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Janssen MF, Dewilde S, Wolfe GI, Muppidi S, Phillips G. Psychometric properties of MG-ADL items and MG-ADL score: An assessment of distributional characteristics, validity and factor structure in two large datasets. J Neurol Sci 2024; 463:123135. [PMID: 39068745 DOI: 10.1016/j.jns.2024.123135] [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: 02/28/2024] [Revised: 06/13/2024] [Accepted: 07/10/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND The Myasthenia Gravis-Activities of Daily Living scale (MG-ADL) is an 8-item outcome measure to assess symptoms and functional limitations in myasthenia gravis (MG) patients. The MG-ADL score is an equally weighted level sum score that is used as primary outcome measures in clinical trials, in clinical practice, and as an end-point in health economic evaluation. This data analysis aims to obtain detailed knowledge of measurement properties of MG-ADL items and the MG-ADL score. METHODS Cross-sectional data from a real-world prospective study (MRW) were combined with longitudinal data from the ADAPT trial. Outcome measures included were MG-ADL, Quantitative Myasthenia Gravis score (QMG), MG 15-item Quality of Life (MG-QOL15r) and EQ-5D-5L. Patients were categorized by their Myasthenia Gravis Foundation of America (MGFA) clinical classification. The following measurement properties were assessed: distributional characteristics, inter-item correlation, convergent, known groups and construct validity and internal factor structure. RESULTS Correlations of items within MG-ADL dimensions were moderate, while MG-ADL correlations between comparable MG-QOL15r and QMG items were mixed. Known groups validity for the MG-ADL score was demonstrated for MGFA class. Mean MG-ADL item level scores by MGFA class demonstrated construct validity. PCA, including all four outcome measures, resulted in a nine factor solution. DISCUSSION Psychometric properties of individual MG-ADL items were moderate to good. This study showed that the MG-ADL adequately captures the multidimensional heterogeneous nature of MG. This is, however, accompanied by mixed psychometric performance of the MG-ADL score, which may complicate health economic modelling. REGISTRATION MyRealWorld-MG was registered on November 25, 2019, with registration numberNCT04176211. The ADAPT randomized clinical trial is registered atClinicalTrials.gov(NCT03669588).
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Affiliation(s)
- Mathieu F Janssen
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Rotterdam, the Netherlands.
| | - Sarah Dewilde
- Services in Health Economics (SHE), Brussels, Belgium
| | - Gil I Wolfe
- Dept. of Neurology, Jacobs School of Medicine and Biomedical Sciences, Univ. at Buffalo/SUNY, Buffalo, NY, USA
| | - Srikanth Muppidi
- Dept of Neurology, Stanford University School of Medicine, Stanford, CA, USA
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Rautenberg TA, Ng SK, George G, Moosa MYS, McCluskey SM, Gilbert RF, Pillay S, Aturinda I, Ard KL, Muyindike WR, Musinguzi N, Masette G, Pillay M, Moodley P, Brijkumar J, Gandhi RT, Johnson B, Sunpath H, Bwana MB, Marconi VC, Siedner MJ. Determinants of health-related quality of life in people with Human Immunodeficiency Virus, failing first-line treatment in Africa. Health Qual Life Outcomes 2023; 21:94. [PMID: 37605150 PMCID: PMC10441724 DOI: 10.1186/s12955-023-02179-x] [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: 01/18/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Antiretroviral treatment improves health related quality of life (HRQoL) of people with human immunodeficiency virus (PWH). However, one third initiating first-line treatment experience virological failure and the determinants of HRQoL in this key population are unknown. Our study aims to identify determinants of among PWH failing antiretroviral treatment in sub-Saharan Africa. METHODS We analysed data from a cohort of PWH having virological failure (> 1,000 copies/mL) on first-line ART in South Africa and Uganda. We measured HRQoL using the EuroQOL EQ-5D-3L and used a two-part regression model to obtain by-country analyses for South Africa and Uganda. The first part identifies risk factors that were associated with the likelihood of participants reporting perfect health (utility = 1) versus non-perfect health (utility < 1). The second part identifies risk factors that were associated with the EQ-5 L-3L utility scores for participants reporting non-perfect health. We performed sensitivity analyses to compare the results between the two-part model using tobit models and ordinary least squares regression. RESULTS In both countries, males were more likely to report perfect health and participants with at least one comorbidity were less likely to report perfect health. In South Africa, participants with side effects and in Uganda those with opportunistic infections were also less likely to report perfect health. In Uganda, participants with 100% ART adherence were more likely to report perfect health. In South Africa, high HIV viral load, experiencing ART side effects, and the presence of opportunistic infections were each associated with lower HRQoL, whereas participants with 100% ART adherence reported higher HRQoL. In Uganda participants with lower CD4 count had lower HRQoL. CONCLUSION Markers of advanced disease (opportunistic infection, high viral load, low CD4), side effects, comorbidities and lack of ART adherence negatively impacted HRQoL for PWH experiencing virological failure. TRIAL REGISTRATION ClinicalTrials.gov: NCT02787499.
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Affiliation(s)
- Tamlyn A Rautenberg
- School of Medicine and Dentistry, Centre for Applied Health Economics, Griffith University, Australia (Sir Samuel Griffith Centre N78 Room 2.34), Nathan campus, QLD, 4111, Australia.
- Menzies Health Institute Queensland, Southport, Australia.
- Metro North Hospital and Health Service Queensland, Herston, Australia.
| | - Shu Kay Ng
- School of Medicine and Dentistry, Centre for Applied Health Economics, Griffith University, Australia (Sir Samuel Griffith Centre N78 Room 2.34), Nathan campus, QLD, 4111, Australia
- Menzies Health Institute Queensland, Southport, Australia
| | - Gavin George
- Health Economics and HIV Research Division, University of KwaZulu-Natal, Durban, South Africa
- Division of Social Medicine and Global Health, Lund University, Lund, Sweden
| | | | - Suzanne M McCluskey
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Rebecca F Gilbert
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Selvan Pillay
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Isaac Aturinda
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kevin L Ard
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Winnie R Muyindike
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nicholas Musinguzi
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godfrey Masette
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Pravi Moodley
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- National Health Laboratory Service, Durban, South Africa
| | - Jaysingh Brijkumar
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Rajesh T Gandhi
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Brent Johnson
- Department of Biostatistics and Computation Biology, University of Rochester, Rochester, NY, USA
| | - Henry Sunpath
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Mwebesa B Bwana
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Vincent C Marconi
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Mark J Siedner
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
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Dou L, Xu Y, Chen G, Li S. Psychometric properties and comparison of four health utility approaches among myopia patients in China. Health Qual Life Outcomes 2023; 21:66. [PMID: 37403059 DOI: 10.1186/s12955-023-02150-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 06/14/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND The increased prevalence of myopia creates and earlier age of onset has created public health concerns for the long-term eye health, vision impairment and carries with it a significant economic burden. The quality of the economic evaluation is dependent on the sensitivity and validity of the approaches. Nowadays, there are many approaches to measure patients' health state utility (HSU). However, little is known regarding the performance of direct approach and indirect approach in people with myopia. This study is aimed to compare the psychometric properties of four HSU approaches among patients with myopia in mainland China, including two direct approaches (TTO and SG), the generic preference-based measures (PBM) (AQoL-7D) and the disease-specific PBM (VFQ-UI). METHODS A convenience sampling framework was used to recruit patients with myopia who attended a large ophthalmic hospital in Jinan, China. Spearman's rank correlations coefficient was used to assess concurrent validity. Known-group validity was analyzed by: (1) whether the patients wear corrective devices; (2) severity of myopia as low or moderate to high of the better eye; (3) duration of myopia as ≤ 10 years or > 10 years. Effect size (ES), relative efficiency (RE) statistic and the largest area under the receiver operating characteristic curve (AUC) were used to assess sensitivity. The intra-class correlation coefficient (ICC) and Bland-Altman plots were used to assess agreement. RESULTS A valid sample size of 477 myopia patients was analyzed (median duration: 10 years). The mean HSU scores between TTO and SG were similar (0.95) and higher than AQoL-7D (0.89) and VFQ-UI (0.83). Overall, the VFQ-UI had the best performance based on the psychometric analysis. The agreement indicated that there was no pair of approaches that could be used interchangeably. CONCLUSIONS The VFQ-UI showed better psychometric properties than other three approaches for providing health state utility in Chinese myopia patients. Given the widespread use and its generic nature of the AQoL-7D, it could be used alongside with VFQ-UI to provide complementary health state utility from a generic and disease-specific perspective for economic evaluation. More evidence on the responsiveness of four health utility approaches in myopia patients is required.
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Affiliation(s)
- Lei Dou
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
- Center for Health Preference Research, Shandong University, Jinan, China
| | - Yanjiao Xu
- Afliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Gang Chen
- Center for Health Economics, Monash Business School, Monash University, Melbourne, Australia
| | - Shunping Li
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China.
- Center for Health Preference Research, Shandong University, Jinan, China.
- Center for Health Management and Policy Research, School of Public Health, Shandong University, Wenhua Xi Rd 44, Shandong Province, 250012, Jinan, China.
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Hong Y, Jiang X, Zhang T, Luo N, Yang Z. Examining the relationship between the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) and EQ-5D-5L and comparing their psychometric properties. Health Qual Life Outcomes 2023; 21:25. [PMID: 36927468 PMCID: PMC10018827 DOI: 10.1186/s12955-023-02108-y] [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: 12/15/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The purpose of this study is to examine the relationship between the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) and EQ-5D-5L and compare their psychometric properties in 4 chronic conditions in China. METHODS Participants were invited to complete the online survey. Spearman's rank correlation was used to evaluate the correlation between SWEMWBS and EQ-5D-5L; exploratory factor analysis was used to ascertain the number of unique underlying latent factors measured by SWEMWBS and EQ-5D-5L. Next, we assessed the psychometric properties of SWEMWBS and EQ-5D-5L by reporting distributions and examining their known-group validity and convergent validity. RESULTS In total, 500 individuals participated the online survey. Spearman's rank correlation showed that EQ-5D-5L dimensions, except for the anxiety/depression dimension, were weakly correlated with all dimensions of SWEMWBS. The two-factor solution for exploratory factor analysis found that all of SWEMWBS dimensions loaded onto one factor, four EQ-5D-5L dimensions (mobility, self-care, usual activities and pain/discomfort) onto another, and the EQ-5D-5L item of anxiety/depression item loaded moderately onto both factors. Patients of four disease groups had different distributions of responses for both SWEMWBS and EQ-5D-5L. In terms of known-group validity, both the F statistic and AUROC value of EQ-5D-5L utility scores were significantly higher than SWEMWBS scores in all four pair-wised comparisons. The Pearson correlation coefficient between EQ-5D-5L utility scores, SWEMWBS scores and EQ-VAS was 0.44 (P < 0.01) and 0.65 (P < 0.01), respectively. CONCLUSIONS SWEMWBS and EQ-5D-5L measure different constructs and can be seen as complementary measures. Both measures demonstrated good convergent validity and known-group validity with EQ-5D-5L being a more sensitive measure, even for mental conditions.
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Affiliation(s)
- Yanming Hong
- The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Xinru Jiang
- Tianhe Foreign Language School, Guangzhou, People’s Republic of China
| | - Tiantian Zhang
- College of Pharmacy, Jinan University, Guangzhou, People’s Republic of China
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Zhihao Yang
- Health Services Management Department, Guizhou Medical University, Guiyang, People’s Republic of China
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Weng G, Hong Y, Luo N, Mukuria C, Jiang J, Yang Z, Li S. Comparing EQ-5D-3L and EQ-5D-5L in measuring the HRQoL burden of 4 health conditions in China. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:197-207. [PMID: 35538178 DOI: 10.1007/s10198-022-01465-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/05/2022] [Indexed: 05/24/2023]
Abstract
BACKGROUND EQ-5D-3L has been used in the National Health Services Survey of China since 2008 to monitor population health. The five-level version of EQ-5D was developed, but there lacks evidence to support the use of five-level version of EQ-5D in China. This study was conducted to compare the measurement properties of both the EQ-5D-3L and EQ-5D-5L in quantifying health-related quality of life (HRQoL) burden for 4 different health conditions in China. METHODS Participants from China were recruited to complete the 3L and 5L questionnaire via Internet. Quota was set to recruit five groups of individuals, with one group of individuals without any health condition and one group of generalized anxiety disorder (GAD), HIV/AIDS, chronic Hepatitis B (CHB), or depression, respectively. The 3L and 5L were compared in terms of response distributions, percentages of reporting 'no problems', index value distributions, known-group validity and their relative efficiency. RESULTS In total, 500 individuals completed the online survey, including 140 healthy individuals, 122 individuals with hepatitis B, 107 with depression, 90 individuals with GAD and 101 with HIV/AIDS. 5L also had smoother and less clustered index value distributions. Healthy group showed different response distributions to the four condition groups. The percentage of reporting 'no problems' decreased significantly in the 5L in all domains (P < 0.01), especially in the pain/discomfort dimension (relative difference: 43.10%). Relative efficiency suggested that 5L had a higher absolute discriminatory power than the 3L version between healthy participant and the other 4 condition groups, especially for the HIV/AIDS group when the 3L results was not significant. CONCLUSIONS The 5L version may be preferable to the 3L, as it demonstrated superior performance with respect to higher sensitivity to mild health problems, better relative efficiency and responses and index value distributions.
