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Bailey C, Howell M, Raghunandan R, Salisbury A, Chen G, Coast J, Craig JC, Devlin NJ, Huynh E, Lancsar E, Mulhern BJ, Norman R, Petrou S, Ratcliffe J, Street DJ, Howard K, Viney R. Preference Elicitation Techniques Used in Valuing Children's Health-Related Quality-of-Life: A Systematic Review. PHARMACOECONOMICS 2022; 40:663-698. [PMID: 35619044 PMCID: PMC9270310 DOI: 10.1007/s40273-022-01149-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 05/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Valuing children's health states for use in economic evaluations is globally relevant and is of particular relevance in jurisdictions where a cost-utility analysis is the preferred form of analysis for decision making. Despite this, the challenges with valuing child health mean that there are many remaining questions for debate about the approach to elicitation of values. The aim of this paper was to identify and describe the methods used to value children's health states and the specific issues that arise in the use of these methods. METHODS We conducted a systematic search of electronic databases to identify studies published in English since 1990 that used preference elicitation methods to value child and adolescent (under 18 years of age) health states. Eligibility criteria comprised valuation studies concerning both child-specific patient-reported outcome measures and child health states defined in other ways, and methodological studies of valuation approaches that may or may not have yielded a value set algorithm. RESULTS A total of 77 eligible studies were identified from which data on country setting, aims, condition (general population or clinically specific), sample size, age of respondents, the perspective that participants were asked to adopt, source of values (respondents who completed the preference elicitation tasks) and methods questions asked were extracted. Extracted data were classified and evaluated using narrative synthesis methods. The studies were classified into three groups: (1) studies comparing elicitation methods (n = 30); (2) studies comparing perspectives (n = 23); and (3) studies where no comparisons were presented (n = 26); selected studies could fall into more than one group. Overall, the studies varied considerably both in methods used and in reporting. The preference elicitation tasks included time trade-off, standard gamble, visual analogue scaling, rating/ranking, discrete choice experiments, best-worst scaling and willingness to pay elicited through a contingent valuation. Perspectives included adults' considering the health states from their own perspective, adults taking the perspective of a child (own, other, hypothetical) and a child/adolescent taking their own or the perspective of another child. There was some evidence that children gave lower values for comparable health states than did adults that adopted their own perspective or adult/parents that adopted the perspective of children. CONCLUSIONS Differences in reporting limited the conclusions that can be formed about which methods are most suitable for eliciting preferences for children's health and the influence of differing perspectives and values. Difficulties encountered in drawing conclusions from the data (such as lack of consensus and poor reporting making it difficult for users to choose and interpret available values) suggest that reporting guidelines are required to improve the consistency and quality of reporting of studies that value children's health using preference-based techniques.
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Affiliation(s)
- Cate Bailey
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Melbourne, VIC, Australia.
| | - Martin Howell
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Rakhee Raghunandan
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Amber Salisbury
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, VIC, Australia
| | - Joanna Coast
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Nancy J Devlin
- Centre for Health Policy, University of Melbourne, Melbourne, VIC, Australia
| | - Elisabeth Huynh
- Department of Health Services and Policy Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Emily Lancsar
- Department of Health Services and Policy Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Brendan J Mulhern
- Centre for Health Economics, Research and Evaluation (CHERE), University of Technology Sydney, Sydney, NSW, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Deborah J Street
- Centre for Health Economics, Research and Evaluation (CHERE), University of Technology Sydney, Sydney, NSW, Australia
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Rosalie Viney
- Centre for Health Economics, Research and Evaluation (CHERE), University of Technology Sydney, Sydney, NSW, Australia
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Mayoral K, Rajmil L, Murillo M, Garin O, Pont A, Alonso J, Bel J, Perez J, Corripio R, Carreras G, Herrero J, Mengibar JM, Rodriguez-Arjona D, Ravens-Sieberer U, Raat H, Serra-Sutton V, Ferrer M. Measurement Properties of the Online EuroQol-5D-Youth Instrument in Children and Adolescents With Type 1 Diabetes Mellitus: Questionnaire Study. J Med Internet Res 2019; 21:e14947. [PMID: 31714252 PMCID: PMC6880238 DOI: 10.2196/14947] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/13/2019] [Accepted: 09/24/2019] [Indexed: 11/23/2022] Open
Abstract
Background The lack of continuity between health-related quality of life (HRQoL) instruments designed for children and adults hinders change analysis with a life course approach. To resolve this gap, EuroQol (EQ) developed the EQ-5D-Youth (EQ-5D-Y), derived from the EQ-5D for adults. Few studies have assessed the metric properties of EQ-5D-Y in children with specific chronic conditions, and none have done so for children with type I diabetes mellitus (T1DM). Objective This study aimed to evaluate the acceptability, validity, reliability, and responsiveness of the EQ-5D-Y in children and adolescents with T1DM, when administered online. Methods Participants with T1DM were consecutively recruited from July to December 2014, from a list of potential candidates aged 8-19 years, who attended outpatient pediatric endocrinology units. Before every quarterly routine visit, participants received an email/telephone reminder to complete the online version of two generic HRQoL questionnaires: EQ-5D-Y and KIDSCREEN-27. The EQ-5D-Y measures five dimensions, from which an equally weighted summary score was constructed (range: 0-100). Completion rate and distribution statistics were calculated. Construct validity was evaluated through known group comparisons based on general health, acute diabetic decompensations, mental health, family function, and a multitrait, multimethod matrix between EQ-5D-Y and KIDSCREEN by using Spearman correlations. Construct validity hypotheses were stated a priori. Reliability was assessed with the intraclass correlation coefficient and responsiveness by testing changes over time and calculating the effect size. Reliability and responsiveness were tested among the stable and improved subsamples defined by a KIDSCREEN-10 index change of <4.5 points or ≥4.5 points, respectively, from the first to the fourth visit. Results Of the 136 participants, 119 (87.5%) responded to the EQ-5D-Y at the last visit. The dimensions that showed higher percentages of participants with problems were “having pain/discomfort” (34.6%) and “worried/sad/unhappy” (28.7%). The mean (SD) of the EQ-5D-Y summary score was 8.5 (10.9), with ceiling and floor effects of 50.7% and 0%, respectively. Statistically significant HRQoL differences between groups defined by their general health (excellent/very good and good/regular/bad) and mental health (Strengths and Difficulties Questionnaire score ≤15 and >16, respectively) were found in three EQ-5D-Y dimensions (“doing usual activities,” “having pain/discomfort,” and “feeling worried/sad/unhappy”), summary score (effect size for general health and mental health groups=0.7 and 1.5, respectively), and KIDSCREEN-10 index (effect size for general health and mental health groups=0.6 and 0.9, respectively). Significant differences in the EQ-5D-Y dimensions were also found according to acute diabetic decompensations in “looking after myself” (P=.005) and according to family function in “having pain/discomfort” (P=.03). Results of the multitrait, multimethod matrix confirmed three of the four relationships hypothesized as substantial (0.21, 0.58, 0.50, and 0.46). The EQ-5D-Y summary score presented an intraclass correlation coefficient of 0.83. Statistically significant change between visits was observed in the improved subsample, with an effect size of 0.7 (P<.001). Conclusions These results support the use of the EQ-5D-Y administered online as an acceptable, valid, reliable, and responsive instrument for evaluating HRQoL in children and adolescents with T1DM.
