiveness of the Korean NHSP for CKD, this study provides evidence that is useful in evaluating the cost‐effectiveness of CKD interventions. Summary at a Glance: The authors successfully demonstrate that the Korean National Health Screening Program (NHSP) for CKD is more cost‐effective for patients with diabetes or hypertension than the general population. [ABSTRACT FROM AUTHOR]

Background: Utility weight, a measure of health-related quality of life, is used in disease burden measurements and economic evaluations. In this study, we used the visual analogue scale (VAS) and standard gamble (SG) method to determine the utility weights of lung cancer health states in South Korea from a societal perspective.Methods: Six hypothetical health states for lung cancer or a related health state reflective of disease severity were developed: 1) Stage I, 2) Stage II, 3) Stage IIIa, 4) Stage IIIB, 5) Stage IV, and 6) Pulmonary nodule. The description of each health state description was divided into four parts: diagnosis, symptoms, treatment, and progression and prognosis. A total of 515 representative adult Korean participants used a VAS and SG to evaluate these six health states via face-to-face computer-assisted interviews. The means, standard deviations, and median utility weights of the six health states were estimated by valuation method.Results: The two valuation methods of the scenarios yielded the same mean utility rankings. Pulmonary nodule received the highest rank (VAS, 0.66 and SG, 0.83), whereas Stage 4 was assigned the lowest rank (VAS, 0.09 and SG, 0.31). For all health states, the mean utility weights calculated using the SG were greater than those calculated using the VAS. The differences between the utility weights obtained using the two valuation methods ranged from 0.14 (Stage I) to 0.22 (Stage IV). The two approaches tended to yield larger differences for more severe stages.Conclusions: This study determined utilities for squamous cell lung cancer that will be useful for estimating the burden of lung cancer and for conducting economic evaluations of lung cancer interventions. [ABSTRACT FROM AUTHOR]

Background: This study aimed to generate utility weights of gastric cancer-related health states from the perspective of the Korean general population. Methods: The Korean adults (age ≥19 years) included in the study were sampled using multistage quota sampling methods stratified by sex, age, and education level. Nine scenarios for hypothetical gastric cancer-related health states were developed and reviewed. After consenting to participate, the subjects were surveyed by trained interviewers using a computer-assisted personal interview method. Participants were asked to perform standard gamble tasks to measure the utility weights of 5 randomly assigned health states (from among nine scenarios). The mean utility weight was calculated for each health state. Results: Three hundred twenty-six of the 407 adults who completed this study were included in the analysis. The mean utility weights from the standard gamble were 0.857 (no gastric cancer with Helicobacter pylori infection), 0.773 (early gastric cancer [EGC] with endoscopic surgery), 0.779 (EGC with subtotal gastrectomy), 0.767 (EGC with total gastrectomy), 0.602 (advanced gastric cancer with subtotal gastrectomy and adjuvant chemotherapy), 0.643 (advanced gastric cancer with total gastrectomy and adjuvant chemotherapy), 0.522 (advanced gastric cancer with extended gastrectomy and adjuvant chemotherapy), 0.404 (metastatic gastric cancer with palliative chemotherapy), and 0.399 (recurrent gastric cancer with palliative chemotherapy). Conclusion: This study was the first to comprehensively estimate the utility weights of gastric cancer-related health states in a general population. The utility weights derived from this study could be useful for future economic evaluations related to gastric cancer interventions. [ABSTRACT FROM AUTHOR]

Background: Low socioeconomic status can increase the risk of adverse pregnancy outcomes, but it remains unclear whether this negative association is attributed to inadequate prenatal care. Korea has been adopting a universal healthcare system. All Korean citizens must be enrolled National Health Insurance (NHI) or be recipient of Medical Aid (MA). In addition, Korean government launched a financial support system for antenatal care for all pregnant women in 2008. Therefore, in theory, there is no financial barrier to receive prenatal cares regardless of someone's social class. However, it is still unclear whether adverse pregnancy outcomes observed in low-income women are attributable to low SES or to economic barriers specific to the utilization of medical services. The purpose of this study was to investigate whether socioeconomic status affects pregnancy outcomes after the introduction of this support system, which allows all pregnant women to receive adequate prenatal care regardless of socioeconomic status. Methods: Using the National Health Insurance database in Korea, we selected women who gave birth between January 1, 2010 and December 31, 2010. As a proxy indicator reflecting socioeconomic status, we classified subjects as MA recipient ("low" SES) or a NHI beneficiary ("middle/high" SES). Results: In the MA group, 29.4% women received inadequate prenatal care, compared to 11.4% in the NHI group. Mothers in the MA group were more likely to have an abortion (30.1%), rather than deliver a baby, than those in the NHI group (20.7%, P < 0.001). Mothers in the MA group were also more likely to undergo a Caesarean delivery (45.8%; NHI group: 39.6%, P < 0.001), and have preeclampsia (1.5%; NHI group: 0.6%, P < 0.001), obstetric hemorrhage (4.7%; NHI group: 3.9%, P = 0.017), and a preterm delivery (2.1%; NHI group: 1.4%, P < 0.001) than those in the NHI group. Conclusions: Women in the MA group tended to show higher rates of abortion, Caesarean delivery, preeclampsia, preterm delivery, and obstetrical hemorrhage than those in the NHI group Therefore, health authorities should consider investigating what kind of barriers exist or what factors may affect these inequitable outcomes. [ABSTRACT FROM AUTHOR]

