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Kuharic M, Mulhern B, Sharp LK, Turpin RS, Pickard AS. Comparison of the EQ-HWB and EQ-HWB-S With Other Preference-Based Measures Among United States Informal Caregivers. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:967-977. [PMID: 38492925 DOI: 10.1016/j.jval.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/14/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES Several measures have been used or developed to capture the health and well-being of caregivers, including the EQ Health and Well-being (EQ-HWB) and its short form, EQ-HWB-S. This study aimed to evaluate the psychometric properties and construct validity of the EQ-HWB/EQ-HWB-S in a US caregiver population. METHODS A cross-sectional survey was conducted involving 504 caregivers. Eligible participants were 18+ years old, provided unpaid care to a relative/friend aged 18+ in the past 6 months, and spent on average of at least 1 hour per week caregiving. Survey included the following measures: EQ-HWB, Adult Social Care Outcomes Toolkit for Carers-Carer, CarerQol, and EQ-5D-5L. Psychometric properties were assessed using response distributions, floor/ceiling effects, Spearman's correlation for convergent validity, and effect sizes (ES) for known-group validity based on caregiving situations and intensity. RESULTS The average age of caregivers was 49.2 (SD = 15.4), with 57.5% being female. More than half (54.4%) reported high caregiving intensity, and 68.3% lived with the care recipient. The EQ-HWB-S index showed a strong positive correlation with the EQ-5D-5L (rs = 0.72), Adult Social Care Outcomes Toolkit for Carers (rs = 0.54), and CarerQol (rs = 0.54) indices. Notably, the EQ-HWB-S index showed the largest ES among measures in differentiating caregiving scenarios with a large ES for caregiver's general health (d = 1.00) and small ES for caregiving intensity (d = 0.39). CONCLUSIONS Results support construct validity of EQ-HWB and EQ-HWB-S as measures for assessing health and well-being of adult informal caregivers in comparison with other validated instruments. Differing levels of known-group validity across anchors emphasize the importance of selecting appropriate measures for caregivers, depending on research question and/or intervention aims.
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Affiliation(s)
- Maja Kuharic
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Lisa K Sharp
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | | | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
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Kuharić M, Pickard AS, Mukuria C, Finch AP. The Measurement Properties of the EQ-HWB and the EQ-HWB-S in Italian Population: A Comparative Study With EQ-5D-5L. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:955-966. [PMID: 38490471 DOI: 10.1016/j.jval.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/12/2024] [Accepted: 03/07/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVES The EQ Health and Well-being, EQ-HWB (25-item) and the EQ-HWB-S (9-item), are new generic measures of health and well-being. The purpose of this study was to examine the measurement properties of the EQ-HWB and EQ-HWB-S measures in relation to the EQ-5D-5L among the Italian general population. METHODS A cross-sectional survey was conducted from October 2020 to February 2021, followed by secondary analysis of collected data from Italian adults. This analysis included response pattern distributions, correlation strength, and known-group comparison. Known-group comparison was assessed using effect sizes (ES) across health conditions, caregiver status, and social care usage. The EQ-HWB-S index-based score was based on the UK pilot value set, whereas the Italian value set was used for scoring the EQ-5D-5L index. RESULTS Out of the 1182 participants, 461 reported having a chronic condition, 185 identified as caregivers, and 42 were social care users. EQ-HWB items (7.5%) showed fewer ceiling effects than EQ-5D-5L items (34.7%). Strong correlations (rs > 0.5) were found between overlapping EQ-HWB and EQ-5D-5L items. EQ-HWB-S and EQ-5D-5L index scores demonstrated similar discrimination based on symptomatic chronic conditions (ES d = 0.68 vs d = 0.71), but EQ-HWB-S had slightly higher ES for social care users (ES d = 0.84 vs d = 0.74). CONCLUSIONS Initial evidence supports the validity of EQ-HWB/EQ-HWB-S because outcome measures in the Italian population. EQ-HWB-S performed comparably to EQ-5D-5L among patients and was better in differentiating social care users. A slight decrease in discriminative properties for caregivers was observed when transitioning from EQ-HWB to EQ-HWB-S.