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Affiliation(s)
- Karina Mayoral
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Luis Rajmil
- Agency for Health Quality & Assessment of Catalonia, Barcelona, Spain
| | - Marta Murillo
- Pediatric Service, Department of Pediatric Endocrinology, University Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Olatz Garin
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.,Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Angels Pont
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Jordi Alonso
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.,Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Joan Bel
- Pediatric Service, Department of Pediatric Endocrinology, University Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Jacobo Perez
- Department of Pediatric Endocrine, Hospital of Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain.,University Institute Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Raquel Corripio
- Department of Pediatric Endocrine, Hospital of Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain.,University Institute Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Gemma Carreras
- Pediatric Endocrinology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Herrero
- Corporació de Salut del Maresme i la Selva, Hospital de Calella, Calella, Spain
| | - Jose-Maria Mengibar
- Corporació de Salut del Maresme i la Selva, Hospital de Blanes, Blanes, Spain
| | | | - Ulrike Ravens-Sieberer
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Vicky Serra-Sutton
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.,Agency for Health Quality & Assessment of Catalonia, Barcelona, Spain
| | - Montse Ferrer
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
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Fang X, Bai G, Windhorst DA, Feeny D, Saigal S, Duijts L, Jaddoe VWV, Hu S, Jin C, Raat H. Feasibility and validity of the Health Status Classification System-Preschool (HSCS-PS) in a large community sample: the Generation R study. BMJ Open 2018; 8:e022449. [PMID: 30567820 PMCID: PMC6303628 DOI: 10.1136/bmjopen-2018-022449] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility, discriminant validity and concurrent validity of the Health Status Classification System-Preschool (HSCS-PS) in children aged 3 years in a large community sample in the Netherlands. DESIGN/SETTING A prospective population-based cohort in Rotterdam, the Netherlands. PARTICIPANTS A questionnaire was administrated to a sample of parents of 4546 children (36.7±1.5 months). OUTCOME MEASURES Health-related quality of life (HRQOL) of children was measured by HSCS-PS. The HSCS-PS consists of 10 original domains. Two single-item measures of 'General health' and 'Behavior' were added. A disability score was calculated by summing up all 10 original domains to describe the overall health status. Feasibility was assessed by the response rate, percentages of missing answers, score distributions and the presence of floor/ceiling effects. Discriminant validity was analysed between subgroups with predefined conditions: low birth weight, preterm birth, wheezing, Ear-Nose-Throat surgical procedures and behaviour problems. In the absence of another HRQOL measure, this study uses the single-items 'General health' and 'Behavior' as a first step to evaluate concurrent validity of the HSCS-PS. RESULTS Feasibility: response rate was 69%. Ceiling effects were observed in all domains. Discriminant validity: the disability score discriminated clearly between subgroups of children born with a 'very low birth weight', 'very preterm birth', with 'four or more than four times wheezing', 'at least one ear-nose-throat surgical procedures', 'behaviour problems present' and the 'reference' group. Concurrent validity: HSCS-PS domains correlated better with hypothesised parallel additional domains than with other non-hypothesised original domains. CONCLUSIONS This study supports the feasibility and validity of the HSCS-PS among preschoolers in community settings. We recommend developing a utility-based scoring algorithm for the HSCS-PS. Further empirical studies and repeated evaluations in varied populations are recommended.