Background: The global burden of liver diseases, such as hepatocellular carcinoma and liver cirrhosis, is substantial. In this study, we estimated utility weights of liver disease-related health states in the general population using a visual analogue scale (VAS) and the standard gamble (SG) method.Methods: Depictions of standardized health states related to major liver diseases were developed based on patient education materials and previous publications. To fully reflect disease progression from diagnosis to prognosis, each health state comprised four parts: diagnosis, symptoms, treatment, and progression and prognosis. A total of 407 participants from the Korean general population evaluated the health states using the VAS and SG methods in computer-assisted personal interviews. After excluding illogical responses, mean utility weights were calculated for each health state.Results: The utility weights for health states were significantly different according to the existence of inconsistency in general. According to the VAS results, the health state with the highest utility was 'Chronic hepatitis B virus infection' (0.64), whereas the health state with the lowest utility was 'Hepatocellular carcinoma that requires palliative therapy' (0.17). Similarly, the SG results revealed that the health state with the highest utility was 'Chronic hepatitis B virus infection' (0.85), and the health state with the lowest utility was 'Hepatocellular carcinoma that requires palliative therapy' (0.40).Conclusions: The estimated utility weights in this study will be useful to measure the burden of liver diseases and evaluate cost-utility of programs for reducing the burden of liver diseases. [ABSTRACT FROM AUTHOR]

We estimated the disability weights in the South Korean population by using a paired comparison-only model wherein ‘full health’ and ‘being dead’ were included as anchor points, without resorting to a cardinal method, such as person trade-off. The study was conducted via 2 types of survey: a household survey involving computer-assisted face-to-face interviews and a web-based survey (similar to that of the GBD 2010 disability weight study). With regard to the valuation methods, paired comparison, visual analogue scale (VAS), and standard gamble (SG) were used in the household survey, whereas paired comparison and population health equivalence (PHE) were used in the web-based survey. Accordingly, we described a total of 258 health states, with ‘full health’ and ‘being dead’ designated as anchor points. In the analysis, 4 models were considered: a paired comparison-only model; hybrid model between paired comparison and PHE; VAS model; and SG model. A total of 2,728 and 3,188 individuals participated in the household and web-based survey, respectively. The Pearson correlation coefficients of the disability weights of health states between the GBD 2010 study and the current models were 0.802 for Model 2, 0.796 for Model 1, 0.681 for Model 3, and 0.574 for Model 4 (all P-values<0.001). The discrimination of values according to health state severity was most suitable in Model 1. Based on these results, the paired comparison-only model was selected as the best model for estimating disability weights in South Korea, and for maintaining simplicity in the analysis. Thus, disability weights can be more easily estimated by using paired comparison alone, with ‘full health’ and ‘being dead’ as one of the health states. As noted in our study, we believe that additional evidence regarding the universality of disability weight can be observed by using a simplified methodology of estimating disability weights. [ABSTRACT FROM AUTHOR]

