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Nikl A, Janssen MF, Jenei B, Brodszky V, Rencz F. Population Norms for the EQ-5D-5L, PROPr and SF-6D in Hungary. PHARMACOECONOMICS 2024; 42:583-603. [PMID: 38416366 DOI: 10.1007/s40273-024-01360-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES This study aimed to develop population norms for three preference-accompanied measures [EQ-5D-5L, Patient-Reported Outcomes Measurement Information System (PROMIS)-preference scoring system (PROPr) and Short-Form Six-Dimension (SF-6D)] in Hungary. METHODS In November 2020, an online cross-sectional survey was conducted among a representative sample of the Hungarian adult general population (n = 1631). Respondents completed the Hungarian versions of the EQ-5D-5L, PROMIS-29+2 version 2.1 and 36-item Short Form Survey version 1 (SF-36v1). The association of utilities with sociodemographic and health-related characteristics of respondents was analysed using multivariate regressions. RESULTS The proportion of respondents reporting problems ranged from 8 to 44% (self-care to pain/discomfort) on the EQ-5D-5L, 39-94% (physical function to sleep) on PROPr and 38-87% (role limitations to vitality) on the SF-6D. Problems related to physical function, self-care, usual activities/role limitations and pain increased with age, while mental health problems decreased in all three measures. In almost all corresponding domains, respondents indicated the fewest problems on the EQ-5D-5L and the most problems on the SF-6D. The mean EQ-5D-5L, PROPr and SF-6D utilities were 0.900, 0.535 and 0.755, respectively. Female gender (PROPr, SF-6D), a lower level of education (EQ-5D-5L, PROPr), being unemployed or a disability pensioner (EQ-5D-5L), being underweight or obese (SF-6D), lack of physical exercise (all) and polypharmacy (all) were associated with significantly lower utilities. PROPr yielded the lowest and EQ-5D-5L the highest mean utilities in 28 of 30 chronic health conditions. CONCLUSIONS This study presents the first set of Hungarian population norms for the EQ-5D-5L, PROPr and SF-6D. Our findings can serve as reference values in clinical trials and observational studies and contribute to the monitoring of population health and the assessment of disease burden in Hungary.
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Affiliation(s)
- Anna Nikl
- Department of Health Policy, Corvinus University of Budapest, 8 Fővám tér, 1093, Budapest, Hungary
- Semmelweis University Doctoral School, Budapest, Hungary
| | - Mathieu F Janssen
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Balázs Jenei
- Department of Health Policy, Corvinus University of Budapest, 8 Fővám tér, 1093, Budapest, Hungary
| | - Valentin Brodszky
- Department of Health Policy, Corvinus University of Budapest, 8 Fővám tér, 1093, Budapest, Hungary
| | - Fanni Rencz
- Department of Health Policy, Corvinus University of Budapest, 8 Fővám tér, 1093, Budapest, Hungary.
- Semmelweis University Doctoral School, Budapest, Hungary.
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Bandi S, Stephen E, Bansal K, Mahdavinia M. Understanding the CRSwNP Patient as Whole. Am J Rhinol Allergy 2023; 37:140-146. [PMID: 36848278 DOI: 10.1177/19458924231152671] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a distinct inflammatory disease of the upper airways with a significant impact on the health and quality of life of affected patients. Several comorbid conditions such as allergic rhinitis, asthma, sleep disorders, and gastroesophageal reflux disease are commonly reported in patients with CRSwNP. OBJECTIVE In this article, we intended to review the UpToDate information on how these comorbidities can impact CRSwNP patients' health and well-being. METHODS A PUBMED search was performed to review relevant recent article on the topic. RESULTS While there have been significant advances in the knowledge and management options for CRSwNP in the past few years, additional studies are needed to understand the underlying pathophysiologic mechanisms of these associations. In addition, awareness of the impact of CRSwNP on mental health, quality of life, and cognition is paramount to treating this condition. CONCLUSION Recognition and addressing CRSwNP comorbidities such as allergic rhinitis, asthma, sleep disorders, gastroesophageal reflux disease, and cognitive function impairment are important to optimally understand and manage the patient with CRSwNP as a whole.
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Affiliation(s)
- Sindhura Bandi
- Division of Allergy/Immunology, Department of Internal Medicine, 2468Rush University Medical Center, Chicago, Illinois
| | - Ellen Stephen
- Division of Allergy/Immunology, Department of Internal Medicine, 2468Rush University Medical Center, Chicago, Illinois
| | - Keerthi Bansal
- Division of Allergy/Immunology, Department of Internal Medicine, 2468Rush University Medical Center, Chicago, Illinois
| | - Mahboobeh Mahdavinia
- Division of Allergy/Immunology, Department of Internal Medicine, 2468Rush University Medical Center, Chicago, Illinois
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Sun CY, Liu Y, Zhou LR, Wang MS, Zhao XM, Huang WD, Liu GX, Zhang X. Comparison of EuroQol-5D-3L and Short Form-6D Utility Scores in Family Caregivers of Colorectal Cancer Patients: A Cross-Sectional Survey in China. Front Public Health 2021; 9:742332. [PMID: 34660519 PMCID: PMC8511410 DOI: 10.3389/fpubh.2021.742332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/26/2021] [Indexed: 01/08/2023] Open
Abstract
Objective: To compare the EuroQol-5D-3L (EQ-5D-3L) and the Short Form-6D (SF-6D) utility scores in family caregivers (FCs) of colorectal cancer (CRC) patients. Method: This study was performed on FCs of CRC patients from three primary cancer centers in the capital city of the Heilongjiang province. The participants (FCs) who were enrolled, filled the EQ-5D-3L, along with the SF-6D questionnaire. Two tools were compared for their distribution, discriminant validity, agreement, and convergent validity along with known-groups validity. Result: Two hundred ninety-two FCs of CRC patients were enrolled. The score distribution of the SF-6D along with the EQ-5D-3L were not normal. A ceiling impact was seen in 31.8% of the FCs for EQ-5D-3L; however, none for the SF-6D. Good associations (Spearman's rho = 0.622, p < 0.01) and intraclass correlation coefficient (ICC 0.637 and average ICC 0.778) between the two scores were observed. The EQ-5D-3L yielded higher utility scores in contrast with the SF-6D in the better health subclass. The SF-6D distinguished better between excellent and good health statuses, with better effect size and relative efficiency statistics. Both tools showed good known-groups validity. Conclusion: The utility scores of SF-6D were remarkably lower relative to that of the EQ-5D-3L, but the difference may be clinically insignificant. However, the SF-6D may be superior because of the lack of ceiling impact. SF-6D exhibited a better convergent validity along with discrimination validity of excellent health condition and improved known-groups validity efficiency.
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Affiliation(s)
- Cheng-yao Sun
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
| | - Yang Liu
- Department of Health Education, College of Public Health of Harbin Medical University, Harbin, China
| | - Liang-ru Zhou
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
| | - Ming-si Wang
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
| | - Xian-ming Zhao
- Tumor Radiotherapy Center, Harbin the First Hospital, Harbin, China
| | - Wei-dong Huang
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
| | - Guo-xiang Liu
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
| | - Xin Zhang
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
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Afshari S, Ameri H, Daroudi RA, Shiravani M, Karami H, Akbari Sari A. Health related quality of life in adults with asthma: a systematic review to identify the values of EQ-5D-5L instrument. J Asthma 2021; 59:1203-1212. [PMID: 33863264 DOI: 10.1080/02770903.2021.1917607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The EQ-5D is the most popular generic preference-based instrument used for asthma patients. This study aims to explore the psychometric properties of the EQ-5D-5L instrument in patients with asthma and identify the EQ-5D-5L scores in these patients. METHOD PubMed, Scopus, Web of Science, Google Scholar and CEA Registry were searched with English language from 2009 until April 2020. Retrieved studies were checked against the inclusion criteria. Reference lists of the included articles were also reviewed. The quality of included articles was evaluated using Mitton checklist and the data were extracted by a reviewer and were checked by a second reviewer. Meta-analysis was done to calculate the overall scores based on type of asthma control. RESULTS A total of 17 articles were included. The EQ-5D-5L scores ranged from 0.45 to 0.93 and the VAS scores ranged from 35.67 to 83.80. The EQ-5D-5L is higher in well-controlled (0.88, 95% CI: 0.81-0.96, P = 0.0001) than partly controlled (0.80, 95% CI: 0.74-0.85, P = 0.001) and poorly controlled asthma (0.72, 95% CI: 0.67-0.77, P = 0.01). Validity in two studies was weak and, in other studies, it was moderate to strong. Responsiveness of the EQ-5D-5L, that was shown in a study, was less than other generic instruments, and reliability was adequate in only study that had been reported. Ceiling effects were between 8.30% to 35%. CONCLUSION Higher score of the EQ-5D-5L was consistent with well-controlled asthma patients and those with lower severity of asthma. The assessment of psychometric properties of the EQ-5D-5L needs further observations.
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Affiliation(s)
- Somayeh Afshari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Hosein Ameri
- Department of Health Services Management, Health Policy and Management Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Rajab Ali Daroudi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Maryam Shiravani
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Hassan Karami
- Department of Health Economics, School of Health Management & Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
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Shah A, Ng X, Shah R, Solem C, Wang P, Obradovic M. Psychometric Validation of the EQ-5D-3L in Patients with Nontuberculous Mycobacterial (NTM) Lung Disease Caused by Mycobacterium avium Complex (MAC). Patient Relat Outcome Meas 2021; 12:45-54. [PMID: 33658880 PMCID: PMC7920600 DOI: 10.2147/prom.s272075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/22/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This analysis evaluated the psychometric properties of the EQ-5D-3L among patients with Mycobacterium avium complex lung disease (MAC-LD). METHODS Data from the Phase III CONVERT trial were analyzed. Study measures including the EQ-5D-3L, St. George's Respiratory Questionnaire (SGRQ), the 6-minute walk test (6MWT), and percent predicted forced expiratory volume in 1 second (ppFEV1) were collected at baseline, month 3 (M3), month 4 (M4; only 6MWT), and month 6 (M6). Item characteristics and validity were evaluated at baseline. Test-retest reliability was assessed using intraclass correlation coefficients (ICC) and a weighted kappa statistic among a subgroup of stable patients. Validity was tested by evaluating correlations of the EQ-5D-3L index/visual analogue scale (VAS) scores with SGRQ and 6MWT and comparing mean index/VAS scores across known groups defined using 6MWT and ppFEV1. Responsiveness of the EQ-5D-3L was assessed using 6MWT, SGRQ, ppFEV1, and culture conversion as anchors. RESULTS The index score was subject to ceiling effects, with 32.6% of patients reporting perfect health at baseline. ICCs for the index (0.80) and VAS (0.85) scores and weighted kappas for the domains (0.5-0.72) indicated adequate test-retest reliability. Correlations between the index/VAS scores and related domains of the SGRQ and 6MWT were as hypothesized (0.31-0.62), and the mean index/VAS scores were significantly different between the 6MWT and ppFEV1 known groups (p<0.05), supporting the validity of the EQ-5D-3L. No evidence was found supporting the responsiveness of the EQ-5D-3L to changes in any of the anchors. CONCLUSION EQ-5D-3L exhibited evidence of validity and reliability but poor responsiveness to clinically meaningful changes in patients with MAC-LD.