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Affiliation(s)
- Xinye Fang
- Shanghai Medical Information Center, Shanghai, China
- Shanghai Health Development Research Center, Shanghai, China
| | - Guannan Bai
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
- The Generation R Group, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dafna A Windhorst
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - David Feeny
- Department of Economics and Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Saroj Saigal
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Liesbeth Duijts
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
- Division of Neonatology, Department of Pediatrics, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Group, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Shanlian Hu
- Shanghai Health Development Research Center, Shanghai, China
| | - Chunlin Jin
- Shanghai Medical Information Center, Shanghai, China
- Shanghai Health Development Research Center, Shanghai, China
| | - Hein Raat
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
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Hays RD, Revicki DA, Feeny D, Fayers P, Spritzer KL, Cella D. Using Linear Equating to Map PROMIS(®) Global Health Items and the PROMIS-29 V2.0 Profile Measure to the Health Utilities Index Mark 3. PHARMACOECONOMICS 2016; 34:1015-22. [PMID: 27116613 PMCID: PMC5026900 DOI: 10.1007/s40273-016-0408-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Preference-based health-related quality of life (HR-QOL) scores are useful as outcome measures in clinical studies, for monitoring the health of populations, and for estimating quality-adjusted life-years. METHODS This was a secondary analysis of data collected in an internet survey as part of the Patient-Reported Outcomes Measurement Information System (PROMIS(®)) project. To estimate Health Utilities Index Mark 3 (HUI-3) preference scores, we used the ten PROMIS(®) global health items, the PROMIS-29 V2.0 single pain intensity item and seven multi-item scales (physical functioning, fatigue, pain interference, depressive symptoms, anxiety, ability to participate in social roles and activities, sleep disturbance), and the PROMIS-29 V2.0 items. Linear regression analyses were used to identify significant predictors, followed by simple linear equating to avoid regression to the mean. RESULTS The regression models explained 48 % (global health items), 61 % (PROMIS-29 V2.0 scales), and 64 % (PROMIS-29 V2.0 items) of the variance in the HUI-3 preference score. Linear equated scores were similar to observed scores, although differences tended to be larger for older study participants. CONCLUSIONS HUI-3 preference scores can be estimated from the PROMIS(®) global health items or PROMIS-29 V2.0. The estimated HUI-3 scores from the PROMIS(®) health measures can be used for economic applications and as a measure of overall HR-QOL in research.
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Affiliation(s)
- Ron D Hays
- Division of General Internal Medicine, Department of Medicine, UCLA, 911 Broxton Avenue, Los Angeles, CA, 90024, USA.
| | | | - David Feeny
- Department of Economics, McMaster University, Hamilton, ON, Canada
- Health Utilities Incorporated, Dundas, ON, Canada
| | - Peter Fayers
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karen L Spritzer
- Division of General Internal Medicine, Department of Medicine, UCLA, 911 Broxton Avenue, Los Angeles, CA, 90024, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Abstract
OBJECTIVE To assess long-term health status and health-related quality of life in survivors of cardiac arrest in childhood and their parents. In addition, to identify predictors of health status and health-related quality of life. DESIGN This medical follow-up study involved consecutive children surviving cardiac arrest between January 2002 and December 2011, who had been admitted to the ICU. Health status was assessed with a medical interview, physical examination, and the Health Utilities Index. Health-related quality of life was assessed with the Child Health Questionnaires and Short-Form 36. SETTING A tertiary care university children's hospital. PATIENTS Of the eligible 107 children, 57 (53%) filled out online questionnaires and 47 visited the outpatient clinic (median age, 8.7 yr; median follow-up interval, 5.6 yr). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of the participants, 60% had an in-hospital cardiac arrest, 90% a nonshockable rhythm, and 50% a respiratory etiology of arrest. Mortality rate after hospital discharge was 10%. On health status, we found that 13% had long-term neurologic deficits, 34% chronic symptoms (e.g., fatigue, headache), 19% at least one sign suggestive of chronic kidney injury, and 15% needed special education. Health Utilities Index scores were significantly decreased on most utility scores and the overall Health Utilities Index mark 3 score. Compared with Dutch normative data, parent-reported health-related quality of life of cardiac arrest survivors was significantly worse on general health perception, physical role functioning, parental impact, and overall physical summary. On patient reports, no significant differences with normative data were found. Parents reported better family cohesion and better health-related quality of life for themselves on most scales. Patients' health status, general health perceptions, and physical summary scores were significantly associated with cardiac arrest-related preexisting condition. CONCLUSIONS Considering the impact of cardiac arrest, the overall outcome after cardiac arrest in childhood is reasonably good. Prospective long-term outcome research in large homogeneous groups is needed.
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Anink J, Prince FHM, Dijkstra M, Otten MH, Twilt M, ten Cate R, Gorter SL, Koopman-Keemink Y, van Rossum MAJ, Hoppenreijs EPA, van Suijlekom-Smit LWA. Long-term quality of life and functional outcome of patients with juvenile idiopathic arthritis in the biologic era: a longitudinal follow-up study in the Dutch Arthritis and Biologicals in Children Register. Rheumatology (Oxford) 2015; 54:1964-9. [PMID: 26078219 DOI: 10.1093/rheumatology/kev195] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To carry out a longitudinal investigation of functional outcome, health-related quality of life (HRQoL) and treatment strategies in JIA patients who started etanercept >5 years ago. METHODS We approached patients whose HRQoL changes were described previously in a subanalysis of the Dutch Arthritis and Biologicals in Children register. Recent disease status, co-morbidities and structural damage were retrieved. Disability and HRQoL were assessed by (Childhood) HAQ [(C)HAQ], Child Health Questionnaire, Short Form 36 and Health Utilities Index Mark 3. Changes over time were analysed with linear mixed models. RESULTS Forty-three patients (81% response) started etanercept a median 8.5 years ago. At the time of this long-term analysis, median age was 22 years (interquartile range: 18-24 years). HRQoL outcome was similar to HRQoL 15-27 months after the initiation of etanercept; 42% had a (C)HAQ of 0.00 and 67% had achieved inactive disease. Patients reported increasing levels of bodily pain compared with earlier measurements. Unemployment (12%) was comparable to the general population; educational level was higher. Use of biologic agents was as follows: 40% etanercept; 40% other biologic agents; and 20% none. Joint surgery occurred in 14% of patients. CONCLUSION At a median 8.5 years after the commencement of etanercept treatment, JIA patients maintain most of the acquired improvement in HRQoL. Although disability and disease activity are low, chronic pain remains an issue. Persistence and possible deterioration of radiological damage emphasize the importance of early treatment. The fact that 20% of patients do not use any anti-rheumatic medication shows that clinical remission of medication might be an achievable goal.