Background The aim of the present study was to compare the association between cardiovascular diseases (CVD) and prediabetes defined by either fasting plasma glucose (FPG), HbA1c, or their combination in a Korean population. Methods In all, 76 434 South Koreans who voluntarily underwent a general health examination in the Health Screening & Promotion Center (Asan Medical Center) were analyzed after excluding patients with a previous history of CVD. Cardiovascular events and death due to CVD during a median follow-up period of 3.1 years (interquartile range 1.9-4.3 years) were identified from the Nationwide Health Insurance Claims Database and death certificates using ICD-10 codes. Results Age- and sex-adjusted hazard ratios (HRs) for overall CVD events were significantly greater for subjects with prediabetes defined by FPG only (HR 1.19; 95% confidence interval [CI] 1.08-1.31), HbA1c only (HR 1.28; 95% CI 1.16-1.42), and combined criteria (HR 1.20; 95% CI 1.09-1.32) compared with the normoglycemic group. After adjusting for multiple conventional risk factors (e.g. hypertension, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, smoking status, family history of CVD, and BMI), the HRs for overall CVD were significantly increased only for participants with prediabetes defined by HbA1c. Age- and sex-adjusted HRs for major ischemic heart disease events were significantly increased for subjects with prediabetes defined either by HbA1c or combined criteria. Similarly, age- and sex-adjusted HRs for percutaneous coronary intervention were significantly higher for subjects with prediabetes defined by HbA1c only. For diabetes, the multivariate-adjusted HRs for all outcomes were significantly increased by all three criteria. Conclusions Adding an HbA1c criterion when defining prediabetes in Koreans can help identify individuals with an increased risk of CVD. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to identify private clinics that have a potential to perform the role of primary care providers (PCPs) in a primary care setting in Korea where private specialists are dominant. Methods: The 2013 National Patient Sample claim data of Health Insurance Review and Assessment Service in Korea was used. Two-step cluster analysis was performed using characteristics of private clinics, and patient and utilization characteristics of 27,797 private clinics. External validation of clusters was performed by assessing the association among clusters and outcomes of care provided by private clinics. Stability of clusters was cross-validated using discriminant analysis. Results: The result classified more than a half of private clinics into a potential PCP cluster. These were private clinics with specialties considered to be those of primary care physicians and were more likely to be located in non-metropolitan areas than specialized PCPs were. Compared to specialized PCPs, they had a higher percentage of pediatric and geriatric patients, patients with greater disease severity, a higher percentage of patients with complex comorbidities or with simple or minor disease groups, a higher number of patients and visits, and the same or higher quality of primary care. The most important factor in explaining variations between PCP clusters was the number of simple or minor disease groups per patient. Conclusion: This study identified potential PCPs and suggested the identifying criteria for PCPs. It will provide useful information for formulation of a primary care strengthening policy to policy makers in Korea as well as other countries with similar specialist-dominant primary care settings. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to estimate Korean preference weights for EQ-5D-5L based on values elicited from Korean population by applying the EuroQol Valuation Technology (EQ-VT) program and the standard protocol by the EuroQol Group.Methods: The multistage quota sampling method was used to recruit 1085 subjects from the general population in Korea. Each respondent valuated 10 health states using the composite time trade-off (cTTO) and 7 health states using discrete choice experiment. The EQ-VT program was developed by the EuroQol Group and translated into Korean with the Korean research team. Computer-assisted, face-to-face interviews were conducted. A range of predictive models were explored using cTTO. The most appropriate model was determined after assessing goodness of fit, logical consistency, and parsimony.Results: Of 3206 contacted, 1085 subjects completed interviews (33.8 %) and 1080 were used for modeling. A model with dummy variables for each level of severity and dimension and a term that picked up whether any dimension in the state was at level 4 or 5 was selected as the best predictive model. All coefficients of the final model were statistically significant and logically consistent. In addition, it was parsimonious. This model had mean absolute error of 0.027, and the absolute error for all 86 health states was below 0.1.Conclusions: The final model built in this study appears to predict the utilities of the states which were valuated directly. This model could be used to interpolate quality weights for all EQ-5D-5L health states. [ABSTRACT FROM AUTHOR]

Objectives: To determine the feasibility of converting ranking data into paired comparison (PC) data and suggest the number of alternatives that can be ranked by comparing a PC and a ranking method.Methods: Using a total of 222 health states, a household survey was conducted in a sample of 300 individuals from the general population. Each respondent performed a PC 15 times and a ranking method 6 times (two attempts of ranking three, four, and five health states, respectively). The health states of the PC and the ranking method were constructed to overlap each other. We converted the ranked data into PC data and examined the consistency of the response rate. Applying probit regression, we obtained the predicted probability of each method. Pearson correlation coefficients were determined between the predicted probabilities of those methods. The mean absolute error was also assessed between the observed and the predicted values.Results: The overall consistency of the response rate was 82.8%. The Pearson correlation coefficients were 0.789, 0.852, and 0.893 for ranking three, four, and five health states, respectively. The lowest mean absolute error was 0.082 (95% confidence interval [CI] 0.074-0.090) in ranking five health states, followed by 0.123 (95% CI 0.111-0.135) in ranking four health states and 0.126 (95% CI 0.113-0.138) in ranking three health states.Conclusions: After empirically examining the consistency of the response rate between a PC and a ranking method, we suggest that using five alternatives in the ranking method may be superior to using three or four alternatives. [ABSTRACT FROM AUTHOR]