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Affiliation(s)
- Anuj Shah
- Patient Centered Outcomes, Pharmerit - An OPEN Health Company, Bethesda, MD, USA
| | - Xinyi Ng
- Patient Centered Outcomes, Pharmerit - An OPEN Health Company, Bethesda, MD, USA
| | - Ruchit Shah
- Patient Centered Outcomes, Pharmerit - An OPEN Health Company, Bethesda, MD, USA
| | - Caitlyn Solem
- Patient Centered Outcomes, Pharmerit - An OPEN Health Company, Bethesda, MD, USA
| | - Ping Wang
- Health Economics and Outcomes Research, Insmed Incorporated, Bridgewater Township, NJ, USA
| | - Marko Obradovic
- Health Economics and Outcomes Research, Insmed Germany GmbH, Frankfurt am Main, Germany
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Correlation between nasal mucosal temperature change and the perception of nasal patency: a literature review. The Journal of Laryngology & Otology 2021; 135:104-109. [PMID: 33612130 DOI: 10.1017/s0022215121000487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The mechanism of nasal airflow sensation is poorly understood. This study aimed to examine the role of nasal mucosal temperature change in the subjective perception of nasal patency and the methods by which it can be quantified. METHOD Medline and PubMed database searches were performed to retrieve literature relevant to the topic. RESULTS The primary mechanism producing the sensation of nasal patency is thought to be the activation of transient receptor potential melastatin family member 8 ('TRPM8'), a thermoreceptor that is activated by nasal mucosal cooling. Computational fluid dynamics studies have demonstrated that increased airflow and heat flux are correlated with better patient-reported outcome measure scores. Similarly, physical measurements of the nasal cavity using temperature probes have shown a correlation between lower nasal mucosal temperatures and better patient-reported outcome measure scores. CONCLUSION Nasal mucosal temperature change may be correlated with the perception of improved nasal patency. Future research should quantify the impact of mucosal cooling on the perception of nasal airway obstruction.
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Epperson MV, McCann AC, Phillips KM, Caradonna DS, Gray ST, Sedaghat AR. Unbiased Measure of General Quality of Life in Chronic Rhinosinusitis Reveals Disease Modifiers. Laryngoscope 2020; 131:1206-1211. [PMID: 33006402 DOI: 10.1002/lary.29139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/22/2020] [Accepted: 09/13/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Chronic rhinosinusitis (CRS) is associated with a significant decrease in general health-related quality of life (QOL). The EuroQol 5-dimensional questionnaire measures general health-related quality of life through a health utility value (EQ-5D HUV)-based on five domains reflecting mobility, self-care, activities of daily life, pain/discomfort, and anxiety/depression-and an unbiased visual analog scale (EQ-5D VAS). We sought to identify characteristics of CRS patients with a high EQ-5D HUV but low EQ-5D VAS score. MATERIALS AND METHODS Retrospective cross-sectional study of 300 CRS patients with EQ-5D HUV equal to 1.0 (reflecting perfect health). All patients completed a 22-item Sinonasal Outcome Test (SNOT-22)-from which nasal, sleep, ear/facial discomfort, and emotional subdomain scores were calculated, as well as the EQ-5D. Low EQ-5D VAS was defined as a score less than 80. RESULTS On multivariate analysis, low EQ-5D VAS was associated with only the SNOT-22 sleep subdomain score (odds ratio [OR] = 1.07, 95%CI: 1.02-1.12, P = .003). Comorbid asthma was also associated with lower EQ-5D VAS (OR = 2.16, 95%CI: 1.02-4.59, P = .045). In contrast, polyps were negatively associated with having a lower EQ-5D VAS (OR = 0.34, 95%CI: 0.17-0.69, P = .003). CONCLUSION There are patients with perfect general health-related QOL according to a health utility value-based methodology (like the EQ-5D HUV) who report low general health-related QOL on an unbiased measure like the EQ-5D VAS. In CRS patients with perfect EQ-5D HUV, poor sleep and asthma were associated with low QOL on the EQ-5D VAS, while polyps were negatively associated with low QOL. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1206-1211, 2021.
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Affiliation(s)
- Madison V Epperson
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Adam C McCann
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - David S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A
| | - Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
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Farrell NF, Mace JC, Sauer DA, Thomas AJ, Geltzeiler M, Detwiller KY, Alt JA, Smith TL. Patient-reported sleep outcomes lack association with mucosal eosinophilia or neutrophilia in patients with chronic rhinosinusitis undergoing functional endoscopic sinus surgery. Int Forum Allergy Rhinol 2020; 11:784-793. [PMID: 32783400 DOI: 10.1002/alr.22678] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/15/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is associated with sleep dysfunction, but the underlying pathophysiology is poorly understood. The purpose of this study was to determine if mucosal eosinophilia or neutrophilia were associated with sleep dysfunction severity or altered the improvement in sleep dysfunction following functional endoscopic sinus surgery (FESS). METHODS A total of 104 patients with medically refractory CRS with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSsNP), completed the Pittsburgh Sleep Quality Index (PSQI) before and after FESS. Anterior ethmoid mucosa was collected during FESS and densest infiltrates of eosinophilia and neutrophilia per high-power field (HPF) were determined by microscopy. Eosinophilic (>10 eosinophils/HPF) and neutrophilic (>4 neutrophils/HPF) CRS were then compared to preoperative and postoperative PSQI measures. RESULTS Of 104 study participants, 88 (85%) reported preoperative PSQI scores consistent with "poor sleep," (PSQI total > 5). The cohort overall demonstrated significant improvement in poor sleep (65%; χ2 = 12.03; p < 0.001) 16.8 ± 5.0 months after FESS. Regardless of nasal polyposis, neither eosinophilic nor neutrophilic CRS was associated with differences in mean postoperative PSQI improvement. However, in patients with neutrophilic CRSsNP, there was a significant relationship between severity of neutrophilia and improvement in sleep latency (R = -0.798, p = 0.003) and sleep efficacy (R = -0.777, p = 0.005). CONCLUSION Chronic inflammation has been hypothesized to play a pathophysiologic role in sleep dysfunction associated with CRS. This study suggests that in patients with medically refractory CRS, evidence of mucosal eosinophilia and neutrophilia lack strong associations with patient-reported sleep dysfunction or improvements in sleep quality after FESS, overall. However, neutrophilia may impact sleep latency and efficacy in patients with CRSsNP.
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Affiliation(s)
- Nyssa Fox Farrell
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Jess C Mace
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - David A Sauer
- Department of Pathology, Oregon Health & Science University, Portland, OR
| | - Andrew J Thomas
- Department of Otolaryngology, Oschner Health Center-West Bank, Gretna, LA
| | - Mathew Geltzeiler
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Kara Y Detwiller
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Jeremiah A Alt
- Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Timothy L Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
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Bae E, Choi SE, Lee H, Shin G, Kang D. Validity of EQ-5D utility index and minimal clinically important difference estimation among patients with chronic obstructive pulmonary disease. BMC Pulm Med 2020; 20:73. [PMID: 32293387 PMCID: PMC7092534 DOI: 10.1186/s12890-020-1116-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/16/2020] [Indexed: 01/21/2023] Open
Abstract
Background The discriminatory ability of multi-attribute utility (MAU) measures compared to condition-specific measures (CSM) in assessing health-related quality of life (HRQoL) among patients with chronic obstructive pulmonary disease (COPD) is an unsettled issue. This study investigated the quality of life of patients with COPD with three different HRQoL instruments and examined whether they could differentiate between adjacent severity groups in a statistically and clinically meaningful manner. In the process, the minimal clinically important differences (MCID) of the EQ-5D utility index were estimated. Methods Cross-sectional survey data were collected from patients with mild to very severe COPD in South Korea. In addition to demographic and clinical information, the following HRQoL questionnaires were used: The three-level five-dimensional Euro-Quality of Life tool (EQ-5D-3L), the EQ-Visual Analog Scale (EQ-VAS), and the Chronic Obstructive Pulmonary Disease Assessment Test (CAT). Patients’ health-related quality of life was analyzed with reference to severity groups based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. To investigate the discriminatory ability of the HRQoL instruments between COPD severity groups, tests examining variance, covariance, and standardized mean difference were performed. After estimating the MCID of the EQ-5D utility index using the anchor-based method, we investigated whether the differences in the EQ-5D utility scores between groups exceeded the clinically meaningful minimum level. Results A total of 298 patients completed this study. All the quality of life scores showed statistically significant differences between the GOLD severity groups. The pooled MCID estimate for the EQ-5D utility index was 0.028 (range: 0.017–0.033). Even after adjusting for other factors affecting quality of life, the EQ-5D utility index differentiated the GOLD groups well. Conclusions We conclude that the EQ-5D utility index is a valid instrument for measuring the quality of life of patients with COPD, and the pooled MCID estimate for the EQ-5D utility index was 0.028.
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Affiliation(s)
- Eunmi Bae
- College of Pharmacy, Korea University, 2511 Sejong-ro, Sejong, 30019, South Korea
| | - Sang-Eun Choi
- College of Pharmacy, Korea University, 2511 Sejong-ro, Sejong, 30019, South Korea.
| | - Haeyoung Lee
- University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Gyeongseon Shin
- College of Pharmacy, Korea University, 2511 Sejong-ro, Sejong, 30019, South Korea
| | - Daewon Kang
- College of Pharmacy, Korea University, 2511 Sejong-ro, Sejong, 30019, South Korea
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Zhao L, Liu X, Liu D, He Y, Liu Z, Li N. Comparison of the psychometric properties of the EQ-5D-3L and SF-6D in the general population of Chengdu city in China. Medicine (Baltimore) 2019; 98:e14719. [PMID: 30882636 PMCID: PMC6426629 DOI: 10.1097/md.0000000000014719] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The EQ-5D-3L and SF-6D are the most commonly used economic evaluation instruments. Data comparing the psychometric properties of the instruments are scarce in the Chinese population. This study compared the psychometric properties of these measures in the Chinese general population in Chengdu.From October to December 2012, 2186 respondents (age ≥18) were selected from urban and rural areas of Chengdu, China, via multistage stratified cluster sampling. Correlations, scatter plots and Bland-Altman plots were used to explore the relationships between the 2 measures. Ceiling and floor effects were used to analyze the score distribution. The known-groups method was used to evaluate discriminant validity.Among 2186 respondents, 2182 completed the questionnaire, and 2178 (18-82 years old, mean 46.09 ± 17.49) met the data quality requirement. The mean scores for the EQ-5D-3LCN, EQ-5D-3LUK, and SF-6DUK were 0.95 (Std: 0.11), 0.93 (Std: 0.15), and 0.79 (Std: 0.12), respectively. The correlations between domains ranged from 0.16 to 0.51. The correlation between the EQ-5D-3LCN and SF-6DUK and between the EQ-5D-3LUK and SF-6DUK was 0.46. The scatter plots and Bland-Altman plots demonstrated poor agreement between the EQ-5D-3L and SF-6D. The floor and ceiling effects were respectively 0.05% and 74.60% for the EQ-5D-3L and 0.05% and 2.53% for the SF-6DUK. The EQ-5D-3LCN, EQ-5D-3LUK and SF-6D have good discriminant validity in different sociodemographic and health condition groups. The SF-6D has higher level of discriminant validity in moderately healthy groups in the EQ-5D-3L full-health population.Both the EQ-5D-3L and SF-6D are valid economic evaluation instruments in the Chinese general population in Chengdu but do not seem to be interchangeable. The EQ-5D-3L has a higher ceiling effect and higher level of discriminant validity among different sociodemographic groups, and the SF-6D has a lower ceiling effect and higher level of discriminant validity in health condition groups. Users may consider the evidence in the choice of these instruments.