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Affiliation(s)
- Janneke Anink
- Department of Paediatrics/Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam,
| | - Femke H M Prince
- Department of Paediatrics/Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam
| | - Maryanne Dijkstra
- Department of Paediatrics/Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam
| | - Marieke H Otten
- Department of Paediatrics/Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam
| | - Marinka Twilt
- Department of Paediatrics/Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam
| | - Rebecca ten Cate
- Department of Paediatrics/Paediatric Rheumatology, Leiden University Medical Centre, Leiden
| | - Simone L Gorter
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht
| | | | - Marion A J van Rossum
- Department of Paediatrics/Paediatric Rheumatology, Emma Children's Hospital/Academic Medical Centre and Reade location Jan van Breemen, Amsterdam and
| | - Esther P A Hoppenreijs
- Department of Paediatrics/Paediatric Rheumatology, St Maartenskliniek and Radboud University Medical Centre, Nijmegen, The Netherlands
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Gandhi M, Thumboo J, Wee HL, Luo N, Cheung YB. How is the most severe health state being valued by the general population? Health Qual Life Outcomes 2014; 12:161. [PMID: 25344269 PMCID: PMC4212106 DOI: 10.1186/s12955-014-0161-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 10/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been reported that valuation of health states that are close to death, such as the most severe health state, can be affected by health state valuation procedure, and their utility values are difficult to predict. We examined how the most severe health states of Short Form-6 dimension (SF-6D) and EuroQoL-5 dimension-3 level (EQ-5D-3L) were valued by the Singapore general population. METHODS Overall, 249 SF-6D and 42 EQ-5D-3L states were valued by two separate samples from the Singapore general population using the visual analogue scale (VAS) method. Ordinary least-square regression model was employed to explain deficit in the valuation of the most severe state using the health state descriptors. RESULTS A total of 1021 participants from the SF-6D sample and 1015 participants from the EQ-5D-3L sample were included in the analysis. We observed that 67% of the SF-6D participants and 74% of the EQ-5D-3L participants considered the most severe state worse than dead. The most severe state had mean VAS valuation scores more than 20-25 points lower than the adjacent states that are better by only one level in only one dimension. SF-6D VAS valuation score for the most severe state was 27 points and 12 points lower than expected according to the health state descriptors among the participants who considered the most severe state worse than dead and better than dead, respectively. Similar results were found for the EQ-5D-3L valuation. CONCLUSIONS The most severe health state was valued lower than expected according to its descriptors.
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Affiliation(s)
- Mihir Gandhi
- Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore. .,Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore. .,Department of International Health, School of Medicine, University of Tampere, Tampere, Finland.
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore. .,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Hwee-Lin Wee
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore.
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Yin-Bun Cheung
- Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore. .,Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore. .,Department of International Health, School of Medicine, University of Tampere, Tampere, Finland.
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van Litsenburg RRL, Huisman J, Raat H, Kaspers GJL, Gemke RJBJ. Health-related quality of life and utility scores in short-term survivors of pediatric acute lymphoblastic leukemia. Qual Life Res 2012; 22:677-81. [PMID: 22547048 PMCID: PMC3607731 DOI: 10.1007/s11136-012-0183-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2012] [Indexed: 11/30/2022]
Abstract
Purpose Increase of survival in pediatric acute lymphoblastic leukemia (ALL) has made outcomes such as health-related quality of life (HRQL) and economic burden more important. To make informed decisions on the use of healthcare resources, costs as well as utilities need to be taken into account. Among the preference-based HRQL instruments, the Health Utilities Index (HUI) is the most employed in pediatric cancer. Information on utility scores during ALL treatment and in long-term survivors is available, but utility scores in short-term survivors are lacking. This study assesses utility scores, health state, and HRQL in short-term (6 months to 4 years) ALL survivors. Methods Cross-sectional single-center cohort study of short-term ALL survivors using HUI3 proxy assessments. Results Thirty-three survivors (median 1.5 years off treatment) reported 14 unique health states. The majority of survivors (61 %) enjoyed a perfect health, but 21 % had three affected attributes. Overall, HRQL was nonsignificantly lower compared to the norm, although the difference was large and may be clinically relevant. Cognition was significantly impaired (p = 0.03). Conclusion Although 61 % of short-term survivors of ALL report no impairment, the health status of the other patients lead to a clinically important impaired HRQL compared to norms. Prospective studies assessing utility scores associated with pediatric ALL should be performed, enabling valid and reliable cost-utility analyses for policy makers to make informed decisions.
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Affiliation(s)
- Raphaële R L van Litsenburg
- Department of Pediatrics, VU University Medical Center Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
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Health-related problems and quality of life in patients with syndromic and complex craniosynostosis. Childs Nerv Syst 2012; 28:879-82. [PMID: 22234545 PMCID: PMC3360850 DOI: 10.1007/s00381-012-1681-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 01/02/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE We conducted this study to gauge the health-related problems, quality of life and the performance of the Health Utility Index Mark 3 (HUI-3) in patients with syndromic and complex craniosynostosis. Patients with syndromic and complex craniosynostosis have various physical and mental problems. More insight on these problems, per syndrome, could provide guidance to improve patient treatment and follow-up. METHODS A cross-sectional, comparative study on 131 patients and their parents was performed. Health-related quality of life was measured with the HUI-3 and the Visual Analogue Scale (VAS). All data were compared to a normative Dutch population. Vision, hearing and intelligence were objectively measured. RESULTS The HUI-3 and the VAS were significant lower compared to the normative Dutch population. All syndromes have a high prevalence of vision and speech problems. Cognitive problems were mainly reported in patients with Apert, Crouzon and Muenke syndrome. Ambulation and dexterity problems were seen in Apert, Crouzon, Saethre-Chotzen and complex craniosynostosis. Only patients with Apert syndrome scored significantly worse on pain. The HUI-3 had a medium to strong correlation with the objectively measured outcomes. CONCLUSIONS The overall quality of life is lower in patients with syndromic and complex craniosynostosis. To improve quality of life, more attention is needed for problems with vision and speech.