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Affiliation(s)
- Maja Kuharić
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, IL, USA.
| | - A Simon Pickard
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Maths in Health BV, Amsterdam, The Netherlands
| | - Clara Mukuria
- Division of Population Health, University of Sheffield, Sheffield, England, UK
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Bailey C, Dalziel K, Jones R, Hiscock H, Devlin NJ, Peasgood T. The Validity of the EuroQol Health and Wellbeing Short Version (EQ-HWB-S) Instrument in Parents of Children With and Without Health Conditions. PHARMACOECONOMICS 2024; 42:163-179. [PMID: 38238605 PMCID: PMC11168993 DOI: 10.1007/s40273-024-01351-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND The EuroQol Health and Wellbeing Short Version (EQ-HWB-S) instrument has been developed to measure the health and wellbeing of care-recipients and their caregivers for use in economic evaluation.The EQ-HWB-S has nine items, and pilot UK preference weights have now been developed. OBJECTIVE We aimed to investigate the validity of the instrument in parents of children with and without health conditions. METHODS EQ-HWB-S data were sourced from an Australian paediatric multi-instrument comparison study. We analysed the baseline characteristics and response distribution of the EQ-HWB-S items. Assessment of known-group validity was conducted for EQ-HWB-S items, level sum-scores and preference-weighted scores, including partial effects. Known-group analyses included three child health variables and where caregivers reported coronavirus disease 2019 (COVID-19) had impacted their wellbeing. We included analyses across gender, controlled for child and parent demographic variables, and compared scores across child health conditions. RESULTS Item responses were distributed as expected, with higher skew for mobility and activities. Parents experienced high levels of exhaustion. We detected significant differences between groups for level sum-scores and preference-weighted scores, as hypothesised; all tests were significant (p < 0.001), with moderate effect sizes (effect sizes were slightly higher for female than male parents). The regression analysis identified significantly different EQ-HWB-S scores for child health samples compared with the general population after controlling for demographic variables. Differences were observed between child health conditions. CONCLUSION The EQ-HWB-S is a useful instrument to measure parent quality of life for economic evaluation in this population. Data were limited to one time point; further research should investigate the instrument's sensitivity to change and test-retest reliability in this population.
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Affiliation(s)
- Cate Bailey
- Melbourne Health Economics, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie St, Carlton, VIC, 3053, Australia.
| | - Kim Dalziel
- Melbourne Health Economics, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie St, Carlton, VIC, 3053, Australia
| | - Renee Jones
- Melbourne Health Economics, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie St, Carlton, VIC, 3053, Australia
| | - Harriet Hiscock
- Health Services and Economics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Health Services Research Unit, Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Nancy J Devlin
- Melbourne Health Economics, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie St, Carlton, VIC, 3053, Australia
| | - Tessa Peasgood
- Melbourne Health Economics, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie St, Carlton, VIC, 3053, Australia
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Barman-Aksözen J, Hentschel N, Pettersson M, Schupp E, Granata F, Dechant C, Aksözen MH, Falchetto R. Fair Funding Decisions: Consistency of the Time Horizons Used in the Calculation of Quality-Adjusted Life Years for Therapies for Very Rare Diseases by the National Institute for Health and Care Excellence in England. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:616. [PMID: 38791830 PMCID: PMC11121024 DOI: 10.3390/ijerph21050616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
The National Institute for Health and Care Excellence (NICE) in England uses quality-adjusted life years (QALYs) to assess the cost-effectiveness of treatments. A QALY is a measure that combines the size of the clinical benefit of a treatment with the time the patient benefits from it, i.e., the time horizon. We wanted to know how consistently QALY gains are calculated at NICE. Therefore, we have analysed information on the time horizons used for the QALY calculations of the concluded evaluations conducted under the Highly Specialised Technologies programme for treatments of very rare diseases at NICE. For treatments with final guidance published by December 2023 (n = 29), a time horizon of median 97.5 years (range: 35 to 125 years) was used to calculate the QALY gains. For most QALY calculations, the accepted time horizon was longer than either the expected treatment duration or the estimated life expectancy. In contrast, for the only technology with a final negative funding decision, i.e., afamelanotide for treating the lifelong chronic disease erythropoietic protoporphyria, a time horizon that was shorter than the expected treatment duration was used. The fairness and consistency of the evaluation process of treatments for very rare diseases at NICE should be reviewed.