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Affiliation(s)
- Longchao Zhao
- Department of Health Related Social and Behavioral Science, West China School of Public Health, Sichuan University, Chengdu
| | - Xiang Liu
- Department of Health Related Social and Behavioral Science, West China School of Public Health, Sichuan University, Chengdu
| | - Danping Liu
- Department of Health Related Social and Behavioral Science, West China School of Public Health, Sichuan University, Chengdu
| | - Yan He
- Department of Social Medicine and Health Management, Public Health College, Zhengzhou University, Zhengzhou
| | - Zhijun Liu
- Applied Psychology Department, School of Management, Zunyi Medical University, Zunyi, China
| | - Ningxiu Li
- Department of Health Related Social and Behavioral Science, West China School of Public Health, Sichuan University, Chengdu
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Kontodimopoulos N, Stamatopoulou E, Brinia A, Talias MA, Ferreira LN. Are condition-specific utilities more valid than generic preference-based ones in asthma? Evidence from a study comparing EQ-5D-3L and SF-6D with AQL-5D. Expert Rev Pharmacoecon Outcomes Res 2018; 18:667-675. [PMID: 30048194 DOI: 10.1080/14737167.2018.1505506] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Systematic discrepancies have been shown in utility values derived from different instruments. This study compares utilities from the condition-specific AQL-5D and the generic EQ-5D-3L and SF-6D in an asthmatic population with heterogeneous health-related quality of life (HRQoL), disease severity, and control status. METHODS A consecutive sample of 104 patients diagnosed with asthma completed a survey containing the Greek versions of SF-36, EQ-5D-3L, and AQLQ(s). Treatment adequacy was assessed with the Asthma Control Questionnaire (ACQ), and asthma severity according to Global Initiative for Asthma 2016 guidelines. Association and agreement between instruments were assessed with Spearman's correlation and Bland-Altman plots. RESULTS AQL-5D utilities exceeded (p < 0.001) those from EQ-5D-3L and SF-6D. There were weak-to-moderate correlations (<0.5) between most dimensions of AQL-5D, and those of EQ-5D-3L and SF-6D, and strong correlations between similar dimensions of EQ-5D-3L and SF-6D. Significant differences (p < 0.001) were observed throughout the visual analog scale (VAS), asthma severity and asthma control subgroups, with AQL-5D consistently higher than EQ-5D-3L and SF-6D. CONCLUSIONS All instruments distinguished between differing degrees of asthma control, but only AQL-5D discriminated between asthma severity and HRQoL as well. Although the relatively small sample warrants caution in interpreting the subgroup results, this study contributes to the growing number of comparisons between condition-specific and generic preference-based instruments.
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Affiliation(s)
- Nick Kontodimopoulos
- a Faculty of Social Sciences , Hellenic Open University , Patras , Greece.,b Division of Management , "KAT" General Hospital , Athens , Greece
| | | | - Aikaterini Brinia
- a Faculty of Social Sciences , Hellenic Open University , Patras , Greece
| | - Michael A Talias
- c Faculty of Economics and Management , Open University of Cyprus , Nicosia , Cyprus
| | - Lara N Ferreira
- d ESGHT , University of the Algarve , Faro , Portugal.,e Centre for Health Studies & Research-CEISUC, University of Coimbra , Coimbra , Portugal
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12
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Zhang Y, Morgan RL, Alonso-Coello P, Wiercioch W, Bała MM, Jaeschke RR, Styczeń K, Pardo-Hernandez H, Selva A, Ara Begum H, Morgano GP, Waligóra M, Agarwal A, Ventresca M, Strzebońska K, Wasylewski MT, Blanco-Silvente L, Kerth JL, Wang M, Zhang Y, Narsingam S, Fei Y, Guyatt G, Schünemann HJ. A systematic review of how patients value COPD outcomes. Eur Respir J 2018; 52:13993003.00222-2018. [PMID: 30002103 DOI: 10.1183/13993003.00222-2018] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/21/2018] [Indexed: 01/06/2023]
Abstract
Our objective was to summarise systematically all research evidence related to how patients value outcomes in chronic obstructive pulmonary disease (COPD).We conducted a systematic review (systematic review registration number CRD42015015206) by searching PubMed, Embase, PsycInfo and CINAHL, and included reports that assessed the relative importance of outcomes from COPD patients' perspective. Two authors independently determined the eligibility of studies, abstracted the eligible studies and assessed risk of bias. We narratively summarised eligible studies, meta-analysed utilities for individual outcomes and assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach.We included 217 quantitative studies. Investigators most commonly used utility measurements of outcomes (n=136), discrete choice exercises (n=13), probability trade-off (n=4) and forced choice techniques (n=46). Patients rated adverse events as important but on average, less so than symptom relief. Exacerbation and hospitalisation due to exacerbation are the outcomes that COPD patients rate as most important. This systematic review provides a comprehensive registry of related studies.
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Affiliation(s)
- Yuan Zhang
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Rebecca L Morgan
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Pablo Alonso-Coello
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Iberoamerican Cochrane Centre, CIBERESP-IIB Sant Pau, Barcelona, Spain
| | - Wojtek Wiercioch
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Małgorzata M Bała
- Dept of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Rafał R Jaeschke
- Section of Affective Disorders, Dept of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Styczeń
- Section of Affective Disorders, Dept of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
| | | | - Anna Selva
- Clinical Epidemiology and Cancer Screening, Corporació Sanitària Parc Taulí, Sabadell, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Spain
| | - Housne Ara Begum
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Gian Paolo Morgano
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Marcin Waligóra
- REMEDY, Research Ethics in Medicine Study Group, Dept of Philosophy and Bioethics, Jagiellonian University Medical College, Krakow, Poland
| | - Arnav Agarwal
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Matthew Ventresca
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Karolina Strzebońska
- REMEDY, Research Ethics in Medicine Study Group, Dept of Philosophy and Bioethics, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz T Wasylewski
- REMEDY, Research Ethics in Medicine Study Group, Dept of Philosophy and Bioethics, Jagiellonian University Medical College, Krakow, Poland
| | - Lídia Blanco-Silvente
- TransLab Research Group, Dept of Medical Sciences, University of Girona, Girona, Spain
| | - Janna-Lina Kerth
- Dept for Medical Didactics and Curricular Development, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Mengxiao Wang
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Yuqing Zhang
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Saiprasad Narsingam
- Dept of Medicine, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Yutong Fei
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Gordon Guyatt
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Holger J Schünemann
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Dept of Medicine, McMaster University, Hamilton, ON, Canada
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13
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Kourlaba G, Bakakos P, Loukides S, Vellopoulou K, Solakidi A, Maniadakis N. The self-reported prevalence and disease burden of asthma in Greece. J Asthma 2018; 56:478-497. [PMID: 29718784 DOI: 10.1080/02770903.2018.1471704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The primary objective was to estimate the self-reported prevalence of asthma in Greece. The secondary one was to assess the impact of asthma control on patients' health related Quality-of-Life (HRQoL), productivity loss, daily activities and psychological distress. METHODS A population-based, random-digit dialing, telephone nationwide survey was conducted to recruit patients with asthma. Among the responders, 3,946 met the age criterion (≥18 years) and completed the screening questions regarding asthma. Of them, 353 subjects reported that they had been diagnosed with asthma sometime in their life and completed the survey. Data on demographic and lifestyle characteristics, asthma control, comorbidities, limitations in daily activities, psychological distress, productivity loss, as well as HRQoL, were collected through telephone interview. RESULTS The lifetime self-reported prevalence of asthma was found to be 9.10% (95% CI:8.14%-9.94%). Sixty three percent of patients had well-controlled (WC) asthma. Asthma control was associated with gender, age, and specific comorbidities. Moreover, patients with not well-controlled (NWC) asthma were more likely to have missed work and reduced productivity during the past 12 months due to their asthma (p < 0.01). Patients with NWC asthma were more likely to declare psychological distress and limitations in their daily living activities. Patients' HRQoL with NWC asthma was significantly worse (0.65 ± 0.24) compared to those with WC asthma (0.86 ± 0.17, p ≤ 0.001). CONCLUSIONS The results of this survey revealed the link between the asthma control and burden of disease demonstrating the need for the implementation of programs aiming at the management of chronic symptoms related to this condition.
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Affiliation(s)
| | - Petros Bakakos
- b 1st Respiratory Medicine Department , National and Kapodistrian University of Athens , Athens , Greece
| | - Stelios Loukides
- c 2nd Respiratory Medicine Department , National and Kapodistrian University of Athens , Chaidari , Greece
| | | | | | - Nikos Maniadakis
- d Department οf Health Services Organization and Management , National School οf Public Health , Athens , Greece
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14
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Buchholz I, Janssen MF, Kohlmann T, Feng YS. A Systematic Review of Studies Comparing the Measurement Properties of the Three-Level and Five-Level Versions of the EQ-5D. PHARMACOECONOMICS 2018; 36:645-661. [PMID: 29572719 PMCID: PMC5954044 DOI: 10.1007/s40273-018-0642-5] [Citation(s) in RCA: 194] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Since the introduction of the five-level version of the EQ-5D (5L), many studies have comparatively investigated the measurement properties of the original three-level version (3L) with the 5L version. OBJECTIVE The aim of this study was to consolidate the available evidence on the performance of both instruments. METHODS A systematic literature search of studies in the English and German languages was conducted (2007-January 2018) using the PubMed, EMBASE, and PsycINFO (EBSCO) databases, as well as the EuroQol Research Foundation website. Data were extracted and assessed on missing values, distributional properties, informativity indices (Shannon's H' and J'), inconsistencies, responsiveness, and test-retest reliability. RESULTS Twenty-four studies were included in the review. Missing values and floor effects (percentage reporting the worst health state) were found to be negligible for both 3L and 5L (< 5%). From 18 studies, inconsistencies ranged from 0 to 10.6%, although they were generally well below 5%, with 9 studies reporting the most inconsistencies for Usual Activities (mean percentage 4.1%). Shannon's indices were always higher for 5L than for 3L, and all but three studies reported lower ceiling effects ('11111') for 5L than for 3L. There is mixed and insufficient evidence on responsiveness and test-retest reliability, although results on index values showed better performance for 5L on test-retest reliability. CONCLUSION Overall, studies showed similar or better measurement properties of the 5L compared with the 3L, and evidence indicated moderately better distributional parameters and substantial improvement in informativity for the 5L compared with the 3L. Insufficient evidence on responsiveness and test-retest reliability implies further research is needed.
