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Yu L, Yang H, Lu L, Fang Y, Zhang X, Li S, Li C. Developing mapping algorithms to predict EQ-5D health utility values from Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index among patients with Ankylosing Spondylitis. Health Qual Life Outcomes 2024; 22:61. [PMID: 39113080 PMCID: PMC11304938 DOI: 10.1186/s12955-024-02276-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 07/19/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Preference-based measures of health-related quality of life (HRQoL), such as the EQ-5D or the SF-6D, are essential for health economic evaluation. However, they are rarely included in clinical trials of ankylosing spondylitis (AS). This study aims to develop mapping algorithms to predict EQ-5D-3L and EQ-5D-5L health utility scores from the Bath Ankylosing Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI). METHODS Patients with AS were recruited from the largest tertiary hospital in Shandong province, China, between December 2019 and October 2020. Patients were selected by convenience sampling method according to the following criteria: (1) diagnosed with AS according to the New York criteria; (2) aged 18 years and above; and (3) without mental disorders; (4) able to understand the questionnaires; (5) without serious complications. There were 243 patients who completed the face-to-face questionnaire survey, and 5 cases with missing values in key variables were excluded. Ordinary least squares, censored least absolute deviations, Tobit, adjusted limited dependent variable mixture model and beta-mixture model (BM) in the direct approach and ordered logit and multinomial logit (Mlogit) model in the response approach were used to develop mapping algorithms. Mean absolute error, root mean square error, Spearman's correlation coefficient and concordance correlation coefficient were used to access predictive performance. RESULTS The 238 patients with AS had a mean age of 35.19 (SD = 9.59) years, and the majority (74.47%) were male. The observed EQ-5D-3L and EQ-5D-5L health utility values were 0.88 (SD = 0.12) and 0.74 (SD = 0.27), respectively. The EQ-5D-5L had higher conceptual overlap with the BASDAI and BASFI than the EQ-5D-3L did. The Mlogit was the best-performing model for the EQ-5D-3L, and the BM showed better performance in predicting EQ-5D-5L than other direct and indirect mapping models did. CONCLUSION This study demonstrates that the EQ-5D-5L, rather than EQ-5D-3L, should be selected as the target outcome measure of HRQoL in patients with AS in China, and the BM mapping algorithm could be used to predict EQ-5D-5L values from BASDAI and BASFI for health economic evaluation.
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Affiliation(s)
- Lingjia Yu
- Nursing Department, Rheumatology department, Qilu hospital of Shandong University, Jinan, 250012, China
| | - Huizhi Yang
- Shunyi District Center for Disease Control and Prevention, Beijing, 101300, China
| | - Liyong Lu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhua Xi Road 44, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Wenhua Xi Road 44, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Wenhua Xi Road 44, Jinan, 250012, China
| | - Yingying Fang
- Nursing Department, Rheumatology department, Qilu hospital of Shandong University, Jinan, 250012, China
| | - Xianyu Zhang
- Nursing Department, Rheumatology department, Qilu hospital of Shandong University, Jinan, 250012, China
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhua Xi Road 44, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Wenhua Xi Road 44, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Wenhua Xi Road 44, Jinan, 250012, China
| | - Chaofan Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhua Xi Road 44, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Wenhua Xi Road 44, Jinan, 250012, China.
- Center for Health Preference Research, Shandong University, Wenhua Xi Road 44, Jinan, 250012, China.