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Affiliation(s)
- Jasmin Barman-Aksözen
- International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland
| | - Nicole Hentschel
- Independent Researcher, Hegarstrasse 3, 8032 Zurich, Switzerland
| | - Mårten Pettersson
- International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland
| | - Eva Schupp
- International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland
| | - Francesca Granata
- International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, S.C Medicina ad Indirizzo Metabolico, 20122 Milano, Italy
| | - Cornelia Dechant
- International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland
| | - Mehmet Hakan Aksözen
- International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland
| | - Rocco Falchetto
- International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland
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Kochuvilayil A, Varma RP. Understanding caregiver burden and quality of life in Kerala's primary palliative care program: a mixed methods study from caregivers and providers' perspectives. Int J Equity Health 2024; 23:92. [PMID: 38715047 PMCID: PMC11077822 DOI: 10.1186/s12939-024-02155-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/18/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Family caregivers are vital for long-term care for persons with serious health-related suffering in Kerala. Long-term caregiving and ageing may become burdensome and detrimental to patients and caregivers. We compared the caregiver burden and quality-of-life of ageing caregivers with younger caregivers. We also explored the palliative care nurses' perceptions of the family caregivers' issues. METHODS We did a mixed method study focusing on two groups: (i) three in-depth interviews and a cross-sectional survey among 221 caregivers of palliative care patients in five randomly selected panchayats (most peripheral tier of three-tier local self-government system in India concerned with governance of a village or small town) of Kollam district, Kerala, as part of development and validation of the Achutha Menon Centre Caregiver Burden Inventory; (ii) five in-depth interviews with purposively selected primary palliative care nurses as part of a study on local governments and palliative care. We used a structured interview schedule to collect cross-sectional data on sociodemographic and caregiving-related characteristics, caregiver burden, and health-related quality of life using the EuroQol EQ5D5L and interview guidelines on caregiver issues tailored based on participant type for qualitative interviews. RESULTS Older caregivers comprised 28.1% of the sample and had significantly poorer health and quality-of-life attributes. More senior caregivers experiencing caregiver burden had the lowest mean scores of 0.877 (Standard deviation (SD 0.066, 95% confidence intervals (CI) 0.854-0.899) followed by younger caregivers with high burden (0.926, SD 0.090, 95% CI 0.907-0.945), older caregivers with low burden (0.935, SD 0.058, 95% CI 0.912-0.958) and younger caregivers with low burden (0.980, SD 0.041, 95% CI 0.970-0.990). Caregivers faced physical, psychological, social, and financial issues, leading to a caregiver burden. The relationships between the palliative care nurses and family caregivers were complex, and nurses perceived caregiver burden, but there were no specific interventions to address this. CONCLUSION In our study from Kollam, Kerala, three out of ten caregivers of palliative care patients were 60 years of age or older. They had significantly lower health-related quality of life, particularly if they perceived caregiver burden. Despite being recognized by palliative care nurses, caregiver issues were not systematically addressed. Further research and suitable interventions must be developed to target such problems in the palliative care programme in Kerala.
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Affiliation(s)
- Arsha Kochuvilayil
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Thiruvananthapuram, Kerala, India
| | - Ravi Prasad Varma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Thiruvananthapuram, Kerala, India.
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Bailey C, Dalziel K, Constable L, Devlin NJ, Hiscock H, Skouteris H, Peasgood T. The performance of the EQ-HWB-S as a measure of quality-of-life of caregivers in families that have experienced adverse events. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-024-01688-w. [PMID: 38578477 DOI: 10.1007/s10198-024-01688-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/28/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE The recently developed EQ Health and Wellbeing Instrument (EQ-HWB) is a broad, generic measure of quality-of-life designed to be suitable for caregivers. The aim of this study was to investigate performance and validity of the 9-item version (EQ-HWB-S) for caregivers where families had experienced adverse-life-events. METHODS Using survey data from caregivers of children aged 0-8 years attending a community-health centre in 2021-2022, the general performance, feasibility, convergent and known-group validity, responsiveness-to-change, and test-retest reliability of the EQ-HWB-S was assessed. Twelve semi-structured interviews were conducted with survey respondents to assess acceptability and content validity. RESULTS The sample included 234 caregivers at baseline (81% female, mean age 36-years, 38% Australian-born) and 190 at 6-months follow-up. Most EQ-HWB-S item responses were evenly spread, except for 'Mobility'. The instrument showed good convergent validity with psychological distress (Kessler 6 (K6)) and personal-wellbeing (PWI-A) scales. EQ-HWB-S level sum-scores and preference-weighted scores were significantly different in all known-group analyses, in expected directions, and the instrument was responsive to change. For test-retest reliability, Intraclass Correlation Coefficients were excellent and individual item Kappa scores were moderate. The instrument was well received by interviewees who found the questions clear and relevant. The items were appropriate for parents experiencing adversity and carers of children with additional needs. CONCLUSION The EQ-HWB-S appeared valid, responsive to change, feasible, and well accepted by caregivers. By demonstrating the validity of the EQ-HWB-S in this hard-to-reach population of caregivers in families experiencing adverse events, this study adds to existing international evidence supporting its use.
