• Korean Journal of Biological Psychiatry
• /
• v.21 no.2
• /
• pp.74-80
• /
• 2014

Objectives More than half of the elders suffer from chronic sleep disturbances. Moreover, sleep disturbances are more prevalent in patients with depressive disorder than in community dwelling elderly. In this study, we aim to estimate the risk factors of poor sleep quality and its effect on quality of life in patients with late life depression. Methods This study included 159 depressive patients aged 65 years or older who completed Pittsburgh Sleep Quality Index (PSQI). A global PSQI score of 5 or greater indicates a poor sleeper. Structural diagnostic interviews were performed using the Korean version of Mini International Neuropsychiatric Interview (MINI). Depression was evaluated by the Korean form of Geriatric Depression Scale (KGDS). Global cognition was assessed by Mini-Mental State Examination in the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease assessment packet. Quality of life was evaluated by the Korean version of Short-Form 36-Item Health Survey (SF-36). Results The frequencies of poor sleepers were 90.5% in major depressive disorder, 71.8% in minor depressive disorder, 47.1% in subsyndromal depressive disorder, and 73.0% in all types of depressive disorders. Multivariate logistic regression analysis indicated that female [odds ratio (OR) = 2.83, 95% confidence interval (CI) = 1.20-6.67] and higher KGDS score (OR = 1.13, 95% CI = 1.05-1.21) were risk factors of poor sleep quality in patients with late life depression. In the analysis of ANCOVA adjusted for age, gender, education and KGDS score, the mean scores of vitality mental health and mental component summary of SF-36 were lower in poor sleepers than in good sleepers. Conclusions Poor sleepers among patients with late life depression are very common and are associated with female and higher KGDS scores. Poor sleep quality causes a significant negative effect on mental health quality. So researchers and clinicians should be more vigilant in the evaluation and treatment of sleep disturbances in patients with late life depression.

• Asian Pacific Journal of Cancer Prevention
• /
• v.17 no.2
• /
• pp.799-805
• /
• 2016

Background: There is no standard treatment for patients with platinum-resistant or refractory epithelial ovarian cancer. Single agent chemotherapies have evidence of more efficacy and less toxicity than combination therapy. Most are very expensive, with appreciable toxicity and minimal survival. Since it is difficult to make comparison between outcomes, economic analysis of single-agent chemotherapy regimens and best supportive care may help to make decisions about an appropriate management for the affected patients. Objective: To evaluate the cost effectiveness of second-line chemotherapy compared with best supportive care for patients with platinum-resistant or refractory epithelial ovarian cancer. Materials and Methods: A Markov model was used to estimate the effectiveness and total costs associated with treatments. The hypothetical patient population comprised women aged 55 with platinum-resistant or refractory epithelial ovarian cancer. Four types of alternative treatment options were evaluated: 1) gemcitabine followed by BSC; 2) pegylated liposomal doxorubicin (PLD) followed by BSC; 3) gemcitabine followed by topotecan; and 4) PLD followed by topotecan. Baseline comparator of alternative treatments was BSC. Time horizon of the analysis was 2 years. Health care provider perspective and 3% discount rate were used to determine the costs of medical treatment in this study. Quality-adjusted life-years (QALY) were used to measure the treatment effectiveness. Treatment effectiveness data were derived from the literature. Costs were calculated from unit cost treatment of epithelial ovarian cancer patients at various stages of disease in King Chulalongkorn Memorial Hospital (KCMH) in the year 2011. Parameter uncertainty was tested in probabilistic sensitivity analysis by using Monte Carlo simulation. One-way sensitivity analysis was used to explore each variable's impact on the uncertainty of the results. Results: Approximated life expectancy of best supportive care was 0.182 years and its total cost was 26,862 Baht. All four alternative treatments increased life expectancy. Life expectancy of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 0.510, 0.513, 0.566, and 0.570 years, respectively. The total cost of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 113,000, 124,302, 139,788 and 151,135 Baht, respectively. PLD followed by topotecan had the highest expected quality-adjusted life-years but was the most expensive of all the above strategies. The incremental cost-effectiveness ratios (ICER) of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 344,643, 385,322, 385,856, and 420,299 Baht, respectively. Conclusions: All of the second-line chemotherapy strategies showed certain benefits due to an increased life-year gained compared with best supportive care. Moreover, gemcitabine as second-line chemotherapy followed by best supportive care in progressive disease case was likely to be more effective strategy with less cost from health care provider perspective. Gemcitabine was the most cost-effective treatment among all four alternative treatments. ICER is only an economic factor. Treatment decisions should be based on the patient benefit.