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Feeny D, Spritzer K, Hays RD, Liu H, Ganiats TG, Kaplan RM, Palta M, Fryback DG. Agreement about identifying patients who change over time: cautionary results in cataract and heart failure patients. Med Decis Making 2011; 32:273-86. [PMID: 22009666 DOI: 10.1177/0272989x11418671] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Preference-based measures of health-related quality of life all use the same dead = 0.00 to perfect health = 1.00 scale, but there are substantial differences among measures. OBJECTIVE The objective was to examine agreement in classifying patients as better, stable, or worse. METHODS The EQ-5D, Health Utilities Index Mark 2 and Mark 3, Quality of Well-Being-Self-Administered scale, Short-Form 36 (Short-Form 6D), and disease-targeted measures were administered prospectively in 2 clinical cohorts. The study was conducted at academic medical centers: University of California, Los Angeles; University of California, San Diego; University of Wisconsin-Madison; and University of Southern California. Patients undergoing cataract extraction surgery with lens replacement completed the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Patients newly referred to congestive heart failure specialty clinics completed the Minnesota Living with Heart Failure Questionnaire (MLHF). In both cohorts, subjects completed surveys at baseline and at 1 and 6 months. The NEI-VFQ-25 and MLHF were used as gold standards to assign patients to categories of change. Agreement was assessed using κ. RESULTS There were 376 cataract patients recruited. Complete data for baseline and the 1-month follow-up were available on all measures for 210 cases. Using criteria specified by Altman, agreement was poor for 6 of 9 pairs of comparisons and fair for 3 pairs. There were 160 heart failure patients recruited. Complete data for baseline and the 6-month follow-up were available for 86 cases. Agreement was negligible for 5 pairs and fair for 1. The study was conducted on selected patients at a few academic medical centers. CONCLUSIONS The results underscore the lack of interchangeability among different preference-based measures.
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Affiliation(s)
- David Feeny
- The Center for Health Research, Kaiser Permanente Northwest and Health Utilities Incorporated, Portland, OR (DF)
| | - Karen Spritzer
- Department of Medicine, University of California, Los Angeles (KS, RDH)
| | - Ron D Hays
- Department of Medicine, University of California, Los Angeles (KS, RDH)
| | - Honghu Liu
- School of Dentistry, University of California, Los Angeles (HL)
| | - Theodore G Ganiats
- Department of Family and Preventive Medicine, University of California, San Diego (TGG)
| | - Robert M Kaplan
- Department of Health Services Research, University of California, Los Angeles (RMK)
| | - Mari Palta
- Department of Population Health Sciences, University of Wisconsin-Madison (MP, DGF)
| | - Dennis G Fryback
- Department of Population Health Sciences, University of Wisconsin-Madison (MP, DGF)
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Bray P, Bundy AC, Ryan MM, North KN, Burns J. Health status of boys with Duchenne muscular dystrophy: a parent's perspective. J Paediatr Child Health 2011; 47:557-62. [PMID: 21392149 DOI: 10.1111/j.1440-1754.2011.02022.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM To investigate parent-reported health status of boys with Duchenne muscular dystrophy (DMD) compared with a large Australian normative population and a cohort of children with Charcot-Marie-Tooth disease type 1A (CMT1A). METHODS The Child Health Questionnaire parent form (CHQ-PF50) was completed by parents of 34 boys with confirmed DMD. Seventeen parents were followed up at 6 months. CHQ-PF50 data were compared with 2620 age-matched norms and 90 children with CMT1A. RESULTS All domains of the CHQ-PF50 for the DMD cohort were significantly lower than the general paediatric population, particularly for physical functioning (t = -17.2, P < 0.001) and the child's ability to fulfil school and social roles because of physical limitations (t = -9.4, P < 0.001). Parents experienced greatest emotional impact of their child's DMD around the time of loss of ambulation. Children with DMD had lower health status compared with children with CMT1A with the exception of the behaviour and pain domains. Physical functioning worsened during 6 months (P = 0.04); no other changes in health status were observed at follow-up. CONCLUSIONS Parents report the impact of DMD on health status to be considerably worse when compared with CMT1A. Interventions should target minimising the impact of physical limitations on role functioning.
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Affiliation(s)
- Paula Bray
- Institute for Neuroscience and Muscle Research, The Children’s Hospital at Westmead, Westmead, Sydney, NSW, Australia.