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Affiliation(s)
- Cate Bailey
- Melbourne Health Economics, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie St, Carlton, VIC, 3053, Australia.
| | - Kim Dalziel
- Melbourne Health Economics, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie St, Carlton, VIC, 3053, Australia
- Health Services and Economics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Leanne Constable
- Health Services and Economics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Nancy J Devlin
- Melbourne Health Economics, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie St, Carlton, VIC, 3053, Australia
| | - Harriet Hiscock
- Health Services and Economics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Health Services Research Unit, Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Tessa Peasgood
- Melbourne Health Economics, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie St, Carlton, VIC, 3053, Australia
- Sheffield Centre for Health and Related Research, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
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Shah R, Salek MS, Finlay AY, Kay R, Nixon SJ, Otwombe K, Ali FM, Ingram JR. Mapping of Family Reported Outcome Measure (FROM-16) scores to EQ-5D: algorithm to calculate utility values. Qual Life Res 2024; 33:1107-1119. [PMID: 38402530 PMCID: PMC10973087 DOI: 10.1007/s11136-023-03590-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 02/26/2024]
Abstract
OBJECTIVE Although decision scientists and health economists encourage inclusion of family member/informal carer utility in health economic evaluation, there is a lack of suitable utility measures comparable to patient utility measures such those based on the EQ-5D. This study aims to predict EQ-5D-3L utility values from Family Reported Outcome Measure (FROM-16) scores, to allow the use of FROM-16 data in health economic evaluation when EQ-5D data is not available. METHODS Data from 4228 family members/partners of patients recruited to an online cross-sectional study through 58 UK-based patient support groups, three research support platforms and Welsh social services departments were randomly divided five times into two groups, to derive and test a mapping model. Split-half cross-validation was employed, resulting in a total of ten multinomial logistic regression models. The Monte Carlo simulation procedure was used to generate predicted EQ-5D-3L responses, and utility scores were calculated and compared against observed values. Mean error and mean absolute error were calculated for all ten validation models. The final model algorithm was derived using the entire sample. RESULTS The model was highly predictive, and its repeated fitting using multinomial logistic regression demonstrated a stable model. The mean differences between predicted and observed health utility estimates ranged from 0.005 to 0.029 across the ten modelling exercises, with an average overall difference of 0.015 (a 2.2% overestimate, not of clinical importance). CONCLUSIONS The algorithm developed will enable researchers and decision scientists to calculate EQ-5D health utility estimates from FROM-16 scores, thus allowing the inclusion of the family impact of disease in health economic evaluation of medical interventions when EQ-5D data is not available.
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Affiliation(s)
- R Shah
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK.
| | - M S Salek
- School of Life & Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - A Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - R Kay
- RK Statistics, Bakewell, UK
| | - S J Nixon
- Multiple Sclerosis Society, Cardiff, UK
| | - K Otwombe
- Statistics and Data Management Centre, Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - F M Ali
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - J R Ingram
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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Svensson M, Strand GC, Bonander C, Johansson N, Jakobsson N. Analyses of quality of life in cancer drug trials - a review of measurements and analytical choices in post-reimbursement studies. BMC Cancer 2024; 24:311. [PMID: 38448848 PMCID: PMC10916053 DOI: 10.1186/s12885-024-12045-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/22/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVES For drugs reimbursed with limited evidence of patient benefits, confirmatory evidence of overall survival (OS) and quality of life (QoL) benefits is important. For QoL data to serve as valuable input to patients and decision-makers, it must be measured and analyzed using appropriate methods. We aimed to assess the measurement and analyses of post-reimbursement QoL data for cancer drugs introduced in Swedish healthcare with limited evidence at the time of reimbursement. METHODS We reviewed any published post-reimbursement trial data on QoL for cancer drugs reimbursed in Sweden between 2010 and 2020 with limited evidence of improvement in QoL and OS benefits at the time of reimbursement. We extracted information on the instruments used, frequency of measurement, extent of missing data, statistical approaches, and the use of pre-registration and study protocols. RESULTS Out of 22 drugs satisfying our inclusion criteria, we identified published QoL data for 12 drugs in 22 studies covering multiple cancer types. The most frequently used QoL instruments were EORTC QLQ-C30 and EQ-5D-3/5L. We identified three areas needing improvement in QoL measurement and analysis: (i) motivation for the frequency of measurements, (ii) handling of the substantial missing data problem, and (iii) inclusion and adherence to QoL analyses in clinical trial pre-registration and study protocols. CONCLUSIONS Our review shows that the measurements and analysis of QoL data in our sample of cancer trials covering drugs initially reimbursed without any confirmed QoL or OS evidence have significant room for improvement. The increasing use of QoL assessments must be accompanied by a stricter adherence to best-practice guidelines to provide valuable input to patients and decision-makers.
