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Naamala A, Eriksson LE, Orem J, Nalwadda GK, Kabir ZN, Wettergren L. Health-related quality of life among adult patients with cancer in Uganda - a cross-sectional study. Glob Health Action 2024; 17:2325728. [PMID: 38596846 PMCID: PMC11008308 DOI: 10.1080/16549716.2024.2325728] [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: 09/14/2023] [Accepted: 02/27/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVES The study aimed to investigate the prevalence and factors associated with poor health-related quality of life in adults with cancer in Uganda. METHODS This cross-sectional study surveyed 385 adult patients (95% response rate) with various cancers at a specialised oncology facility in Uganda. Health-related quality of life was measured using the EORTC QLQ-C30 in the Luganda and English languages. Predetermined validated clinical thresholds were applied to the instrument in order to identify patients with poor health-related quality of life, that is, functional impairments or symptoms warranting concern. Multivariable logistic regression was used to identify factors associated with poor health-related quality of life in six subscales: Physical Function, Role Function, Emotional Function, Social Function, Pain and Fatigue. RESULTS The mean age of the patients was 48 years. The majority self-reported poor functioning ranging between 61% (Emotional Function) to 79% (Physical Function) and symptoms (Fatigue 63%, Pain 80%) at clinically concerning levels. These patients were more likely to be older, without formal education and not currently working. Being an inpatient at the facility and being diagnosed with cervical cancer or leukaemia was a predictor of poor health-related quality of life. CONCLUSION Improvement of cancer care in East Africa requires a comprehensive and integrated approach that addresses various challenges specific to the region. Such strategies include investment in healthcare infrastructure, for example, clinical guidelines to improve pain management, and patient education and support services.
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Affiliation(s)
- Allen Naamala
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medical Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Lars E. Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- School of Health and Psychological Sciences, University of London, London, UK
- Medical Unit Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
| | - Jackson Orem
- Department of Medical Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Gorrette K. Nalwadda
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Zarina Nahar Kabir
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Lena Wettergren
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
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Zhang A, Li J, Mao Z, Wang Z, Wu J, Luo N, Liu P, Wang P. Psychometric performance of EQ-5D-5L and SF-6Dv2 in patients with lymphoma in China. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:1471-1484. [PMID: 38451345 DOI: 10.1007/s10198-024-01672-4] [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: 10/06/2023] [Accepted: 01/10/2024] [Indexed: 03/08/2024]
Abstract
AIM To assess and compare the measurement properties of EQ-5D-5L and SF-6Dv2 among lymphoma patients in China. METHODS A face-to-face survey of Chinese lymphoma patients was conducted at baseline (all types) and follow-up (diffuse large B-cell). EQ-5D-5L and SF-6Dv2 health utility scores (HUSs) were calculated using the respective Chinese value sets. Ceiling effect was assessed by calculating the percentage of respondents reporting the optimal health state. Convergent validity of EQ-5D-5L and SF-6Dv2 was assessed using the Spearman rank correlation coefficient (r) with QLQ-C30 as a calibration standard. Known-groups validity of the two HUSs was evaluated by comparing their scores of patients with different conditions; and their sensitivity was further assessed in the known-groups using relative efficiency (RE). Test-retest reliability and responsiveness was tested using ICC and standardized response mean (SRM), respectively. RESULTS Altogether 200 patients were enrolled at baseline and 78 were followed up. No ceiling effect was found for SF-6Dv2 compared to 24.5% for EQ-5D-5L. Correlation between the two HUSs and with QLQ-C30 score was strong (r > 0.5). Each dimension of EQ-5D-5L and SF-6Dv2 had moderate or greater correlations with similar dimensions of QLQ-C30 (r > 0.35). Both EQ-5D-5L and SF-6Dv2 could only a minority known-groups, and the latter may have better sensitivity. EQ-5D-5L had better test-retest reliability (ICC = 0.939); while both of them were responsive to patients with worsened and improved clinical status. CONCLUSIONS EQ-5D-5L and SF-6Dv2 were found to have good convergent validity and responsiveness, while EQ-5D-5L had better test-retest reliability and higher ceiling effect. Not enough evidence indicates which of the two measures has better known-group validity and sensitivity.