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Affiliation(s)
- Guizhi Weng
- College of Pharmacy, Jinan University, 601 West Huangpu avenue, 510632, Guangzhou, People's Republic of China
| | - Yanming Hong
- College of Pharmacy, Jinan University, 601 West Huangpu avenue, 510632, Guangzhou, People's Republic of China
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Clara Mukuria
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jie Jiang
- College of Pharmacy, Jinan University, 601 West Huangpu avenue, 510632, Guangzhou, People's Republic of China
- Dongguan Institute of Jinan University, Dongguan, People's Republic of China
| | - Zhihao Yang
- College of Pharmacy, Jinan University, 601 West Huangpu avenue, 510632, Guangzhou, People's Republic of China.
- Health Services Management Department, Guizhou Medical University, Guiyang, People's Republic of China.
| | - Sha Li
- College of Pharmacy, Jinan University, 601 West Huangpu avenue, 510632, Guangzhou, People's Republic of China.
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Redenz G, Ibaceta MC, Aceituno D, Balmaceda C, Espinoza MA. Health State Utility Values of Type 2 Diabetes Mellitus and Related Complications: A Systematic Review and Meta-Analysis. Value Health Reg Issues 2023; 34:14-22. [PMID: 36371899 DOI: 10.1016/j.vhri.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/01/2022] [Accepted: 09/25/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES This study aims to synthesize health state utility values (HSUVs) of type 2 diabetes mellitus (T2DM) and its related complications published in the literature, conducting a meta-analysis of the data when possible. METHODS We conducted a systematic search in MEDLINE and School of Health and Related Research Health Utilities Database repository. Studies focused on T2DM and its complications reporting utility values elicited using direct and indirect methods were selected. We categorized the results according to the instrument to describe health and meta-analyzed them accordingly. Data included in the analysis were pooled in a fixed-effect model by the inverse of variance mean and random-effects DerSimonian-Laird method. Two approaches on sensitivity analysis were performed: leave-one-out method and including data of HSUVs obtained by foreign population value sets. RESULTS We identified 70 studies for the meta-analysis from a total of 467 studies. Sufficient data to pool T2DM HSUVs from EQ-5D instrument, hypoglycemia, and stroke were obtained. HSUVs varied from 0.7 to 0.92 in direct valuations, and the pooled mean of 3-level version of EQ-5D studies was 0.772 (95% confidence interval 0.763-0.78) and of 5-level version of EQ-5D 0.815 (95% confidence interval 0.808-0.823). HSUVs of complications varied from 0.739 to 0.843, or reductions of HSUVs between -0.014 and -0.094. In general, HSUVs obtained from 3-level version of EQ-5D and Health Utility Index 3 instruments were lower than those directly elicited. A considerable amount of heterogeneity was observed. Some complications remained unable to be pooled due to scarce of original articles. CONCLUSIONS T2DM and its complications have a considerable impact on health-related quality of life. 5-level version of EQ-5D estimates seems comparable with direct elicited HSUVs.
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Affiliation(s)
- Gunther Redenz
- Escuela de Kinesiología, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | - Marcela Cárcamo Ibaceta
- Departamento de Epidemiología y estudios en salud, Universidad de los Andes, Santiago, Chile
| | - David Aceituno
- Departamento de psiquiatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Balmaceda
- Unidad de Evaluación de Tecnologías Sanitarias, Centro de Investigaciones Clínicas, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Manuel A Espinoza
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Powell LC, L'Italien G, Popoff E, Johnston K, O'Sullivan F, Harris L, Croop R, Coric V, Lipton RB. Health State Utility Mapping of Rimegepant for the Preventive Treatment of Migraine: Double-Blind Treatment Phase and Open Label Extension (BHV3000-305). Adv Ther 2023; 40:585-600. [PMID: 36417057 PMCID: PMC9898331 DOI: 10.1007/s12325-022-02369-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/24/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The objectives of this study were to (1) report long-term health-related quality of life (HRQoL) outcomes among patients using rimegepant preventatively in BHV3000-305 (NCT03732638) open-label extension (OLE) and (2) map Migraine-Specific Quality of Life questionnaire version 2.1 (MSQv2) to EQ-5D-3L utility values over the double-blind treatment (DBT; 0-12 weeks) and the OLE (13-64 weeks) to assess the influence of treatment on these values. METHODS This was a post hoc analysis using data from a rimegepant study for the prevention of migraine (BHV3000-305). Adult patients with migraine took either rimegepant 75 mg or placebo every other day (EOD) during the DBT phase. All patients received rimegepant during the OLE. MSQv2 was measured at baseline, weeks 12, 24, and 64. A validated algorithm was used to map MSQv2 scores to EQ-5D utilities. RESULTS Baseline data were available for 347 patients treated with placebo and 348 treated with rimegepant in the DBT period, who continued to the OLE. Baseline EQ-5D utilities were similar between trial arms: 0.598 for placebo and 0.614 for rimegepant. EQ-5D improved from baseline to week 12 and utilities increased by + 0.09 for placebo and + 0.10 for rimegepant (p value = 0.011). By 24 weeks, at which point patients who were originally randomized to placebo had received rimegepant 75 mg EOD for 12 weeks, HRQoL measures (MSQv2 and EQ-5D) were similar across groups, demonstrating rapid onset of treatment effect. This HRQoL improvement was durable out to 64 weeks. CONCLUSION Compared to placebo, treatment with rimegepant 75 mg was associated with greater improvement in EQ-5D utilities during the 12-week DBT phase. Patients originally randomized to placebo experienced a similar improvement in EQ-5D utilities after switching to rimegepant during the OLE, demonstrating that benefits are realized within 12 weeks of active treatment. This preventive effect was durable out to 64 weeks and was associated with an additional increase in HRQoL over time. TRIAL REGISTRATION NCT03732638.
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Affiliation(s)
- Lauren C Powell
- Broadstreet Health Economics and Outcomes Research, 201-343 Railway Street, Vancouver, BC, V6A 1A4, Canada.
| | | | - Evan Popoff
- Broadstreet Health Economics and Outcomes Research, 201-343 Railway Street, Vancouver, BC, V6A 1A4, Canada
| | - Karissa Johnston
- Broadstreet Health Economics and Outcomes Research, 201-343 Railway Street, Vancouver, BC, V6A 1A4, Canada
| | - Fiona O'Sullivan
- Broadstreet Health Economics and Outcomes Research, 201-343 Railway Street, Vancouver, BC, V6A 1A4, Canada
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Melstrom LG, Zhou X, Kaiser A, Chan K, Lau C, Raoof M, Warner SG, Zhumkhawala A, Yuh B, Singh G, Fong Y, Sun V. Feasibility of perioperative remote monitoring of patient-generated health data in complex surgical oncology. J Surg Oncol 2023; 127:192-202. [PMID: 36169200 DOI: 10.1002/jso.27106] [citation(s)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 08/16/2024]
Abstract
BACKGROUND The feasibility of remote perioperative telemonitoring of patient-generated physiologic health data and patient-reported outcomes in a high risk complex general and urologic oncology surgery population is evaluated. METHODS Complex general surgical/urologic oncology patients wore a pedometer, completed ePROs (electronic patient-reported outcome surveys) and record their vitals (weight, pulse, pulse oximetry, blood pressure, and temperature) via a telehealth app platform. Feasibility (% adherence) was assessed as the primary outcome measure. RESULTS Twenty-one patients with a median age 58 (32-82) years were included. The readmission rate was 33% and the incidence of ≥Grade 3a morbidity was 24%. Adherence to vital sign and ePRO measurements was 95% before surgery, 91% at discharge, and 82%, 68%, and 64% at postdischarge d2, 7, 14, and 30, respectively. There was significant worsening of mobility, self-care and usual daily activity at postdischarge d2 compared to preoperative baseline (p < 0.05). Median daily preoperative steps taken by patients with CONCLUSIONS Telemonitoring is feasible in a general surgical and urologic oncology setting. Future studies will ascertain optimal patient selection, duration, and extent of perioperative monitoring.
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Affiliation(s)
- Laleh G Melstrom
- Department of Surgery City of Hope, Division of Surgical Oncology, Duarte, California, USA
| | - Xiaoke Zhou
- Department of Population Sciences, City of Hope, Duarte, California, USA
| | - Andreas Kaiser
- Department of Surgery City of Hope, Division of Colorectal Surgery, Duarte, California, USA
| | - Kevin Chan
- Department of Surgery City of Hope, Division of Urologic Oncology, Duarte, California, USA
| | - Clayton Lau
- Department of Surgery City of Hope, Division of Urologic Oncology, Duarte, California, USA
| | - Mustafa Raoof
- Department of Surgery City of Hope, Division of Surgical Oncology, Duarte, California, USA
| | | | - Ali Zhumkhawala
- Department of Surgery City of Hope, Division of Urologic Oncology, Duarte, California, USA
| | - Bertram Yuh
- Department of Surgery City of Hope, Division of Urologic Oncology, Duarte, California, USA
| | - Gagandeep Singh
- Department of Surgery City of Hope, Division of Surgical Oncology, Duarte, California, USA
| | - Yuman Fong
- Department of Surgery City of Hope, Division of Surgical Oncology, Duarte, California, USA
| | - Virginia Sun
- Department of Surgery City of Hope, Division of Surgical Oncology, Duarte, California, USA
- Department of Population Sciences, City of Hope, Duarte, California, USA
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Janssen MF, Buchholz I, Golicki D, Bonsel GJ. Is EQ-5D-5L Better Than EQ-5D-3L Over Time? A Head-to-Head Comparison of Responsiveness of Descriptive Systems and Value Sets from Nine Countries. PHARMACOECONOMICS 2022; 40:1081-1093. [PMID: 35930137 PMCID: PMC9550755 DOI: 10.1007/s40273-022-01172-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The aim of this study was to compare the responsiveness of EQ-5D-3L (3L) with EQ-5D-5L (5L) descriptive systems and value sets in two independent samples (rehabilitation and stroke patients). METHODS Descriptive system results were compared cross-sectionally, and descriptive responsiveness was tested by calculating changed level responses ('moves') from baseline to follow-up, proportion of improved patients, Paretian Classification of Health Change (PCHC), and probability of superiority (PS). Responsiveness of values based on nine country-specific value sets was assessed by standardized response mean (SRM) and standardized effect size (SES). Relative efficiency of 5L over 3L was assessed by calculating ratios of the SRM and SES statistics. RESULTS Descriptive comparisons confirmed earlier evidence and showed a consistent overestimation of health problems in 3L. Descriptive responsiveness improved with 5L in terms of moves per respondent, proportions of improved patients and PS, whereas PCHC showed mixed results. Better value responsiveness statistics were observed for 5L in rehabilitation patients for all value sets. In stroke patients, 3L showed better responsiveness statistics compared with 5L. Relative efficiency results were moderately to strongly better with 5L for rehabilitation, and slightly to moderately better with 3L for stroke. CONCLUSIONS Descriptive results were the main driver of 3L-5L responsiveness differences. Responsiveness of 3L was influenced by the 'confined to bed' label and the overestimation bias of 3L, which affected all responsiveness results. This may impact quality-adjusted life-year (QALY) estimations, leading to over- or underestimations of QALYs gained, depending on the condition and condition severity. QALY calculations based on 5L data will result in more accurate estimates.
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Affiliation(s)
- Mathieu F. Janssen
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | | | - Dominik Golicki
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Gouke J. Bonsel
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
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Melstrom LG, Zhou X, Kaiser A, Chan K, Lau C, Raoof M, Warner SG, Zhumkhawala A, Yuh B, Singh G, Fong Y, Sun V. Feasibility of perioperative remote monitoring of patient-generated health data in complex surgical oncology. J Surg Oncol 2022; 127:192-202. [PMID: 36169200 PMCID: PMC10087541 DOI: 10.1002/jso.27106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND The feasibility of remote perioperative telemonitoring of patient-generated physiologic health data and patient-reported outcomes in a high risk complex general and urologic oncology surgery population is evaluated. METHODS Complex general surgical/urologic oncology patients wore a pedometer, completed ePROs (electronic patient-reported outcome surveys) and record their vitals (weight, pulse, pulse oximetry, blood pressure, and temperature) via a telehealth app platform. Feasibility (% adherence) was assessed as the primary outcome measure. RESULTS Twenty-one patients with a median age 58 (32-82) years were included. The readmission rate was 33% and the incidence of ≥Grade 3a morbidity was 24%. Adherence to vital sign and ePRO measurements was 95% before surgery, 91% at discharge, and 82%, 68%, and 64% at postdischarge d2, 7, 14, and 30, respectively. There was significant worsening of mobility, self-care and usual daily activity at postdischarge d2 compared to preoperative baseline (p < 0.05). Median daily preoperative steps taken by patients with <Grade 3a versus ≥Grade 3a postoperative morbidity was 6062 versus 4166 (p < 0.05). Of those interviewed, 87% (13/15) viewed vital sign devices as helpful in recovery. CONCLUSIONS Telemonitoring is feasible in a general surgical and urologic oncology setting. Future studies will ascertain optimal patient selection, duration, and extent of perioperative monitoring.
