PMT33: LINGUISTIC VALIDATION OF THE VASCULAR QUALITY OF LIFE QUESTIONNAIRE (VASCUQOL) IN 8 LANGUAGES Abstracts 113 PMT33 LINGUISTIC VALIDATION OF THE VASCULAR QUALITY OF LIFE QUESTIONNAIRE (VASCUQOL) IN 8 LANGUAGES Conway K1, Uzun V1, Girod I2, Morgan M3, Koch P4 1Mapi Research Institute, Lyon, France; 2Mapi Values, Lyon, France; 3Lewisham Hospital, London, UK; 4Boehringer Ingelheim, Ingelheim, Germany INTRODUCTION: Measuring Quality of Life (QoL) has become a vital part of assessing lower limb ischemia and peripheral vascular disease in international studies. The 25-item VascuQoL was developed in UK English and investigates 5 domains: symptoms, pain, activities, social life and emotional state. Prior to use in an international trial the measure underwent linguistic validation in 8 lan- guages. METHODS: A QoL specialist coordinated the translation process in each target country using the fol- lowing methodology: 1) two forward translations by pro- fessional, native speaking translators of the target lan- guage fluent in English; 2) comparison and reconciliation of the translations by a QoL specialist and translators; 3) backward translation by a native English speaker; 4) comparison of the source and backward versions; 5) re- view of the translation by a clinician in each country; 6) comprehension test in a sample target population; 7) in- ternational harmonization. RESULTS: Linguistic and conceptual issues emerged when translating idiomatic phrases and response scales. Linguistic equivalents had to be found for expressions such as “being (or becoming) housebound” and “social activities”. The notions of “discomfort”/“distress” did not have direct equivalents in some languages where a single notion had to be used. In most languages the frequency scale expressed in amounts of time had to be simplified to establish equidis- tant responses. CONCLUSIONS: A rigorous translation methodology was performed to ensure conceptual equiv- alence and acceptability of translations. International feedback obtained through the translation process re- vealed issues regarding the original instrument, indicating that future amendments to the original may be necessary. Future psychometric testing will be conducted to ensure reliability and validity of each translation, appropriate- ness of the questionnaire in each country and compara- bility of data across countries. PMT34 ASSESSING PHYSICIAN PRACTICE PROFITABILITY USING AN ACTIVITY BASED COSTING MODEL Stephens JM, Bell CF, Klingman D PAREXEL International, Outcomes Research Group, Alexandria, VA, USA Physicians are increasingly challenged to maintain prac- tice profits in the face of tightening reimbursements from payers. While office visits generate a revenue stream for physicians, it is not clear whether frequent lower com- plexity visits (e.g., nurse visits to administer injections) are actually profitable for physician practices. OBJEC- TIVE: To develop an adaptable model and methodology to evaluate profitability and financial incentives for vari- ous in-office services provided by physicians and their staff. METHODS: A literature and expert opinion based model was developed from the physician practice per- spective and was designed to be flexible for a variety of office-based services. The practice cost component of the model was developed using activity-based costing princi- ples and included direct (drug acquisition, supplies, clini- cal labor time, office visits) and indirect (malpractice in- surance, office rent) expenses. The practice revenue component of the model consisted of the reimbursement amount from payers, including: drug reimbursement; of- fice visits for physician evaluation, injections, end of treatment follow-up and adverse events; and laboratory tests. RESULTS: Practice profitability is inversely pro- portional to the number of low complexity office visits per year. Payer mix is also an important determinant of profitability for in-office services, with Medicare reim- bursements generally resulting in a net loss for practices (�5 loss per office visit for the lowest complexity ser- vices) and typical managed care reimbursements provid- ing only small profits (approximately 4 per low complex- ity visit). CONCLUSIONS: Frequent low-complexity office visits for administration of drug therapies do not appear profitable for physician practices under Medicare reimbursement. Alternative modes of drug delivery such as implantable drug delivery devices or patient self-ad- ministration may be more profitable for physician prac- tices by allowing substitution of more highly reimbursed office services. PMT35 VALUING NON-WORKPLACE PRODUCTIVITY LOST IN MIGRAINEURS: HUMAN CAPITAL APPROACH AND REPLACEMENT COST METHOD Kim SS, Lofland JH Office of Health Policy and Clinical Outcomes at Thomas Jefferson University Hospital, Philadelphia, PA, USA OBJECTIVE: To determine the non-workplace produc- tivity costs (NWPC) for migraineurs using the human capital approach (HCA) and replacement cost method (RCM). METHOD: This was a supplemental analysis to a prospective, observational migraine outcomes study conducted at a managed care organization. Migraineurs self-reported their work status, occupational category, number of days missed from normal ‘activities’ outside of paid job(s) due to migraine symptoms, number of days performing normal ‘activities’ with migraine symptoms, and percent effectiveness while performing normal ‘activ- ities’ with migraine symptoms, at baseline, 3 months, and 6 months after the initiation of sumatriptan. Daily occu- pational wages were obtained from the Bureau of Labor Statistics. NWPC were calculated using the HCA and