Background: Population aging is a major health concern in Asian countries and it has affected the age distribution of patients with end-stage renal disease (ESRD). As a consequence, the need for kidney transplantation in the geriatric population has increased, but the shortage of donors is an obstacle for geriatric renal transplantation. The aim of this study was to evaluate risk factors for graft failure and death in geriatric renal transplantation. Methods: Kidney transplantations performed in a tertiary hospital in South Korea from May 1995 to December 2014 were retrospectively reviewed. Recipients younger than 60 years of age or who underwent other organ transplantations were excluded. The Kaplan-Meier method was used to assess patient and graft survival. A Cox regression analysis was used to evaluate risk factors for graft failure and patient death. Results: A total of 229 kidney transplantation patients were included. Graft survival at 1, 5, and 10 years were 93.2%, 82.9%, and 61.2% respectively. Patient survival at 1, 5, and 10 years were 94.6%, 86.9%, and 68.8%, respectively. According to the Cox multivariate analysis, ABO incompatibility (hazard ratio [HR] 3.91, p < 0.002), DGF (HR 3.544, p < 0.004), CMV infection (HR 2.244, p < 0.011), and HBV infection (HR 6.349, p < 0.015) were independent risk factors for graft survival. Recipient age (HR 1.128, p < 0.024), ABO incompatibility (HR 3.014, p < 0.025), CMV infection (HR 2.532, p < 0.010), and the number of HLA mismatches (HR 1.425, p < 0.007) were independent risk factors for patient death. Conclusion: Kidney transplantation in the geriatric population showed good clinical outcomes. ABO incompatibility, DGF, CMV infection, and HBV infection were risk factors for graft failure and the recipient age, ABO incompatibility, CMV infection, and the number of HLA mismatches were risk factors for patient death in geriatric renal transplantation. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of data on the distribution of disease severity. In this study, we estimated disease severity distributions in South Korea using two EQ-5D-3L population surveys.Methods: A total of 110 health states for 35 diseases with 2-5 severity levels (e.g., mild, moderate, severe) were included in this study. A general population of 360 participants from the areas surrounding Seoul and Gyunggi evaluated these health states using EQ-5D-3L via face-to-face interviews and a paper questionnaire. The EQ-5D indices were used to measure the severity levels of health states and used as the cutoff points for the disease severity distributions. Finally, these cutoff points were applied to disease prevalence data with EQ-5D-3L, which were obtained from the Korean National Health and Nutrition Examination Surveys (KNHNES) and Korean Community Health Survey, in order to estimate the disease severity distributions.Results: The severity distributions of 8 diseases were estimated, including asthma, angina, stroke, chronic obstructive pulmonary disease, major depressive disorder, musculoskeletal problems in the legs, anemia, and allergic rhinitis and conjunctivitis. For example, the EQ-5D indices for chronic obstructive pulmonary disease severity were 0.929, 0.742, and 0.620, and the cut-off points were 0.835 (between mild and moderate) and 0.681 (between moderate and severe). Using these cutoff points, the distributions of chronic obstructive pulmonary disease severity were 66.5 % (mild), 23.3 % (moderate), and 10.1 % (severe) according to KNHNES.Conclusions: The estimated severity distributions in this study can be used as a valid calculation of the disease burden in the general population. [ABSTRACT FROM AUTHOR]

Background: Recently, breast cancer incidence and prevalence has been increasing. Patients' health related quality of life is important considerations in the treatment of breast cancer. The EQ-5D-3L is one of most popular instruments to measure health related quality of life. This study was aimed to evaluate the validity and reliability of EQ-5D-3L in post-operative breast cancer patients from Korea.Methods: A total of 827 patients visiting the ambulatory cancer center of 1 tertiary hospital after breast cancer surgery self-administered the EQ-5D-3L and Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B). We evaluated known-group validity using differences in the EQ-5D-3L index and EQ-VAS score according to demographic and clinical data. The discriminatory ability of the EQ-5D-3L was determined by comparing the mean FACT-B subscale scores between subjects with no problems and subjects with moderate or severe problems in each EQ-5D-3L dimension. Construct validity was evaluated by Pearson correlation coefficients among the EQ-5D-3L index and FACT-B subscales, respectively. Reliability was assessed in terms of test-retest reliability using Cohen's kappa value and intra-class correlation coefficient (ICC).Results: The EQ-5D-3L index and EQ-VAS score were higher in the educated, current radiotherapy and unmarried groups. The correlation of EQ-5D-3L index and subscales for the FACT-B was highest in physical well-being (r = 0.553) and lowest in social well-being (r = 0.199). For reliability, the Kappa values' range was from 0.32 to 0.70, and ICCs of the EQ-5D-3L index and EQ-VAS scores were 0.70 and 0.48, respectively.Conclusions: This study indicated that the EQ-5D-3L could be a valid health related quality of life instrument for postoperative breast cancer patients. [ABSTRACT FROM AUTHOR]