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Affiliation(s)
- Aixue Zhang
- School of Public Health, Fudan University, 130 Dong An Road, Shanghai, 200032, China
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), Shanghai, China
| | - Jing Li
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Zhuxin Mao
- Centre for Health Economics Research and Modelling Infectious Diseases (CHER-MID), University of Antwerp, Antwerp, Belgium
| | - Zitong Wang
- School of Public Health, Fudan University, 130 Dong An Road, Shanghai, 200032, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Peng Liu
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
| | - Pei Wang
- School of Public Health, Fudan University, 130 Dong An Road, Shanghai, 200032, China.
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), Shanghai, China.
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Daroudi R, Zeraati H, Poder TG, Norman R, Olyaeemanesh A, Sari AA, Ameri H. Valuing the SF-6Dv2 in the capital of Iran using a discrete choice experiment with duration. Qual Life Res 2024; 33:1853-1863. [PMID: 38630166 DOI: 10.1007/s11136-024-03649-5] [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: 03/10/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND The second version of the Short-Form 6-Dimension (SF-6Dv2) classification system has recently been developed. The objective of this study was to develop a value set for SF-6Dv2 based on the societal preferences of a general population in the capital of Iran. METHODS A representative sample of the capital of Iran (n = 3061) was recruited using a stratified multistage quota sampling technique. Face-to-face interviews were conducted using binary choice sets from the international valuation protocol of the discrete choice experiment with duration. The conditional logit was used to estimate the final value set, and a latent class model was employed to assess heterogeneity of preferences. RESULTS Coefficients generated from the models were logically consistent and significant. The best model was the one that included an additional interaction term for cases where one or more dimensions reached their most severe levels. It provides a value set with logical consistent coefficients and the lowest percentage of worse than death health states. Predicted values for the SF-6Dv2 were within the range of - 0.796-1. Pain dimension had the largest impact on utility decrement, whereas vitality had the least impact. The presence of preference heterogeneity was evident, and the Bayesian Information Criterion indicated the optimal fit for a latent class model with two classes. CONCLUSION This study provided the SF-6Dv2 value set for application in the context of Iran. This value set will facilitate the use of the SF-6Dv2 instrument in health economic evaluations and clinical settings.
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Affiliation(s)
- Rajabali Daroudi
- Department of Health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hojjat Zeraati
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Thomas G Poder
- Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal, Montreal, QC, Canada
- Centre de Recherche de L'Institut Universitaire en Santé Mentale de Montréal, CIUSSS de L'Est de L'île de Montréal, Montreal, QC, Canada
| | | | - Alireza Olyaeemanesh
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hosein Ameri
- Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal, Montreal, QC, Canada.
- Centre de Recherche de L'Institut Universitaire en Santé Mentale de Montréal, CIUSSS de L'Est de L'île de Montréal, Montreal, QC, Canada.
- Department of Health Management and Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Yang Q, Jiang LL, Li YF, Huang D. Prediction of the SF-6D utility score from Lung cancer FACT-L: a mapping study in China. Health Qual Life Outcomes 2023; 21:122. [PMID: 37964348 PMCID: PMC10648360 DOI: 10.1186/s12955-023-02209-8] [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: 04/26/2023] [Accepted: 11/07/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE To develop a mapping algorithm for generating the Short Form Six-Dimension (SF-6D) utility score based on the Functional Assessment of Cancer Therapy-Lung (FACT-L) of lung cancer patients. METHODS Data were collected from 625 lung cancer patients in mainland China. The Spearman rank correlation coefficient and principal component analysis were used to evaluate the conceptual overlap between the FACT-L and SF-6D. Five model specifications and four statistical techniques were used to derive mapping algorithms, including ordinary least squares (OLS), Tobit and beta-mixture regression models, which were used to directly estimate health utility, and ordered probit regression was used to predict the response level. The prediction performance was evaluated using the correlations between the root mean square error (RMSE), mean absolute error (MAE), concordance correlation coefficient (CCC), Akaike information criterion (AIC) and Bayesian information criterion (BIC) and the observed and predicted SF-6D scores. A five-fold cross-validation method was used to test the universality of each model and select the best model. RESULTS The average FACT-L score was 103.024. The average SF-6D score was 0.774. A strong correlation was found between FACT-L and SF-6D scores (ρ = 0.797). The ordered probit regression model with the total score of each dimension and its square term, as well as age and sex as covariates, was most suitable for mapping FACT-L to SF-6D scores (5-fold cross-validation: RMSE = 0.0854; MAE = 0.0655; CCC = 0.8197; AEs > 0.1 (%) = 53.44; AEs > 0.05 (%) = 21.76), followed by beta-mixture regression for direct mapping. The Bland‒Altman plots showed that the ordered probit regression M5 had the lowest proportion of prediction scores outside the 95% agreement limit (-0.166, 0.163) at 4.96%. CONCLUSIONS The algorithm reported in this paper enables lung cancer data from the FACT-L to be mapped to the utility of the SF-6D. The algorithm allows the calculation of quality-adjusted life years for cost-utility analyses of lung cancer.