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Affiliation(s)
- Laleh G Melstrom
- Department of Surgery City of Hope, Division of Surgical Oncology, Duarte, California, USA
| | - Xiaoke Zhou
- Department of Population Sciences, City of Hope, Duarte, California, USA
| | - Andreas Kaiser
- Department of Surgery City of Hope, Division of Colorectal Surgery, Duarte, California, USA
| | - Kevin Chan
- Department of Surgery City of Hope, Division of Urologic Oncology, Duarte, California, USA
| | - Clayton Lau
- Department of Surgery City of Hope, Division of Urologic Oncology, Duarte, California, USA
| | - Mustafa Raoof
- Department of Surgery City of Hope, Division of Surgical Oncology, Duarte, California, USA
| | | | - Ali Zhumkhawala
- Department of Surgery City of Hope, Division of Urologic Oncology, Duarte, California, USA
| | - Bertram Yuh
- Department of Surgery City of Hope, Division of Urologic Oncology, Duarte, California, USA
| | - Gagandeep Singh
- Department of Surgery City of Hope, Division of Surgical Oncology, Duarte, California, USA
| | - Yuman Fong
- Department of Surgery City of Hope, Division of Surgical Oncology, Duarte, California, USA
| | - Virginia Sun
- Department of Surgery City of Hope, Division of Surgical Oncology, Duarte, California, USA.,Department of Population Sciences, City of Hope, Duarte, California, USA
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Jiang R, Rand K, Kuharic M, Pickard AS. EQ-5D-5L measurement properties are superior to EQ-5D-3L across the continuum of health using US value sets. Health Qual Life Outcomes 2022; 20:134. [PMID: 36085228 PMCID: PMC9463847 DOI: 10.1186/s12955-022-02031-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 08/03/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The objective of this study was to compare the measurement properties of the US EQ-5D-3L, EQ-5D-5L, and -5L to -3L crosswalk value sets (3L; 5L; 5L > 3L) across the spectrum of health. Methods The three scoring approaches were compared in terms of range of scale, percent of worse-than-dead health states, and mean single-level transitions. Discriminative ability was compared by leveraging two cross-sectional datasets. A novel method was used to visualize and compare the responsiveness of 3L and 5L scoring approaches across EQ VAS values. Results The US 5L value set had the broadest range of scale at 1.573 (vs. 1.109 for 3L and crosswalk). The crosswalk had the smallest mean single-level transition of 0.061 (vs. 0.078 for 5L and 0.111 for 3L). The 5L value set tended to be more discriminative/greater statistical efficiency than the crosswalk (F-statistic ratio: 1.111, 95% CI 0.989–1.240) and 3L (F-statistic ratio: 1.102 95% CI 0.861–1.383) across levels of general health. The 5L was the most responsive value set between EQ VAS values of 25 and 75. Conclusion These results imply greater sensitivity of the 5L to health changes and potentially lower incremental cost-utility ratios compared to the 3L. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-02031-8. This study is among the first to compare the performance of value sets for the US to help users understand health utility gains depending on the value set/scoring approach selected. The 5L value set had improved interval-level measurement properties than the 3L and 3L > 5L value sets. Empirical analyses, including a novel simulation method, showed that the 5L value set tended to have greater discriminative ability across the entire health continuum.
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Affiliation(s)
- Ruixuan Jiang
- Center for Observational and Real-World Evidence, Merck & Co., Rahway, NJ, 07065, USA
| | - Kim Rand
- The Health Services Research Unit - HØKH, Akershus University Hospital, Lørenskog, Norway.,Maths in Health, Rotterdam, The Netherlands
| | - Maja Kuharic
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood St, MC 871, Chicago, IL, 60612, USA
| | - A Simon Pickard
- Maths in Health, Rotterdam, The Netherlands. .,Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood St, MC 871, Chicago, IL, 60612, USA.
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12
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Si Y, Li S, Xu Y, Chen G. Validation and comparison of five preference-based measures among age-related macular degeneration patients: evidence from mainland China. Qual Life Res 2021; 31:1561-1572. [PMID: 34853992 DOI: 10.1007/s11136-021-03047-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the psychometric properties of five preference-based measures (PBMs) among patients with age-related macular degeneration (AMD) in mainland China, including three health-related quality of life (HRQoL) measures [the 15D, the Assessment of Quality of Life (AQoL)-7D, and EQ-5D-5L] and two capability wellbeing measures [the ICEpop CAPability measure for Adults (ICECAP-A) and ICECAP measure for Older people (ICECAP-O)]. METHODS A convenience sampling framework was used to successively recruit inpatients with AMD who attended a large ophthalmic hospital in Jinan, China. Psychometric properties (known-group validity, concurrent validity, and sensitivity) were assessed. The agreements between PBMs were reported. RESULTS A valid sample of 210 AMD inpatients (median duration: 12 months) was analyzed. Overall, the AQoL-7D had the best performance based on the psychometric tests been conducted. Sufficient evidence was found on psychometric properties for other 2 preference-based HRQoL measures. The ICECAP-A outperformed ICECAP-O on known-group validity and concurrent validity whereas opposite results were found on sensitivity. The Bland-Altman plots indicate that there was no pair of PBMs that could be used interchangeably. CONCLUSIONS The AQoL-7D had shown better psychometric properties than other four PBMs based on Chinese AMD inpatients. The EQ-5D-5L demonstrated sufficient psychometric properties and given the availability of a Chinese-specific tariff and the recommendations of China guidelines for pharmacoeconomic evaluations, it may be prioritized to be used in China. Capability wellbeing instruments could also be considered given they provide information that goes beyond health. Further evidence on responsiveness and reliability for all five PBMs among AMD patients is required.
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Affiliation(s)
- Yanhui Si
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China. .,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China. .,Centre for Health Preference Research, Shandong University, Jinan, 250012, China.
| | - Yanjiao Xu
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250002, China
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, 3145, Australia
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Development and Critical Evaluation of a Condition-Specific Preference-Based Measure Sensitive to Binaural Hearing in Adults: The York Binaural Hearing-Related Quality-of-Life System. Ear Hear 2021; 43:379-397. [PMID: 34432671 DOI: 10.1097/aud.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The widely-used generic preference-based measures of health-related quality of life-the EuroQol Descriptive System (EQ-5D) and the Health Utilities Index (HUI3)-are limited in their response to technologies that improve hearing. The EQ-5D lacks construct validity for hearing, while the HUI3 is restricted by a ceiling effect and by using speech reception as the only evidence of the ability to hear. Consequently, neither measure consistently registers benefits from binaural hearing, such as those from bilateral versus unilateral cochlear implantation. The objectives were to test whether informants value binaural hearing, to develop a condition-specific preference-based measure sensitive to binaural hearing, to assess the psychometric properties of the new instrument, and to determine whether it meets requirements for informing judgments of cost-effectiveness: does it measure greater gains than do the generic preference-based measures, while avoiding exaggerating losses, and displaying sensitivity to side effects? DESIGN Three levels of function, ranging from no difficulty to great difficulty, were defined on each of three dimensions where listening is easier or more successful when hearing is binaural rather than monaural: perception of speech in spatially separated noise, localization of sounds, and effort and fatigue. Informants (N = 203) valued the 27 combinations of levels and dimensions in a time trade-off task with a 10-year time frame to provide a value of binaural-related quality of life ("binaural utility") for each combination. A questionnaire was compiled to allow respondents to report their level of function on each dimension so that a value of binaural utility could be assigned to them. The questionnaire and the age-standardized valuations constitute The York Binaural Hearing-Related Quality-of-Life System (YBHRQL). Adult users of unilateral implants (N = 8), bilateral implants (N = 11), or bimodal aiding (N = 9) undertook performance tests of spatial listening and completed the HUI3, EQ-5D, and Speech, Spatial, and Qualities of Hearing (SSQ) questionnaires. They completed the YBHRQL questionnaire 24 and 38 mo later. RESULTS Despite long intervals between measurements, the YBHRQL demonstrated desirable psychometric properties: good construct validity evidenced by significant correlations with performance measures and the SSQ index; a greater ability than the EQ-5D or HUI3 to distinguish unilateral, bimodal, and bilateral listening; and good reproducibility. The YBHRQL did not exaggerate losses of utility but was insensitive to a potential side effect of implantation (pain/discomfort). It measured a gain in utility from bilateral compared with unilateral implantation (median = 0.11, interquartile range, 0.03 to 0.16) that was greater than the gain measured by the EQ-5D (0.00, 0.00 to 0.00) but not the HUI3 (0.00, 0.00 to 0.17). CONCLUSIONS The YBHRQL summarizes the contribution of binaural hearing to quality of life by combining the functional status of a listener with the preferences of independent informants. It would be an efficient clinical outcome measure. In addition, if used alongside the EQ-5D or HUI3, it would provide evidence which could beneficially modulate confidence in the cost-effectiveness of interventions. Further research on its sensitivity to side effects, and on the size of the gains in utility which it measures, is needed to determine whether it could stand alone to inform resource-allocation decisions.
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Impairment in Health-Related Quality of Life among Community-Dwelling Stroke Survivors. Can J Neurol Sci 2021; 49:373-380. [PMID: 34075863 DOI: 10.1017/cjn.2021.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Health utility instruments are increasingly being used to measure impairment in health-related quality of life (HRQoL) after stroke. Population-based studies of HRQoL after stroke and assessment of differences by age and functional domain are needed. METHODS We used the Canadian Community Health Survey linked with administrative databases to determine HRQoL using the Health Utilities Index Mark 3 (HUI3) among those with prior hospitalization or emergency department visit for stroke and compared to controls without stroke. We used multivariable linear regression to determine the difference in HUI3 between those with stroke and controls for the global index and individual attributes, with assessment for modification by age (<60, 60-74, and 75+ years) and sex, and we combined estimates across survey years using random effects meta-analysis. RESULTS Our cohort contained 1240 stroke survivors and 123,765 controls and was weighted to be representative of the Canadian household population. Mean health utility was 0.63 (95% confidence interval [CI] 0.58, 0.68) for those with stroke and 0.83 (95% CI 0.82, 0.84) for controls. There was significant modification by age, but not sex, with the greatest adjusted reduction in HUI3 among stroke respondents aged 60-74 years. Individual HUI3 attributes with the largest reductions in utility among stroke survivors compared to controls were mobility, cognition, emotion, and pain. CONCLUSIONS In this population-based study, the reduction in HUI3 among stroke survivors compared to controls was greatest among respondents aged 60-74, and in attributes of mobility, cognition, emotion, and pain. These results highlight the persistent impairment of HRQoL in the chronic phase of stroke and potential targets for community support.
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15
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Whang KA, Le TK, Khanna R, Williams KA, Roh YS, Sutaria N, Choi J, Gabriel S, Chavda R, Semenov Y, Kwatra SG. Health-related quality of life and economic burden of prurigo nodularis. J Am Acad Dermatol 2021; 86:573-580. [PMID: 34058278 DOI: 10.1016/j.jaad.2021.05.036] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prurigo nodularis (PN) is an understudied, pruritic inflammatory skin disease. Little is known about the effect of PN on quality of life and its associated economic burden. OBJECTIVE To quantify the impact of PN on quality of life and its economic implications. METHODS A cohort study of PN patients (n = 36) was conducted using the Health Utilities Index Mark 3 questionnaire. Control data from US adults (n = 4187) were obtained from the 2002-2003 Joint Canada/United States Survey of Health. Quality-adjusted life year loss and economic costs were estimated by comparing the Health Utilities Index Mark 3 scores of the PN patients with those of the controls. RESULTS The PN patients had lower overall health performance compared to the controls, (mean ± SE, 0.52 ± 0.06 vs 0.86 ± 0.003, respectively, P < .001). In multivariable regression, PN was found to be associated with worse health performance (coefficient -0.34, 95% CI [-0.46 to -0.23]), most prominent in the pain subdomain (coefficient -0.24, 95% CI [-0.35 to -0.13]). This correlated to an average of 6.5 lifetime quality-adjusted life years lost per patient, translating to an individual lifetime economic burden of $323,292 and a societal burden of $38.8 billion. CONCLUSION These results demonstrate that PN is associated with significant quality-of-life impairment, similar to the level of other chronic systemic conditions. PN is also associated with a substantial individual economic burden, emphasizing the necessity of research on effective treatment options.