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Affiliation(s)
- Ines Buchholz
- Institute for Community Medicine, University Medicine of Greifswald, Greifswald, Germany.
| | - Mathieu F Janssen
- Department of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
| | - Thomas Kohlmann
- Institute for Community Medicine, University Medicine of Greifswald, Greifswald, Germany
| | - You-Shan Feng
- Institute for Community Medicine, University Medicine of Greifswald, Greifswald, Germany
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15
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Poortinga W, Rodgers SE, Lyons RA, Anderson P, Tweed C, Grey C, Jiang S, Johnson R, Watkins A, Winfield TG. The health impacts of energy performance investments in low-income areas: a mixed-methods approach. PUBLIC HEALTH RESEARCH 2018. [DOI: 10.3310/phr06050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundCold homes and fuel poverty contribute to health inequalities in ways that could be addressed through energy efficiency interventions.ObjectivesTo determine the health and psychosocial impacts of energy performance investments in low-income areas, particularly hospital admissions for cardiorespiratory conditions, prevalence of respiratory symptoms and mental health status, hydrothermal conditions and household energy use, psychosocial outcomes, cost consequences to the health system and the cost utility of these investments.DesignA mixed-methods study comprising data linkage (25,908 individuals living in 4968 intervention homes), a field study with a controlled pre-/post-test design (intervention,n = 418; control,n = 418), a controlled multilevel interrupted time series analysis of internal hydrothermal conditions (intervention,n = 48; control,n = 40) and a health economic assessment.SettingLow-income areas across Wales.ParticipantsResidents who received energy efficiency measures through the intervention programme and matched control groups.Main outcome measuresPrimary outcomes – emergency hospital admissions for cardiorespiratory conditions, self-reported respiratory symptoms, mental health status, indoor air temperature and indoor relative humidity. Secondary outcomes – emergency hospital admissions for chronic obstructive pulmonary disease-related cardiorespiratory conditions, excess winter admissions, health-related quality of life, subjective well-being, self-reported fuel poverty, financial stress and difficulties, food security, social interaction, thermal satisfaction and self-reported housing conditions.MethodsAnonymously linked individual health records for emergency hospital admissions were analysed using mixed multilevel linear models. A quasi-experimental controlled field study used a multilevel repeated measures approach. Controlled multilevel interrupted time series analyses were conducted to estimate changes in internal hydrothermal conditions following the intervention. The economic evaluation comprised cost–consequence and cost–utility analyses.Data sourcesThe Patient Episode Database for Wales 2005–14, intervention records from 28 local authorities and housing associations, and scheme managers who delivered the programme.ResultsThe study found no evidence of changes in physical health. However, there were improvements in subjective well-being and a number of psychosocial outcomes. The household monitoring study found that the intervention raised indoor temperature and helped reduce energy use. No evidence was found of substantial increases in indoor humidity levels. The health economic assessment found no explicit cost reductions to the health service as a result of non-significant changes in emergency admissions for cardiorespiratory conditions.LimitationsThis was a non-randomised intervention study with household monitoring and field studies that relied on self-response. Data linkage focused on emergency admissions only.ConclusionAlthough there was no evidence that energy performance investments provide physical health benefits or reduce health service usage, there was evidence that they improve social and economic conditions that are conducive to better health and improved subjective well-being. The intervention has been successful in reducing energy use and improving the living conditions of households in low-income areas. The lack of association of emergency hospital admissions with energy performance investments means that we were unable to evidence cost saving to health-service providers.Future workOur research suggests the importance of incorporating evaluations with follow-up into intervention research from the start.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
| | - Sarah E Rodgers
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Ronan A Lyons
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Pippa Anderson
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Chris Tweed
- Welsh School of Architecture, Cardiff University, Cardiff, UK
| | - Charlotte Grey
- Welsh School of Architecture, Cardiff University, Cardiff, UK
| | - Shiyu Jiang
- Welsh School of Architecture, Cardiff University, Cardiff, UK
| | - Rhodri Johnson
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Alan Watkins
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Thomas G Winfield
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
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16
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Nelsen LM, Vernon M, Ortega H, Cockle SM, Yancey SW, Brusselle G, Albers FC, Jones PW. Evaluation of the psychometric properties of the St George's Respiratory Questionnaire in patients with severe asthma. Respir Med 2017; 128:42-49. [PMID: 28610668 DOI: 10.1016/j.rmed.2017.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/18/2017] [Accepted: 04/27/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE Limited data exist on the quantitative validity of the St George's Respiratory Questionnaire (SGRQ) in asthma populations. This study evaluated the psychometric properties of the SGRQ in patients with severe asthma. METHODS This was a post-hoc analysis of pooled data from MENSA (N = 576; NCT01691508) and SIRIUS (N = 135; NCT01691521), two randomized, placebo controlled trials of mepolizumab in patients with severe asthma. Patients completed the SGRQ at Baseline and Exit (MENSA Week 32; SIRIUS Week 24). Distributional characteristics, internal consistency reliability, test-retest reliability, convergent and discriminant validity, known-groups validity and responsiveness were assessed. RESULTS Internal consistency reliability was acceptable for the total and domain scores at Baseline and Exit (Cronbach's α was 0.92 and 0.94 at Baseline and Exit, respectively, for the total score). Test-retest reliability was demonstrated (intraclass correlation coefficients >0.7) for total score and the Activity and Impacts domains. Convergent and discriminant validity were demonstrated with measures associated or not associated with respiratory-related health status. Known groups validity based on baseline FEV1% predicted, Asthma Control Questionnaire (ACQ)-5 score, exacerbations and eosinophil counts was demonstrated for the SGRQ total and domain scores. Responses to therapy based on clinician-rated response, patient-rated response, ACQ-5 change score and exacerbations generally correlated with improvements in SGRQ scores. CONCLUSIONS This analysis demonstrated that the SGRQ has acceptable psychometric properties in patients with severe asthma, exceeding the thresholds for adequate reliability, validity and responsiveness. The SGRQ appears to be a good instrument for identifying response to therapy in patients with severe asthma.
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Affiliation(s)
- Linda M Nelsen
- Value Evidence and Outcomes, GSK, Collegeville, PA, USA.
| | | | - Hector Ortega
- Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, NC, USA
| | - Sarah M Cockle
- Value Evidence and Outcomes, GSK, GSK House, Brentford, Middlesex, UK
| | - Steven W Yancey
- Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, NC, USA
| | - Guy Brusselle
- Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Frank C Albers
- Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, NC, USA
| | - Paul W Jones
- Value Evidence and Outcomes, GSK, GSK House, Brentford, Middlesex, UK
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17
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Mahdavinia M, Schleimer RP, Keshavarzian A. Sleep disruption in chronic rhinosinusitis. Expert Rev Anti Infect Ther 2017; 15:457-465. [PMID: 28276943 DOI: 10.1080/14787210.2017.1294063] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Chronic rhinosinusitis (CRS) is a common disease of the upper airways and paranasal sinuses with a marked decline in quality of life (QOL). CRS patients suffer from sleep disruption at a significantly higher proportion (60 to 75%) than in the general population (8-18 %). Sleep disruption in CRS causes decreased QOL and is linked to poor functional outcomes such as impaired cognitive function and depression. Areas covered: A systematic PubMed/Medline search was done to assess the results of studies that have investigated sleep and sleep disturbances in CRS. Expert commentary: These studies reported sleep disruption in most CRS patients. The main risk factors for sleep disruption in CRS include allergic rhinitis, smoking, and high SNOT-22 total scores. The literature is inconsistent with regard to the prevalence of sleep-related disordered breathing (e.g. obstructive sleep apnea) in CRS patients. Although nasal obstruction is linked to sleep disruption, the extent of sleep disruption in CRS seems to expand beyond that expected from physical blockage of the upper airways alone. Despite the high prevalence of sleep disruption in CRS, and its detrimental effects on QOL, the literature contains a paucity of studies that have investigated the mechanisms underlying this major problem in CRS.
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Affiliation(s)
- Mahboobeh Mahdavinia
- a Allergy and Immunology Section, Department of Immunology and Microbiology , Rush University Medical Center , Chicago , IL , USA
| | - Robert P Schleimer
- b Division of Allergy-Immunology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Ali Keshavarzian
- c Division of Digestive Diseases and Nutrition, Department of Medicine , Rush University Medical Center , Chicago , IL , USA
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18
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DeConde AS, Soler ZM. Chronic rhinosinusitis: Epidemiology and burden of disease. Am J Rhinol Allergy 2016; 30:134-9. [PMID: 26980394 DOI: 10.2500/ajra.2016.30.4297] [Citation(s) in RCA: 219] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is based on sinonasal symptoms coupled with sinonasal tissue inflammation. Establishing the epidemiology and prevalence of CRS, therefore, is challenging given that confirming objective evidence of sinonasal inflammation on a large scale is not feasible. Although the sinonasal symptoms are well documented at the sinonasal level, analysis of emerging data indicates that the impact on the general-health-related domains of health are the symptoms that are most bothersome to patients' quality of life. OBJECTIVE To review the literature on the epidemiology and the societal and individual burdens of CRS. METHODS A literature review. RESULTS A refinement of questionnaire-based surveys coupled with sampling of respondents for accuracy likely provides the most accurate assessment of prevalence. There is geographic variation, but, in North American and European countries, the rates range from 4.5 to 12%. Although CRS is marked by sinonasal symptoms, the most problematic symptoms for patients seem to be the symptoms that affect general-health-related domains. Diminished sleep, productivity, cognition, mood, and fatigue are associated with the decision to elect surgical intervention and are associated with diminished healthy utility values. Direct costs of CRS have been well documented, but new data on the indirect costs of decreased productivity surpass direct costs, at $12.8 billion dollars per year in the United States. CONCLUSION CRS is a common disease with a large and vast symptom burden with high indirect costs. Although clinicians are focused by guidelines on sinus-specific symptoms, patients seem to be most impacted by the general-health-related consequences of CRS. An expanded understanding of the extent and costs of these symptoms will allow for a cost-effective allocation of limited health care resources.
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Affiliation(s)
- Adam S DeConde
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego, San Diego, California, USA
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Rencz F, Gulácsi L, Drummond M, Golicki D, Prevolnik Rupel V, Simon J, Stolk EA, Brodszky V, Baji P, Závada J, Petrova G, Rotar A, Péntek M. EQ-5D in Central and Eastern Europe: 2000-2015. Qual Life Res 2016; 25:2693-2710. [PMID: 27472992 DOI: 10.1007/s11136-016-1375-6] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Cost per quality-adjusted life year data are required for reimbursement decisions in many Central and Eastern European (CEE) countries. EQ-5D is by far the most commonly used instrument to generate utility values in CEE. This study aims to systematically review the literature on EQ-5D from eight CEE countries. METHODS An electronic database search was performed up to 1 July 2015 to identify original EQ-5D studies from the countries of interest. We analysed the use of EQ-5D with respect to clinical areas, methodological rigor, population norms and value sets. RESULTS We identified 143 studies providing 152 country-specific results with a total sample size of 81,619: Austria (n = 11), Bulgaria (n = 6), Czech Republic (n = 18), Hungary (n = 47), Poland (n = 51), Romania (n = 2), Slovakia (n = 3) and Slovenia (n = 14). Cardiovascular (21 %), neurologic (17 %), musculoskeletal (15 %) and endocrine, nutritional and metabolic diseases (13 %) were the most frequently studied clinical areas. Overall, 112 (78 %) of the studies reported EQ VAS results and 86 (60 %) EQ-5D index scores, of which 27 (31 %) did not specify the applied tariff. Hungary, Poland and Slovenia have population norms. Poland and Slovenia also have a national value set. CONCLUSIONS Increasing use of EQ-5D is observed throughout CEE. The spread of health technology assessment activities in countries seems to be reflected in the number of EQ-5D studies. However, improvement in informed use and methodological quality of reporting is needed. In jurisdictions where no national value set is available, in order to ensure comparability we recommend to apply the most frequently used UK tariff. Regional collaboration between CEE countries should be strengthened.
