Search

Background: Venous access devices commonly used in clinical practice for long-term chemotherapy of breast cancer include central venous catheters (CVCs), peripherally inserted central venous catheters (PICCs), and implantable venous access ports (IVAPs). CVCs and PICCs are less costly to place but have a higher complication rate than IVAPs. However, there is a lack of cost-utility comparisons among the three devices. The aim of this study was to assess the cost-effectiveness of three catheters for long-term chemotherapy in breast cancer patients. Methods: This study used propensity score matching (PSM) to establish a retrospective cohort. Decision tree models were used to compare the cost-effectiveness of three different intravenous lines in breast cancer chemotherapy patients. Cost parameters were derived from data extracted from the outpatient and inpatient charging systems, and total costs included costs of placement, maintenance, extraction, and handling of complications; utility parameters were derived from previous cross-sectional survey results of the research group; and complication rates were derived from breast cancer catheterization patient information as well as follow-up information. Quality-adjusted life years (QALYs) were measured for efficacy outcomes. Incremental cost-effectiveness ratios (ICERs) were used to compare the three strategies. To assess uncertainty in model parameters, sensitivity analyses (univariate sensitivity analysis and probabilistic sensitivity analysis) were performed. Results: A total of 10,718 patients (3780 after propensity score matching) were included. IVAPs had the smallest cost-utility ratio, and PICCs had the largest cost-utility ratio when left in place for more than 12 months. The incremental cost-utility ratio of PICC to CVC was $2375.08/QALY, IVAP to PICC was $522.01/QALY, and IVAP to CVC was $612.98/QALY. Incremental cost-effectiveness ratios showed that IVAPs were more effective than CVCs and PICCs. Model regression analysis showed that the IVAP was recommended as the best regimen regardless of the catheter indwelling time (6 months, 12 months or more than 12 months). The reliability and stability of the model were verified by single-factor sensitivity analysis and Monte Carlo simulation (probabilistic sensitivity analysis). Conclusion: This study provides economic evidence for the selection of vascular access in breast cancer chemotherapy patients. In the case of limited resources in China, establishing a decision tree model comparing the cost-effectiveness of three vascular access devices for breast cancer chemotherapy patients determined that the IVAP was the most cost-effective regimen. [ABSTRACT FROM AUTHOR]

This research aims to restructure a Simpler Quality of e-Life Indicators (SEQOL) and use this simpler structure to understand whether the usage of computer and Internet will make impacts on quality of life in Taiwan. By using telephone interviews, 3,563 valid respondents, aged 15 and above with Taiwan nationality, were interviewed. After performing exploratory factor analysis, confirmatory factor analysis, reliability and validity assessment, a simpler factor structure of the SEQOL was formed. The new structure contains 24 items categorized into seven domains: Socioeconomic status, Selfesteem, Social competence, Life freedom, Community support, Psychological pressure and physical health. This research also found that gender divide on most domains did not exist. Those who are aged between 35 and 54 exhibit the highest satisfaction. Residents with university degree have the highest satisfaction on their quality of life and the residents of northern Taiwan have the lowest satisfaction. People who having computer at home show higher satisfaction on quality of life in dimensions of overall, Socioeconomic Status, Social Competence, Psychological Pressure, and Physical Health. On overall quality of life, there is no significant difference between Internet user and non user. But, People who having access to Internet show higher satisfaction on quality of life in dimensions of Socioeconomic Status, Social Competence, Psychological Pressure, and Physical Health, oppositely, have lower satisfaction on quality of life in dimensions of Life Freedom and Community Support. [ABSTRACT FROM AUTHOR]