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Hirniak S, Edginton AN, Iorio A, Alsabbagh MW, Hajducek DM, Wong WW. Health utilities in adults with hemophilia A: A retrospective cohort study. Haemophilia 2024; 30:733-742. [PMID: 38506967 DOI: 10.1111/hae.14979] [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: 08/01/2023] [Revised: 02/08/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Haemophilia A negatively affects a patient's quality of life. There is a limited amount of health utility data (a measure of health-related quality of life) available for patients with haemophilia A. This information is crucial for cost-effectiveness analysis for haemophilia A treatment. OBJECTIVES The goal of this project is to elicit the health utilities and factors impacting utility values for haemophilia A patients in Canada. METHODS This is a population-based, cross-sectional, retrospective study of health utilities in patients with haemophilia A using Patient Report Outcomes Burdens and Experiences (PROBE) components from the Canadian Bleeding Disorders Registry (CBDR). A review of the mean utilities for three severity states, defined by clotting factor VIII level, was completed. A multiple linear regression analysis was completed to examine the determinants of health utilities including age, treatment type, chronic pain status, number of limited joints, and bleed rate. RESULTS The average utility values (and standard deviations) for patients with haemophilia A in Canada are .79(.17), .76(.20), and .77(.19) for patients with severe, moderate, and mild haemophilia. The regression showed chronic pain status and the number of additional comorbidities as major significant factors (p-value < .001) in haemophilia A utility. Haemophilia severity was shown to be a major factor with smaller p-value (p-value < .05). CONCLUSIONS Haemophilia A patients have lower utility than the general population. Chronic pain was shown to be a significant, major factor in health-related quality of life. Our study is essential for valuing health outcomes in haemophilia A-related cost-effectiveness analysis.
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Affiliation(s)
- Sam Hirniak
- School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, ON, Canada
| | - Andrea N Edginton
- School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, ON, Canada
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Mhd Wasem Alsabbagh
- School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, ON, Canada
| | - Dagmar M Hajducek
- School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, ON, Canada
| | - William Wl Wong
- School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, ON, Canada
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Sang S, Liao W, Kang N, Wu X, Hu Z, Liu X, Zhang H, Wang C. Health-related quality of life assessed by EQ-5D-5L and its determinants among rural adults: result from the Henan rural cohort study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:21-30. [PMID: 36715888 DOI: 10.1007/s10198-023-01565-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/11/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Evidence on the health-related quality of life (HRQoL) among Chinese rural populations and its influence factors were limited. This study aimed to describe the distribution of HRQoL assessed by EQ-5D-5L and its determinants among a Chinese rural population. METHODS A total of 23,510 eligible participants (9542 men and 13,968 women) from the Henan rural cohort study were included. Tobit regression and generalized linear models were performed to investigate the associations between demographic characteristics, lifestyle factors, common chronic diseases, and HRQoL. RESULTS Of all respondents, the most frequently reported problem was pain/discomfort dimension (23.05%), followed by mobility (12.72%), anxiety/depression (7.77%), and usual activities (6.45%), while the least reported was the self-care dimension (3.84%). The more problems reported in all dimensions with age increased except anxiety/depression. The mean (standard deviation) utility index and VAS score were 0.954 (0.111) and 78.34 (14.80), respectively. The regression analysis indicated that increasing age, former drinkers, poor sleep quality, and suffering from common chronic diseases were significantly associated with low HRQoL, while high education level, average monthly income, and physical activity were significantly associated with high HRQoL. CONCLUSION This study described the distribution of HRQoL and its influence factors among the Chinese rural population, which was helpful for medical institutions and policymakers to allocate medical resources and better understand HRQoL among the Chinese rural population.
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Affiliation(s)
- Shengxiang Sang
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- Shandong Cancer Hospital affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Wei Liao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan, People's Republic of China
| | - Ning Kang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan, People's Republic of China
| | - Xueyan Wu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan, People's Republic of China
| | - Ze Hu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan, People's Republic of China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan, People's Republic of China
| | - Hongjian Zhang
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan, People's Republic of China.