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Affiliation(s)
- Qing Yang
- Nursing Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, 610041, Chengdu, China.
| | - Long Lin Jiang
- Nursing Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, 610041, Chengdu, China
| | - Yin Feng Li
- Nursing Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, 610041, Chengdu, China
| | - Deyu Huang
- School of Nursing, Chengdu Medical College, 610500, Chengdu, China
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Yang Q, Huang D, Jiang L, Tang Y, Zeng D. Obtaining SF-6D utilities from FACT-H&N in thyroid carcinoma patients: development and results from a mapping study. Front Endocrinol (Lausanne) 2023; 14:1160882. [PMID: 37664851 PMCID: PMC10470082 DOI: 10.3389/fendo.2023.1160882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Objective There is limited evidence for mapping clinical tools to preference-based generic tools in the Chinese thyroid cancer patient population. The current study aims to map the FACT-H&N (Functional Assessment of Cancer Therapy-Head and Neck Cancer) to the SF-6D (Short Form Six-Dimension), which will inform future cost-utility analyses related to thyroid cancer treatment. Methods A total of 1050 participants who completed the FACT-H&N and SF-6D questionnaires were included in the analysis. Four methods of direct and indirect mapping were estimated: OLS regression, Tobit regression, ordered probit regression, and beta mixture regression. We evaluated the predictive performance in terms of root mean square error (RMSE), mean absolute error (MAE), concordance correlation coefficient (CCC), Akaike information criterion (AIC) and Bayesian information criterion (BIC) and the correlation between the observed and predicted SF-6D scores. Results The mean value of SF-6D was 0.690 (SD = 0.128). The RMSE values for the fivefold cross-validation as well as the 30% random sample validation for multiple models in this study were 0.0833-0.0909, MAE values were 0.0676-0.0782, and CCC values were 0.6940-0.7161. SF-6D utility scores were best predicted by a regression model consisting of the total score of each dimension of the FACT-H&N, the square of the total score of each dimension, and covariates including age and gender. We proposed to use direct mapping (OLS regression) and indirect mapping (ordered probit regression) to establish a mapping model of FACT-H&N to SF-6D. The mean SF-6D and cumulative distribution functions simulated from the recommended mapping algorithm generally matched the observed ones. Conclusions In the absence of preference-based quality of life tools, obtaining the health status utility of thyroid cancer patients from directly mapped OLS regression and indirectly mapped ordered probit regression is an effective alternative.
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Affiliation(s)
- Qing Yang
- Nursing Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Deyu Huang
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Longlin Jiang
- Nursing Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Yuan Tang
- Nursing Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Dingfen Zeng
- Nursing Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
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A national survey of Iranian general population to estimate a value set for the EQ-5D-5L. Qual Life Res 2023:10.1007/s11136-023-03378-1. [PMID: 36897530 DOI: 10.1007/s11136-023-03378-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES The main aim of this study is to estimate a national value set of the EQ-5D-5L questionnaire for Iran. METHODS The composite time trade-off (cTTO) and discrete choice experiment (DCE) methods; and the protocol for EuroQol Portable Valuation Technology (EQ-PVT) were used to estimate the Iran national value set. 1179 face-to-face computer-assisted interviews were conducted with adults that were recruited from five Iran major cities in 2021. Generalized least squares, Tobit, heteroskedastic, logit, and hybrid models were used to analyze the data and to identify the best fitting model. RESULTS According to the logical consistency of the parameters, significance levels and prediction accuracy indices of the MAE; a heteroscedastic censored Tobit hybrid model combining cTTO and DCE responses was considered as the best fitting model to estimate the final value set. The predicted values ranged from - 1.19 for the worst health state (55555) to 1 for full health (11111), with 53.6% of the predicted values being negative. Mobility was the most influential dimension on health state preference values. CONCLUSIONS The present study estimated a national EQ-5D-5L value set for Iranian policy makers and researchers. The value set enables the EQ-5D-5L questionnaire to use to calculate QALYs to assist the priority setting and efficient allocation of limited healthcare resources.