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Affiliation(s)
- Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, H-1093, Hungary.,Semmelweis University Doctoral School of Clinical Medicine, Üllői út 26., Budapest, H-1085, Hungary
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, H-1093, Hungary.
| | - Michael Drummond
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
| | - Dominik Golicki
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Poland, ul. Banacha 1b, 02-097, Warsaw, Poland
| | | | - Judit Simon
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| | - Elly A Stolk
- Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, H-1093, Hungary
| | - Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, H-1093, Hungary
| | - Jakub Závada
- Institute of Rheumatology, 1st Faculty of Medicine, Charles University, Na Slupi 4, 128 00, Prague, Czech Republic
| | - Guenka Petrova
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University, Sofia, Bulgaria
| | - Alexandru Rotar
- Department of Social Medicine, University of Amsterdam, Meibergdreef 9, 22660, 1100 DD, Amsterdam, The Netherlands
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, H-1093, Hungary
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Atsou K, Crequit P, Chouaid C, Hejblum G. Simulation-Based Estimates of the Effectiveness and Cost-Effectiveness of Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease in France. PLoS One 2016; 11:e0156514. [PMID: 27327159 PMCID: PMC4915708 DOI: 10.1371/journal.pone.0156514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/16/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The medico-economic impact of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) is poorly documented. OBJECTIVE To estimate the effectiveness and cost-effectiveness of pulmonary rehabilitation in a hypothetical cohort of COPD patients. METHODS We used a multi-state Markov model, adopting society's perspective. Simulated cohorts of French GOLD stage 2 to 4 COPD patients with and without pulmonary rehabilitation were compared in terms of life expectancy, quality-adjusted life years (QALY), disease-related costs, and the incremental cost-effectiveness ratio (ICER). Sensitivity analyses included variations of key model parameters. PRINCIPAL FINDINGS At the horizon of a COPD patient's remaining lifetime, pulmonary rehabilitation would result in mean gain of 0.8 QALY, with an over disease-related costs of 14 102 € per patient. The ICER was 17 583 €/QALY. Sensitivity analysis showed that pulmonary rehabilitation was cost-effective in every scenario (ICER <50 000 €/QALY). CONCLUSIONS These results should provide a useful basis for COPD pulmonary rehabilitation programs.
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Affiliation(s)
- Kokuvi Atsou
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, Sorbonne Universités
| | - Perrine Crequit
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, Sorbonne Universités
- UPMC Univ Paris 06, AP-HP, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
| | - Christos Chouaid
- GRC OncoTho, Paris Est, UPEC, Créteil, CHI Créteil, Service de Pneumologie, Créteil, France
| | - Gilles Hejblum
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, Sorbonne Universités
- UPMC Univ Paris 06, AP-HP, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
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Moayeri F, Hsueh YSA, Clarke P, Hua X, Dunt D. Health State Utility Value in Chronic Obstructive Pulmonary Disease (COPD); The Challenge of Heterogeneity: A Systematic Review and Meta-Analysis. COPD 2015; 13:380-98. [PMID: 26678545 DOI: 10.3109/15412555.2015.1092953] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) has a considerable impact on quality of life and well-being of patients. Health state utility value (HSUV) is a recognized measure for health economic appraisals and is extensively used as an indicator for decision-making studies. This study is a systematic review of literature aimed to estimate mean utility value in COPD using meta-analysis and explore degree of heterogeneity in the utility values across a variety of clinical and study characteristic. The literature review covers studies that used EQ-5D to estimate utility value for patient level research in COPD. Studies that reported utility values elicited by EQ-5D in COPD patients were selected for random-effect meta-analysis addressing inter-study heterogeneity and subgroup analyses. Thirty-two studies were included in the general utility meta-analysis. The estimated general utility value was 0.673 (95% CI 0.653 to 0.693). Meta-analyses of COPD stages utility values showed influence of airway obstruction on utility value. The utility values ranged from 0.820 (95% CI 0.767 to 0.872) for stage I to 0.624 (95% CI 0.571 to 0.677) for stage IV. There was substantial heterogeneity in utility values: I(2) = 97.7%. A more accurate measurement of utility values in COPD is needed to refine valid and generalizable scores of HSUV. Given the limited success of the factors studied to reduce heterogeneity, an approach needs to be developed how best to use mean utility values for COPD in health economic evaluation.
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Affiliation(s)
- Foruhar Moayeri
- a Centre for Health Policy School of Population and Global Health , The University of Melbourne , Melbourne , Australia
| | - Ya-Seng Arthur Hsueh
- a Centre for Health Policy School of Population and Global Health , The University of Melbourne , Melbourne , Australia
| | - Philip Clarke
- a Centre for Health Policy School of Population and Global Health , The University of Melbourne , Melbourne , Australia
| | - Xinyang Hua
- a Centre for Health Policy School of Population and Global Health , The University of Melbourne , Melbourne , Australia
| | - David Dunt
- a Centre for Health Policy School of Population and Global Health , The University of Melbourne , Melbourne , Australia
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Greenberg D, Schwartz D, Vardi H, Friger M, Sarid O, Slonim-Nevo V, Odes S. Health-Related Utility Weights in a Cohort of Real-World Crohn's Disease Patients. J Crohns Colitis 2015; 9:1138-45. [PMID: 26374662 DOI: 10.1093/ecco-jcc/jjv167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 08/31/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Estimating health-related utility weights in Crohn's Disease [CD] patients is crucial for assessing the cost-effectiveness of new pharmaceutical interventions. Values used in most analyses are based on secondary data and vary substantially among studies. We estimated utility weights in a consecutive sample of real-world CD patients. METHODS Patients enrolled in an ongoing socioeconomic study of CD in the Israeli adult patient population completed a self-administered Short Form 36 health survey [SF-36] and Short Inflammatory Bowel Disease [SIBDQ] questionnaires and were assessed for their current clinical status, including the Harvey-Bradshaw Index [HBI] of disease severity. For each patient enrolled we calculated a utility weight using the SF-6D scoring system. RESULTS The cohort comprised 425 patients [40% male] with mean age of 39.1 [± 14.0] years. The average HBI was 6.1 [± 5.4]; 198 [47%] patients were in remission state [HBI < 5], 99 [23%] had mild disease [HBI 5-7], 102 [25%] moderate [HBI 8-16], and 26 [6%] severe disease [HBI > 16]. Mean utility weights were: 0.667 in all patients, 0.744 in patients with disease remission, 0.638 in mild disease, 0.587 in moderate disease, and 0.505 in severe disease. The significant predictors of utility weights in a multivariable regression analysis were the HBI [β = -0.494; p < 0.001], economic status [β = 0.198; p < 0.001], time since diagnosis [β = 0.106; p < 0.001], male [compared with female] gender [β = 0.099; p = 0.009], hospital admission in the past year for any cause [β = -0.086; p = 0.027], and treatment with steroids [β = -0.100; p = 0.012] where β denotes the standardised regression coefficients; model adjusted R(2) = 0.428. CONCLUSIONS Utility weights for patients in the remission and mild disease states were generally lower as compared with values used in published cost-effectiveness analyses. These values should be considered when assessing the value for money of future interventions for CD.
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Affiliation(s)
- Dan Greenberg
- Department of Health Systems Management, Faculty of Health Sciences & Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Doron Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center, Beer-Sheva, Israel
| | - Hillel Vardi
- Department of Public Health. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michael Friger
- Department of Public Health. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Orly Sarid
- The Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Vered Slonim-Nevo
- The Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shmuel Odes
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Lacasse Y, Bernard S, Martin S, Boivin M, Maltais F. Utility Scores In Patients With Oxygen-Dependent COPD: A Case-Control Study. COPD 2015; 12:510-5. [PMID: 25774981 DOI: 10.3109/15412555.2014.995290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Utility measures that summarize the health-related quality of life of an individual using a single number usually between 0 (death) and 1 (full health) are useful to quantify the benefits of health care interventions in terms of quality-adjusted life years (QALYs) and to help prioritizing limited health resources from cost-effectiveness analyses among patients with different health conditions. OBJECTIVE To determine utility scores in patients with oxygen-dependent chronic obstructive pulmonary disease (COPD). METHODS Patients with oxygen-dependent COPD (the cases) were matched, on a 1:2 basis, to COPD controls according to gender, age (± 5 years) and FEV1 (±5% predicted). Utility scores were obtained from the SF-6D, a measure derived from the SF-36. RESULTS From a cohort of 102 patients with oxygen-dependent COPD, 68 (42 men; mean age: 71 years; mean FEV1: 35% predicted) were successfully matched with 136 controls. We found clinically and statistically significant differences in mean utility scores between cases (0.588 ± 0.071) and controls (0.627 ± 0.085; p = 0.001). The same differences were observed in men and women. CONCLUSION Oxygen-dependence adds to the burden of disease in terms of quality of life. These utility scores may be useful in cost-utility analyses involving patients with oxygen-dependent COPD.
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Affiliation(s)
- Yves Lacasse
- a Centre de Recherche, Hôpital Laval , Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval , Québec , Canada
| | - Sarah Bernard
- a Centre de Recherche, Hôpital Laval , Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval , Québec , Canada
| | - Sylvie Martin
- a Centre de Recherche, Hôpital Laval , Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval , Québec , Canada
| | - Martine Boivin
- a Centre de Recherche, Hôpital Laval , Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval , Québec , Canada
| | - François Maltais
- a Centre de Recherche, Hôpital Laval , Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval , Québec , Canada
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Einarson TR, Bereza BG, Nielsen TA, Hemels MEH. Utilities for asthma and COPD according to category of severity: a comprehensive literature review. J Med Econ 2015; 18:550-63. [PMID: 25735652 DOI: 10.3111/13696998.2015.1025793] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) are incurable diseases that impact quality-of-life. OBJECTIVE To summarize original research articles that measured or utilized preference-based utilities or disutilities according to disease severity. METHODS Medline and Embase were searched from inception until the end of November 2014. Two reviewers independently searched the literature with differences settled through discussion. Data extracted included utility scores as determined in original research categorized according to disease severity as well as disutilities associated with exacerbations or comorbidities. Data were tabulated and analyzed descriptively. RESULTS In total, 862 articles were identified, 790 were rejected, and 69 analyzed. There were 44 dealing with COPD and 25 with asthma. Average utilities determined by research were 0.828 ± 0.062, 0.765 ± 0.090, 0.711 ± 0.120, and 0.607 ± 0.120 for mild, moderate, severe, and very severe COPD, respectively. Utilities used in economic analyses were 0.866 ± 0.038, 0.770 ± 0.024, 0.739 ± 0.045, and 0.596 ± 0.075, respectively. Disutilities (annual) ranged from 0.002-0.378; major and minor exacerbations had respective disutilities of 0.287 and 0.108. For asthma patients, utilities were for 0.86 ± 0.32, 0.83 ± 0.065, and 0.74 ± 0.029, for mild, moderate, and severe disease, respectively. CONCLUSIONS Utilities have been summarized according to severity category of asthma and COPD. These values should be useful for researchers undertaking economic analyses of these diseases.