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Affiliation(s)
- Katherine A Whang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas K Le
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Raveena Khanna
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kyle A Williams
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Youkyung Sophie Roh
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nishadh Sutaria
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin Choi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sylvie Gabriel
- Galderma Prescription Global Business Unit, Rue d'Entre-deux-Villes, La Tour-de-Peilz, Switzerland
| | - Rajeev Chavda
- Galderma Prescription Global Business Unit, Rue d'Entre-deux-Villes, La Tour-de-Peilz, Switzerland
| | - Yevgeniy Semenov
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Comparing the measurement properties of the EQ-5D-5L and the EQ-5D-3L in hypertensive patients living in rural China. Qual Life Res 2021; 30:2045-2060. [PMID: 33821418 DOI: 10.1007/s11136-021-02786-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to compare the measurement properties of two versions of EQ-5D (i.e.EQ-5D-3L and EQ-5D-5L) in hypertensive patients in rural China. METHODS A cross-sectional survey was carried out in hypertensive patients in rural China. We compared the ceiling effects, redistribution properties, informativity, known-groups validity, and relative efficiency of the 3L and 5L and examined their agreement. RESULTS A total of 11,412 patients were enrolled in our study. The mean EQ-5D index score was 0.84 (SD 0.21) according to the 5L and 0.86 (SD 0.17) according to the 3L. A good agreement was observed between the 3L and 5L. The overall ceiling effect decreased from 46.4% (3L) to 29.4% (5L). The Shannon index, H' improved in all dimensions when used 5L. When used 3L, the median responses of all groups were consistent with 5L across the three dimensions of 'mobility', 'self-care', 'usual activities', while the median responses were inconsistent for the 'pain/discomfort' and 'anxiety/depression' dimensions. The 3L performed better in eight comorbidities in terms of F-statistics and six comorbidities in terms of the area under the receiver operating characteristic curves (AUROCs). The 5L performed better both in terms of the F-statistics and AUROCs in age, education level, anti-hypertensive medication use. CONCLUSION Taking all comparisons into account, we recommend the EQ-5D-5L for use in patients with hypertension in rural China.
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Ahadi MS, Vahidpour N, Togha M, Daroudi R, Nadjafi-Semnani F, Mohammadshirazi Z, Akbari-Sari A, Ghorbani Z. Assessment of Utility in Migraine: Mapping the Migraine-Specific Questionnaire to the EQ-5D-5L. Value Health Reg Issues 2021; 25:57-63. [PMID: 33773328 DOI: 10.1016/j.vhri.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION There are increasing demands for studies of cost-effectiveness to allocate resources for disease prevention and treatment strategies. The aim of this study is to measure quality of life in migraineurs, based on the Migraine-Specific Questionnaire (MSQ) and EQ-5D-5L, and thereafter map an algorithm to estimate health-state utility values from the MSQ in individuals with migraine. METHODS In this cross-sectional study conducted between May and July 2018 in a tertiary headache clinic in Tehran, Iran, migraineurs diagnosed based on International Classification of Headache Disorders (ICHD)-3β were enrolled and were asked to complete the MSQ questionnaire and EQ-5D questionnaire. The Spearman correlation coefficient (ρ) was calculated to measure the correlation between the EQ-5D-5L and MSQ v2.1 domains' score. A P value of <.05 was considered statistically significant. After statistical analysis, several regression models were presented to map the results of the MSQ domains to the utility index, and the preferred model was achieved based on goodness of fit and the model's predictive performance. RESULTS The preferred MSQ algorithm had approximately the same prediction errors in all migraineurs, episodic and chronic migraine (root mean square error 0.24, 0.24, and 0.23, respectively). The preferred MSQ model explained a variance of 0.26 (R2) in episodic and 0.38 in chronic migraine in the EQ-5D-5L questionnaire. CONCLUSION The preferred MSQ mapping algorithm will be suitable in estimating health state utilities in trials of patients with migraine that contain MSQ scores but lack utility values.
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Affiliation(s)
- Maral Seyed Ahadi
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Headache Department, Neurology Ward, Sina University Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Niusha Vahidpour
- Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mansoureh Togha
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Headache Department, Neurology Ward, Sina University Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Rajabali Daroudi
- Department of Health, Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Fatemeh Nadjafi-Semnani
- Eye Research Center, The Five Senses Institute Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ali Akbari-Sari
- Department of Health, Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Ghorbani
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Feng YS, Kohlmann T, Janssen MF, Buchholz I. Psychometric properties of the EQ-5D-5L: a systematic review of the literature. Qual Life Res 2021; 30:647-673. [PMID: 33284428 PMCID: PMC7952346 DOI: 10.1007/s11136-020-02688-y] [Citation(s) in RCA: 301] [Impact Index Per Article: 100.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Although the EQ-5D has a long history of use in a wide range of populations, the newer five-level version (EQ-5D-5L) has not yet had such extensive experience. This systematic review summarizes the available published scientific evidence on the psychometric properties of the EQ-5D-5L. METHODS Pre-determined key words and exclusion criteria were used to systematically search publications from 2011 to 2019. Information on study characteristics and psychometric properties were extracted: specifically, EQ-5D-5L distribution (including ceiling and floor), missing values, reliability (test-retest), validity (convergent, known-groups, discriminate) and responsiveness (distribution, anchor-based). EQ-5D-5L index value means, ceiling and correlation coefficients (convergent validity) were pooled across the studies using random-effects models. RESULTS Of the 889 identified publications, 99 were included for review, representing 32 countries. Musculoskeletal/orthopedic problems and cancer (n = 8 each) were most often studied. Most papers found missing values (17 of 17 papers) and floor effects (43 of 48 papers) to be unproblematic. While the index was found to be reliable (9 of 9 papers), individual dimensions exhibited instability over time. Index values and dimensions demonstrated moderate to strong correlations with global health measures, other multi-attribute utility instruments, physical/functional health, pain, activities of daily living, and clinical/biological measures. The instrument was not correlated with life satisfaction and cognition/communication measures. Responsiveness was addressed by 15 studies, finding moderate effect sizes when confined to studied subgroups with improvements in health. CONCLUSIONS The EQ-5D-5L exhibits excellent psychometric properties across a broad range of populations, conditions and settings. Rigorous exploration of its responsiveness is needed.
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Affiliation(s)
- You-Shan Feng
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany.
- Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany.
| | - Thomas Kohlmann
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
| | - Mathieu F Janssen
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Erasmus University, Rotterdam, The Netherlands
| | - Ines Buchholz
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
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Measurement Properties of the EQ-5D-5L and EQ-5D-3L in Six Commonly Diagnosed Cancers. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 14:209-222. [PMID: 33123985 DOI: 10.1007/s40271-020-00466-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND This study aimed to compare the measurement properties of the EQ-5D-3L (3L) and EQ-5D-5L (5L) in cancer patients. METHODS A consecutive sample of inpatients with lung, breast, colorectal, liver, gastric, or thyroid cancer were interviewed using the 3L, 5L, and Functional Assessment of Cancer Therapy-General (FACT-G) questionnaires, and a subgroup was invited to complete the 3L and 5L again. Kappa and intraclass correlation coefficient were used to assess test-retest reliability, and Spearman's correlation between the EQ-5D and FACT-G was evaluated to assess convergent validity. Comparison of subgroups defined using Eastern Cooperative Oncology Group status and cancer stage were performed to assess known-group validity and discriminatory power using the F-statistic and area under the receiver-operating characteristics curve. All analyses were also performed for each subgroup of cancer patients. RESULTS A total of 416 cancer patients completed the baseline questionnaire and 90 patients also completed the follow-up survey after 2 days. Ceiling effects were smaller in 5L (10.1%) than in 3L (17.8%). The test-retest reliability and convergent validity of the 5L were slightly better than those of the 3L. Both the 3L and 5L showed known-group validity; however, the 5L index showed better discriminatory power. Similar trends were found in the six types of cancers. CONCLUSION In general, 5L appears to have better measurement properties than 3L for measuring the health-related quality of life of cancer patients. While both the 3L and 5L are suitable, 5L should be preferable to 3L for use in cancer outcomes research.
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Whang KA, Khanna R, Williams KA, Mahadevan V, Semenov Y, Kwatra SG. Health-Related QOL and Economic Burden of Chronic Pruritus. J Invest Dermatol 2020; 141:754-760.e1. [PMID: 32941916 DOI: 10.1016/j.jid.2020.08.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 02/06/2023]
Abstract
Chronic pruritus (CP) has considerable implications for QOL. However, its impact on health-related QOL and economic burden is not fully characterized. We administered a cross-sectional survey on 132 patients with CP using the Health Utilities Index Mark 3 instrument. Normative data from healthy adults (n = 4,187) were obtained from the Joint Canada/US Survey of Health. Quality-adjusted life-year loss and economic costs were estimated on the basis of Health Utilities Index Mark 3 scores of patients with CP versus controls. Patients with CP had lower overall health performance than the control (0.56 ± 0.03 vs. 0.86 ± 0.003, P < 0.001). In multivariable regression, CP was associated with worse overall health performance (coefficient = -0.30, 95% confidence interval = -0.33 to -0.27), most accentuated in the domains of pain (coefficient = -0.24, confidence interval = -0.28 to -0.21) and emotion (coefficient = -0.11, confidence interval = -0.13 to -0.10). The reduced Health Utilities Index Mark 3 score correlated with 5.5 average lifetime quality-adjusted life-years lost per patient. Using conservative estimates for willingness to pay, the quality-adjusted life-year loss translated to an individual lifetime economic burden of $274,921 and a societal burden of $88.8 billion. CP is associated with significant QOL impairment. The economic burden of CP highlights the necessity for further research into management options.
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Affiliation(s)
- Katherine A Whang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Raveena Khanna
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kyle A Williams
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Varun Mahadevan
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yevgeniy Semenov
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
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Abdin E, Chong SA, Seow E, Peh CX, Tan JH, Liu J, Hui SFS, Chua BY, Sim K, Verma S, Vaingankar JA, Subramaniam M. A comparison of the reliability and validity of SF-6D, EQ-5D and HUI3 utility measures in patients with schizophrenia and patients with depression in Singapore. Psychiatry Res 2019; 274:400-408. [PMID: 30852434 DOI: 10.1016/j.psychres.2019.02.077] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 10/27/2022]
Abstract
There is limited evidence of a direct comparison of the psychometric performance of generic preference-based measures in patients with mental illness in an Asian patient population. The current study aimed to compare the test-retest reliability, convergent and known-group validity and magnitude of change in scores of the EuroQol Five-Dimension, Health Utility Index Mark 3 (HUI3) and Short-Form Six-Dimension (SF-6D) measures in patients with depression and patients with schizophrenia spectrum disorder. 500 patients were recruited from a tertiary psychiatric institution in Singapore. The Schizophrenia Quality of Life Scale (SQLS), 8-item Patient Health Questionnaire, Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), and Positive and Negative Syndrome Scale were also included. In the schizophrenia sample, the SF-6D was found to have higher test-retest validity, convergent validity with SQLS domain scores, known-group validity and magnitude of change in scores over 6-month follow up than other measures. In the depression sample, the HUI3 was found to have higher test-retest reliability, convergent validity with Q-LES-Q, known group validity and magnitude of change in scores than other measures. Results suggest that the SF-6D and HUI3 to be more suitable as a utility measure for patients with schizophrenia and depression in an Asian patient population.
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Affiliation(s)
- Edimansyah Abdin
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore.
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Esmond Seow
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Chao Xu Peh
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Jit Hui Tan
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Jianlin Liu
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Sophia Foo Si Hui
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Boon Yiang Chua
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Kang Sim
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Swapna Verma
- Early Psychosis Intervention Programme, Institute of Mental Health, Singapore
| | - Janhavi Ajit Vaingankar
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
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Zhao L, Liu X, Liu D, He Y, Liu Z, Li N. Comparison of the psychometric properties of the EQ-5D-3L and SF-6D in the general population of Chengdu city in China. Medicine (Baltimore) 2019; 98:e14719. [PMID: 30882636 PMCID: PMC6426629 DOI: 10.1097/md.0000000000014719] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The EQ-5D-3L and SF-6D are the most commonly used economic evaluation instruments. Data comparing the psychometric properties of the instruments are scarce in the Chinese population. This study compared the psychometric properties of these measures in the Chinese general population in Chengdu.From October to December 2012, 2186 respondents (age ≥18) were selected from urban and rural areas of Chengdu, China, via multistage stratified cluster sampling. Correlations, scatter plots and Bland-Altman plots were used to explore the relationships between the 2 measures. Ceiling and floor effects were used to analyze the score distribution. The known-groups method was used to evaluate discriminant validity.Among 2186 respondents, 2182 completed the questionnaire, and 2178 (18-82 years old, mean 46.09 ± 17.49) met the data quality requirement. The mean scores for the EQ-5D-3LCN, EQ-5D-3LUK, and SF-6DUK were 0.95 (Std: 0.11), 0.93 (Std: 0.15), and 0.79 (Std: 0.12), respectively. The correlations between domains ranged from 0.16 to 0.51. The correlation between the EQ-5D-3LCN and SF-6DUK and between the EQ-5D-3LUK and SF-6DUK was 0.46. The scatter plots and Bland-Altman plots demonstrated poor agreement between the EQ-5D-3L and SF-6D. The floor and ceiling effects were respectively 0.05% and 74.60% for the EQ-5D-3L and 0.05% and 2.53% for the SF-6DUK. The EQ-5D-3LCN, EQ-5D-3LUK and SF-6D have good discriminant validity in different sociodemographic and health condition groups. The SF-6D has higher level of discriminant validity in moderately healthy groups in the EQ-5D-3L full-health population.Both the EQ-5D-3L and SF-6D are valid economic evaluation instruments in the Chinese general population in Chengdu but do not seem to be interchangeable. The EQ-5D-3L has a higher ceiling effect and higher level of discriminant validity among different sociodemographic groups, and the SF-6D has a lower ceiling effect and higher level of discriminant validity in health condition groups. Users may consider the evidence in the choice of these instruments.