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Huang D, Peng J, Chen N, Yang Q, Jiang L. Mapping study of papillary thyroid carcinoma in China: Predicting EQ-5D-5L utility values from FACT-H&N. Front Public Health 2023; 11:1076879. [PMID: 36908441 PMCID: PMC9998072 DOI: 10.3389/fpubh.2023.1076879] [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: 10/26/2022] [Accepted: 02/02/2023] [Indexed: 02/25/2023] Open
Abstract
Objective To develop a mapping algorithm that can be used to predict EQ-5D-5L health utility scores from FACT-H&N and obtain health utility parameters for Chinese patients with papillary thyroid carcinoma (PTC), which can be used for cost-utility analysis in health economic. Methods A total of 1,050 patients with PTC from a tertiary hospital in China were included, and they completed FACT-H&N and EQ-5D-5L. Four mapping algorithms of direct mapping functions were used to derive the models: Ordinary least squares (OLS), Tobit model (Tobit), Two-part model (TPM), and Beta mixture regression model (Beta). The goodness-of-fit of models was assessed by the mean absolute error (MAE), root mean square error (RMSE), Akaike information criteria (AIC), Bayesian information criteria (BIC), and absolute error (AE). A fivefold cross-validation method was used to test the stability of the models. Results The mean utility value of the EQ-5D-5L was 0.870 ± 0.094. The mean EQ-VAS score was 76.5 ± 13.0. The Beta mixture regression model mapping FACT-H&N to EQ-5D-5L achieved the best performance [fivefold cross-validation MAE = 0.04612, RMSE = 0.06829, AIC = -2480.538, BIC = -2381.137, AE > 0.05 (%) = 32.48, AE > 0.1 (%) = 8.95]. The independent variables in this model were Physical Well-Being (PWB), Emotional Well-Being (EWB), Head & Neck Cancer Subscale (HNCS) scores and its square term and interaction term scores. Conclusions This study calculated the health utility score of Chinese patients with PTC. The reported algorithms can be used to map the FACT-H&N into the EQ-5D-5L, which can be applied in the cost-utility related study of patients with PTC.
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Affiliation(s)
- Deyu Huang
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Jialing Peng
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Na Chen
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Qing Yang
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Longlin Jiang
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Hagiwara Y, Shiroiwa T, Taira N, Kawahara T, Konomura K, Noto S, Fukuda T, Shimozuma K. Gradient Boosted Tree Approaches for Mapping European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 Onto 5-Level Version of EQ-5D Index for Patients With Cancer. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:269-279. [PMID: 36096966 DOI: 10.1016/j.jval.2022.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/10/2022] [Accepted: 07/31/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to develop direct and response mapping algorithms from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 onto the 5-level version of EQ-5D index based on the gradient boosted tree (GBT), a promising modern machine learning method. METHODS We used the Quality of Life Mapping Algorithm for Cancer study data (903 observations from 903 patients) for training GBTs and testing their predictive performance. In the Quality of Life Mapping Algorithm for Cancer study, patients with advanced solid tumor were enrolled, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and 5-level version of EQ-5D were simultaneously evaluated. The Japanese value set was used for direct mapping, whereas the Japanese and US value sets were used for response mapping. We trained the GBTs in the training data set (80%) with cross-validation and tested the predictive performance measured by the root mean squared error (RMSE), mean absolute error (MAE), and mean error in the test data set (20%). RESULTS The RMSE and MAE in the test data set were larger in the GBT approaches than in the previously developed regression-based approaches. The mean error in the test data set tended to be smaller in the GBT approaches than in the previously developed regression-based approaches. CONCLUSIONS The predictive performances in the RMSE and MAE did not improve by the GBT approaches compared with regression approaches. The flexibility of the GBT approaches had the potential to reduce overprediction and underprediction in poor and good health, respectively. Further research is needed to establish the role of machine learning methods in mapping a nonpreference-based measure onto health utility.