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Affiliation(s)
- Thomas R Einarson
- Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto, ON , Canada
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Chen J, Wong CKH, McGhee SM, Pang PKP, Yu WC. A comparison between the EQ-5D and the SF-6D in patients with chronic obstructive pulmonary disease (COPD). PLoS One 2014; 9:e112389. [PMID: 25379673 PMCID: PMC4224433 DOI: 10.1371/journal.pone.0112389] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 10/15/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The appropriate use of generic preference-based measures determines the accuracy of disease assessment and further decision on healthcare policy using quality adjusted life years. The discriminative capacity of different instruments would differ across disease groups. Our study was to examine the difference in utility scores for COPD patients measured by EQ-5D and SF-6D and to assist the choice of a proper instrument in this disease group. METHODS Differences of mean utility scores of EQ-5D and SF-6D in groups defined by socio-demographic characteristics, comorbidities, health service utilisation and severity of illness were tested using Mann-Whitney test, t-test, Kruskal-Wallis test, Pearson's correlation coefficient and ANOVA, as appropriate. The discriminative properties of the two instruments were compared against indicators of quality of life using receiver operating characteristic curves. The statistical significance of the area under the curves (AUC) was tested by ANOVA and F-statistics used to compare the efficiency with which each instrument discriminated between disease severity groups. RESULTS Mean utility scores of EQ-5D and SF-6D were 0.644 and 0.629 respectively in the 154 subjects included in the analysis. EQ-5D scores were significantly higher than SF-6D in groups less severe and these differences corresponded to a minimally important difference of greater than 0.03 (p<0.001). EQ-5D and SF-6D scores were strongly correlated across the whole sample (r = 0.677, p<0.001) and in pre-defined groups (r>0.5 and p<0.05 for all correlation coefficients). AUCs were above 0.5 against the indicators of health-related quality of life for both instruments. F-ratios suggested SF-6D was more efficient in discriminating cases of different disease severity than EQ-5D. CONCLUSIONS Both EQ-5D and SF-6D appeared to be valid preference-based measures in Chinese COPD patients. SF-6D was more efficient in detecting differences among subgroups with differing health status. EQ-5D and SF-6D measured different things and might not be used interchangeably in COPD patients.
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Affiliation(s)
- Jing Chen
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Carlos K. H. Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Sarah M. McGhee
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Polly K. P. Pang
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Wai-Cho Yu
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
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Kanters TA, Redekop WK, Kruijshaar ME, van der Ploeg AT, Rutten-van Mölken MPMH, Hakkaart L. Comparison of EQ-5D and SF-6D utilities in Pompe disease. Qual Life Res 2014; 24:837-44. [DOI: 10.1007/s11136-014-0833-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2014] [Indexed: 11/28/2022]
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Miravitlles M, Huerta A, Fernández-Villar JA, Alcázar B, Villa G, Forné C, Cuesta M, Crespo C, García-Río F. Generic utilities in chronic obstructive pulmonary disease patients stratified according to different staging systems. Health Qual Life Outcomes 2014; 12:120. [PMID: 25189786 PMCID: PMC4173058 DOI: 10.1186/s12955-014-0120-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/22/2014] [Indexed: 11/10/2022] Open
Abstract
Background To determine generic utilities for Spanish chronic obstructive pulmonary disease (COPD) patients stratified by different classifications: GOLD 2007, GOLD 2013, GesEPOC 2012 and BODEx index. Methods Multicentre, observational, cross-sectional study. Patients were aged ≥40 years, with spirometrically confirmed COPD. Utility values were derived from EQ-5D-3 L. Means, standard deviations (SD), medians and interquartile ranges (IQR) were computed based on the different classifications. Differences in median utilities between groups were assessed by non-parametric tests. Results 346 patients were included, of which 85.5% were male with a mean age of 67.9 (SD = 9.7) years and a mean duration of COPD of 7.6 (SD = 5.8) years; 80.3% were ex-smokers and the mean smoking history was 54.2 (SD = 33.2) pack-years. Median utilities (IQR) by GOLD 2007 were 0.87 (0.22) for moderate; 0.80 (0.26) for severe and 0.67 (0.42) for very-severe patients (p < 0.001 for all comparisons). Median utilities by GOLD 2013 were group A: 1.0 (0.09); group B: 0.87 (0.13); group C: 1.0 (0.16); group D: 0.74 (0.29); comparisons were statistically significant (p < 0.001) except A vs C. Median utilities by GesEPOC phenotypes were 0.84 (0.33) for non exacerbator; 0.80 (0.26) for COPD-asthma overlap; 0.71 (0.62) for exacerbator with emphysema; 0.72 (0.57) for exacerbator with chronic bronchitis (p < 0.001). Comparisons between patients with or without exacerbations and between patients with COPD-asthma overlap and exacerbator with chronic bronchitis were statistically-significant (p < 0.001). Median utilities by BODEx index were: group 0–2: 0.89 (0.20); group 3–4: 0.80 (0.27); group 5–6: 0.67 (0.29); group 7–9: 0.41 (0.31). All comparisons were significant (p < 0.001) except between groups 3–4 and 5–6. Conclusion Irrespective of the classification used utilities were associated to disease severity. Some clinical phenotypes were associated with worse utilities, probably related to a higher frequency of exacerbations. GOLD 2007 guidelines and BODEx index better discriminated patients with a worse health status than GOLD 2013 guidelines, while GOLD 2013 guidelines were better able to identify a smaller group of patients with the best health.
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Factors associated with quality of life measured by EQ-5D in patients with nontuberculous mycobacterial pulmonary disease. Qual Life Res 2014; 23:2735-41. [PMID: 24908057 DOI: 10.1007/s11136-014-0727-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The impact of pulmonary nontuberculous mycobacterial (pNTM) disease on health-related quality of life (HRQoL) has not received significant attention in the literature. In this study, we compared the HRQoL in patients with pNTM disease and healthy subjects and identified influencing factors using EuroQol 5D (EQ-5D) data. METHODS The present study used an age- and sex-matched case-control analysis from a cohort of 85 pNTM patients and 340 participants from a national survey. Baseline EQ-5D utility scores and EQ-5D visual analog scale (VAS) scores were measured in both groups. In patients with pNTM disease, the factors affecting EQ-5D were identified using multiple linear regression analysis. RESULTS While the median EQ-5D VAS scores were lower in pNTM patients than in the control subjects (pNTM, 70; control, 80; P < 0.001), the median EQ-5D utility scores were similar in two groups (both, 1.000, P = 0.878). Interestingly, the percentage of subjects reporting problems on the anxiety/depression dimension was higher for patients with pNTM disease (18.8 %) compared with the control subjects (11.5 %, P = 0.07). In multivariate analysis, increasing severity of forced expired volume in one second (FEV1) decline was associated with a significant decrease in EQ-5D scores of pNTM patients. CONCLUSIONS This study suggested the EQ-5D may not be useful instrument in pNTM patients due to ceiling effect of EQ-5D and mild disease activity. Patients with pNTM disease tended to report more reduced health status and more problems with anxiety/depression than the healthy controls. Lung function, measured by FEV1, was independently associated with EQ-5D scores in patients with pNTM disease.
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Validation of the SF-6D Health State Utilities Measure in Lower Extremity Sarcoma. Sarcoma 2014; 2014:450902. [PMID: 24771999 PMCID: PMC3977426 DOI: 10.1155/2014/450902] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 02/16/2014] [Indexed: 11/17/2022] Open
Abstract
Aim. Health state utilities measures are preference-weighted patient-reported outcome (PRO) instruments that facilitate comparative effectiveness research. One such measure, the SF-6D, is generated from the Short Form 36 (SF-36). This report describes a psychometric evaluation of the SF-6D in a cross-sectional population of lower extremity sarcoma patients. Methods. Patients with lower extremity sarcoma from a prospective database who had completed the SF-36 and Toronto Extremity Salvage Score (TESS) were eligible for inclusion. Computed SF-6D health states were given preference weights based on a prior valuation. The primary outcome was correlation between the SF-6D and TESS. Results. In 63 pairs of surveys in a lower extremity sarcoma population, the mean preference-weighted SF-6D score was 0.59 (95% CI 0.4–0.81). The distribution of SF-6D scores approximated a normal curve (skewness = 0.11). There was a positive correlation between the SF-6D and TESS (r = 0.75, P < 0.01). Respondents who reported walking aid use had lower SF-6D scores (0.53 versus 0.61, P = 0.03). Five respondents underwent amputation, with lower SF-6D scores that approached significance (0.48 versus 0.6, P = 0.06). Conclusions. The SF-6D health state utilities measure demonstrated convergent validity without evidence of ceiling or floor effects. The SF-6D is a health state utilities measure suitable for further research in sarcoma patients.
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Rudmik L, Mace J, Soler ZM, Smith TL. Long-term utility outcomes in patients undergoing endoscopic sinus surgery. Laryngoscope 2014; 124:19-23. [PMID: 23670699 PMCID: PMC3877194 DOI: 10.1002/lary.24135] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 02/15/2013] [Accepted: 03/11/2013] [Indexed: 12/15/2022]
Abstract
OBJECTIVES/HYPOTHESIS To define long-term health-state utility outcomes in patients undergoing endoscopic sinus surgery (ESS) for refractory chronic rhinosinusitis (CRS). STUDY DESIGN Prospective, longitudinal, cohort study. METHODS The short-form (SF)-12 survey was issued to the 168 patients who were enrolled in an initial study evaluating short-term utility outcomes following ESS. SF-12 responses were converted into SF-6D utility scores using the University of Sheffield algorithm. The primary outcome was mean overall long-term utility level following ESS. Secondary outcomes evaluated annual utility level following ESS and utility outcomes for different subgroups of patients with CRS. RESULTS A total of 83 patients provided long-term health-state utility outcomes. The mean overall long-term utility level was 0.80 at a mean follow-up of 5.2 years after ESS. Compared to the baseline (0.67) and short-term follow-up (0.75) utility levels in this group, there was a significant improvement at the long-term period (P = .002). A total of 54% (45/83) of patients achieved long-term postoperative utility scores higher than the United States norm of 0.81. There was a significant improvement in utility scores for all subsequent years after ESS compared to preoperative responses (all P < .028). All subgroups of CRS received significant long-term utility improvements (all P < .001), and those undergoing revision ESS demonstrated continued improvement past the short-term postoperative period. CONCLUSIONS This study has demonstrated that patients with refractory CRS achieve stable mean long-term utility levels following ESS and often return to a health state comparable to US population norms.