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Affiliation(s)
- Longchao Zhao
- Department of Health Related Social and Behavioral Science, West China School of Public Health, Sichuan University, Chengdu
| | - Xiang Liu
- Department of Health Related Social and Behavioral Science, West China School of Public Health, Sichuan University, Chengdu
| | - Danping Liu
- Department of Health Related Social and Behavioral Science, West China School of Public Health, Sichuan University, Chengdu
| | - Yan He
- Department of Social Medicine and Health Management, Public Health College, Zhengzhou University, Zhengzhou
| | - Zhijun Liu
- Applied Psychology Department, School of Management, Zunyi Medical University, Zunyi, China
| | - Ningxiu Li
- Department of Health Related Social and Behavioral Science, West China School of Public Health, Sichuan University, Chengdu
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Janssen MF, Bonsel GJ, Luo N. Is EQ-5D-5L Better Than EQ-5D-3L? A Head-to-Head Comparison of Descriptive Systems and Value Sets from Seven Countries. PHARMACOECONOMICS 2018; 36:675-697. [PMID: 29470821 PMCID: PMC5954015 DOI: 10.1007/s40273-018-0623-8] [Citation(s) in RCA: 219] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE This study describes the first empirical head-to-head comparison of EQ-5D-3L (3L) and EQ-5D-5L (5L) value sets for multiple countries. METHODS A large multinational dataset, including 3L and 5L data for eight patient groups and a student cohort, was used to compare 3L versus 5L value sets for Canada, China, England/UK (5L/3L, respectively), Japan, The Netherlands, South Korea and Spain. We used distributional analyses and two methods exploring discriminatory power: relative efficiency as assessed by the F statistic, and an area under the curve for the receiver-operating characteristics approach. Differences in outcomes were explored by separating descriptive system effects from valuation effects, and by exploring distributional location effects. RESULTS In terms of distributional evenness, efficiency of scale use and the face validity of the resulting distributions, 5L was superior, leading to an increase in sensitivity and precision in health status measurement. When compared with 5L, 3L systematically overestimated health problems and consequently underestimated utilities. This led to bias, i.e. over- or underestimations of discriminatory power. CONCLUSION We conclude that 5L provides more precise measurement at individual and group levels, both in terms of descriptive system data and utilities. The increased sensitivity and precision of 5L is likely to be generalisable to longitudinal studies, such as in intervention designs. Hence, we recommend the use of the 5L across applications, including economic evaluation, clinical and public health studies. The evaluative framework proved to be useful in assessing preference-based instruments and might be useful for future work in the development of descriptive systems or health classifications.
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Affiliation(s)
- Mathieu F Janssen
- Department of Medical Psychology and Psychotherapy, Erasmus MC, Erasmus University, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Gouke J Bonsel
- Department of Public Health, Erasmus MC, Erasmus University, Rotterdam, The Netherlands
- Division Mother and Child, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Sun V, Dumitra S, Ruel N, Lee B, Melstrom L, Melstrom K, Woo Y, Sentovich S, Singh G, Fong Y. Wireless Monitoring Program of Patient-Centered Outcomes and Recovery Before and After Major Abdominal Cancer Surgery. JAMA Surg 2017; 152:852-859. [PMID: 28593266 DOI: 10.1001/jamasurg.2017.1519] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance A combined subjective and objective wireless monitoring program of patient-centered outcomes can be carried out in patients before and after major abdominal cancer surgery. Objective To conduct a proof-of-concept pilot study of a wireless, patient-centered outcomes monitoring program before and after major abdominal cancer surgery. Design, Setting, and Participants In this proof-of-concept pilot study, patients wore wristband pedometers and completed online patient-reported outcome surveys (symptoms and quality of life) 3 to 7 days before surgery, during hospitalization, and up to 2 weeks after discharge. Reminders via email were generated for all moderate to severe scores for symptoms and quality of life. Surgery-related data were collected via electronic medical records, and complications were calculated using the Clavien-Dindo classification. The study was carried out in the inpatient and outpatient surgical oncology unit of one National Cancer Institute-designated comprehensive cancer center. Eligible patients were scheduled to undergo curative resection for hepatobiliary and gastrointestinal cancers, were English speaking, and were 18 years or older. Twenty participants were enrolled over 4 months. The study dates were April 1, 2015, to July 31, 2016. Main Outcomes and Measures Outcomes included adherence to wearing the pedometer, adherence to completing the surveys (MD Anderson Symptom Inventory and EuroQol 5-dimensional descriptive system), and satisfaction with the monitoring program. Results This study included a final sample of 20 patients (median age, 55.5 years [range, 22-74 years]; 15 [75%] female) with evaluable data. Pedometer adherence (88% [17 of 20] before surgery vs 83% [16 of 20] after discharge) was higher than survey adherence (65% to 75% [13 of 20 and 15 of 20] completed). The median number of daily steps at day 7 was 1689 (19% of daily steps at baseline), which correlated with the Comprehensive Complication Index, for which the median was 15 of 100 (r = -0.64, P < .05). Postdischarge overall symptom severity (2.3 of 10) and symptom interference with activities (3.5 of 10) were mild. Pain (4.4 of 10), fatigue (4.7 of 10), and appetite loss (4.0 of 10) were moderate after surgery. Quality-of-life scores were lowest at discharge (66.6 of 100) but improved at week 2 (73.9 of 100). While patient-reported outcomes returned to baseline at 2 weeks, the number of daily steps was only one-third of preoperative baseline. Conclusions and Relevance Wireless monitoring of combined subjective and objective patient-centered outcomes can be carried out in the surgical oncology setting. Preoperative and postoperative patient-centered outcomes have the potential of identifying high-risk populations who may need additional interventions to support postoperative functional and symptom recovery.
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Affiliation(s)
- Virginia Sun
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, California
| | - Sinziana Dumitra
- Division of Surgical Oncology, Department of Surgery, City of Hope, Duarte, California
| | - Nora Ruel
- Division of Biostatistics, Department of Information Sciences, City of Hope, Duarte, California
| | - Byrne Lee
- Division of Surgical Oncology, Department of Surgery, City of Hope, Duarte, California
| | - Laleh Melstrom
- Division of Surgical Oncology, Department of Surgery, City of Hope, Duarte, California
| | - Kurt Melstrom
- Division of Surgical Oncology, Department of Surgery, City of Hope, Duarte, California
| | - Yanghee Woo
- Division of Surgical Oncology, Department of Surgery, City of Hope, Duarte, California
| | - Stephen Sentovich
- Division of Surgical Oncology, Department of Surgery, City of Hope, Duarte, California
| | - Gagandeep Singh
- Division of Surgical Oncology, Department of Surgery, City of Hope, Duarte, California
| | - Yuman Fong
- Division of Surgical Oncology, Department of Surgery, City of Hope, Duarte, California
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Assessment of the psychometric properties of the EQ-5D-3L and EQ-5D-5L instruments in psoriasis. Arch Dermatol Res 2017; 309:357-370. [DOI: 10.1007/s00403-017-1743-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 04/23/2017] [Accepted: 05/03/2017] [Indexed: 02/08/2023]
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Yfantopoulos JN, Chantzaras AE. Validation and comparison of the psychometric properties of the EQ-5D-3L and EQ-5D-5L instruments in Greece. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:519-531. [PMID: 27262480 DOI: 10.1007/s10198-016-0807-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 05/12/2016] [Indexed: 05/07/2023]
Abstract
PURPOSE To validate and compare the psychometric properties of the EQ-5D-3L with the EQ-5D-5L classification systems in Greece. METHODS Participants (n = 2279) over 40 years old, sampled from the greater area of Athens using a multistage stratified quota sampling method, completed both EQ-5D versions, while information was also collected on socio-demographics and health-related characteristics. The EQ-5D-5L and EQ-5D-3L were evaluated in terms of agreement, ceiling effects, redistribution and inconsistency, informativity, and convergent and known-groups validity. RESULTS The agreement between the EQ-5D-3L and EQ-5D-5L was high (ICC = 0.85). Ceiling effects decreased significantly in the EQ-5D-5L in all domains (P < 0.001), with "usual activities" (-21.4 %) and "self-care" (-20.1 %) showing the highest absolute and "anxiety/depression" the highest relative reduction (-32.46 %). Inconsistency was low (5.7 %). The increase in prevalence of problems was larger than the decrease in their severity, resulting in a lower mean health utility for the EQ-5D-5L. Overall absolute and relative informativity improved by 70.5 % and 16.4 %, respectively, in the EQ-5D-5L. Both instruments exhibited good convergent and known-groups validity, with evidence of a considerably better convergent performance and discriminatory ability of the EQ-5D-5L. CONCLUSIONS Both EQ-5D versions demonstrated good construct validity and had consistent redistribution. The EQ-5D-5L system may be preferable to the EQ-5D-3L, as it exhibited superior performance in terms of lower ceiling effects, higher absolute and relative informativity, and improved convergent and known-groups validity efficiency.
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Affiliation(s)
- John N Yfantopoulos
- School of Economics and Political Sciences, University of Athens, 6 Themistokleous Street, 106 78, Athens, Greece.
| | - Athanasios E Chantzaras
- School of Economics and Political Sciences, University of Athens, 6 Themistokleous Street, 106 78, Athens, Greece
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Bos I, Wynia K, Drost G, Almansa J, Kuks JBM. The extremity function index (EFI), a disability severity measure for neuromuscular diseases: psychometric evaluation. Disabil Rehabil 2017; 40:1561-1568. [PMID: 28291950 DOI: 10.1080/09638288.2017.1300690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To adapt and to combine the self-report Upper Extremity Functional Index and Lower Extremity Function Scale, for the assessment of disability severity in patients with a neuromuscular disease and to examine its psychometric properties in order to make it suitable for indicating disease severity in neuromuscular diseases. DESIGN A cross-sectional postal survey study was performed among patients diagnosed with a neuromuscular disease. METHODS Patients completed both adapted extremity function scales, questionnaires for psychometric evaluation, and disease-specific questions. Confirmatory factor analysis was performed, and reliability and validity were examined. RESULTS Response rate was 70% (n = 702). The Extremity Function Index model with a two-factor structure - for upper and lower extremities - showed an acceptable fit. The Extremity Function Index scales showed good internal consistency (alphas: 0.97-0.98). The known-groups validity test confirmed that Extremity Function Index scales discriminate between categories of "Extent of limitations" and "Quality of Life." Convergent and divergent validity tests confirmed that Extremity Function Index scales measure the physical impact of neuromuscular diseases. Relative validity tests showed that the Extremity Function Index scales performed well in discriminating between subgroups of patients with increasing "Extent of limitations" compared to concurrent measurement instruments. CONCLUSION The Extremity Function Index proved to be a sound and easy to apply self-report disability severity measurement instrument in neuromuscular diseases. Implications for rehabilitation The Extremity Function Index reflects the functioning of all muscles in the upper and lower extremities involved in activities of daily living. The Extremity Function Index is an easy to administer and patient-friendly disability severity measurement instrument that has the ability to evaluate differences in disability severity between relevant neuromuscular disease subgroups. The Extremity Function Index is a valid and reliable disability severity measurement instrument for neuromuscular diseases.
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Affiliation(s)
- Isaäc Bos
- a Department of Neurology , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Klaske Wynia
- a Department of Neurology , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands.,b Department of Community and Occupational Health , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Gea Drost
- a Department of Neurology , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Josué Almansa
- b Department of Community and Occupational Health , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Jan B M Kuks
- a Department of Neurology , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
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Xin Y, McIntosh E. Assessment of the construct validity and responsiveness of preference-based quality of life measures in people with Parkinson’s: a systematic review. Qual Life Res 2016; 26:1-23. [DOI: 10.1007/s11136-016-1428-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
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Luo N, Wang X, Ang M, Finkelstein EA, Aung T, Wong TY, Lamoureux E. A Vision "Bolt-On" Item Could Increase the Discriminatory Power of the EQ-5D Index Score. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:1037-1042. [PMID: 26686788 DOI: 10.1016/j.jval.2015.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 06/28/2015] [Accepted: 08/03/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Recently, a vision "bolt-on" EuroQol five-dimensional questionnaire (EQ-5D) was developed and tentative utility values (i.e., a "value set") for this new descriptive system were estimated. OBJECTIVES To compare the discriminatory power of this bolt-on and standard utility-based EQ-5D health indices. METHODS Cross-sectional data on the (3-level) vision bolt-on EQ-5D were collected through face-to-face interviews with 500 and 336 individuals with and without visual impairment, respectively. To assess the discriminatory power of the vision bolt-on index relative to the standard EQ-5D index developed in the vision bolt-on valuation study, 16 pairs of mutually exclusive subgroups of individuals defined by the individuals' visual acuity and responses to the 14-item visual function questionnaire were compared pairwise. The absolute mean difference in the two index scores and the corresponding F statistic derived from the comparisons were used as measures of discriminatory power. RESULTS The absolute mean difference in the bolt-on index score was larger than that in the standard EQ-5D index score in 14 of the 16 comparisons. The bolt-on index score exhibited a larger F-statistic value than did the standard EQ-5D index score in all known-group comparisons, with the F-statistic ratio ranging from 0.415 to 0.770. CONCLUSIONS The vision bolt-on EQ-5D appears to be more discriminative than the standard EQ-5D in measurement of vision problems. Future studies should investigate the extent to which the vision bolt-on item can increase the sensitivity of the EQ-5D to vision change in interventional studies.