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Affiliation(s)
- Yasuhiro Hagiwara
- Department of Biostatistics, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Takeru Shiroiwa
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako, Japan
| | - Naruto Taira
- Department of Breast and Thyroid Surgery, Kawasaki Medical School, Kurashiki, Japan
| | - Takuya Kawahara
- Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Keiko Konomura
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako, Japan
| | - Shinichi Noto
- Center for Health Economics and QOL Research, Niigata University of Health and Welfare, Niigata, Japan
| | - Takashi Fukuda
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako, Japan
| | - Kojiro Shimozuma
- Department of Biomedical Sciences, College of Life Sciences, Ritsumeikan University, Kusatsu, Japan
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Perwitasari DA, Purba FD, Candradewi SF, Dania H, Muhammad Irham L, Noor Faridah I, Septiantoro BP. Quality of Life of Cancer Patients during Chemotherapy in Indonesia: A Comparison of EORTC QLQ-C30 and EQ-5D-5L, Based on Patients' Characteristics. Int J Clin Pract 2023; 2023:9357299. [PMID: 36908296 PMCID: PMC10005864 DOI: 10.1155/2023/9357299] [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: 09/10/2022] [Revised: 01/28/2023] [Accepted: 02/11/2023] [Indexed: 03/06/2023] Open
Abstract
One of the important outcomes to define the success of cancer treatment is the health-related quality of life (HRQoL) that can be measured using generic and/or specific instruments. Our study aims to define the cancer patients' HRQoL in some hospitals in Indonesia as measured by the European Organization for Research and Treatment for Cancer (EORTC QLQ-C30) and the EQ-5D-5L, to define the differences of cancer patients' HRQoL referring to patients' characteristics, and to explore determinants of cancer patients' HRQoL. We recruited 451 cancer patients using a cross-sectional design in two referral hospitals in Central Java, Indonesia, using the purposive sampling technique. All subjects, recruited from July 2020 to October 2021, met the inclusion criteria, namely, adult patients diagnosed with cancers in all stages who willingly participated in the study. The Indonesian value set was used to obtain the EQ-5D-5L index score. We further analyzed the data based on cancer stages and compared two questionnaires using independent t test. We highlighted that most of the cancer patients are female (69.4%), young (86%), and at advanced stages of cancer (54.1%). The physical and role functions and global health status of the cancer patients are poor, and the most severe symptom is fatigue. Moreover, most of them experience severe pain and perform daily activities with difficulties. Some patients' characteristics show significant influences on the HRQoL domains in both questionnaires (p < 0.05). Interestingly, both of the questionnaires have shown significant correlations between similar domains and revealed the poor HRQoL of advanced cancer patients (p < 0.05). Our study finds that cancer patients still have poor HRQoL in some domains. We suggest to the health providers that they apply education and psychological intervention to increase their HRQoL.