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Hernández Alava M, Pudney S, Wailoo A. Estimating the Relationship Between EQ-5D-5L and EQ-5D-3L: Results from a UK Population Study. PHARMACOECONOMICS 2023; 41:199-207. [PMID: 36449173 PMCID: PMC9883358 DOI: 10.1007/s40273-022-01218-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 05/20/2023]
Abstract
OBJECTIVES The aim of this study was to estimate the relationship between EQ-5D-3L and EQ-5D-5L, in both directions, using a single model. METHODS An online survey containing both variants of EQ-5D, with randomised ordering, was administered to a large UK sample in 2020. A joint statistical model of the ten EQ-5D responses (five at 5L, five at 3L), using a multi-equation ordinal regression framework was estimated. The joint model ensures mappings in either direction are fully consistent with the information in the sample and satisfy Bayes' rule. Three extensions enhance model flexibility: a copula specification allows differing degrees of correlation between the 3L and 5L responses at the upper and lower extremes of health; a normal mixture residual distribution gives flexibility in the distributional form of responses; and a common factor captures correlations in responses across the five dimensions. RESULTS Almost 50,000 responses were received. Thirty-five percent of respondents reported an existing medical condition. Ninety percent of possible 3L and 43% of possible 5L health states were observed. The preferred model specification includes age, sex and the responses to the EQ-5D instrument. Close alignment to the observed data was observed both in within-sample and out-of-sample comparisons. CONCLUSION The results from this study provide a means of translating evidence to or from EQ-5D-3L to or from 5L based on a large-scale UK population survey with randomised ordering. Mapping can be performed either using descriptive system responses, individual utility scores or summary statistics.
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Affiliation(s)
| | - Steve Pudney
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Allan Wailoo
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK.
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Sprave T, Gkika E, Verma V, Grosu AL, Stoian R. Patient reported outcomes based on EQ-5D-5L questionnaires in head and neck cancer patients: a real-world study. BMC Cancer 2022; 22:1236. [PMID: 36447175 PMCID: PMC9710161 DOI: 10.1186/s12885-022-10346-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Health economic comparisons of various therapies are often based on health-related quality of life (HRQOL) using EQ-5D questionnaires within the framework of clinical trials. This real-world study prospectively evaluates the patient reported outcomes (PROs)-based HRQOL of head-and-neck (H&N) cancer patients undergoing modern radiotherapy (RT) to reflect PRO trajectories. METHODS All H&N cancer patients treated in our clinic between July 2019 and December 2020 who completed the self-reported validated EQ-5D-5L questionnaire (health state index (HI) and Visual Analog Scale (VAS)) at baseline, end of radiotherapy, and at each respective follow up (FU) were included. Descriptive analysis of clinical and sociodemographic data, the frequency and level of each dimension was conducted. To assess the significance of therapy-induced HRQOL changes within and between the group, a distribution-based approach was used. RESULTS Altogether, 366 participants completed a total of 565 questionnaires. For the whole cohort, HI at baseline was 0.804 (±0.208), 0.830 (±0.162) at RT completion, 0.812 (±0.205) at the first follow-up, and 0.769 (±0.224) at the second follow-up. The respective VAS values were 62.06 (±23,94), 66.73 (±82.20), 63.30 (±22.74), and 65.48 (±23.39). Females showed significantly lower HI values compared to males, but only at baseline (p = 0.034). Significantly lower HI values were also seen in patients with definitive RT as compared to adjuvant RT at baseline (p = 0.023), the second follow-up (p = 0.047), and the third follow-up (p = 0.010). As compared to outpatients, inpatients had significantly lower HI values at RT completion (p = 0.017), the second follow-up (p = 0.007), and the third follow-up (p = 0.031). Subgroup analyses by age (< 65 vs. ≥65) and smoking status (smokers vs. non-smokers) showed no difference at any time point. CONCLUSION PROs demonstrated detectability of time- and intra-/inter-group therapy-induced HRQOL changes. A further detailed exploration of EQ-5D-5L responsiveness for H&N cancer patients is required.