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Affiliation(s)
- Mikael Svensson
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, 1225 Center Dr, Gainesville, FL, 32610, USA.
- School of Public Health & Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - Gabriella Chauca Strand
- School of Public Health & Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Carl Bonander
- School of Public Health & Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Centre for Societal Risk Research, Karlstad University, Karlstad, Sweden
| | - Naimi Johansson
- University Health Care Research Center, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
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Lathe J, Silverwood RJ, Hughes AD, Patalay P. Examining how well economic evaluations capture the value of mental health. Lancet Psychiatry 2024; 11:221-230. [PMID: 38281493 DOI: 10.1016/s2215-0366(23)00436-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/30/2024]
Abstract
Health economics evidence informs health-care decision making, but the field has historically paid insufficient attention to mental health. Economic evaluations in health should define an appropriate scope for benefits and costs and how to value them. This Health Policy provides an overview of these processes and considers to what extent they capture the value of mental health. We suggest that although current practices are both transparent and justifiable, they have distinct limitations from the perspective of mental health. Most social value judgements, such as the exclusion of interindividual outcomes and intersectoral costs, diminish the value of improving mental health, and this reduction in value might be disproportionate compared with other types of health. Economic analyses might have disadvantaged interventions that improve mental health compared with physical health, but research is required to test the size of such differential effects and any subsequent effect on decision-making systems such as health technology assessment systems. Collaboration between health economics and the mental health sciences is crucial for achieving mental-physical health parity in evaluative frameworks and, ultimately, improving population mental health.
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Affiliation(s)
- James Lathe
- MRC Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, Faculty of Population Health Sciences, University College London, London, UK.
| | - Richard J Silverwood
- Centre for Longitudinal Studies, Social Research Institute, Institute of Education, Faculty of Education and Society, University College London, London, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, Faculty of Population Health Sciences, University College London, London, UK
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, Faculty of Population Health Sciences, University College London, London, UK; Centre for Longitudinal Studies, Social Research Institute, Institute of Education, Faculty of Education and Society, University College London, London, UK
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Henry E, Al-Janabi H, Brouwer W, Cullinan J, Engel L, Griffin S, Hulme C, Kingkaew P, Lloyd A, Payakachat N, Pennington B, Peña-Longobardo LM, Prosser LA, Shah K, Ungar WJ, Wilkinson T, Wittenberg E. Recommendations for Emerging Good Practice and Future Research in Relation to Family and Caregiver Health Spillovers in Health Economic Evaluations: A Report of the SHEER Task Force. PHARMACOECONOMICS 2024; 42:343-362. [PMID: 38041698 PMCID: PMC10861630 DOI: 10.1007/s40273-023-01321-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Omission of family and caregiver health spillovers from the economic evaluation of healthcare interventions remains common practice. When reported, a high degree of methodological inconsistency in incorporating spillovers has been observed. AIM To promote emerging good practice, this paper from the Spillovers in Health Economic Evaluation and Research (SHEER) task force aims to provide guidance on the incorporation of family and caregiver health spillovers in cost-effectiveness and cost-utility analysis. SHEER also seeks to inform the basis for a spillover research agenda and future practice. METHODS A modified nominal group technique was used to reach consensus on a set of recommendations, representative of the views of participating subject-matter experts. Through the structured discussions of the group, as well as on the basis of evidence identified during a review process, recommendations were proposed and voted upon, with voting being held over two rounds. RESULTS This report describes 11 consensus recommendations for emerging good practice. SHEER advocates for the incorporation of health spillovers into analyses conducted from a healthcare/health payer perspective, and more generally inclusive perspectives such as a societal perspective. Where possible, spillovers related to displaced/foregone activities should be considered, as should the distributional consequences of inclusion. Time horizons ought to be sufficient to capture all relevant impacts. Currently, the collection of primary spillover data is preferred and clear justification should be provided when using secondary data. Transparency and consistency when reporting on the incorporation of health spillovers are crucial. In addition, given that the evidence base relating to health spillovers remains limited and requires much development, 12 avenues for future research are proposed. CONCLUSIONS Consideration of health spillovers in economic evaluations has been called for by researchers and policymakers alike. Accordingly, it is hoped that the consensus recommendations of SHEER will motivate more widespread incorporation of health spillovers into analyses. The developing nature of spillover research necessitates that this guidance be viewed as an initial roadmap, rather than a strict checklist. Moreover, there is a need for balance between consistency in approach, where valuable in a decision making context, and variation in application, to reflect differing decision maker perspectives and to support innovation.