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Affiliation(s)
| | - Fredrick D. Purba
- Faculty of Psychology, Universitas Padjadjaran, Jatinangor 45363, Indonesia
| | | | - Haafizah Dania
- Faculty of Pharmacy, Universitas Ahmad Dahlan, Yogyakarta 55164, Indonesia
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Safari H, Poder TG, Afshari S, Nahvijou A, Arab-Zozani M, Moradi N, Ameri H. Determination of a cost-effectiveness threshold for cancer interventions in Iran. Front Oncol 2022; 12:1039589. [PMID: 36578935 PMCID: PMC9791211 DOI: 10.3389/fonc.2022.1039589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
Background and objectives The estimation of a cost- Effectiveness (CE) threshold from the perspective of those who have experienced a life-threatening disease can provide empirical evidence for health policy makers to make the best allocation decisions on limited resources. The aim of the current study was to empirically determine the CE threshold for cancer interventions from the perspective of cancer patients in Iran. Methods A composite time trade-off (cTTO) task for deriving quality adjusted life-year (QALY) and a double-bounded dichotomous choice (DBDC) approach followed by open-ended question for examining patients' willingness-to-pay were performed. A nationally representative sample of 580 cancer patients was recruited from the largest governmental cancer centers in Iran between June 2021 and January 2022, and data were gathered using face-to-face interviews. The CE threshold was calculated using the nonparametric Turnbull model and parametric interval-censored Weibull regression model. Furthermore, the factors that affect the CE threshold were determined using the parametric model. Results The estimated CE threshold using the nonparametric Turnbull model and parametric interval-censored Weibull regression model was IRR 440,410,000 (USD 10,485.95) and IRR 595,280,000 (USD 14,173.33) per QALY, respectively. Gender, age, education, income, type of cancer, and current treatment status were significantly associated with the estimated CE threshold. Conclusions The value of parametric model-based threshold in this study was 1.98 times the Iranian GDP per capita, which was lower than the CE threshold value recommended by the WHO (i.e., 3 times the GDP per capita) for low-and middle-income countries.
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Affiliation(s)
- Hossein Safari
- Health Promotion Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Thomas G. Poder
- Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal, Montreal, QC, Canada,Centre de recherche de l’Institut universitaire en santé mentale de Montréal, CIUSSS de l’Est de l’île de Montréal, Montreal, QC, Canada
| | - Somayeh Afshari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Azin Nahvijou
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Nasrin Moradi
- Department of Health Management and Economics, School of Public Health, Iran University of Medical Science, Tehran, Iran
| | - Hosein Ameri
- Health Policy and Management Research Center, Department of Health Management and Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran,*Correspondence: Hosein Ameri,
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11
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Moradi N, Poder TG, Safari H, Mojahedian MM, Ameri H. Psychometric properties of the EQ-5D-5L compared with EQ-5D-3L in cancer patients in Iran. Front Oncol 2022; 12:1052155. [PMID: 36568223 PMCID: PMC9782428 DOI: 10.3389/fonc.2022.1052155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
Background and Objective Psychometric evidence to support the validity and reliability of the EuroQol-5 Dimensions (EQ-5D) in cancer patients is limited. This study aimed to test the validity and reliability of the EQ-5D-5L (5L) in comparison with EQ-5D-3L (3L) in cancer patients. Methods Data of 650 cancer patients were collected through consecutive sampling method from three largest governmental cancer centers in Iran between June 2021 and January 2022. The data were gathered using the 3L, 5L, and the European Organization for Research and Treatment of Cancer quality of life questionnaire (QLQ-C30) instruments. The 3L and 5L were compared in terms of ceiling effect, discriminatory power, convergent and known-groups validity, relative efficiency, inconsistency, agreement, and reliability. Results Compared with the 3L, ceiling effect decreased by 27.86%. Absolute and relative informativity of discriminatory power improved by 45.93% and 22.92% in the 5L, respectively. All convergent validity coefficients with 5L were stronger than with 3L. Both 3L and 5L demonstrated good known-groups validity, and the relative efficiency was higher for 5L in 4 out of 7 patients' characteristics. The two instruments showed low overall inconsistency (1.45%) and 92.57% of the differences of observations between the 3L and 5L were within the 95% limit of agreement. The interclass correlation coefficient (ICC) for 3L and 5L indexes were 0.88 and 0.85, respectively, and kappa coefficients in the 3L dimensions (range=0.66-0.92) were higher than the 5L(range=0.64-0.79). Conclusions The 5L demonstrated to be better than the 3L in terms of ceiling effect, inconsistency, discriminatory power, convergent validity, relative efficiency.