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Affiliation(s)
- Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Xingzhi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | | | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Graduate Medical School, Singapore; Department of Ophthalmology, National University Health System and National University of Singapore, Singapore
| | - Tien-Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Graduate Medical School, Singapore; Department of Ophthalmology, National University Health System and National University of Singapore, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Graduate Medical School, Singapore; Department of Ophthalmology, National University Health System and National University of Singapore, Singapore; Centre for Eye Research Australia, Department of Ophthalmology, University of Melbourne, Melbourne, Australia
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Tramontano AC, Schrag DL, Malin JK, Miller MC, Weeks JC, Swan JS, McMahon PM. Catalog and comparison of societal preferences (utilities) for lung cancer health states: results from the Cancer Care Outcomes Research and Surveillance (CanCORS) study. Med Decis Making 2015; 35:371-87. [PMID: 25670839 DOI: 10.1177/0272989x15570364] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The EQ-5D and SF-6D are 2 health-related quality-of-life indexes that provide preference-weighted measures for use in cost-effectiveness analyses. METHODS The National Cancer Institute's Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium included the EQ-5D and SF-12v2 in their survey of newly diagnosed lung cancer patients. Utilities were calculated from patient-provided scores for each domain of the EQ-5D or the SF-6D. Utilities were calculated for categories of cancer type, stage, and treatment. RESULTS There were 5015 enrolled lung cancer patients with a baseline survey in CanCORS; 2396 (47.8%) completed the EQ-5D, and 2344 (46.7%) also completed the SF-12v2. The mean (standard deviation) utility from the EQ-5D was 0.78 (0.18), and from the SF-6D (derived from SF-12v2) was 0.68 (0.14). The EQ-5D demonstrated a ceiling effect, with 20% of patients reporting perfect scores, translating to a utility of 1.0. No substantial SF-6D floor effects were noted. Utilities increased with age and decreased with stage and comorbidities. Patient-reported (EQ-5D) visual analog scale scores for health status had a moderate (r = 0.48, p < 0.0001) positive correlation with utilities. A subset (n = 1474) completed follow-up EQ-5D questionnaires 11-13 months after diagnosis. Among these patients, there was a nonsignificant decrease in mean utility for stage IV and an increase in mean utility for stages I, II, and III. CONCLUSION This study generated a catalog of community-weighted utilities applicable to societal-perspective cost-effectiveness analyses of lung cancer interventions and compared utilities based on the EQ-5D and SF-6D. Potential users of these scores should be aware of the limitations and think carefully about their use in specific studies.
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Affiliation(s)
- Angela C Tramontano
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA (ACT, MCM, JSS, PMM)
| | - Deborah L Schrag
- Dna-Farber Cancer Institute, Boston, MA (DLS, JCW),Department of Radiology, Harvard Medical School, Boston, MA (DLS, JSS, PMM)
| | | | - Melecia C Miller
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA (ACT, MCM, JSS, PMM)
| | - Jane C Weeks
- Dna-Farber Cancer Institute, Boston, MA (DLS, JCW)
| | - J Shannon Swan
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA (ACT, MCM, JSS, PMM),Department of Radiology, Harvard Medical School, Boston, MA (DLS, JSS, PMM)
| | - Pamela M McMahon
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA (ACT, MCM, JSS, PMM),Department of Radiology, Harvard Medical School, Boston, MA (DLS, JSS, PMM)
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Health status and quality of life: results from a national survey in a community-dwelling sample of elderly people. Qual Life Res 2014; 24:1687-96. [PMID: 25510216 DOI: 10.1007/s11136-014-0894-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 01/09/2023]
Abstract
PURPOSE To investigate the relation between age and HRQoL indicators in a community-dwelling population aged 65 years and older. METHODS Data were collected within a sample stratified by age (65-69; 70-74; 75-79; 80-84; 85-89; 90 years and above) and sex and randomly selected in the population records in Switzerland. The EQ-5D was used to assess HRQoL. Analyses were conducted on the entire available sample (N = 3,073) and on the subsample with no missing data in the EQ-5D (N = 2,888), considering age, gender, education and region. RESULTS Results of multiple regression analyses showed different age-related patterns across the EQ-5D. The proportion of respondents reporting no problems ranged from 51 % in the 65- to 69-year age group to 20 % in the 90 years and above age group. Odds ratio (OR) for Mobility problems increased from 2.04 in the 75- to 79-year age group to 13.34 in the 90 years and above age group; OR for Usual Activities increased from 1.76 to 11.68 and from 1.55 to 2.32 for Pain/Discomfort; OR for Self-Care increased from 5.26 in the 80- to 84-year age group to 30.36 in the 90 years and above age group. Problems with Self-Care remained low, increasing from 6.22 % in the 80- to 84-year age group to 26.21 % in the oldest age group. The magnitude of the gender, region and education effects was much lower than that of age. CONCLUSION HRQoL is globally preserved in older adults in Switzerland, even if substantial impairment is reported in very old age affecting mainly functional health dimensions. Anxiety/Depression and Pain/Discomfort did not appear to be affected by age; high rates of difficulties were reported for Pain/Discomfort but not for Anxiety/Depression.
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Ownby RL, Acevedo A, Jacobs RJ, Caballero J, Waldrop-Valverde D. Quality of life, health status, and health service utilization related to a new measure of health literacy: FLIGHT/VIDAS. PATIENT EDUCATION AND COUNSELING 2014; 96:404-410. [PMID: 24856447 PMCID: PMC4700512 DOI: 10.1016/j.pec.2014.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/08/2014] [Accepted: 05/01/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Researchers have identified significant limitations in some currently used measures of health literacy. The purpose of this paper is to present data on the relation of health-related quality of life, health status, and health service utilization to performance on a new measure of health literacy in a nonpatient population. METHODS The new measure was administered to 475 English- and Spanish-speaking community-dwelling volunteers along with existing measures of health literacy and assessments of health-related quality of life, health status, and healthcare service utilization. Relations among measures were assessed via correlations and health status and utilization was tested across levels of health literacy using ANCOVA models. RESULTS The new health literacy measure is significantly related to existing measures of health literacy as well as to participants' health-related quality of life. Persons with lower levels of health literacy reported more health conditions, more frequent physical symptoms, and greater healthcare service utilization. CONCLUSION The new measure of health literacy is valid and shows relations to measures of conceptually related constructs such as quality of life and health behaviors. PRACTICE IMPLICATIONS FLIGHT/VIDAS may be useful to researchers and clinicians interested in a computer administered and scored measure of health literacy.
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Affiliation(s)
- Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, USA.
| | - Amarilis Acevedo
- Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, USA
| | - Robin J Jacobs
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Joshua Caballero
- College of Pharmacy, Department of Pharmacy Practice, Nova Southeastern University, Fort Lauderdale, USA
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Tang DH, Colayco DC, Khalaf KM, Piercy J, Patel V, Globe D, Ginsberg D. Impact of urinary incontinence on healthcare resource utilization, health-related quality of life and productivity in patients with overactive bladder. BJU Int 2014; 113:484-91. [PMID: 24528881 DOI: 10.1111/bju.12505] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the impact of urinary incontinence (UI) on healthcare resource utilization (HRU), health-related quality of life (HRQoL) and productivity measures in patients with overactive bladder (OAB). PATIENTS AND METHODS This retrospective, cross-sectional study used data from the Adelphi OAB/UI Disease Specific Programme, a multinational survey of patient- and physician-reported data, fielded between November 2010 and February 2011. The primary patient groups of interest were those with OAB, both with and without UI. Health-related quality of life and productivity measures were derived from the EuroQoL-5D, the Incontinence Quality of Life questionnaire, the Overactive Bladder Questionnaire, and the Work Productivity and Activity Impairment Questionnaire. Measures of HRU included OAB-related surgeries, OAB-related hospitalizations, incontinence pads, anticholinergic use and physician visits. Multivariate linear regression models and literature-based minimal clinically important differences were used to assess statistically significant and clinically meaningful differences in HRQoL and productivity measures between patients with OAB with UI and those without UI. RESULTS A total of 1 730 patients were identified, with a mean age of 60.7 years, and 77.0% of them were women, 84.2% were non-Hispanic whites, and 71% were incontinent. Bivariate analyses showed that HRU was significantly higher among patients with OAB with UI than among those without UI in all categories except for the number of OAB-related physician visits. In both bivariate and multivariate analyses, incontinent patients presented with clinically and statistically significantly lower HRQoL and productivity measures with respect to all study endpoints, except for percentage of work time missed due to their OAB/UI. CONCLUSIONS Urinary incontinence was associated with significantly higher HRU and lower HRQoL and productivity in this population of patients with OAB from five different countries. In addition to clinical considerations, the economic and humanistic impact of UI should be taken into account when evaluating treatment options for patients with OAB.
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Affiliation(s)
- Derek H Tang
- The University of Arizona College of Pharmacy, Tucson, AZ, USA
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Tang DH, Colayco D, Piercy J, Patel V, Globe D, Chancellor MB. Impact of urinary incontinence on health-related quality of life, daily activities, and healthcare resource utilization in patients with neurogenic detrusor overactivity. BMC Neurol 2014; 14:74. [PMID: 24708598 PMCID: PMC3984584 DOI: 10.1186/1471-2377-14-74] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 03/20/2014] [Indexed: 01/22/2023] Open
Abstract
Background Neurogenic detrusor overactivity (NDO) leads to impaired health-related quality of life (HRQoL), productivity, and greater healthcare resource burden. The humanistic and economic burden may be more apparent in NDO patients with urinary incontinence (UI). The objective of this study was to compare the HRQoL, productivity, and health resource use (HRU) between continent and incontinent NDO patients. Methods A retrospective database analysis was conducted using the Adelphi Overactive Bladder (OAB)/UI Disease Specific Programme, a multi-national, cross-sectional survey reported from both patients’ and physicians’ perspectives. The population for this analysis included NDO patients with or without UI. General and disease-specific HRQoL were assessed using the EuroQoL-5D (EQ-5D), Incontinence Quality of Life questionnaire (I-QOL), and the Overactive Bladder Questionnaire (OAB-q). Productivity and daily activity impairment were measured using the Work Productivity and Activity Impairment (WPAI) questionnaire. HRU indicators included OAB-related surgery, OAB-related hospitalizations, incontinence pad usage, switching anticholinergics used for OAB due to inadequate response or adverse effects, and OAB-related physician visits. Bivariate analyses, multivariate ordinary least squares (OLS) regression analyses and published minimal clinically important differences (MCID) were used to assess relationships between incontinent status and the aforementioned outcome measures. Results A total of 324 NDO patients with or without urinary incontinence were included, averaging 54 years of age (SD 16), of whom 43.8 percent were male. Bivariate analyses detected no significant relationship between incontinent status and HRU variables. Regression analyses revealed that incontinent patients had clinically and statistically lower disease-specific HRQoL and greater impairment in daily activities as compared to continent patients. On average, incontinent patients scored 10 points lower on the I-QOL total score, 9 points lower on the OAB-q HRQoL score, 15 points higher on OAB-q symptom severity, and experienced 8.2 percent higher activity impairment due to their bladder condition (all p < 0.001). Conclusions Incontinent NDO patients experience significantly lower HRQoL and activity impairment as compared to continent NDO patients.
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Affiliation(s)
- Derek H Tang
- The University of Arizona College of Pharmacy, 1295 N, Martin, PO Box 210202, Tucson, AZ 85721, USA.
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Swan JS, Hur C, Lee P, Motazedi T, Donelan K. Responsiveness of the testing morbidities index in colonoscopy. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:1046-1053. [PMID: 24041354 DOI: 10.1016/j.jval.2013.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 06/20/2013] [Accepted: 07/30/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The Testing Morbidities Index (TMI) was developed to measure the effects of any diagnostic or screening procedure on health-related quality of life (HRQOL); it includes seven domains incorporating mental and physical aspects before, during, and after testing. To add to prior work on the validity of the TMI classification, responsiveness of a summated scale version was evaluated in 71 colonoscopy patients. Further data on construct validity were also obtained. METHODS Patients enrolled in the study when scheduling colonoscopy days to weeks beforehand. The baseline survey included the EuroQol five-dimensional (EQ-5D) questionnaire with five levels in each attribute (EQ-5D-5L questionnaire) and its visual analogue scale (VAS) assessment (EQ-VAS), the Short Form 12 version 2 (SF-12v2) component summary scores and six-dimensional health state short-form (derived from the short-form 12v2 health survey [SF-6D] utilities), and an original construct-specific VAS (CS-VAS) for usual HRQOL using utility scale anchors. The TMI's highest possible summated score (all best levels) served as its baseline. Survey data were generally obtained by telephone interview. A postprocedure survey was given to patients after colonoscopy and interviews conducted as soon as possible after the day of the procedure. The postprocedure survey included the SF-12v2/SF-6D, EQ-5D questionnaire instruments, TMI items, and a CS-VAS incorporating the overall HRQOL effects of colonoscopy. RESULTS Standardized response means showed greatest responsiveness by the TMI (-1.52) followed by the CS-VAS instruments (-0.42). The EQ-5D-5L questionnaire, the EQ-VAS, and the SF-12 component summaries were unresponsive, and the SF-6D was minimally responsive (-0.05). Correlation of the post-CS-VAS with the TMI was substantial (r = -0.52), suggesting TMI construct validity. Moderate to strong correlation of the baseline CS-VAS with standard indexes was observed (r = 0.54-0.81). CONCLUSION The TMI appears responsive and exhibits further evidence of construct validity.