Objective Due to physical impairments of stroke patients oral health tends to deteriorate, which may have an impact on the oral health-related quality of life (OHRQoL). Therefore, the aim of this study was to evaluate the OHRQoL and analyze its related factors among stroke patients cared for at home in Korea. Methods OHRQoL of 549 stroke patients aged over 50 who received care at home was assessed by Oral Health Impact Profile-14 (OHIP-14) in a City, Korea, from May to June 2009. Trained researchers and five nurses conducted interviews with patients or caregivers in their homes using structured questionnaires. Demographic, general health, stroke, and oral health related variables were surveyed. Statistically, t -test, an analysis of variance (ANOVA), and multiple regression analyses were used to evaluate the relationship between OHRQoL and various covariates. Results Mean of total OHIP-14 score was 35.7 ± 10.0. Age, activity of daily living (ADL) ( p < 0.001), subjective general and oral health status ( p < 0.001), degree of disability ( p < 0.001), frequency of tooth brushing ( p < 0.001), use of dental floss ( p < 0.01), missing teeth, and use of denture ( p < 0.001) showed significant association with the OHIP-14 scores. In multiple regression analyses, ADL, frequency of tooth brushing per day, subjective general status, and oral health status were identified as significant factors with the OHIP-14 scores in stroke patients who received care at home. Conclusion Among strong patients who received care at home, participants who had more severe physical disability, poorer oral hygiene and more missing teeth showed poorer OHRQoL. [ABSTRACT FROM AUTHOR]

Objectives: Hypercholesterolemia, especially elevated levels of LDL-cholesterol, is a well-known risk factor for cardiovascular disease (CVD). However, the role of triglycerides in CVD risk remains controversial. Methods: We enrolled 86,476 individuals who had undergone a general health checkup at Asan Medical Center between January 2007 and June 2011. After exclusion criteria were applied to the total cohort, 76,434 participants were included. CVD events and death were gathered from the nationwide health insurance claims database and death certificates using ICD-10 codes. Results: Age- and sex-adjusted odds ratios (ORs) of the higher triglyceride group were significantly increased: 1.52 (95% CI: 1.27-1.82) for major CVD events, 1.53 (95% CI: 1.24-1.88) for major ischemic heart disease events, and 1.49 (95% CI: 1.37-1.63) for overall CVD events. After adjustment for multiple risk factors including HDL-cholesterol, ORs for overall CVD events were significantly increased in the higher triglyceride group. When the analysis was stratified according to BMI, hypertension, and glycemic status at baseline, age- and sex-adjusted ORs for the outcomes were significantly increased in the higher triglyceride group with nonobese, normotensive, or nondiabetic subjects. Conclusions: Hypertriglyceridemia is independently associated with an increased risk for CVD, especially in nonobese, normotensive, or nondiabetic individuals. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background Pro-inflammatory cytokines play important roles in bone metabolism and several studies have shown that carcinoembryonic antigen (CEA) may promote inflammation. We investigated the association of serum CEA levels with the risk of osteoporosis and incident fracture. Methods We performed a small cross-sectional study with 302 Korean women and a large, longitudinal study with 7192 Korean women in an average 3-year follow-up period. For the cross-sectional study, bone mineral density (BMD) and bone turnover markers (BTMs) were measured. For the longitudinal study, incident fractures in the follow-up period were identified by using the selected International Classification of Diseases, 10th revision (ICD-10) codes and the nationwide claims database of the Health Insurance Review and Assessment Service of Korea. Results In the cross-sectional study, serum CEA levels correlated negatively with BMD at the lumbar spine (γ = − 0.023; P = 0.029) and positively with BTMs (γ = 0.122 to 0.138, P = 0.002 to P < 0.001) after adjustment for confounding variables. In the longitudinal study, 254 (3.5%) women developed incident fractures in the follow-up period (2.8 ± 1.3 years). After adjustment for potential confounders, the hazard ratio (HR) per 1 ng/mL increment of the baseline CEA level for the development of incident fracture was 1.22 [95% confidence interval (CI): 1.05–1.42]. The HR was markedly higher in subjects in the highest CEA quartile category compared with those in the lowest CEA quartile category (HR = 1.54, 95% CI: 1.04–2.28). Conclusion Therefore, serum CEA may be a biomarker of the risk of incident fracture in postmenopausal Korean women. [ABSTRACT FROM AUTHOR]