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Affiliation(s)
- Nasrin Moradi
- Department of Health Management and Economics, School of Public Health, Iran University of Medical Science, Tehran, Iran
| | - Thomas G. Poder
- Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal, Montreal, QC, Canada
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal, CIUSSS de l’Est de l’île de Montréal, Montreal, QC, Canada
| | - Hossein Safari
- Health Promotion Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad M. Mojahedian
- Department of Pharmacoeconomics, School of Pharmacy, Iran University of Medical Science, Tehran, Iran
| | - Hosein Ameri
- Health Policy and Management Research Center, Department of Health Management and Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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12
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Wang X, Luo H, Yao E, Tang R, Dong W, Liu F, Liang J, Xiao M, Zhang Z, Niu J, Song L, Fu L, Li X, Qian S, Guo Q, Song Z. Health utility measurement for people living with HIV/AIDS under combined antiretroviral therapy: A comparison of EQ-5D-5L and SF-6D. Medicine (Baltimore) 2022; 101:e31666. [PMID: 36397330 PMCID: PMC9666157 DOI: 10.1097/md.0000000000031666] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We compared the discriminative validity, agreement and sensitivity of EQ-5D-5L and SF-6D utility scores in people living with HIV/AIDS (PLWHIV). We conducted a cross-sectional survey among PLWHIV aged more than 18 years old in 9 municipalities in Yunnan Province, China. A convenience sample was enrolled. We administered the SF-12 and EQ-5D-5L to measure health-related quality of life. The utility index of the SF-6D was derived from the SF-12. We calculate correlation coefficients to evaluate the relationship and agreement of 2 instruments. To evaluate the homogeneity of the EQ-5D-5L and SF-6D, intraclass correlation coefficients, scatter plots, and Bland-Altman plots were computed and drawn. We also used receiver operating characteristic curves to compare the discriminative properties and sensitivity of the econometric index. A total of 1797 respondents, with a mean age of 45.6 ± 11.7 years, was interviewed. The distribution of EQ-5D-5L scores skewed towards full health with a skewness of -3.316. The overall correlation between EQ-5D-5L and SF-6D index scores was 0.46 (P < .001). The association of the 2 scales appeared stronger at the upper end. An intraclass correlation coefficient of 0.59 between the EQ-5D-5L and SF-6D meant a moderate correlation and indicated general agreement. The Bland-Altman plot displayed the same results as the scatter plot. The receiver operating characteristic curve showed that the AUC for the SF-6D was 0.776 (95% CI: 0.757, 0.796) and that for the EQ-5D-5L was 0.732 (95% CI: 0.712, 0.752) by the PCS-12, and it was 0.782 (95% CI: 0.763, 0.802) for the SF-6D and 0.690 (95% CI: 0.669, 0.711) for the EQ-5D-5L by the MCS-12. Our study demonstrated evidence of the performance of EQ-5D-5L and SF-6D index scores to measure health utility in people living with HIV/AIDS. There were significant differences in their performance. We preferred to apply the SF-6D to measure the health utility of PLWHIV during the combined antiretroviral therapy period. Our study has demonstrated evidence for instrument choice and preference measurements in PLWHIV under combined antiretroviral therapy.
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Affiliation(s)
- Xiaowen Wang
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Hongbing Luo
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Enlong Yao
- Honghe Municipal Center for Disease Control and Prevention, Honghe, China
| | - Renhai Tang
- Dehong Municipal Center for Disease Control and Prevention, Dehong, China
| | - Wenbing Dong
- Yuxi Municipal Center for Disease Control and Prevention, Yuxi, China
| | - Fuyong Liu
- Zhaotong Municipal Center for Disease Control and Prevention, Zhaotong, China
| | - Jun Liang
- Kunming Municipal Center for Disease Control and Prevention, Kunming, China
| | - Minyang Xiao
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Zuyang Zhang
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Jin Niu
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Lijun Song
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Liru Fu
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Xuehua Li
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Shicong Qian
- Wenshan Municipal Center for Disease Control and Prevention, Wenshan, China
| | - Qing Guo
- Lincang Municipal Center for Disease Control and Prevention, Lincang, China
| | - Zhizhong Song
- Yunnan Center for Disease Control and Prevention, Kunming, China
- * Correspondence: Zhizhong Song, Yunnan center for disease control and prevention, No.158, Dongsi street, Xishan municipal, Kunming, Yunnan province, China (e-mail: )
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13
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Cong J, Zhu Y, Du J, Lin L, He Y, Zhang Q, Chye TO, Lv X, Liu W, Wu X, Ma F, Zhao X, Li Y, Long L. Mapping the Minnesota Living with Heart Failure Questionnaire (MLHFQ) to SF-6Dv2 in Chinese patients with heart failure. Health Qual Life Outcomes 2022; 20:98. [PMID: 35725609 PMCID: PMC9208129 DOI: 10.1186/s12955-022-02004-x] [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: 07/09/2021] [Accepted: 06/08/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose Mapping the Minnesota Living with Heart Failure Questionnaire (MLHFQ) to SF-6Dv2 in Chinese patients with chronic heart failure, and to obtain the health utility value for health economic assessment.