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Affiliation(s)
- J Shannon Swan
- Massachusetts General Hospital Institute for Technology Assessment, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Jutkowitz E, Pizzi L, Hess E, Suh DC, Gitlin LN. Comparison of three societally derived health-state classification values among older African Americans with depressive symptoms. Qual Life Res 2013; 22:1491-8. [PMID: 22972437 PMCID: PMC3822045 DOI: 10.1007/s11136-012-0263-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare societal values across three health-state classification systems in older African Americans with depression and to describe the association of these instruments to depression severity. METHODS We summarized baseline values for EQ-5D (US weights) and HUI2/3 (Canadian weights) and their subscales for 118 older African American participants enrolled in a randomized depression treatment trial and calculated correlations between the different instruments. We evaluated ceiling and floor effects for each instrument by comparing the proportion at the highest and lowest possible score for each tool. Also, utility scores were assessed by level of depression severity (mild, moderate, moderate severe, severe) scores as measured by the Patient Health Questionnaire (PHQ-9). RESULTS Mean utility values were 0.58 (SD = 0.21) for EQ-5D, 0.52 (SD = 0.21) for HUI2, and 0.36 (SD = 0.31) for HUI3. For the EQ-5D, 72 % of participants reported having some problems on the anxiety/depression domain. On the emotion domain for the HUI2, 23 % reported the highest level of impairment compared to only 3 % on the HUI3. No participant scored at the floor for the EQ-5D, HUI2, or HUI3 index; one participant scored at the ceiling value on the HUI3 index. Correlations ranged from 0.63 to 0.82 (all of which were significant at an alpha level of 0.05). In general, utility scores trended inversely with depression level. CONCLUSION Small differences in the three preference-weighted health-state classification systems were evident for this sample of older African Americans with depressive symptoms, with HUI scores lower than EQ-5D. For this sample, utility scores were lower (i.e., poorer) than the general United States population with depression on each utility measure.
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Affiliation(s)
- Eric Jutkowitz
- Department of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware Street SE, Minneapolis, MN 55455, USA,
| | - Laura Pizzi
- Department of Pharmacy Practice, Jefferson School of Pharmacy, 130 South 9th Street, Suite 1540, Philadelphia, PA 19107, USA,
| | - Edward Hess
- School of Medicine, Johns Hopkins University, 511 N. Washington Street, Baltimore, MD 21205, USA,
| | - Dong-Churl Suh
- College of Pharmacy, Chung-Ang University, 221 Heukseok-dong, Dongjak-gu, Seoul, South Korea,
| | - Laura N. Gitlin
- Johns Hopkins University School of Nursing Center for Innovative Care in Aging, Johns Hopkins University, 525 Wolfe Street, Suite 316, Baltimore, MD 21205, USA,
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Greenberg-Kushnir N, Freedman S, Eshel R, Zwerdling N, Elhasid R, Dvir R, Yalon M, Kulkarni AV, Constantini S. Screening tool for late-effect pediatric neuro-oncological clinics: a treatment-oriented questionnaire. Pediatr Blood Cancer 2013; 60:1369-74. [PMID: 23418062 DOI: 10.1002/pbc.24495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 01/10/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Many survivors of pediatric brain tumors (SPBTs) suffer from long-term late effects (LEs). Our aim was to create a practical screening tool for detecting LEs in this population. Such a screening tool will improve our ability to identify those patients who may benefit from treatment in LE clinics while focusing on individual relevant issues. PROCEDURE We developed the Treatment-Oriented Screening Questionnaire (TOSQ); a self-reported, risk-based questionnaire that addresses all LEs SPBTs can potentially suffer. As a basis for the TOSQ design we used the Long-Term Follow-Up Guidelines published by the Children's Oncology Group. Output includes individual recommendations for further treatment. We prospectively assessed whether the TOSQ can accurately detect treatment targets in SPBTs by comparing patient and caregiver questionnaire scores with physician evaluations. Data are presented from 41 SPBTs. RESULTS The TOSQ is a precise screening tool for identifying LEs in SPBTs based on the significant correlation (P < 0.05) that was found between parental scores and physician evaluations. Statistical testing proved that parents are a good source of information about child's health status, and that TOSQ accurately reflects the correlation between patient difficulties and quality of life. CONCLUSIONS The TOSQ is the first described screening tool for identification of LEs designed specifically for SPBTs. It is simple to use and provides a valid, comprehensive and economic assessment followed by targeted treatment plan for each patient. By repeatedly using the TOSQ over the years, we can improve our ability to detect and give focused treatment to those who require assistance.
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Affiliation(s)
- Noa Greenberg-Kushnir
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel
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Deng N, Allison JJ, Fang HJ, Ash AS, Ware JE. Using the bootstrap to establish statistical significance for relative validity comparisons among patient-reported outcome measures. Health Qual Life Outcomes 2013; 11:89. [PMID: 23721463 PMCID: PMC3681626 DOI: 10.1186/1477-7525-11-89] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 05/27/2013] [Indexed: 12/26/2022] Open
Abstract
Background Relative validity (RV), a ratio of ANOVA F-statistics, is often used to compare the validity of patient-reported outcome (PRO) measures. We used the bootstrap to establish the statistical significance of the RV and to identify key factors affecting its significance. Methods Based on responses from 453 chronic kidney disease (CKD) patients to 16 CKD-specific and generic PRO measures, RVs were computed to determine how well each measure discriminated across clinically-defined groups of patients compared to the most discriminating (reference) measure. Statistical significance of RV was quantified by the 95% bootstrap confidence interval. Simulations examined the effects of sample size, denominator F-statistic, correlation between comparator and reference measures, and number of bootstrap replicates. Results The statistical significance of the RV increased as the magnitude of denominator F-statistic increased or as the correlation between comparator and reference measures increased. A denominator F-statistic of 57 conveyed sufficient power (80%) to detect an RV of 0.6 for two measures correlated at r = 0.7. Larger denominator F-statistics or higher correlations provided greater power. Larger sample size with a fixed denominator F-statistic or more bootstrap replicates (beyond 500) had minimal impact. Conclusions The bootstrap is valuable for establishing the statistical significance of RV estimates. A reasonably large denominator F-statistic (F > 57) is required for adequate power when using the RV to compare the validity of measures with small or moderate correlations (r < 0.7). Substantially greater power can be achieved when comparing measures of a very high correlation (r > 0.9).
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Affiliation(s)
- Nina Deng
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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Swan JS, Kong CY, Lee JM, Itauma O, Halpern EF, Lee PA, Vavinskiy S, Williams O, Zoltick ES, Donelan K. Patient and societal value functions for the testing morbidities index. Med Decis Making 2013; 33:819-38. [PMID: 23689044 DOI: 10.1177/0272989x13487605] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We developed preference-based and summated scale scoring for the Testing Morbidities Index (TMI) classification, which addresses short-term effects on quality of life from diagnostic testing before, during, and after testing procedures. METHODS The two TMI preference functions use multiattribute value techniques; one is patient-based and the other has a societal perspective, informed by 206 breast biopsy patients and 466 (societal) subjects. Because of a lack of standard short-term methods for this application, we used the visual analog scale (VAS). Waiting tradeoff (WTO) tolls provided an additional option for linear transformation of the TMI. We randomized participants to 1 of 3 surveys: The first derived weights for generic testing morbidity attributes and levels of severity with the VAS; a second developed VAS values and WTO tolls for linear transformation of the TMI to a "dead-healthy" scale; the third addressed initial validation in a specific test (breast biopsy). The initial validation included 188 patients and 425 community subjects. Direct VAS and WTO values were compared with the TMI. Alternative TMI scoring as a nonpreference summated scale was included, given evidence of construct and content validity. RESULTS The patient model can use an additive function, whereas the societal model is multiplicative. Direct VAS and the VAS-scaled TMI were correlated across modeling groups (r = 0.45-0.62). Agreement was comparable to the value function validation of the Health Utilities Index 2. Mean absolute difference (MAD) calculations showed a range of 0.07-0.10 in patients and 0.11-0.17 in subjects. MAD for direct WTO tolls compared with the WTO-scaled TMI varied closely around 1 quality-adjusted life day. CONCLUSIONS The TMI shows initial promise in measuring short-term testing-related health states.
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Affiliation(s)
- J Shannon Swan
- Massachusetts General Hospital Institute for Technology Assessment, Boston, MA (JSS, CYK, JML, OA, EFH, PL, OW, ESZ, KD),Harvard Medical School, Boston, MA (JSS, CYK, JML, EFH, KD)
| | - Chung Yin Kong
- Massachusetts General Hospital Institute for Technology Assessment, Boston, MA (JSS, CYK, JML, OA, EFH, PL, OW, ESZ, KD),Harvard Medical School, Boston, MA (JSS, CYK, JML, EFH, KD)
| | - Janie M Lee
- Massachusetts General Hospital Institute for Technology Assessment, Boston, MA (JSS, CYK, JML, OA, EFH, PL, OW, ESZ, KD),Harvard Medical School, Boston, MA (JSS, CYK, JML, EFH, KD)
| | - Omosalewa Itauma
- Massachusetts General Hospital Institute for Technology Assessment, Boston, MA (JSS, CYK, JML, OA, EFH, PL, OW, ESZ, KD),Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI (OA)
| | - Elkan F Halpern
- Massachusetts General Hospital Institute for Technology Assessment, Boston, MA (JSS, CYK, JML, OA, EFH, PL, OW, ESZ, KD),Harvard Medical School, Boston, MA (JSS, CYK, JML, EFH, KD)
| | - Pablo A Lee
- Massachusetts General Hospital Institute for Technology Assessment, Boston, MA (JSS, CYK, JML, OA, EFH, PL, OW, ESZ, KD)
| | - Sergey Vavinskiy
- Indiana University Department of Radiology, Indianapolis, IN (SV),Indiana State Government, Indianapolis, IN (SV)
| | - Olubunmi Williams
- Massachusetts General Hospital Institute for Technology Assessment, Boston, MA (JSS, CYK, JML, OA, EFH, PL, OW, ESZ, KD)
| | - Emilie S Zoltick
- Massachusetts General Hospital Institute for Technology Assessment, Boston, MA (JSS, CYK, JML, OA, EFH, PL, OW, ESZ, KD),Boston University School of Public Health, Boston, MA (ESZ)
| | - Karen Donelan
- Massachusetts General Hospital Institute for Technology Assessment, Boston, MA (JSS, CYK, JML, OA, EFH, PL, OW, ESZ, KD),Harvard Medical School, Boston, MA (JSS, CYK, JML, EFH, KD),Mongan Institute for Health Policy and Massachusetts General Hospital, Boston, MA (KD)
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Wong CKH, Lam ETP, Lam CLK. Comparison of direct-measured and derived short form six dimensions (SF-6D) health preference values among chronic hepatitis B patients. Qual Life Res 2013; 22:2973-81. [PMID: 23564621 DOI: 10.1007/s11136-013-0403-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The short form six dimensions (SF-6D) are derived from the SF-36 Health Survey with the intention that item data of the latter are often converted to a preference value, which was subsequently used in economic evaluations of interventions. The aim was to compare the equivalence and sensitivity of health preference values derived from the SF-36/SF-12 Health Surveys to that measured directly by the SF-6D for chronic hepatitis B (CHB) patients. METHODS This was a secondary analysis of the SF-6D and SF-36 data from a baseline sample of 589 patients with CHB infection with different stages of liver diseases. Degree of agreement (equivalence) between direct-measured and derived SF-6D values was determined using spearman correlation and intra-class correlation. Sensitivity and discriminative power of different SF-6D values were compared by standardized effect size and relative efficiency (RE) statistics. RESULTS Significant differences in the direct-measured or derived SF-6D preference values were found between CHB groups. Degree of agreement between SF-6D values was satisfactory. Direct-measured SF-6D was the most efficient, followed by SF-12-derived and the SF-36-derived was the least, based on the standardized effect size and the RE statistics. Sensitivity and discriminative power of direct-measured SF-6D were superior to derived SF-6D among people with different CHB health states. CONCLUSIONS Although direct-measured and derived SF-6D preference values had satisfactory sensitivity in discriminating between CHB groups, direct-measured SF-6D is the most sensitive and preferable method of obtaining health preference.