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Prince FHM, de Bekker-Grob EW, Twilt M, van Rossum MAJ, Hoppenreijs EPAH, ten Cate R, Koopman-Keemink Y, Gorter SL, Raat H, van Suijlekom-Smit LWA. An analysis of the costs and treatment success of etanercept in juvenile idiopathic arthritis: results from the Dutch Arthritis and Biologicals in Children register. Rheumatology (Oxford) 2011; 50:1131-6. [PMID: 21278067 DOI: 10.1093/rheumatology/keq432] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To analyse and report the costs and effects of etanercept therapy in patients with JIA. METHODS Forty-nine JIA patients were evaluated by means of the JIA core set at the start of etanercept and after 3, 15 and 27 months of therapy. At the same time-points, parents of the patients were asked to complete the Health Utility Index Mark 3 (HUI3). Direct medical costs were collected for 1 year before and 27 months after the start of etanercept and compared with gain in utility. RESULTS Mean total direct medical costs after the start of etanercept were on average 12 478 euros per patient-year compared with 3720 euros before start. The cost analysis showed that three-quarters of total direct medical costs were from etanercept itself. Other direct medical costs, such as costs concerning hospitalization and concomitant medication, decreased compared with the costs in the period before start of etanercept. Especially a great reduction of consultations at the outpatient clinic was seen. Utility was 0.53 before start of etanercept, according to the multi-attribute utility function of the HUI3 on a scale from 0 (dead) to 1 (perfect health). After 27 months, utility was 0.78. In accordance, also all JIA core set response variables improved significantly over 27 months of etanercept treatment. CONCLUSIONS Although costs of etanercept therapy are substantial, the gain in utility is even more impressive. Considering that these JIA patients were previously refractory to conventional treatment including MTX, and were at risk of long-time disability and pain, costs are justifiable.
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Affiliation(s)
- Femke H M Prince
- Department of Paediatrics/ Paediatric Rheumatology, Room Sp-1546, Erasmus MC Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands.
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The Generation R study: a candidate gene study and genome-wide association study (GWAS) on health-related quality of life (HRQOL) of mothers and young children. Qual Life Res 2010; 19:1439-46. [DOI: 10.1007/s11136-010-9773-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2010] [Indexed: 10/18/2022]
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Hafkamp-de Groen E, Mohangoo AD, de Jongste JC, van der Wouden JC, Moll HA, Jaddoe VW, Hofman A, de Koning HJ, Raat H. Early detection and counselling intervention of asthma symptoms in preschool children: study design of a cluster randomised controlled trial. BMC Public Health 2010; 10:555. [PMID: 20843313 PMCID: PMC2944378 DOI: 10.1186/1471-2458-10-555] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 09/15/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prevention of childhood asthma is an important public health objective. This study evaluates the effectiveness of early detection of preschool children with asthma symptoms, followed by a counselling intervention at preventive child health centres. Early detection and counselling is expected to reduce the prevalence of asthma symptoms and improve health-related quality of life at age 6 years. METHODS/DESIGN This cluster randomised controlled trial was embedded within the Rotterdam population-based prospective cohort study Generation R in which 7893 children (born between April 2002 and January 2006) participated in the postnatal phase. Sixteen child health centres are involved, randomised into 8 intervention and 8 control centres. Since June 2005, an early detection tool has been applied at age 14, 24, 36 and 45 months at the intervention centres. Children who met the intervention criteria received counselling intervention (personal advice to parents to prevent smoke exposure of the child, and/or referral to the general practitioner or asthma nurse). The primary outcome was asthma diagnosis at age 6 years. Secondary outcomes included frequency and severity of asthma symptoms, health-related quality of life, fractional exhaled nitric oxide and airway resistance at age 6 years. Analysis was according to the intention-to-treat principle. Data collection will be completed end 2011. DISCUSSION This study among preschool children provides insight into the effectiveness of early detection of asthma symptoms followed by a counselling intervention at preventive child health centres. TRIAL REGISTRATION Current Controlled Trials ISRCTN15790308.
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Feeny D, Kaplan MS, Huguet N, McFarland BH. Comparing population health in the United States and Canada. Popul Health Metr 2010; 8:8. [PMID: 20429875 PMCID: PMC2873793 DOI: 10.1186/1478-7954-8-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 04/29/2010] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The objective of the paper is to compare population health in the United States (US) and Canada. Although the two countries are very similar in many ways, there are potentially important differences in the levels of social and economic inequality and the organization and financing of and access to health care in the two countries. METHODS Data are from the Joint Canada/United States Survey of Health 2002/03. The Health Utilities Index Mark 3 (HUI3) was used to measure overall health-related quality of life (HRQL). Mean HUI3 scores were compared, adjusting for major determinants of health, including body mass index, smoking, education, gender, race, and income. In addition, estimates of life expectancy were compared. Finally, mean HUI3 scores by age and gender and Canadian and US life tables were used to estimate health-adjusted life expectancy (HALE). RESULTS Life expectancy in Canada is higher than in the US. For those < 40 years, there were no differences in HRQL between the US and Canada. For the 40+ group, HRQL appears to be higher in Canada. The results comparing the white-only population in both countries were very similar. For a 19-year-old, HALE was 52.0 years in Canada and 49.3 in the US. CONCLUSIONS The population of Canada appears to be substantially healthier than the US population with respect to life expectancy, HRQL, and HALE. Factors that account for the difference may include access to health care over the full life span (universal health insurance) and lower levels of social and economic inequality, especially among the elderly.
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Affiliation(s)
- David Feeny
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Avenue, Portland, OR, 97227, USA
- University of Alberta and Institute of Health Economics, 10405 Jasper Avenue, #1200, Edmonton, AB, T5J 3N4, Canada
- Health Utilities Incorporated, 88 Sydenham Street, Dundas, ON, L9H 2V3, Canada
| | - Mark S Kaplan
- Department of Community Health, Portland State University, 506 SW Mill Street, Portland, OR, 97201, USA
| | - Nathalie Huguet
- Research Associate, Center for Public Health Studies, Portland State University, 506 SW Mill Street, Portland, OR, 97201, USA
| | - Bentson H McFarland
- Departments of Psychiatry and Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
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Comparing the health of low income and less well educated groups in the United States and Canada. Popul Health Metr 2007; 5:10. [PMID: 17939874 PMCID: PMC2148034 DOI: 10.1186/1478-7954-5-10] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 10/16/2007] [Indexed: 11/16/2022] Open
Abstract
Background A limited number of health status and health-related quality of life (HRQL) measures have been used for inter-country comparisons of population health. We compared the health of Canadians and Americans using a preference-based measure. Methods The Joint Canada/United States Survey of Health (JCUSH) 2002–03 conducted a comprehensive cross-sectional telephone survey on the health of community-dwelling residents in Canada and the US (n = 8688). A preference-based measure, the Health Utilities Index Mark 3 (HUI3), was included in the JCUSH. Health status was analyzed for the entire population and white population only in both countries. Mean HUI3 overall scores were compared for both countries. A linear regression determinants of health model was estimated to account for differences in health between Canada and the US. Estimation with bootstraps was used to derive variance estimates that account for the survey's complex sampling design of clustering and stratification. Results Income is associated with health in both countries. In the lowest income quintile, Canadians are healthier than Americans. At lower levels of education, again Canadians are healthier than Americans. Differences in health among subjects in the JCUSH are explained by age, gender, education, income, marital status, and country of residence. Conclusion On average, population health in Canada and the US is similar. However, health disparities between Canadians and Americans exist at lower levels of education and income with Americans worse off. The results highlight the usefulness of continuous preference-based measures of population health such as the HUI3.