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Affiliation(s)
- Edward Henry
- J.E. Cairnes School of Business & Economics, University of Galway, Galway, Ireland.
| | - Hareth Al-Janabi
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Werner Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - John Cullinan
- J.E. Cairnes School of Business & Economics, University of Galway, Galway, Ireland
| | - Lidia Engel
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Susan Griffin
- Centre for Health Economics, University of York, York, UK
| | - Claire Hulme
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Pritaporn Kingkaew
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | | | - Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | - Becky Pennington
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Lisa A Prosser
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Koonal Shah
- National Institute for Health and Care Excellence, London, UK
| | - Wendy J Ungar
- The Hospital for Sick Children Research Institute/University of Toronto, Toronto, ON, Canada
| | - Thomas Wilkinson
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Eve Wittenberg
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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11
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Fraser H, Thompson L, Crawley E, Ridd MJ, Brigden A. "not one size fits all" The challenges of measuring paediatric health-related quality of life and the potential role of digital ecological momentary assessment: a qualitative study. Qual Life Res 2024; 33:443-452. [PMID: 37889385 PMCID: PMC10850023 DOI: 10.1007/s11136-023-03535-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE To explore the views of clinicians and researchers about the challenges of measuring health-related quality of life (HRQoL) in children (5-11 years) and to explore whether digital ecological momentary assessment (EMA) could enhance HRQoL measurement. METHODS Semi-structured qualitative interviews with 18 professionals (10 academics/researchers, four clinicians, four with both professional backgrounds) experienced in child HRQoL measurement. We analysed data thematically. RESULTS Theme One describes the uncertainty around conceptualising HRQoL for children and which domains to include; the greater immediacy and sensitivity of children's reflections on their HRQoL, leading to high variability of the construct; and the wide individual differences across childhood, incongruent with fixed HRQoL measures. Theme Two describes the challenges of proxy reporting, questioning whether proxies can meaningfully report a child's HRQoL and reflecting on discrepancies between child and proxy reporting. Theme Three covers the challenge of interpreting change in HRQoL over time; does a change in HRQoL reflect a change in health, or does this reflect developmental changes in how children report HRQoL. Theme Four discusses digital EMA for HRQoL data capture. In-the-moment, repeated measurement could provide rich data and address challenges of recall, ecological validity and variability; passive data could provide objective markers to supplement subjective responses; and technology could enable personalisation and child-centred design. However, participants also raised methodological, practical and ethical challenges of digital approaches. CONCLUSION Digital EMA may address some of the challenges of HRQoL data collection with children. We conclude by discussing potential future research to explore and develop this approach.
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Affiliation(s)
- Holly Fraser
- Digital Health, Faculty of Engineering, School of Computer Science, Electrical and Electronic Engineering, University of Bristol, Amberly Brigden, 1 Cathedral Square, Bristol, BS1 5DD, UK
| | - Lauren Thompson
- Digital Health, Faculty of Engineering, School of Computer Science, Electrical and Electronic Engineering, University of Bristol, Amberly Brigden, 1 Cathedral Square, Bristol, BS1 5DD, UK
| | - Esther Crawley
- Faculty of Health Sciences, Centre for Child and Adolescent Health, University of Bristol, Bristol, BS8 2PS, UK
| | - Matthew J Ridd
- Faculty of Health Sciences, Centre for Academic Primary Care, University of Bristol, Bristol, BS8 2PS, UK
| | - Amberly Brigden
- Digital Health, Faculty of Engineering, School of Computer Science, Electrical and Electronic Engineering, University of Bristol, Amberly Brigden, 1 Cathedral Square, Bristol, BS1 5DD, UK.