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Affiliation(s)
- Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong Island, Hong Kong,
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Measuring health-related quality of life among adults in Singapore: population norms for the EQ-5D. Qual Life Res 2013; 22:2983-91. [DOI: 10.1007/s11136-013-0405-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2013] [Indexed: 12/22/2022]
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LINDSAY BRUCED. Perspective on Cost-Effective Utilization of Cardiac Resynchronization Therapy. J Cardiovasc Electrophysiol 2013; 24:75-6. [DOI: 10.1111/jce.12007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gada H, Desai MY, Marwick TH. Cost-Effectiveness of Computed Tomographic Angiography Before Reoperative Coronary Artery Bypass Grafting. Circ Cardiovasc Qual Outcomes 2012; 5:705-10. [DOI: 10.1161/circoutcomes.112.966465] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hemal Gada
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Milind Y. Desai
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Thomas H. Marwick
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
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Preference-based SF-6D scores derived from the SF-36 and SF-12 have different discriminative power in a population health survey. Med Care 2012; 50:627-32. [PMID: 22456112 DOI: 10.1097/mlr.0b013e31824d7471] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the discriminative power of the SF-6D index scores derived from the SF-36 (SF-6D36) and SF-12 (SF-6D12) in the general population. METHODS Data from the National Health Measurement Study were used. The F statistic was used to compare the relative efficiency of the SF-6D36 and SF-6D12, as well as the EQ-5D, HUI2, and HUI3 index scores, in discriminating between respondents with and without 1 of the 11 chronic medical conditions. The efficiency of the multiattribute health classification systems of the study instruments was measured using the Shannon index (H'). The relative efficiency of the SF-6D36 and SF-6D12 was also compared in respondents who were on the ceilings of the EQ-5D, HUI2, and HUI3 scales. RESULTS The SF-6D36 score was systematically lower than the SF-6D12 score at the group level (range, 0.022-0.036). The SF-6D36 exhibited higher discriminative power in 8 and 5 conditions than the SF-6D12 and all other index scores, respectively. The SF-6D36 had higher H' values than the SF-6D12 in the dimensions of physical functioning (1.73 vs. 0.78), mental health (1.70 vs. 1.39), and bodily pain (2.16 vs. 1.56) as well as than all other instruments in similar health dimensions. In respondents reporting full health on the EQ-5D, HUI2, or HUI3, the SF-6D36 better discriminated between those with and without medical conditions than the SF-6D12. CONCLUSIONS The SF-6D derived from the SF-36 is more discriminative than that derived from the SF-12 and is therefore preferred for use in population health surveys where a preference-based health index is needed.
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Stafford MR, Hareendran A, Ng-Mak DS, Insinga RP, Xu R, Stull DE. EQ-5D™-derived utility values for different levels of migraine severity from a UK sample of migraineurs. Health Qual Life Outcomes 2012; 10:65. [PMID: 22691697 PMCID: PMC3407525 DOI: 10.1186/1477-7525-10-65] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 06/12/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To estimate utility values for different levels of migraine pain severity from a United Kingdom (UK) sample of migraineurs. METHODS One hundred and six migraineurs completed the EQ-5D to evaluate their health status for mild, moderate and severe levels of migraine pain severity for a recent migraine attack, and for current health defined as health status within seven days post-migraine attack. Statistical tests were used to evaluate differences in mean utility scores by migraine severity. RESULTS Utility scores for each health state were significantly different from 1.0 (no problems on any EQ-5D dimension) (p < 0.0001) and one another (p < 0.0001). The lowest mean utility, - 0.20 (95% confidence interval [CI]: -0.27 - -0.13), was for severe migraine pain. The smallest difference in mean utility was between mild and moderate migraine pain (0.13) and the largest difference in mean utility was between current health (without migraine) and severe migraine pain (1.07). CONCLUSIONS Results indicate that all levels of migraine pain are associated with significantly reduced utility values. As severity worsened, utility decreased and severe migraine pain was considered a health state worse than death. Results can be used in cost-utility models examining the relative economic value of therapeutic strategies for migraine in the UK.
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Affiliation(s)
- Megan R Stafford
- Outcomes Research, United BioSource Corporation, 26-28 Hammersmith Grove, Floor 5E, London, W6 7HA, United Kingdom
- NCCMH, Royal College of Psychiatrists, (during the work conducted and preparation of this manuscript, MRS was employed by United BioSource Corporation), 4th Floor Mansell Street, 21 Standon House, London, E1 8AA, United Kingdom
| | - Asha Hareendran
- Outcomes Research, United BioSource Corporation, 26-28 Hammersmith Grove, Floor 5E, London, W6 7HA, United Kingdom
| | - Daisy S Ng-Mak
- Director, Global Health Outcomes Strategy & Research, Allergan, (during the work conducted and preparation of this manuscript, DSN was employed by Merck Research Laboratories), 2525 Dupont Drive (MI3-110A), Irvine, CA, 92612-1599, USA
| | - Ralph P Insinga
- Department of Health Economic Statistics, Merck Research Laboratories, Merck Sharp & Dohme Corp, Whitehouse Station, NJ, 08889, USA
| | - Ruifeng Xu
- Department of Health Economic Statistics, Merck Research Laboratories, Merck Sharp & Dohme Corp, Whitehouse Station, NJ, 08889, USA
| | - Donald E Stull
- Outcomes Research, United BioSource Corporation, 26-28 Hammersmith Grove, Floor 5E, London, W6 7HA, United Kingdom
- RTI-Health Solutions, (during the work conducted and preparation of this manuscript, DES was employed by United BioSource Corporation), 2nd floor, the Pavilion; Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 2LS, United Kingdom
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Heintz E, Wiréhn AB, Peebo BB, Rosenqvist U, Levin LÅ. QALY weights for diabetic retinopathy--a comparison of health state valuations with HUI-3, EQ-5D, EQ-VAS, and TTO. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:475-484. [PMID: 22583458 DOI: 10.1016/j.jval.2011.11.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 10/14/2011] [Accepted: 11/22/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To estimate quality-adjusted life-year weights for patients with diabetic retinopathy by using various methods and to investigate the empirical validity of the different measures. METHODS The study population comprised 152 patients with diabetes in Östergötland County, Sweden. Participants were interviewed by telephone by using the time trade-off (TTO) method and a visual analogue scale (EQ-VAS) (direct valuations) as well as the EuroQol five-dimensional questionnaire (EQ-5D) and the health utilities index mark 3 (HUI-3) (indirect valuations). The quality-adjusted life-year weights were adjusted for potential confounders by using analysis of covariance. The empirical validity of the measures was examined by testing their ability to detect hypothetical differences between severity levels of diabetic retinopathy and by investigating the correlation between the measures and the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). RESULTS All measures detected significant differences in scores between patient groups classified according to visual impairment in the better eye (analysis of covariance, P < 0.05), but only HUI-3 and EQ-VAS detected significant differences between patient groups classified according to visual impairment or pathological progression in the worse eye. HUI-3 recorded a difference of 0.43 in values between normal vision and blindness in the better eye, which was more than twice the differences captured by the other measures (0.15-0.20). In addition, HUI-3 showed the highest correlation with NEI VFQ-25 (r = 0.54; P < 0.001). CONCLUSIONS In cost-utility analyses, the choice of quality-adjusted life-year measure may affect whether an intervention is considered cost-effective. Furthermore, if decisions are to be based on values from the general public, HUI-3 can be recommended for cost-utility analyses of interventions directed at diabetic retinopathy.
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Affiliation(s)
- Emelie Heintz
- Center for Medical Technology Assessment, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
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Assessment of health state in patients with tinnitus: a comparison of the EQ-5D and HUI mark III. Ear Hear 2011; 32:428-35. [PMID: 21221004 DOI: 10.1097/aud.0b013e3181fdf09f] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Expressing the outcomes of treatment in quality-adjusted life years is increasingly important as a tool to aid decision makers concerning the allocation of scarce resources within the health care sector. A quality-adjusted life year is a measure of life expectancy that is weighted by health-related quality of life. These weights are referred to as utility scores and are usually measured by multiattribute utility measures. Several studies found that different utility measures provide different estimates of the same person's level of utility. The aim of this study was to investigate which of two widely used utility measures, the EQ-5D and the HUI mark III, is preferred in a tinnitus population. METHODS Baseline and follow-up data on EQ-5D and HUI mark III of 429 patients of a randomized controlled clinical trial, investigating cost-effectiveness of usual care versus specialized care of tinnitus, were included. Agreement, discriminative power, and responsiveness of the health state description and the utility scores were examined. RESULTS Corresponding dimensions of the EQ-5D and HUI mark III showed large correlations; although ceiling effects were more frequently observed in the EQ-5D. Mean utility scores for EQ-5D (0.77; SD 0.22) and HUI mark III (0.64; SD 0.28) were significantly different (Wilcoxon signed ranks test, p < 0.001), and agreement was low to moderate (intraclass correlation coefficient = 0.53). Both health state description and utility scores of both measures discriminated between different severity groups. These groups were based on baseline scores of the Tinnitus Questionnaire. The HUI mark III had a higher ability than the EQ-5D to detect improved patients from randomly selected pairs of improved and unimproved patients. CONCLUSION This study shows that different utility measures lead to different health state descriptions and utility scores among tinnitus patients. However, both measures are capable of discriminating between clinically different groups. The HUI mark III is more responsive than the EQ-5D, and therefore preferred in a tinnitus population.
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Leidl R, Reitmeir P. A value set for the EQ-5D based on experienced health states: development and testing for the German population. PHARMACOECONOMICS 2011; 29:521-34. [PMID: 21247225 DOI: 10.2165/11538380-000000000-00000] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Decision makers responsible for allocation of healthcare resources may require that health states are valued by the population for whom they are making decisions. To achieve this, health-state descriptions can be combined with a value set that reflects the valuations of the target population. In the decision-utility approach, such a value set is at least partly based on wants and expectations regarding given health states. This may reflect aspects different from the health state experienced and valued by a respondent. OBJECTIVES To derive a value set that is completely based on experienced health states, emphasising the patient's perspective, and test its predictive performance in comparison with established approaches. METHODS Problem descriptions and rating scale valuations of the EQ-5D were drawn from two representative German population surveys in 2006 and 2007. Two models based on given health states but differing in valuation method (1a, b) were analysed, along with three models based on experienced health states: (2) ordinary least squares regression; (3) scale-transformed regression; and (4) a generalized linear model with binomial error distribution and constraint parameter estimation. The models were compared with respect to issues in specification, and accuracy in predicting the actual valuations of experienced health states in a new data set, using correlation, mean error and ranking measures for the latter. In addition, the impact of standardizing experience-based index models for age and sex of the subjects was investigated. RESULTS Models 1 (a, b), 2 and 3 partly led to plausible and comparable parameter estimates, but also led to problems of insignificance and inconsistencies in some of the estimates. Model 4 achieved consistency and featured partly equivalent and partly better predictive accuracy. Using this model, mean valuations of health states were much better predicted by the experience-based approach than by the decision-utility approach, especially for health states that frequently (>10) occurred in the population sample. Standardizing the experience-based index models for age and sex further improved predictive accuracy and strengthened the position of model 4. CONCLUSIONS A value set for the EQ-5D can be plausibly estimated from experience-based valuations. The approach offers an alternative to decision makers who prefer experience-based valuation over decision utilities in the measurement of health outcome. Although usefulness in population samples was shown, use in a clinical context will first require indication-specific tests. Current limitations include use in a general population only, and a restricted range of health states covered.
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Affiliation(s)
- Reiner Leidl
- Institute for Health Economics and Health Care Management, Helmholtz Zentrum Mnchen, Neuherberg, Germany.
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Schwalm A, Danner M, Seidl A, Volz F, Dintsios CM, Gerber A. [IQWiG's methods for the cost-benefit assessment : Comparison with an international reference scenario]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 53:615-22. [PMID: 20449550 DOI: 10.1007/s00103-010-1067-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Standardization of international health economic guidelines has been repeatedly requested. In this context, an international reference case was proposed, which constitutes an agreed approach for the key elements of health economic evaluation including study perspective, comparators, source of effectiveness data, role of modeling, main (economic) outcome, source of utilities, characterizing uncertainty. It is, however, questionable whether such a reference scenario can reasonably be applied across all health care systems. Our analysis pursues the question to which degree the Institute for Quality and Efficiency in Health Care's (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG) "General methods for evaluating the relation between cost and benefit" comply with the key elements of the reference case. In case of divergences, they will be described and discussed in light of the German social legislation and in consideration of current scientific evidence. In conclusion, the analysis revealed that IQWiG complied with the reference case in almost all aspects. Differences were found only with respect to the choice of main (economic) outcome and the source of utilities. These differences seem justified and well explained in the context of the German social legislation as well as in view of the weaknesses of the quality-adjusted life year (QALY) concept.
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Affiliation(s)
- A Schwalm
- Ressort Gesundheitsökonomie, Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, Köln.
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50
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EuroQol (EQ-5D) health utility scores for patients with migraine. Qual Life Res 2010; 20:601-8. [DOI: 10.1007/s11136-010-9783-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2010] [Indexed: 11/26/2022]
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