Objectives To estimate the loss in quality-adjusted life-years (QALYs) in Korean adults due to 13 noncommunicable diseases (NCDs) in 2010 and predict changes in QALY loss through to the year 2040. Methods Thirteen NCDs (hypertension, diabetes mellitus, hyperlipidemia, stroke, myocardial infarction, angina, arthritis, osteoporosis, asthma, allergic rhinitis, atopic dermatitis, cataract, and depression) were selected from the Korean Community Health Survey 2010. The EuroQol five-dimensional questionnaire index from the Korean Community Health Survey 2010 and the Korean valuation set were used to estimate utility weights according to sex, age, and disease. Morbidity data were also obtained from the Korean Community Health Survey 2010. Mortality data according to disease and life expectancy were retrieved from the Korean Statistical Information Service. To predict future QALY loss, future population projection data from the Korean Statistical Information Service were used as substitutes for 2010 population size. Results Among the assessed 13 NCDs, the largest total QALY loss was for hypertension (513,113 QALYs; units are omitted hereafter), followed by arthritis (509,317) and stroke (431,049). The largest QALY loss due to mortality was stroke (306,733), whereas the largest QALY loss due to morbidity was arthritis (502,513). By applying the middle estimate of future population, the largest increase in total QALY loss between 2010 and 2040 was for hypertension (840,582), followed by stroke (719,076) and diabetes mellitus (474,607). Conclusions Hypertension, arthritis, and stroke are important in terms of total QALY loss, which will continuous to increase because of aging. These results could be used to develop cost-effective interventions that reduce the burden of NCDs. [ABSTRACT FROM AUTHOR]

Objective To evaluate the impact of a high-alert medication clinical decision support system called HARMLESS on point-of-order entry errors in a tertiary hospital. Method HARMLESS was designed to provide three kinds of interventions for five high-alert medications: clinical knowledge support, pop-ups for erroneous orders that block the order or provide a warning, and order recommendations. The impact of this program on prescription order was evaluated by comparing the orders in 6 month periods before and after implementing the program, by analyzing the intervention log data, and by checking for order pattern changes. Result During the entire evaluation period, there were 357,417 orders and 5233 logs. After HARMLESS deployment, orders that omitted dilution fluids and exceeded the maximum dose dropped from 12,878 and 214 cases to 0 and 9 cases, respectively. The latter nine cases were unexpected, but after the responsible programming error was corrected, there were no further such cases. If all blocking interventions were seen as errors that were prevented, this meant that 4137 errors (3584 of which were ‘dilution fluid omitted’ errors) were prevented over the 6-month post-deployment period. There were some unexpected order pattern changes after deployment and several unexpected errors emerged, including intramuscular or intravenous push orders for potassium chloride (although a case review revealed that the drug was not actually administered via these methods) and an increase in pro re nata (PRN; administer when required) orders for most drugs. Conclusion HARMLESS effectively implemented blocking interventions but was associated with the emergence of unexpected errors. After a program is deployed, it must be monitored and subjected to data analysis to fix bugs and prevent the emergence of new error types. [ABSTRACT FROM AUTHOR]