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Affiliation(s)
- Tanja Sprave
- grid.7708.80000 0000 9428 7911Department of Radiation Oncology, Freiburg University Medical Center, Robert-Koch-Str. 3, 79106 Freiburg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Eleni Gkika
- grid.7708.80000 0000 9428 7911Department of Radiation Oncology, Freiburg University Medical Center, Robert-Koch-Str. 3, 79106 Freiburg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Vivek Verma
- grid.240145.60000 0001 2291 4776Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX USA
| | - Anca-Ligia Grosu
- grid.7708.80000 0000 9428 7911Department of Radiation Oncology, Freiburg University Medical Center, Robert-Koch-Str. 3, 79106 Freiburg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Raluca Stoian
- grid.7708.80000 0000 9428 7911Department of Radiation Oncology, Freiburg University Medical Center, Robert-Koch-Str. 3, 79106 Freiburg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Centre (DKFZ), Heidelberg, Germany
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Enzing JJ, van Krugten FCW, Sabat I, Neumann-Böhme S, Boer B, Knies S, Brouwer WBF. Psychometric evaluation of the Mental Health Quality of Life (MHQoL) instrument in seven European countries. Health Qual Life Outcomes 2022; 20:129. [PMID: 36050766 PMCID: PMC9434504 DOI: 10.1186/s12955-022-02041-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/14/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction To make efficient use of available resources, decision-makers in healthcare may assess the costs and (health) benefits of health interventions. For interventions aimed at improving mental health capturing the full health benefits is an important challenge. The Mental Health Quality of Life (MHQoL) instrument was recently developed to meet this challenge. Evaluating the pyschometric properties of this instrument in different contexts remains important.
Methods A psychometric evaluation of the MHQoL was performed using existing international, cross-sectional data with 7155 respondents from seven European countries (Denmark, France, Germany, Italy, Portugal, The Netherlands, Portugal and the United Kingdom). Reliability was examined by calculating Cronbach’s alpha, a measure of internal consistency of the seven MHQoL dimensions, and by examining the association of the MHQoL sum scores with the MHQoL-VAS scores. Construct validity was examined by calculating Spearman’s rank correlation coefficients between the MHQoL sum scores and EQ-5D index scores, EQ-VAS scores, EQ-5D anxiety/depression dimension scores, ICECAP-A index scores and PHQ-4 sum scores. Results The MHQoL was found to have good internal consistency for all seven countries. The MHQoL sum score and the MHQoL-VAS had a high correlation. Spearman’s rank correlation coefficients were moderate to very high for all outcomes. Conclusion Our results, based on data gathered in seven European countries, suggest that the MHQoL shows favourable psychometrical characteristics. While further validation remains important, the MHQoL may be a useful instrument in measuring mental health-related quality of life in the Western European context. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-02041-6.
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Affiliation(s)
- Joost J Enzing
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands. .,Zorginstituut Nederland, Diemen, The Netherlands.
| | - Frédérique C W van Krugten
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Iryna Sabat
- Nova School of Business and Economics, Lisbon, Portugal.,Hamburg Center for Health Economics, Hamburg, Germany
| | - Sebastian Neumann-Böhme
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.,Hamburg Center for Health Economics, Hamburg, Germany
| | - Bert Boer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Saskia Knies
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.,Zorginstituut Nederland, Diemen, The Netherlands
| | - Werner B F Brouwer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
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Franklin M, Hunter RM, Enrique A, Palacios J, Richards D. Estimating Cost-Effectiveness Using Alternative Preference-Based Scores and Within-Trial Methods: Exploring the Dynamics of the Quality-Adjusted Life-Year Using the EQ-5D 5-Level Version and Recovering Quality of Life Utility Index. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1018-1029. [PMID: 35667775 DOI: 10.1016/j.jval.2021.11.1358] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/15/2021] [Accepted: 11/01/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to explore quality-adjusted life-year (QALY) and subsequent cost-effectiveness estimates based on the more physical health-focused EQ-5D 5-level version (EQ-5D-5L) value set for England or cross-walked EQ-5D 3-level version UK value set scores or more mental health recovery-focused Recovering Quality of Life Utility Index (ReQoL-UI), when using alternative within-trial statistical methods. We describe possible reasons for the different QALY estimates based on the interaction between item scores, health state profiles, preference-based scores, and mathematical and statistical methods chosen. METHODS QALYs are calculated over 8 weeks from a case study 2:1 (intervention:control) randomized controlled trial in patients with anxiety or depression. Complete case and with missing cases imputed using multiple-imputation analyses are conducted, using unadjusted and regression baseline-adjusted QALYs. Cost-effectiveness is judged using incremental cost-effectiveness ratios and acceptability curves. We use previously established psychometric results to reflect on estimated QALYs. RESULTS A total of 361 people (241:120) were randomized. EQ-5D-5L crosswalk produced higher incremental QALYs than the value set for England or ReQoL-UI, which produced similar unadjusted QALYs, but contrasting baseline-adjusted QALYs. Probability of cost-effectiveness <£30 000 per QALY ranged from 6% (complete case ReQoL-UI baseline-adjusted QALYs) to 64.3% (multiple-imputation EQ-5D-5L crosswalk unadjusted QALYs). The control arm improved more on average than the intervention arm on the ReQoL-UI, a result not mirrored on the EQ-5D-5L nor condition-specific (Patient-Health Questionnaire-9, depression; Generalized Anxiety Disorder-7, anxiety) measures. CONCLUSIONS ReQoL-UI produced contradictory cost-effectiveness results relative to the EQ-5D-5L. The EQ-5D-5L's better responsiveness and "anxiety/depression" and "usual activities" items drove the incremental QALY results. The ReQoL-UI's single physical health item and "personal recovery" construct may have influenced its lower 8-week incremental QALY estimates in this patient sample.