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Affiliation(s)
- Luke Rudmik
- Rhinology and Sinus Surgery, Division of Otolaryngology, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Jess Mace
- Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery; Oregon Health and Science University, Portland, Oregon, USA
| | - Zachary M. Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology – Head and Neck Surgery; Medical University of South Carolina; Charleston, South Carolina, USA
| | - Timothy L. Smith
- Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery; Oregon Health and Science University, Portland, Oregon, USA
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Solem CT, Sun SX, Sudharshan L, Macahilig C, Katyal M, Gao X. Exacerbation-related impairment of quality of life and work productivity in severe and very severe chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2013; 8:641-52. [PMID: 24376348 PMCID: PMC3864879 DOI: 10.2147/copd.s51245] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Purpose Exacerbation-associated health-related quality of life (HRQoL) in patients with severe and very severe chronic obstructive pulmonary disease (COPD) is ill-defined. This study describes patterns, HRQoL, and the work productivity impact of COPD-related moderate and SEV exacerbations in patients with SEV/VSEV COPD, focusing on the chronic bronchitis subtype. Patients and methods A US sample of SEV and VSEV COPD patients with recent moderate or SEV exacerbation was recruited. Along with the demographic and clinical data collected from medical records, patients reported on exacerbation frequency, health-related quality of life (HRQoL) (using the St George’s Respiratory Questionnaire for COPD [SGRQ-C] and the European Quality of Life-5 Dimensions [EQ-5D]™ index), and work productivity and activity impairment (using the Work Productivity and Activity Impairment Questionnaire – Specific Health Problem [WPAI-SHP]). The HRQoL-related impacts of exacerbation frequency, time since exacerbation, and last exacerbation severity were evaluated via linear regressions. Results A total of 314 patients (190 SEV/124 VSEV, mean age =68.0 years, 51% male, 28% current smokers) were included. In the previous 12 months, patients reported an average of 1.8 moderate exacerbations and 0.9 SEV exacerbations. Overall, 16% of patients were employed and reported a high percentage of overall work impairment (42.4% ± 31.1%). Activity impairment was positively associated with recent exacerbation severity (SEV 64.6% ± 26.8% versus moderate 55.6% ± 28.2%) (P=0.006). The HRQoL was significantly worse for SEV versus VSEV COPD (EQ-5D: 0.62 ± 0.23 versus 0.70 ± 0.17, respectively, and SGRQ-C: 70.1 ± 21.3 versus 61.1 ± 19.0, respectively) (P<0.001). Worse current HRQoL was reported by patients with a SEV versus moderate recent exacerbation (EQ-5D: 0.63 ± 0.21 versus 0.70 ± 0.20, respectively) (P=0.003); SGRQ-C: 70.3 ± 19.9 versus 61.7 ± 20.1, respectively (P<0.001). One additional exacerbation in the previous 12 months was associated with a 2.4-point SGRQ-C increase and a 0.02-point EQ-5D index decrease. Conclusion The severity and frequency of COPD-related moderate/SEV exacerbations in SEV and VSEV COPD patients were positively associated with poor HRQoL and work productivity and activity impairment.
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Affiliation(s)
| | - Shawn X Sun
- Forest Research Institute, Jersey City, NJ, USA
| | | | | | | | - Xin Gao
- Pharmerit International, Bethesda, MD, USA
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Doz M, Chouaid C, Com-Ruelle L, Calvo E, Brosa M, Robert J, Decuypère L, Pribil C, Huerta A, Detournay B. The association between asthma control, health care costs, and quality of life in France and Spain. BMC Pulm Med 2013; 13:15. [PMID: 23517484 PMCID: PMC3610114 DOI: 10.1186/1471-2466-13-15] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 02/19/2013] [Indexed: 11/23/2022] Open
Abstract
Background Current asthma management guidelines are based on the level of asthma control. The impact of asthma control on health care resources and quality of life (QoL) is insufficiently studied. EUCOAST study was designed to describe costs and QoL in adult patients according to level of asthma control in France and Spain. Methods An observational cost of illness study was conducted simultaneously in both countries among patients age greater or equal to 18 with a diagnosis of asthma for at least 12 months. Patients were recruited prospectively by GPs in 2010 in four waves to avoid a seasonal bias. Health care resources utilization of the three months before the inclusion was collected through physician questionnaires. Asthma control was evaluated using 2009 GINA criteria over a 3-month period. QoL was assessed using EQ-5D-3L®. Results 2,671 patients (France: 1,154; Spain: 1,517) were enrolled. Asthma was controlled in 40.6% [95% CI: 37.7% - 43.4%] and 29.9% [95% CI: 27.6% - 32.3%] of French and Spanish patients respectively. For all types of costs, the percentage of patients using health care resources varied significantly according to the level of asthma control. The average cost (euros/3-months/patient) of controlled asthma was €85.4 (SD: 153.5) in France compared with €314.0 (SD: 2,160.4) for partially controlled asthma and €537.9 (SD: 2,355.7) for uncontrolled asthma (p<0.0001). In Spain, the corresponding figures were €152.6 (SD: 162.1), €241.2 (SD: 266.8), and €556.8 (SD: 762.4). EQ-5D-3L® score was higher (p<0.0001) in patients with controlled asthma compared to partially controlled and uncontrolled asthma in both countries (respectively 0.88; 0.78; 0.63 in France and 0.89; 0.82; 0.69 in Spain). Conclusions In both countries, patients presenting with uncontrolled asthma had a significantly higher asthma costs and lower scores of Qol compared to the others.
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Affiliation(s)
- Marianne Doz
- Cemka-Eval, 43 Boulevard du Maréchal Joffre, Bourg-la-Reine, F-92340, France
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Bozzani FM, Alavi Y, Jofre-Bonet M, Kuper H. A comparison of the sensitivity of EQ-5D, SF-6D and TTO utility values to changes in vision and perceived visual function in patients with primary open-angle glaucoma. BMC Ophthalmol 2012; 12:43. [PMID: 22909264 PMCID: PMC3552875 DOI: 10.1186/1471-2415-12-43] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 07/25/2012] [Indexed: 11/21/2022] Open
Abstract
Background Economic viability of treatments for primary open-angle glaucoma (POAG) should be assessed objectively to prioritise health care interventions. This study aims to identify the methods for eliciting utility values (UVs) most sensitive to differences in visual field and visual functioning in patients with POAG. As a secondary objective, the dimensions of generic health-related and vision-related quality of life most affected by progressive vision loss will be identified. Methods A total of 132 POAG patients were recruited. Three sets of utility values (EuroQoL EQ-5D, Short Form SF-6D, Time Trade Off) and a measure of perceived visual functioning from the National Eye Institute Visual Function Questionnaire (VFQ-25) were elicited during face-to-face interviews. The sensitivity of UVs to differences in the binocular visual field, visual acuity and visual functioning measures was analysed using non-parametric statistical methods. Results Median utilities were similar across Integrated Visual Field score quartiles for EQ-5D (P = 0.08) whereas SF-6D and Time-Trade-Off UVs significantly decreased (p = 0.01 and p = 0.001, respectively). The VFQ-25 score varied across Integrated Visual Field and binocular visual acuity groups and was associated with all three UVs (P ≤ 0.001); most of its vision-specific sub-scales were associated with the vision markers. The most affected dimension was driving. A relationship with vision markers was found for the physical component of SF-36 and not for any dimension of EQ-5D. Conclusions The Time-Trade-Off was more sensitive than EQ-5D and SF-6D to changes in vision and visual functioning associated with glaucoma progression but could not measure quality of life changes in the mildest disease stages.
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Petrillo J, van Nooten F, Jones P, Rutten-van Mölken M. Utility estimation in chronic obstructive pulmonary disease: a preference for change? PHARMACOECONOMICS 2011; 29:917-32. [PMID: 21988291 DOI: 10.2165/11589280-000000000-00000] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Economic evaluations of chronic obstructive pulmonary disease (COPD) incorporate utilities through multi-attribute utility (MAU) measures, most commonly the EQ-5D, to report health-related quality-of-life (HR-QOL) changes or differences. Questions have been raised about the sensitivity of these measures in COPD. Limitations in detecting adequate patient-level changes in HR-QOL over time in stable and exacerbation states compared with disease-specific instruments could also result in underestimation of known treatment benefits. The purpose of this article was to present and discuss the empirical evidence on the validity of generic MAU measures within the COPD population. We built upon a previously conducted validation review for the period 1997-2007 that used 'respiratory disease' and 'EQ-5D' as keywords. For this discussion, PubMed and EMBASE databases were searched for articles in English from 1988 to August 2009, using similar search words. Based on the performance of MAU measures in COPD and exacerbations, they appear to have limited discriminatory ability, particularly between moderate and severe COPD, despite known differences in HR-QOL. Sensitivity to clinically relevant change in stable COPD over time due to treatment also appears limited. Current research suggests adequate sensitivity regarding detecting the onset and resolution of an exacerbation; however, sensitivity is limited in the short term, such as daily changes in health status. The evidence suggests responsiveness of MAU measures may be restricted to large within-patient change, which leads to difficulties in evaluating the subtle but important impact of exacerbations. Studies presenting alternative methods of deriving COPD-related utilities are also discussed. Overall, the insensitivities of generic MAU measures in COPD can lead to biased cost-effectiveness analyses and ill-informed economic decisions. Alternative measures such as condition-specific preference-based measures may be used in circumstances where more sensitivity is needed. The trade-off allows relevant and sensitive matters most important to patients to be evaluated; however inevitable gaps such as those related to adverse events are not considered.
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Affiliation(s)
- Jennifer Petrillo
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
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Soler ZM, Wittenberg E, Schlosser RJ, Mace JC, Smith TL. Health state utility values in patients undergoing endoscopic sinus surgery. Laryngoscope 2011; 121:2672-8. [PMID: 22034223 DOI: 10.1002/lary.21847] [Citation(s) in RCA: 161] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 03/29/2011] [Indexed: 01/15/2023]
Abstract
OBJECTIVES/HYPOTHESIS The primary study goal was to measure health state utility values in patients with chronic rhinosinusitis (CRS) before and after undergoing endoscopic sinus surgery (ESS). A secondary goal was to assess the meaning of these values by comparing them with other chronic disease processes and currently available medical or surgical treatments. STUDY DESIGN Prospective, observational cohort study. METHODS Adults with CRS were enrolled after electing ESS and were observed for a 5-year period. Baseline demographic and medical comorbidities were recorded for each patient, as well as findings from computed tomography (CT), endoscopy, olfaction, and disease-specific quality of life scores. Utility values were derived using the Short-Form 6D (SF-6D) at baseline and again after surgery. RESULTS The mean SF-6D utility value for the baseline health state of all patients with CRS (n = 232) was 0.65 (95% confidence interval [CI]: 0.63-0.66). Baseline utility values correlated with disease-specific quality of life as measured by the Rhinosinusitis Disability Index (r = -0.660; P < .001), but not baseline CT, endoscopy, or olfactory scores. Follow-up utility values (≥ 6 months) after ESS improved by 0.087 (95% CI: 0.06-0.12; P < .001) in patients with no history of sinus surgery and 0.062 (95% CI: 0.04-0.09; P < .001) in those undergoing a revision procedure. CONCLUSIONS Patients with CRS who failed medical therapy and elected to undergo ESS reported health state utility values that were significantly lower than the US population norm. Utility values showed improvement after ESS, which was statistically and clinically significant. These results provide the initial data necessary for formal cost-effectiveness analyses incorporating ESS.