Background: There are few publications on quality measurement of COPD health state according to the severity level using EQ-5D in Korea. The present study aimed to evaluate the health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD) in terms of disease severity in Korea.Methods: Totally two hundred patients with COPD were consecutively recruited in one tertiary hospital of Korea. Each respondent was asked to fill out the questionnaire through a face-to-face interview after providing informed consent. The questionnaire included general and clinical characteristics as well as the EQ-5D and Clinical COPD Questionnaire (CCQ). HRQoL was evaluated according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria and severity of breathlessness.Results: The adjusted mean EQ-5D index scores were 0.83, 0.88, 0.81 and 0.60 in stage I, II, III and IV, respectively. The EQ-5D index tended to decrease with GOLD criteria. The adjusted mean EQ-Visual Analog Scale (VAS) scores ranged from 65.1 in stage IV to 73.9 in stage I. The CCQ total scores deteriorated with an increasing GOLD stage and severity of breathlessness (all P < 0.001). The correlation between CCQ total score and EQ-5D index was -0.69.Conclusions: Our study shows that HRQoL in COPD measured by EQ-5D and CCQ worsens with the GOLD stage and severity of breathlessness. EQ-5D and CCQ could be useful instruments for an evaluation of HRQoL in COPD patients in Korea. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess the validity and reliability of the Korean version of the EQ-5D health questionnaire for use in patients with cancer in Korea. Methods: Patients with colorectal cancer were recruited from one ambulatory cancer center. Each participant consecutively self-administered the EQ-5D, the EORTC QLQ-C30, and the Short Form-36 (SF-36). Discriminatory ability was evaluated by comparing the SF-36 subscales with their corresponding EQ-5D dimensions. Convergent validity was assessed by examining the correlations between the EQ-5D index, EORTC QLQ-C30 subscales, and SF-36 scale and summary scores. Test-retest reliability was also evaluated. Results: Subjects reporting problems in each EQ-5D dimension showed lower scores on all SF-36 subscales. As expected, the relationships were stronger between the EQ-5D functional dimensions and physical function on the EORTC QLQ-C30 and between the EQ-5D anxiety/depression dimension and emotional function on the EORTC QLQ-C30. The EQ-5D index and SF-36 scales were moderately or highly correlated. intraclass correlation coefficient of the EQ-5D index was 0.45. Conclusions: The Korean version of the EQ-5D may be a valid tool for assessing the health-related quality of life of patients with cancer. However, further research is needed to determine the reliability of the Korean EQ-5D over different time intervals and disease conditions. [ABSTRACT FROM AUTHOR]

Objective This study aims to develop and validate a new comorbidity index using data from hospitalized patients in South Korea. Study design Retrospective cohort study. Setting Hospital inpatients. Study participants Data from 4677 hospitalized patients aged 40–79 who had admitted in a medical center in Korea between September and December in 1997 were individually linked to national mortality data through December 2007. Among them, 3274 patients (70%) were randomly included in the development data set and the other 1403 patients (30%) in the validation data set. Another 3413 liver cancer patients from the same hospital were used to validate the index. Main measures Comorbidity index and mortality risk. Results Based on mortality using stratified Cox regression analyses, comorbidity scores ranging from 1 to 4 were assigned for 20 comorbid conditions. Summation of the scores produced the new comorbidity index (Asan comorbidity index, ACI). C-indices in the Cox regression analyses showed the greatest increase [0.589 (95% confidence interval, 0.568–0.609) in age- and sex-adjusted model; 0.697 (0.678–0.716) in the ACI and 0.664 (0.645–0.684) in the Charlson comorbidity index, respectively] when the ACI was added in the validation models. Conclusions A newly developed comorbidity index using Korean hospitalized patient data based on the International Classification of Disease, 10th Revision (ICD-10) was valid among both general medical inpatients and liver cancer patients. This index may well be widely used in various health-care settings in Korea where patients' information on health conditions is coded with ICD-10. [ABSTRACT FROM PUBLISHER]

Purpose: This study was conducted to assess the redistribution properties of the EQ-5D-3L when using the EQ-5D-5L and to compare the validity, informativity, and reliability of both EQ-5D-3L and EQ-5D-5L in Korean cancer patients. Methods: Patients visiting one ambulatory cancer center self-administered the two versions of the EQ-5D and the EORTC QLQ-C30 questionnaire. Redistribution properties in each dimension of EQ-5D were analyzed between EQ-5D-3L and EQ-5D-5L. Informativity was evaluated using the Shannon entropy and ceiling effect. Convergent validity was evaluated by comparing the EQ-VAS, ECOG performance status, and EORTC QLQ-C30 subscales. Reliability was also evaluated in terms of test-retest reliability. Results: All levels of the EQ-5D-3L substantially partitioned into associated levels of the EQ-5D-5L. The average inconsistency rate of the two versions was 3.5%. Absolute informativity was higher for the EQ-5D-5L than for the EQ-5D-3L, but their informative efficiency tended to be similar. The proportion of 'perfect health' (11111) decreased from 16.8% in the EQ-5D-3L to 9.7% in the EQ-5D-5L. EQ-5D-5L demonstrated similar or higher correlations with the EQ-VAS, ECOG performance status, and EORTC QLQ-C30, than the EQ-5D-3L. The intraclass correlation coefficient of the EQ-5D-5L index was 0.77. Conclusions: The EQ-5D-5L had greater informativity and lower rate in the ceiling effect than those values of the EQ-5D-3L. The EQ-5D-5L showed good construct validity and reasonable reliability. Therefore, considering these findings, the EQ-5D-5L may be preferable to the EQ-5D-3L. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity negatively affects health outcomes and impairs health-related quality of life (HRQoL). We assessed the prevalence of multimorbidity in Koreans aged 50 and older, taking into consideration their socioeconomic status, and estimated the loss in HRQoL due to multimorbidity.Methods: This study is based on an analysis of data for adults aged 50 and older derived from the cross-sectional nationally representative Korean National Health and Nutrition Examination Survey conducted in 2013-14. The five most prevalent chronic diseases and disease dyads were identified. The impact of the degree of multimorbidity, sex, and socioeconomic status on the European Quality of Life 5 Dimension (EQ-5D) index score were analyzed. Marital status, educational attainment, household income, basic livelihood security benefit, and occupation were considered as socioeconomic factors.Results: The analysis included 5996 adults aged 50 years and older with males comprising 46.6%. Two or more chronic diseases were present in 26.8% of the participants aged 50 and older and 37.9% of the participants aged 65 and older. The most prevalent dyadic combination was hypertension and dyslipidemia in the 50 and older group, and hypertension and osteoarthritis in the 65 and older age group. Hypertension dominated the multimorbidity combinations (four of the five most prevalent multimorbidity dyads), while a few conditions such as osteoarthritis had a relatively large influence on quality of life. In addition to the degree of multimorbidity, female and lower socioeconomic status were associated with significantly lower EQ-5D index scores.Conclusions: Integrated, holistic healthcare based on a patient-oriented perspective for earlier, more effective intervention, targeting multimorbidity is warranted. Special consideration should be given to patients with low socioeconomic status. [ABSTRACT FROM AUTHOR]