Methods Four statistical algorithms, including ordinary least square method (OLS), Tobit model, robust MM estimator (MM) and censored least absolute deviations (CLAD), were used to establish the alternative model. Models were validated by using a tenfold cross-validation technique. The mean absolute error (MAE) and root mean square error (RMSE) were used to evaluate the prediction performance of the model. The Spearman correlation coefficient and Intraclass Correlation Coefficients (ICC) were used to examine the relationship between the predicted and observed SF-6Dv2 values. Results A total of 195 patients with chronic heart failure were recruited from 3 general hospitals in Beijing. The MLHFQ summary score and domain scores of the study sample were negatively correlated with SF-6Dv2 health utility value. The OLS regression model established based on the MLHFQ domain scores was the optimal fitting model and the predicted value was highly positively correlated with the observed value. Conclusion The MLHFQ can be mapped to SF-6Dv2 by OLS, which can be used for health economic assessment of cardiovascular diseases such as chronic heart failure. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-02004-x.
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Affiliation(s)
- Jianni Cong
- School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Yanbo Zhu
- School of Management, Beijing University of Chinese Medicine, Beijing, 102488, China.
| | - Jinhang Du
- Cardiology Department of Integrated Traditional Chinese and Western Medicine, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Lin Lin
- Department of Personnel, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Yuan He
- University of Paris Saclay, 91190, Saint-Aubin, France
| | - Qian Zhang
- School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Tan Ooh Chye
- School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Xiaoying Lv
- School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Wenqiong Liu
- School of Management, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Xinrui Wu
- School of Management, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Fanghui Ma
- School of Management, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Xinyuan Zhao
- School of Management, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Yuqiong Li
- School of Management, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Liqun Long
- School of Management, Beijing University of Chinese Medicine, Beijing, 102488, China
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Esmaeili MH, Seyednejad F, Mahboub-Ahari A, Ameri H, Abdollahzad H, Safaei N, Alinezhad F, Yousefi M. Cost-effectiveness analysis of lung cancer screening with low-dose computed tomography in an Iranian high-risk population. J Med Screen 2021; 28:494-501. [PMID: 34039102 DOI: 10.1177/09691413211018253] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The results of recent studies have shown that using low-dose computed tomography (LDCT) for screening of lung cancer (LC) improves cancer outcomes. The objective of the current study was to evaluate the cost-effectiveness of LDCT in an Iranian high-risk population. METHODS A Markov cohort simulation model with four health states was used to evaluate the cost-effectiveness of LDCT from a healthcare system perspective in the people aged 55-74 who smoked 25 or more cigarettes per day for 10-30 years. Cost data were collected, reviewing 324 medical records of patients with LC, and utilities and transition probabilities were extracted from the literature. The Monte Carlo simulation method was applied to run the model. Probabilistic sensitivity analysis and one-way analysis were also performed. RESULTS LC screening in comparison to a no-screening strategy was costly and effective. The incremental cost-effectiveness ratio of screening versus no-screening was IRR (Iranian rials) 98,515,014.04 which falls below the Iranian threshold of three times GDP (gross domestic product) per capita. One-way and probabilistic sensitivity analyses demonstrated that the results of the economic analysis were robust to variations in the key inputs for both. CONCLUSIONS Using LDCT for screening of LC patients in a high-risk population is a cost-effective strategy.
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Affiliation(s)
- Mansur Haji Esmaeili
- Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farshad Seyednejad
- Department of Radiation Oncology, Madani Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Mahboub-Ahari
- Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hosein Ameri
- Health Policy and Management Research Center, Department of Health Services Management, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hadi Abdollahzad
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Naser Safaei
- Madani Heart Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farbod Alinezhad
- Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmood Yousefi
- Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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