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Polinder S, van Beeck EF, Essink-Bot ML, Toet H, Looman CWN, Mulder S, Meerding WJ. Functional outcome at 2.5, 5, 9, and 24 months after injury in the Netherlands. ACTA ACUST UNITED AC 2007; 62:133-41. [PMID: 17215744 DOI: 10.1097/ta.0b013e31802b71c9] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The collection of empirical data on the frequency, severity, and duration of functioning is a prerequisite to identify patient groups with long term or permanent disability. METHODS We fielded postal questionnaires in a stratified sample of 8,564 injury patients aged 15 years and older, who had visited an emergency department in the Netherlands. Measurements were at 2.5, 5, 9, and 24 months after the injury and included a generic health status classification (EQ-5D), socio-demographic, and medical information. We analyzed determinants of long-term functional outcome by multivariate regression analysis. RESULTS Five months after the injury health status of nonhospitalized injury patients was comparable to the general population's health (EQ-5D summary measure 0.87). Health status of patients admitted for 3 days or less improved until 9 months (0.82). For those admitted more than 3 days health status improved until 24 months (0.48 toward 0.67), but remained below population norms. Hospitalization, age and sex (females), type of injury (spinal cord injury, hip fracture, and lower extremity injury), and comorbidity were significant predictors of poor functioning in the long term. CONCLUSIONS Recovery patterns vary widely between nonhospitalized, shortly, and long hospitalized injury patients. Nonhospitalized injury patients recover within 5 months from an injury whereas a considerable group of hospitalized injury patients suffer from persistent health problems. Our study indicates the importance of health monitoring with an adapted longitudinal design for injury patients. The time intervals used should match the various stages of the recovery process, which depends on the severity of the injury studied.
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Affiliation(s)
- Suzanne Polinder
- Department of Public Health, ErasmusMC/University Medical Center Rotterdam, The Netherlands.
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Wee HL, Li SC, Xie F, Zhang XH, Luo N, Cheung YB, Machin D, Fong KY, Thumboo J. Are Asians comfortable with discussing death in health valuation studies? A study in multi-ethnic Singapore. Health Qual Life Outcomes 2006; 4:93. [PMID: 17147791 PMCID: PMC1698477 DOI: 10.1186/1477-7525-4-93] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 12/05/2006] [Indexed: 11/10/2022] Open
Abstract
Background To characterize ease in discussing death (EID) and its influence on health valuation in a multi-ethnic Asian population and to determine the acceptability of various descriptors of death and "pits"/"all-worst" in health valuation. Methods In-depth interviews (English or mother-tongue) among adult Chinese, Malay and Indian Singaporeans selected to represent both genders and a wide range of ages/educational levels. Subjects rated using 0–10 visual analogue scales (VAS): (1) EID, (2) acceptability of 8 descriptors for death, and (3) appropriateness of "pits" and "all-worst" as descriptors for the worst possible health state. Subjects also valued 3 health states using VAS followed by time trade-off (TTO). The influence of sociocultural variables on EID and these descriptors was studied using univariable analyses and multiple linear regression (MLR). The influence of EID on VAS/TTO utilities with adjustment for sociocultural variables was assessed using MLR. Results Subjects (n = 63, 35% Chinese, 32% Malay, median age 44 years) were generally comfortable with discussing death (median EID: 8.0). Only education significantly influenced EID (p = 0.045). EID correlated weakly with VAS/TTO scores (range: VAS: -0.23 to 0.07; TTO: -0.14 to 0.11). All subjects felt "passed away", "departed" and "deceased" were most acceptable (median acceptability: 8.0) while "sudden death" and "immediate death" were least acceptable (median acceptability: 5.0). Subjects clearly preferred "all-worst" to "pits" (63% vs. 19%, p < 0.001). Conclusion Singaporeans were generally comfortable with discussing death and had clear preferences for several descriptors of death and for "all-worst". EID is unlikely to influence health preference measurement in health valuation studies.