Background: Although several studies have evaluated health-related quality of life (HRQoL) in breast cancer survivors, few have compared HRQoL between breast cancer survivors and an age-matched general population in terms of improvement patterns according to time after surgery. Thus, we compared the postoperative changes in HRQoL in breast cancer survivors with those of age-matched general population groups using the EuroQoL five-dimension three-level questionnaire (EQ-5D-3 L).Methods: EQ-5D-3 L questionnaires were obtained from 686 breast cancer survivors during follow-up visits. They were divided into five groups according to time after surgery: 0-5 months, 6-11 months, 12-35 months, 36-59 months, and ≥ 60 months. Their EQ-5D-3 L data, covering five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), were compared with those of age-matched general population groups.Results: The mean EQ-5D-3 L index of breast cancer survivors was high in group with longer time after surgery and the mean EQ-5D-3 L index of breast cancer group over 5 years after surgery was similar to that of an age-matched general population (0.919 vs 0.928, p = 0.305). Although there were deficits in all dimensions of breast cancer survivors, motility eventually exceeded that of general population groups and self-care and usual activities of groups over 3 years after surgery matched those of general population however, pain/discomfort and anxiety/depression of survivors over 5 years after surgery remained worse than those of the general population (p = 0.028, p < 0.001).Conclusions: Motility, self-care, and usual activities decreased in the early postoperative period for breast cancer survivors but showed recovery after 3 years. However, pain/discomfort and anxiety/depression remained poorer in these patients than in the general population for many years. [ABSTRACT FROM AUTHOR]

After publication of the original article [1] the authors flagged that the Funding information in the Declarations was incorrect. [ABSTRACT FROM AUTHOR]

Background: There is no research on mapping algorithms between EQ-5D and SF-36 in Korea. The aim of this study was to derive a predictive model for converting the SF-36 health profile to the EQ-5D index using data from several studies.Methods: Individual data (n = 2211) were collected from three different studies and separated into derivation (n = 1660) and internal validation sets (n = 551). Data from 123 colon cancer patients were analyzed for external validation. The prediction models were analyzed using ordinary least-square (OLS) regression, two-part modeling, and multinomial logistic modeling using eight scale scores; two summary scores and the interaction terms of SF-36 were used as independent variables. The EQ-5D index using the Korean value set and each dimension of the EQ-5D were used as dependent variables. The mean absolute errors (MAE) and R2 values of the internal and external validation dataset were used to evaluate model performance.Results: Our findings show that the three different scoring algorithms demonstrate similar performances in terms of MAE and R2. After considering familiarity and parsimony, the OLS model (including Physical Function, Bodily Pain, Social Function, Role Emotional, and Mental Health) was found to be optimal as the final algorithm for use in this study. The MAEs of the OLS models demonstrated consistent results in both the derivation (0.087-0.109) and external validation sets (0.082-0.097).Conclusion: This study provides mapping algorithms for estimating the EQ-5D index from the SF-36 profile using individual data and confirms that these algorithms demonstrate high explanatory power and low prediction errors. [ABSTRACT FROM AUTHOR]