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Hernandez Alava M, Sasso A, Hnynn Si PE, Gittus M, Powell R, Dunn L, Thokala P, Fotheringham J. Relationship Between Standardized Measures of Chronic Kidney Disease-associated Pruritus Intensity and Health-related Quality of Life Measured with the EQ-5D Questionnaire: A Mapping Study. Acta Derm Venereol 2023; 103:adv11604. [PMID: 37731210 PMCID: PMC10522326 DOI: 10.2340/actadv.v103.11604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/29/2023] [Indexed: 09/22/2023] Open
Abstract
Chronic kidney disease-associated pruritus is linked with decreased health-related quality of life assessed using disease-specific instruments. The extent to which worsening pruritus reduces generic quality of life assessed using the EQ-5D instrument is unknown. Prevalent kidney failure patients receiving in-centre haemodialysis from 5 centres completed the EQ-5D-5L quality of life measure, worst Itching Intensity Numerical Rating Scale and 5-D itch pruritus instruments. Latent class models were used to identify clusters of patients with similarly affected body parts, and mixture models were used to map the pruritus measures to the EQ-5D. Data on 487 respondents were obtained. Latent class analysis identified 3 groups of patients who had progressively worsening severity and an increasing number of body parts affected. Although the worst itching intensity numerical rating scale and 5-D itch instruments correlated with each other, only the latter had a strong relationship with EQ-5D. When controlling for age, sex, diabetes and years receiving dialysis, the meanpredicted EQ-5D utility (1: perfect health, 0: dead) decreased progressively from 0.69 to 0.41. These findings suggest that pruritus instruments that include domains capturing how the individual is physically, mentally and socially affected by their pruritus, in addition to severity, more closely approximate the EQ-5D generic quality of life measure.
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Affiliation(s)
| | - Alessandro Sasso
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Pann Ei Hnynn Si
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Matthew Gittus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Louese Dunn
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Praveen Thokala
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - James Fotheringham
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
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13
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Goadsby PJ, Barbanti P, Lambru G, Ettrup A, Christoffersen CL, Josiassen MK, Phul R, Sperling B. Eptinezumab improved patient-reported outcomes and quality of life in patients with migraine and prior preventive treatment failures. Eur J Neurol 2023; 30:1089-1098. [PMID: 36583633 DOI: 10.1111/ene.15670] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE In the phase 3b, randomized, double-blind, placebo-controlled DELIVER clinical trial, eptinezumab reduced migraine frequency and headache in adults with two to four prior preventive treatment failures. Here, the effect of eptinezumab on coinciding patient-reported outcomes is reported. METHODS Adults were randomized to receive eptinezumab 100, 300 mg or placebo intravenously at weeks 12 and 24. The EQ-5D-5L, measuring overall patient health, and the six-item Headache Impact Test were completed every 4 weeks. The Patient Global Impression of Change was completed at weeks 4, 12 and 24. Patient-identified most bothersome symptom and the Migraine-Specific Quality of Life Questionnaire were administered at weeks 12 and 24. RESULTS Eptinezumab improved patient-reported outcomes more than placebo, starting at week 4 and at all subsequent time points. By week 12, patients' overall health (EQ-5D-5L visual analog scale score) improved with eptinezumab treatment (difference from placebo in change from baseline: 100 mg, 5.1, 95% confidence interval [CI] 2.2, 8.1, p < 0.001; 300 mg, 7.5, 95% CI 4.5, 10.4, p < 0.0001). At week 12, eptinezumab improved headache-related quality of life (difference from placebo in change from baseline in Headache Impact Test total score: 100 mg, -3.8, 95% CI -5.0, -2.5, p < 0.0001; 300 mg, -5.4, 95% CI -6.7, -4.2, p < 0.0001), including each Migraine-Specific Quality of Life Questionnaire domain (p ≤ 0.0001, all comparisons). Over twice as many patients receiving eptinezumab than placebo reported much or very much improvement on the Patient Global Impression of Change and patient-identified most bothersome symptom. CONCLUSION Patients with two to four prior preventive treatment failures receiving eptinezumab versus placebo reported greater improvements in well-being, quality of life and most bothersome symptoms compared to placebo. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04418765; EudraCT identifier: 2019-004497-25.