• Asian Pacific Journal of Cancer Prevention
• /
• v.13 no.6
• /
• pp.2721-2728
• /
• 2012

Background: There are limited data evaluating the cost-effectiveness of gastric cancer screening using endoscopy or upper gastrointestinal x-ray in the general population. Objective: To evaluate the cost-effectiveness of population-based screening for gastric cancer in South Korea by decision analysis. Methods: A time-dependent Markov model for gastric cancer was constructed for healthy adults 30 years of age and older, and a deterministic sensitivity analysis was performed. Cost-utility analysis with multiple strategies was conducted to compare the costs and effects of 13 different screening alternatives with respect to the following eligibility criteria: age at the beginning of screening, screening interval, and screening method. The main outcome measurement was the incremental cost-effectiveness ratio. Results: The results revealed that annual endoscopic screening from ages 50-80 was the most cost-effective for the male population. In the females, biennial endoscopy screening from ages 50-80 was calculated as the most cost-effective strategy among the 12 screening alternatives. The most cost-effective screening strategy may be adjustable according to the screening costs and the distribution of cancer stage at screening. The limitation was that effectiveness data were obtained from published sources. Conclusions: Using the threshold of $19,162 per quality-adjusted life year on the basis of the Korean gross domestic product (2008), as suggested by the World Health Organization, endoscopic gastric cancer screening starting at the age of 50 years was highly cost-effective in the Korean population. The national recommendation for gastric cancer screening should consider the starting age of screening, the screening interval, and the screening modality.

• Journal of Korean Neurosurgical Society
• /
• v.62 no.1
• /
• pp.83-89
• /
• 2019

Objective : This study is a retrospective cost-benefit analysis of cervical anterior interbody fusion and cervical artificial disc replacement, which are the main surgical methods to treat degenerative cervical disc disease. Methods : We analyzed 156 patients who underwent anterior cervical disc fusion and cervical artificial disc replacement from January 1, 2008 to December 31, 2009, diagnosed with degenerative cervical disc disorder. In this study, the costs and benefits were analyzed by using quality adjusted life year (QALY) as the outcome index for patients undergoing surgery, and a Markov model was used for the analysis. Only direct medical costs were included in the analysis; indirect medical costs were excluded. Data were analyzed with TreeAge Pro $2015^{TM}$ (TreeAge Software, Inc, Williamstown, MA, USA). Results : Patients who underwent cervical anterior fusion had a total cost of KRW 2501807/USD 2357 over 5 years and obtained a utility of 3.72 QALY. Patients who underwent cervical artificial disc replacement received 4.18 QALY for a total of KRW 3685949/USD 3473 over 5 years. The cumulative cost-effectiveness ratio of cervical spine replacement surgery was KRW 2549511/QALY (USD 2402/QALY), which was lower than the general Korean payment standard. Conclusion : Both cervical anterior fusion and cervical artificial disc replacement are cost-effective treatments for patients with degenerative cervical disc disease. Cervical artificial disc replacement may be an effective alternative to obtain more benefits.