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Affiliation(s)
- Hwee-Lin Wee
- Department of Rheumatology and Immunology, Singapore General Hospital, Republic of Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore, Republic of Singapore
| | - Shu-Chuen Li
- Department of Pharmacy, Faculty of Science, National University of Singapore, Republic of Singapore
| | - Feng Xie
- Department of Pharmacy, Faculty of Science, National University of Singapore, Republic of Singapore
| | - Xu-Hao Zhang
- Department of Pharmacy, Faculty of Science, National University of Singapore, Republic of Singapore
| | - Nan Luo
- Health Services Research Unit, Yong Loo Lin School of Medicine, National University of Singapore, Republic of Singapore
| | - Yin-Bun Cheung
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - David Machin
- Clinical Trials & Epidemiological Sciences, National Cancer Centre Singapore, Republic of Singapore
- Clinical Trials & Epidemiology Research Unit, Republic of Singapore
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kok-Yong Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Republic of Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Republic of Singapore
| | - Julian Thumboo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Republic of Singapore
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Krabbe PFM, Stalmeier PFM, Lamers LM, Busschbach JJV. Testing the interval-level measurement property of multi-item visual analogue scales. Qual Life Res 2006; 15:1651-61. [PMID: 17031501 DOI: 10.1007/s11136-006-0027-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND Conditions were studied that may invalidate health-state values derived from the visual analogue scale (VAS). METHODS Respondents were asked to place cards with descriptions of EQ-5D health states on a 20 cm EuroQol VAS and modified versions of it, positioning them such that the distances between the states reflect their valuation for these states. Anchor-point bias was examined using the standard EuroQol VAS (n = 212) and a modified version (n = 97) with a different lower anchor. Context bias was examined in another group of respondents (n = 112) who valued three different sets of EQ-5D health states. Marker bias was studied in yet another group of respondents (n = 100) who placed the same EQ-5D states on the standard EuroQol VAS and on a modified VAS without anchors, categories, or measurement markers. RESULTS No indication for the existence of the anchor-point and the marker bias was found. However, the VAS valuations were significantly affected by the context of the set of health states in the scaling task. CONCLUSION Advanced methodologies should be incorporated in VAS valuation studies to deal with the context bias.
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Affiliation(s)
- Paul F M Krabbe
- Department of Medical Technology Assessment (138), Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands.
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Raat H, Mohangoo AD, Grootenhuis MA. Pediatric health-related quality of life questionnaires in clinical trials. Curr Opin Allergy Clin Immunol 2006; 6:180-5. [PMID: 16670511 DOI: 10.1097/01.all.0000225157.67897.c2] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW This review summarizes recent studies on the feasibility, reliability and validity of pediatric health-related quality of life questionnaires and gives an overview of recent applications of these measures in pediatrics. RECENT FINDINGS The often-applied short form of the Child Health Questionnaire (CHQ-PF28) provides reliable physical and psychosocial summary measures, but reliable estimates for each scale require the longer version (CHQ-PF50). In addition to this questionnaire, the Pediatric Quality of Life Inventory is another reliable and valid measure. The TNO-AZL Preschool Children Quality of Life questionnaire is a feasible and reliable measure for preschool children. Generally, generic questionnaires are less sensitive to the impact of specific diseases than are disease-specific questionnaires. Parent and self-reports provide different outlooks on quality of life, which complement each other. SUMMARY There are several feasible, reliable and validated pediatric quality of life questionnaires that can be used in clinical trials. These include generic and disease-specific questionnaires and health profile measures, as well as preference-based measures in pediatric settings. Generally, a combination of these types of questionnaires would be the most appropriate approach. Moreover, a combination of parent and self-reports should be applied. Appropriate selection of outcome measures will enhance the quality of pediatric studies and the ability to assess treatment effects in clinical trials.
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Affiliation(s)
- Hein Raat
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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Rashidi AA, Anis AH, Marra CA. Do visual analogue scale (VAS) derived standard gamble (SG) utilities agree with Health Utilities Index utilities? A comparison of patient and community preferences for health status in rheumatoid arthritis patients. Health Qual Life Outcomes 2006; 4:25. [PMID: 16626489 PMCID: PMC1553436 DOI: 10.1186/1477-7525-4-25] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Accepted: 04/20/2006] [Indexed: 01/18/2023] Open
Abstract
Background Assessment of Health Related Quality of Life (HRQL) has become increasingly important and various direct and indirect methods and instruments have been devised to measure it. In direct methods such as Visual Analog Scale (VAS) and Standard Gamble (SG), respondent both assesses and values health states therefore the final score reflects patient's preferences. In indirect methods such as multi-attribute health status classification systems, the patient provides the assessment of a health state and then a multi-attribute utility function is used for evaluation of the health state. Because these functions have been estimated using valuations of general population, the final score reflects community's preferences. The objective of this study is to assess the agreement between community preferences derived from the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) systems, and patient preferences. Methods Visual analog scale (VAS) and HUI scores were obtained from a sample of 320 rheumatoid arthritis patients. VAS scores were adjusted for end-aversion bias and transformed to standard gamble (SG) utility scores using 8 different power conversion formulas reported in other studies. Individual level agreement between SG utilities and HUI2 and HUI3 utilities was assessed using the intraclass correlation coefficient (ICC). Group level agreement was assessed by comparing group means using the paired t-test. Results After examining all 8 different SG estimates, the ICC (95% confidence interval) between SG and HUI2 utilities ranged from 0.45 (0.36 to 0.54) to 0.55 (0.47 to 0.62). The ICC between SG and HUI3 utilities ranged from 0.45 (0.35 to 0.53) to 0.57 (0.49 to 0.64). The mean differences between SG and HUI2 utilities ranged from 0.10 (0.08 to 0.12) to 0.22 (0.20 to 0.24). The mean differences between SG and HUI3 utilities ranged from 0.18 (0.16 to 0.2) to 0.28 (0.26 to 0.3). Conclusion At the individual level, patient and community preferences show moderate to strong agreement, but at the group level they have clinically important and statistically significant differences. Using different sources of preference might alter clinical and policy decisions that are based on methods that incorporate HRQL assessment. VAS-derived utility scores are not good substitutes for HUI scores.
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Affiliation(s)
- Amir Adel Rashidi
- Centre for Clinical Epidemiology and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| | - Aslam H Anis
- MHA Program, Department of Health Care and Epidemiology, Faculty of Medicine, University of British Columbia, Canada
| | - Carlo A Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
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