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Affiliation(s)
- Matthew Franklin
- Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK.
| | - Rachael Maree Hunter
- Research Department of Primary Care and Population Health, Royal Free Medical School, University College London, London, England, UK
| | - Angel Enrique
- Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland; E-mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, Ireland
| | - Jorge Palacios
- Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland; E-mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, Ireland
| | - Derek Richards
- Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland; E-mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, Ireland
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Ho-Henriksson CM, Svensson M, Thorstensson CA, Nordeman L. Physiotherapist or physician as primary assessor for patients with suspected knee osteoarthritis in primary care - a cost-effectiveness analysis of a pragmatic trial. BMC Musculoskelet Disord 2022; 23:260. [PMID: 35300671 PMCID: PMC8932301 DOI: 10.1186/s12891-022-05201-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background Over the next decade, the number of osteoarthritis consultations in health care is expected to increase. Physiotherapists may be considered equally qualified as primary assessors as physicians for patients with knee osteoarthritis. However, economic evaluations of this model of care have not yet been described. To determine whether physiotherapists as primary assessors for patients with suspected knee osteoarthritis in primary care are a cost-effective alternative compared with traditional physician-led care, we conducted a cost-effectiveness analysis alongside a randomized controlled pragmatic trial. Methods Patients were randomized to be assessed and treated by either a physiotherapist or physician first in primary care. A cost-effectiveness analysis compared costs and effects in quality adjusted life years (QALY) for the different care models. Analyses were applied with intention to treat, using complete case dataset, and missing data approaches included last observation carried forward and multiple imputation. Non-parametric bootstrapping was conducted to assess sampling uncertainty, presented with a cost-effectiveness plane and cost-effectiveness acceptability curve. Results 69 patients were randomized to a physiotherapist (n = 35) or physician first (n = 34). There were significantly higher costs for physician visits and radiography in the physician group (p < 0.001 and p = 0.01). Both groups improved their health-related quality of life 1 year after assessment compared with baseline. There were no statistically significant differences in QALYs or total costs between groups. The incremental cost-effectiveness ratio for physiotherapist versus physician was savings of 24,266 €/lost QALY (societal perspective) and 15,533 €/lost QALY (health care perspective). There is a 72–80% probability that physiotherapist first for patients with suspected knee osteoarthritis is less costly and differs less than ±0.1 in QALY compared to traditional physician-led care. Conclusion These findings suggest that physiotherapist-led care model might reduce health care costs and lead to marginally less QALYs, but confidence intervals were wide and overlapped no difference at all. Health consequences depending on the profession of the first assessor for knee osteoarthritis seem to be comparable for physiotherapists and physicians. Direct access to physiotherapist in primary care seems to lead to fewer physician consultations and radiography. However, larger clinical trials and qualitative studies to evaluate patients’ perception of this model of care are needed. Clinical trial registration The study was retrospectively registered in clinicaltrial.gov, ID: NCT03822533. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05201-3.