• Journal of Preventive Medicine and Public Health
• /
• v.55 no.5
• /
• pp.415-423
• /
• 2022

Economic evaluations in the healthcare are used to assess economic efficiency of pharmaceuticals and medical interventions such as diagnoses and medical procedures. This study introduces the main concepts of economic evaluation across its key steps: planning, outcome and cost calculation, modeling, cost-effectiveness results, uncertainty analysis, and decision-making. When planning an economic evaluation, we determine the study population, intervention, comparators, perspectives, time horizon, discount rates, and type of economic evaluation. In healthcare economic evaluations, outcomes include changes in mortality, the survival rate, life years, and quality-adjusted life years, while costs include medical, non-medical, and productivity costs. Model-based economic evaluations, including decision tree and Markov models, are mainly used to calculate the total costs and total effects. In cost-effectiveness or costutility analyses, cost-effectiveness is evaluated using the incremental cost-effectiveness ratio, which is the additional cost per one additional unit of effectiveness gained by an intervention compared with a comparator. All outcomes have uncertainties owing to limited evidence, diverse methodologies, and unexplained variation. Thus, researchers should review these uncertainties and confirm their robustness. We hope to contribute to the establishment and dissemination of economic evaluation methodologies that reflect Korean clinical and research environment and ultimately improve the rationality of healthcare policies.

• Korean Journal of Health Education and Promotion
• /
• v.29 no.2
• /
• pp.23-32
• /
• 2012

Objectives: This study evaluated the association between osteoarthritis (OA) and health-related quality of life (HRQoL) in elderly Korean women. Methods: We selected participants (n=2,597) aged 50 years or older from Korea National Health and Nutrition Examination Survey [KNHANES] 2005-2008. Demographic and personal characteristics, medical history of OA, and EQ-5D were extracted from the KNHANES data. Results: We found that demographic variables, including age, education level, income, and personal characteristics, were important covariates associated with the prevalence of OA and with HRQoL. In this study, OA was an important factor affecting HRQoL in women. The adjusted odds ratio for HRQoL in participants with OA was 2.92 [(95% confidence interval (CI)=2.43-3.51, p<.001)] in mobility, 2.60 (95% CI=2.17-3.10, p<.001) in pain/discomfort, 2.17 (95% CI=1.78-2.65, p<.001) in usual activities, 1.65 (95% CI=1.22-2.24, p=.001) in self care, and 1.47 (95% CI=1.22-1.77, p<.001) in anxiety/depression. After adjustment of covariates, HRQoL was significantly decreased in participants with OA. Conclusions: Our findings reveal that there is a strong association between OA and HRQoL. Preventing and controlling OA may significantly improve the quality of life for elderly Korean women.

• Journal of Society of Preventive Korean Medicine
• /
• v.16 no.3
• /
• pp.15-26
• /
• 2012

Objective : Only a few studies have investigated the life expectance and health related quality of life (HRQOL) about stroke patients. The purpose of this study is to analyze the life expectancy, preference based quality of life(QOL) and quality adjusted life years(QALYs) of stroke patients. Methods : We used data of 10,533 adults from 4th Korean national health and nutritional examination survey 2009 for evaluating HRQOL of stroke patients. We also analyzed the life expectancy for stroke patients using life table from national public health data. Finally we calculated the QALYs with and without stroke conditions and assumed the difference of QALYs. Results : The mean age of stroke patients was assumed to be 65. Lower income and less educated groups were prone to be exposed to the stroke conditions. Common comorbidities of stroke patients were ischemic heart attack, hypertension, diabetes and hyperlipidemia. The proportions of participants who reported problems in each of the five EQ-5D dimensions increased significantly at chronic stroke group. Participants with chronic stroke conditions had an almost 6-fold higher risk of impaired health utility(the lowest quartile of EQ-5D utility score) compared with non stroke participants, after adjustment of age, gender, income, education, comorbidity variables. The differences of life expectancy and QALYs between non-stroke and stroke group from the age of 65 till death were assumed to be 0.767 year and 3.103 QALYs. Conclusions : Although the authors analyzed the affecting factors of QOL and assumed the differences of life expectance and QALYs about stroke patients using domestic national data and statistic references, well designed cohort studies should be needed to prove the causal effects of affecting factors and to assume more correct QALY differences.