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Affiliation(s)
- Peter J Goadsby
- NIHR SLaM Clinical Research Facility, and Headache Group Wolfson CARD, King's College London, London, UK
- Department of Neurology, University of California, Los Angeles, CA, USA
| | - Piero Barbanti
- Headache and Pain Unit, IRCCS San Raffaele, Rome, Italy
- San Raffaele University, Rome, Italy
| | - Giorgio Lambru
- The Headache Service, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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14
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Kelly CB, Soley-Bori M, Lingam R, Forman J, Cecil L, Newham J, Wolfe I, Fox-Rushby J. Mapping PedsQL™ scores to CHU9D utility weights for children with chronic conditions in a multi-ethnic and deprived metropolitan population. Qual Life Res 2023:10.1007/s11136-023-03359-4. [PMID: 36814010 DOI: 10.1007/s11136-023-03359-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE The Child Health Utility-9 Dimensions (CHU9D) is a patient-reported outcome measure to generate Quality-Adjusted Life Years (QALYs), recommended for economic evaluations of interventions to inform funding decisions. When the CHU9D is not available, mapping algorithms offer an opportunity to convert other paediatric instruments, such as the Paediatric Quality of Life Inventory™ (PedsQL), onto the CHU9D scores. This study aims to validate current PedsQL to CHU9D mappings in a sample of children and young people of a wide age range (0 to 16 years of age) and with chronic conditions. New algorithms with improved predictive accuracy are also developed. METHODS Data from the Children and Young People's Health Partnership (CYPHP) were used (N = 1735). Four regression models were estimated: ordinal least squared, generalized linear model, beta-binomial and censored least absolute deviations. Standard goodness of fit measures were used for validation and to assess new algorithms. RESULTS While previous algorithms perform well, performance can be enhanced. OLS was the best estimation method for the final equations at the total, dimension and item PedsQL scores levels. The CYPHP mapping algorithms include age as an important predictor and more non-linear terms compared with previous work. CONCLUSION The new CYPHP mappings are particularly relevant for samples with children and young people with chronic conditions living in deprived and urban settings. Further validation in an external sample is required. Trial registration number NCT03461848; pre-results.
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Affiliation(s)
- Clare B Kelly
- Institute for Women and Children's Health, King's Health Partners, London, UK
- Department of Women's and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Marina Soley-Bori
- Institute for Women and Children's Health, King's Health Partners, London, UK.
- Department of Population Health, School of Life Course and Population Sciences, King's College London, London, UK.
- Faculty of Life Sciences and Medicine, School of Life Course & Population Sciences, King's College London, Guy's Campus, Great Maze Pond, London, SE1 1UL, UK.
| | - Raghu Lingam
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Julia Forman
- Institute for Women and Children's Health, King's Health Partners, London, UK
- Department of Women's and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Lizzie Cecil
- Institute for Women and Children's Health, King's Health Partners, London, UK
- Department of Women's and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - James Newham
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Ingrid Wolfe
- Institute for Women and Children's Health, King's Health Partners, London, UK
- Department of Women's and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Julia Fox-Rushby
- Department of Population Health, School of Life Course and Population Sciences, King's College London, London, UK
- NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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15
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Jakovljevic M, Tan CJ, Chaiyakunapruk N, Silva Julian G, Cheung KL, Hiligsmann M, Godman B, Opanga S, Scuffham PA, Gregg M. Global article collection: essential reads from around the world. J Med Econ 2022; 25:864-869. [PMID: 35678118 DOI: 10.1080/13696998.2022.2087960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mihajlo Jakovljevic
- Institute of Comparative Economic Studies, Hosei University Faculty of Economics, Tokyo, Japan
- Department Global Health Economics & Policy, University of Kragujevac, Kragujevac, Serbia
- Institute of Advanced Manufacturing Technologies, Peter the Great St. Petersburg Polytechnic University, St. Petersburg, Russia
| | - Chia Jie Tan
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | | | - Kei Long Cheung
- Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University London, London, UK
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Michael Gregg
- Executive Editor, Journal of Medical Economics, Taylor & Francis, London, UK
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