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Affiliation(s)
- Chan-Mei Ho-Henriksson
- Region Västra Götaland, Primary Care Rehabilitation, Närhälsan Lidköping Rehabmottagning, Lidköping, Sweden. .,Department of Health and rehabilitation, Unit of Physiotherapy, University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden.
| | - Mikael Svensson
- University of Gothenburg, Sahlgrenska Academy, Institute of Medicine, School of Public Health and Community Medicine, Gothenburg, Sweden
| | - Carina A Thorstensson
- Department of Health and rehabilitation, Unit of Physiotherapy, University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden.,Research and Development Department at Region Halland, Halmstad, Sweden
| | - Lena Nordeman
- Department of Health and rehabilitation, Unit of Physiotherapy, University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden.,Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Research, Education, Development and Innovation Centre Södra Älvsborg, Borås, Sweden
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Masterson Creber R, Spadaccio C, Dimagli A, Myers A, Taylor B, Fremes S. Patient-Reported Outcomes in Cardiovascular Trials. Can J Cardiol 2021; 37:1340-1352. [PMID: 33974992 PMCID: PMC8487900 DOI: 10.1016/j.cjca.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/31/2021] [Accepted: 04/11/2021] [Indexed: 12/25/2022] Open
Abstract
Patient-reported outcomes (PROs) are reports of a person's health status that provide a global perspective of patient well-being. PROs can be classified into 4 primary domains: global, mental, physical, and social health. In this descriptive review, we focus on how PROs can be used in cardiac clinical trials, with an emphasis on cardiac surgical trials for patients with coronary heart disease and heart failure. We also highlight ongoing challenges and provide specific suggestions and novel opportunities to advance cardiac clinical trials. Current challenges include the long-term measurement of PROs in clinical trials beyond 1 year, inconsistency in the choice of the outcome measures among studies, and the lack of measurement of PROs across multiple domains. Opportunities for advancement include measuring PROs using consumer health informatics tools, including returning information back to participants in formats that they can understand using visualization. Future opportunities include quantifying cohort-specific minimal clinically important differences for PROs.
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Affiliation(s)
- Ruth Masterson Creber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA.
| | - Cristiano Spadaccio
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Arnaldo Dimagli
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Annie Myers
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Brittany Taylor
- School of Nursing, Columbia University, New York, New York, USA
| | - Stephen Fremes
- Sunnybrook Health Science, University of Toronto, Toronto, Ontario, Canada
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Langley PC. Peter Rabbit is a Badger in Disguise: Deconstructing the Belief System of the Institute for Clinical and Economic Review in Health Technology Assessment. Innov Pharm 2021; 12:10.24926/iip.v12i2.3992. [PMID: 34345518 PMCID: PMC8326703 DOI: 10.24926/iip.v12i2.3992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The Institute for Clinical and Economic Review (ICER), a Boston-based consulting group, has seen itself as the lead organization in the US for evaluating pharmaceuticals and, at product launch, making recommendations for pricing and access. Previous commentaries in Innovations in Pharmacy have made the case that the ICER analytical framework is nonsensical. It abandons the standards of normal science in favor of inventing evidence through unsupported assertions regarding measurement properties and lifetime assumption driven simulations. It has been labeled pseudoscience. Yet ICER persists in its belief that all preference scales have ratio properties. ICER believes it can disregard these standards, notably in respect of the axioms of fundamental evidence, and continue its technology assessment activities. Challenging a belief system is not undertaken lightly, although in the case of ICER the belief system is built on such shaky foundations that the effort seems almost superfluous. This deeply held belief, shared apparently by the majority of health economists according to ICER, that all preference scores have ratio properties with a true zero, is easily overturned: if it has ratio properties how is it that preferences scores have been known for over 30 years to recognize health states worse than death? In other words, they can have negative preferences. Recognizing this manifest contradiction is important because it brings into relief the wider belief system of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) who share the same mythical certainties. A key issue is one of cultural relativity: can we accept with equanimity the parallel existence of two belief systems in health technology assessment when one is clearly nonsense? The answer proposed here is clearly no; although unfortunately the blowback by ICER and ISPOR will ensure the survival at least in the near term of their unfortunate meme.
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Affiliation(s)
- Paul C Langley
- College of Pharmacy, University of Minnesota – Twin Cities MN; Maimon Research, Tucson AZ
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