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Affiliation(s)
- Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Louie AV, Rodrigues G, Hannouf M, Lagerwaard F, Palma D, Zaric GS, Haasbeek C, Senan S. Withholding stereotactic radiotherapy in elderly patients with stage I non-small cell lung cancer and co-existing COPD is not justified: outcomes of a Markov model analysis. Radiother Oncol 2011; 99:161-5. [PMID: 21620503 DOI: 10.1016/j.radonc.2011.04.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 03/31/2011] [Accepted: 04/08/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE To model outcomes of SBRT versus best supportive care (BSC) in elderly COPD patients with stage I NSCLC. MATERIAL AND METHODS A Markov model was constructed to simulate the quality-adjusted and overall survival (OS) in patients ⩾75years undergoing either SBRT or BSC for a five-year timeframe. SBRT rates of local, regional and distant recurrences were obtained from 247 patients treated at the VUMC, Amsterdam. Recurrence rates were converted into transition probabilities and stratified into four groups according to T stage (1, 2) and COPD GOLD score (I-II, III-IV). Data for untreated patients were obtained from the California Cancer Registry. Tumor stage and GOLD score utilities were adapted from the literature. RESULTS Our model correlated closely with the source OS data for SBRT treated and untreated patients. After SBRT, our model predicted for 6.8-47.2% five-year OS and 14.9-27.4 quality adjusted life months (QALMs). The model predicted for 9.0% and 2.8% five-year OS, and 10.1 and 6.1 QALMs for untreated T1 and T2 patients, respectively. The benefit of SBRT was the least for T2, GOLD III-IV patients. CONCLUSION Our model indicates that SBRT should be considered in elderly stage I NSCLC patients with COPD.
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Affiliation(s)
- Alexander V Louie
- Department of Radiation Oncology, London Regional Cancer Program, London, Canada
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Korthuis PT, Tozzi MJ, Nandi V, Fiellin DA, Weiss L, Egan JE, Botsko M, Acosta A, Gourevitch MN, Hersh D, Hsu J, Boverman J, Altice FL. Improved quality of life for opioid-dependent patients receiving buprenorphine treatment in HIV clinics. J Acquir Immune Defic Syndr 2011; 56 Suppl 1:S39-45. [PMID: 21317593 PMCID: PMC3073082 DOI: 10.1097/qai.0b013e318209754c] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Opioid dependence and HIV infection are associated with poor health-related quality of life (HRQOL). Buprenorphine/naloxone (bup/nx) provided in HIV care settings may improve HRQOL. METHODS We surveyed 289 HIV-infected opioid-dependent persons treated with clinic-based bup/nx about HRQOL using the Short Form Health Survey (SF-12) administered at baseline, 3, 6, 9, and 12 months. We used normalized SF-12 scores, which correspond to a mean HRQOL of 50 for the general US population (SD 10, possible range 0-100). We compared mean normalized mental and physical composite and component scores in quarters 1, 2, 3, and 4 with baseline scores using generalized estimating equation models. We assessed the effect of clinic-based bup/nx prescription on HRQOL composite scores using mixed effects regression with site as random effect and time as repeated effect. RESULTS Baseline normalized SF-12 scores were lower than the general US population for all HRQOL domains. Average composite mental HRQOL improved from 38.3 (SE 12.5) to 43.4 (SE 13.2) [β 1.13 (95% CI: 0.72 to 1.54)] and composite physical HRQOL remained unchanged [β 0.21 (95% CI: -0.16 to 0.57)] over 12 months follow-up. Continued bup/nx treatment across all 4 quarters was associated with improvements in both physical [β 2.38 (95% CI: 0.63 to 4.12)] and mental [β 2.51 (95% CI: 0.42 to 4.60)] HRQOL after adjusting for other contributors to HRQOL. CONCLUSIONS Clinic-based bup/nx maintenance therapy is potentially effective in ameliorating some of the adverse effects of opioid dependence on HRQOL for HIV-infected populations.
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Affiliation(s)
- P Todd Korthuis
- Department of Medicine, Oregon Health and Science University, Portland, OR 97239-3098, USA.
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Mazur W, Kupiainen H, Pitkäniemi J, Kilpeläinen M, Sintonen H, Lindqvist A, Kinnula VL, Laitinen T. Comparison between the disease-specific Airways Questionnaire 20 and the generic 15D instruments in COPD. Health Qual Life Outcomes 2011; 9:4. [PMID: 21235818 PMCID: PMC3031191 DOI: 10.1186/1477-7525-9-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 01/16/2011] [Indexed: 11/10/2022] Open
Abstract
Background Given that the assessment of health-related quality of life (HRQoL) is an essential outcome measure to optimize chronic obstructive pulmonary disease (COPD) patient management, there is a need for a short and fast, reliable and valid instrument for routine use in clinical practice. The objective of this study was to analyse the relationship between the disease-specific Airways questionnaire (AQ20) and the generic 15D health-related quality of life (HRQoL) instrument simultaneously in a large cohort of patients with COPD. We also compare the HRQoL of COPD patients with that of the general population. Methods The AQ20 and 15D were administered to 739 COPD patients representing an unselected hospital-based COPD population. The completion rates and validity of, and correlations among the questions and dimension scores were examined. A factor analysis with varimax rotation was performed in order to find subsets of highly correlating items of the questionnaires. Results The summary scores of AQ20 and 15D were highly correlated (r = - 0.71, p < 0.01). In AQ20 over 50% of patients reported frequent cough, breathlessness during domestic work, and chest problem limiting their full enjoyment of life. 15D results showed a noteworthy decrease of HRQoL in breathing, mobility, sleeping, usual activities, discomfort and symptoms, vitality, and sexual activity (scores ≤ 0.75). Compared to the age- and gender-standardized Finnish general population, the COPD patients were statistically significantly worse off on 13 of 15 dimensions. Conclusions The AQ20 and 15D summary scores are comparable in terms of measuring HRQoL in COPD patients. The data support the validity of 15D to measure the quality of life in COPD. COPD compromises the HRQoL broadly, as reflected by the generic instrument. Both questionnaires are simple and short, and could easily be used in clinical practice with high completion rates.
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Affiliation(s)
- Witold Mazur
- Department of Medicine, Pulmonary Division, Helsinki University Central Hospital, Haartmaninkatu 4, Helsinki, Finland.
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Menn P, Weber N, Holle R. Health-related quality of life in patients with severe COPD hospitalized for exacerbations - comparing EQ-5D, SF-12 and SGRQ. Health Qual Life Outcomes 2010; 8:39. [PMID: 20398326 PMCID: PMC2864208 DOI: 10.1186/1477-7525-8-39] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 04/15/2010] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The aim of this study was to measure HrQoL during acute exacerbations of COPD using generic and disease-specific instruments, and to assess completeness, proportion with best or worst health state, sensitivity to change and discriminative ability for each instrument. METHODS EQ-5D, SF-12 and SGRQ were obtained from COPD patients with GOLD stage III and IV hospitalized for an acute exacerbation both at admission and discharge. To assess the instruments' properties, utility values were calculated for EQ-5D and SF-12, and a total score was derived from the SGRQ. RESULTS Mean utilities ranged from 0.54 (SF-12, stage IV) to 0.62 (EQ-5D, stage III) at admission, and from 0.58 (SF-12, stage IV) to 0.84 (EQ-5D, stage III) at discharge. Completeness was best for EQ-5D and SGRQ, while no utility value for the SF-12 could be calculated for more than 30%. For SGRQ subscales, the minimal score occurred in up to 11% at admission, while full health was observed for the EQ-5D at discharge in 13%. Sensitivity to change was generally good, whereas discrimination between COPD stages was low for the EQ-5D. CONCLUSIONS Acute exacerbations seriously impair health status and quality of life. The EQ-5D is generally suitable to measure HrQoL in exacerbations of severe COPD, although the high proportion of patients reporting full health at discharge poses a problem. The main issue with the SF-12 is the high proportion of missing values in a self-assessed setting. Properties of the SGRQ were satisfactory. However, since no utility values can be derived from this disease-specific instrument, it is not suitable for cost-utility analyses in health-economic evaluations.
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Affiliation(s)
- Petra Menn
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | | | - Rolf Holle
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany
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Wilson ECF, Sims EJ, Musgrave SD, Shepstone L, Blyth A, Murdoch J, Mugford HM, Juniper EF, Ayres JG, Wolfe S, Freeman D, Gilbert RFT, Harvey I, Hillyer EV, Price D. Cost effectiveness of leukotriene receptor antagonists versus inhaled corticosteroids for initial asthma controller therapy: a pragmatic trial. PHARMACOECONOMICS 2010; 28:585-595. [PMID: 20550224 DOI: 10.2165/11537550-000000000-00000] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Information is lacking on the relative effectiveness and cost effectiveness--in a primary-care setting--of leukotriene receptor antagonists (LTRAs) as an alternative to inhaled corticosteroids (ICS) for initial asthma controller therapy. OBJECTIVE To compare the cost effectiveness of LTRAs versus ICS for patients initiating asthma controller therapy. METHODS An economic evaluation was conducted alongside a 2-year, pragmatic, randomized controlled trial set in 53 primary-care practices in the UK. Patients aged 12-80 years with asthma and symptoms requiring regular anti-inflammatory therapy (n = 326) were randomly assigned to LTRAs (n = 162) or ICS (n = 164). The main outcome measures were the incremental costs per point improvement in the Mini Asthma Quality of Life Questionnaire, per point improvement in the Asthma Control Questionnaire and per QALY gained from the UK NHS and societal perspectives. RESULTS Over 2 years, resource use was similar between the two treatment groups, but the cost to society per patient was significantly higher for the LTRA group, at pounds sterling 711 versus pounds sterling 433 for the ICS group (adjusted difference pounds sterling 204; 95% CI 74, 308) [year 2005 values]. Cost differences were driven primarily by differences in prescription drug costs, particularly study drug costs. There was a nonsignificant (imputed, adjusted) difference between treatment groups, favouring ICS, in QALYs gained at 2 years of -0.073 (95% CI -0.143, 0.010). Therapy with LTRAs was, on average, a dominated strategy, and, at a threshold for willingness to pay of pounds sterling 30,000 per QALY gained, the probability of LTRAs being cost effective compared with ICS was approximately 3% from both societal and NHS perspectives. CONCLUSIONS There is a very low probability of LTRAs being cost effective in the UK, at 2005 values, compared with ICS for initial asthma controller therapy. TRIAL REGISTRATION UK National Research Register N0547145240; Controlled Clinical Trials ISRCTN99132811.
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