• Journal of Korean society of Dental Hygiene
• /
• v.20 no.3
• /
• pp.281-290
• /
• 2020

Objectives: Stress is the cause of several illnesses, in older people, stress may also cause various social problems. The oral health of older adults is closely related to the quality of life, and chewing ability is particularly important for their general health. The purpose of this study was to investigate the relationship between stress, the number of teeth remaining, and the chewing ability, which reflects the oral health status among older adults. Methods: This study evaluated the stress level and chewing ability of adults older than 65 years using the 6th (2014-2015) Korea National Health and Nutrition Examination data. The total number of remaining teeth was determined based on the data of the teeth conditions. Results: There was an association between stress and chewing ability among older adults. The odds ratio of chewing function increased by 2.67 times (crude OR=2.67; 95% CI=1.88-3.79) with increased stress. After adjusting, the odds ratio increased to 2.74 times (adjusted OR=2.74; 95% CI=1.88-3.98). Conclusions: Reducing stress may facilitate effective oral health management and improve the overall quality of life in older adults. The findings of this study may help in the discovery of various approaches s to reducing stress in older adults and provide relevant information for oral health education.

• Korean Journal of Health Education and Promotion
• /
• v.28 no.2
• /
• pp.15-25
• /
• 2011

Objectives: This study aimed to assess the association between physical activity and health-related quality of life (HRQOL) in Koreans. Methods: A total of 9,689 adults(${\geq}19$ years, 4,036 men) from the Fourth National Health and Nutrition Examination Survey(2007-2008) were examined by the International Physical Activity Questionnaraire (IPAQ)-short form and Korean EuroQol-5 Dimension(KEQ-5D). Results: For the physical activity by IPAQ, 'Inactive group' was 75.3%, 'Minimally active group' was 23.5%, and 'Health-Enhancing Physical Activity(HEPA) group' was 1.2%. The mean HRQOL index was $0.89{\pm}0.13$. These relations of physical activity and HRQOL remained significant after adjustment for age, sex, smoking, subjective health status, stress, depression, and socioeconomic status variables (Adjusted $R^2$ = 0.334). Conclusions: Physical activity was associated with health-related quality of life. Physically active group had higher health-related quality of life than the inactive group.

• Journal of Sasang Constitutional Medicine
• /
• v.33 no.2
• /
• pp.37-46
• /
• 2021

Background According to the Sasang constitutional medicine, eating habits according to the characteristics of Sasang Constitution (SC) types affect management of chronic diseases and health conditions. The aim of this study is to identify the association between eating habits, such as breakfast, eating frequency, and energy intake, according to SC, and quality of life. Method This study is a cross-sectional study of people aged 33 to 55 years, sampled by stratification based on population distribution. The SC types were classified into Taeeumin (TE), Soeumin (SE), and Soyangin (SY) using a structured questionnaire (KS-15). Items examined regarding eating habits were whether the subjects had breakfast; the frequency of eating such as breakfast, lunch, dinner, and after-dinner snacks; and energy intake surveyed using a food frequency questionnaire. As for quality of life, SF-12, which is widely used worldwide to assess health conditions, was utilized. A regression analysis was conducted on the relations between eating habits according to SC and quality of life. Results The SC distribution of the 3,895 subjects was 47% for TE, 22% for SE, and 31% for SY. The scores indicating quality of life differed for TE and SY depending on whether they ate breakfast and eating frequency groups, and those of SE varied depending on levels of energy intake. A regression analysis having adjusted all covariates demonstrated for TE a positive relation between the eating frequency of three times per day or more (compared to 1.5 to 3 meals per day) and quality of life (B=1.365, p<0.001). For SE, there was a negative association between low energy intake (compared to adequate energy intake) and quality of life (B=-1.642, p=0.004). Meanwhile, no relation was found between eating habits and quality of life for SY. Conclusion This study identified the association between eating habits according to SC types and quality of life. For TE, it was found to be important to eat evenly dispersed adequate amounts as opposed to overeating or binging at once. For SE, adequate energy intake affected good quality of life. This study suggests that eating habits based on SC improve quality of life, and health management customized for each constitution should be performed in the future through proper eating habits.