Developing and piloting approaches for the valuation of outcomes associated with sexually transmitted infections

Okeke Ogwulu, Chidubem (2018). Developing and piloting approaches for the valuation of outcomes associated with sexually transmitted infections. University of Birmingham. Ph.D.

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Eliciting health-state utility values (HSUVs) for use in cost-utility analysis (CUA) for some diseases is limited by the variation in the duration of the health-states such as it includes both temporary and chronic health-states. There is no 'gold standard' approach for valuing temporary health states (THS). Conventional time trade-off (TTO) is deemed inappropriate because it presents an unrealistic scenario to respondents and the chained TTO has been proposed to solve this problem. This thesis uses a case study, Chlamydia trachomatis (a sexually transmitted infection) to explore this challenge. The main burden of chlamydia is typically believed to be borne by women, with a paucity of studies describing the psychosocial outcomes for men, hence making it difficult to value outcomes associated with men.

This thesis aimed to: develop approaches for valuing the health-states associated with chlamydia and derive utility values for the chronic and temporary health-states associated with chlamydia. An additional objective was to define the psychosocial impact of chlamydia in men via an exploration of the asymmetric nature of the disease burden.

The thesis elicited utilities for seven health-states (five THS and two chronic health-state) depicting the symptoms of chlamydia. The health-states were developed using evidence from the literature and interviews with clinical experts. Chained time trade-off (TTO) was applied to THSs and conventional TTO to CHSs. Ectopic pregnancy was used as a lower anchor for chained TTO. The VAS technique was also employed. The study sampled from three different population groups and the survey was administered face-to-face. A qualitative synthesis was conducted using meta-ethnography, to identify the psychosocial impact of chlamydia in men.

The thesis identified appropriate approaches for valuing chlamydia health-states and showed that chained TTO is feasible. Methodological challenges arising from this study include the development of health-state description, the selection of appropriate anchor states and the duration of the anchor state. The HSUV s could potentially be used in cost-utility analyses examining the cost-effectiveness of screening. The meta-ethnography highlighted the need to broaden the focus of future evaluations.

Type of Work: Thesis (Doctorates > Ph.D.)
Award Type: Doctorates > Ph.D.
College/Faculty: Colleges (2008 onwards) > College of Medical & Dental Sciences
School or Department: Institute of Applied Health Research
Funders: None/not applicable
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine


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