1
|
Commentary. In Praise of Studies That Use More Than One Generic Preference-Based Measure. Int J Technol Assess Health Care 2019; 35:257-262. [PMID: 31296277 DOI: 10.1017/s0266462319000412] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES AND BACKGROUND Generic preference-based (GPB) measures of health-related quality of life (HRQL) are widely used as outcome measures in cost-effectiveness and cost-utility analyses (CEA, CUA). Health technology assessment agencies favor GPB measures because they facilitate comparisons among conditions and because the scoring functions for these measures are based on community preferences. However, there is no gold standard HRQL measure, scores generated by GPB measures may differ importantly, and changes in scores may fail to detect important changes in HRQL. Therefore, to enhance the accumulation of empirical evidence on how well GPB measures perform, we advocate that investigators routinely use two (or more) GPB measures in each study. METHODS We discuss key measurement properties and present examples to illustrate differences in responsiveness for several major GPB measures across a wide variety of health contexts. We highlight the contributions of longitudinal head-to-head studies. RESULTS There is substantial evidence that the performance of GPB measures varies importantly among diseases and health conditions. Scores are often not interchangeable. There are numerous examples of studies in which one GPB measure was responsive while another was not. CONCLUSIONS Investigators should use two (or more) GPB measures. Study protocols should designate one measure as the primary outcome measure; the other measure(s) would be used in secondary analyses. As evidence accumulates it will better inform the relative strengths and weaknesses of alternative GPB measures in various clinical conditions. This will facilitate the selection and interpretation of GPB measures in future studies.
Collapse
|
2
|
Matza LS, Boye KS, Feeny DH, Bowman L, Johnston JA, Stewart KD, McDaniel K, Jordan J. The time horizon matters: results of an exploratory study varying the timeframe in time trade-off and standard gamble utility elicitation. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:979-990. [PMID: 26611792 PMCID: PMC5047932 DOI: 10.1007/s10198-015-0740-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 10/05/2015] [Indexed: 05/04/2023]
Abstract
INTRODUCTION The purpose of this study was to examine whether the time horizon of time trade-off (TTO) and standard gamble (SG) utility assessment influences utility scores and discrimination between health states. METHODS In two phases, UK general population participants rated three osteoarthritis health states in TTO and SG procedures with two time horizons: (1) 10-year and (2) a time horizon derived from self-reported additional life expectancy (ALE). The two time horizons were compared in terms of mean utilities and discrimination among health states. RESULTS In Phase 1, the 10-year tasks were completed by 80 participants, 35 of whom also completed utility assessment with the ALE. In Phase 2, all 101 participants completed procedures with both time horizons. Utility scores tended to be lower with the ALE than the 10-year, a difference that was statistically significant for two health states with SG in Phase 1 (P < 0.05), two health states with TTO in Phase 2 (P < 0.01), and one health state with SG in Phase 2 (P < 0.001). In Phase 1, rates of discrimination between mild and moderate osteoarthritis health states were significantly higher with the ALE than the 10-year (TTO: P = 0.03; SG: P = 0.001). This pattern of discrimination was similar in Phase 2. DISCUSSION Results suggest that the time horizon could influence utility scores and discrimination among health states. When designing utility evaluations, researchers should carefully consider the time horizon so that the value of health states is accurately represented in cost-utility models.
Collapse
Affiliation(s)
- Louis S Matza
- Outcomes Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA.
| | | | - David H Feeny
- Department of Economics, McMaster University, Hamilton, ON, Canada
| | - Lee Bowman
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Katie D Stewart
- Outcomes Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
| | - Kelly McDaniel
- Outcomes Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
| | - Jessica Jordan
- Outcomes Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
| |
Collapse
|
3
|
Craig BM, Greiner W, Brown DS, Reeve BB. Valuation of Child Health-Related Quality of Life in the United States. HEALTH ECONOMICS 2016; 25:768-77. [PMID: 25926161 DOI: 10.1002/hec.3184] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 02/23/2015] [Accepted: 03/25/2015] [Indexed: 05/18/2023]
Abstract
Many economic analyses fail to incorporate evidence on child health-related quality of life because of a paucity of quality-adjusted life year (QALY) estimates. This health valuation study is the first to summarize the EQ-5D-Y on a QALY scale. Drawn from a nationally representative panel, 5207 adult respondents were asked to choose between two losses in child health-related quality of life. Based on their choices, a 1-year increase in child pain/discomfort from 'some' to 'a lot' equals a loss of 4 QALYs (95% CI, 3.8-4.4). Likewise, a 1-year increase in child anxiety/depression from 'a bit' to 'very worried, sad, or unhappy' equals a loss of 2 QALYs (95% CI, 1.9-2.2). These findings enable the integration of child-reported outcomes with adult preferences to inform economic analysis. Results inform both clinical practice and resource allocation decisions by enhancing understanding of difficult tradeoffs in child-reported outcomes. Copyright © 2015 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Benjamin M Craig
- Moffitt Cancer Center and University of South Florida, Tampa, FL, USA
| | - Wolfgang Greiner
- School of Public Health, University of Bielefeld, Bielefeld, Germany
| | - Derek S Brown
- Brown School and Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
| | - Bryce B Reeve
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
4
|
Hanmer J, Cherepanov D, Palta M, Kaplan RM, Feeny D, Fryback DG. Health Condition Impacts in a Nationally Representative Cross-Sectional Survey Vary Substantially by Preference-Based Health Index. Med Decis Making 2015; 36:264-74. [PMID: 26314728 DOI: 10.1177/0272989x15599546] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 03/09/2015] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Many cost-utility analyses rely on generic utility measures for estimates of disease impact. Commonly used generic preference-based indexes may generate different absolute estimates of disease burden despite sharing anchors of dead at 0 and full health at 1.0. OBJECTIVE We compare the impact of 16 prevalent chronic health conditions using 6 utility-based indexes of health and a visual analog scale. DESIGN Data were from the National Health Measurement Study (NHMS), a cross-sectional telephone survey of 3844 adults aged 35 to 89 years in the United States. MAIN OUTCOME MEASURES The NHMS included the EuroQol-5D-3L, Health and Activities Limitation Index (HALex), Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3), preference-based scoring for the SF-36v2 (SF-6D), Quality of Well-Being Scale, and visual analog scale. Respondents self-reported 16 chronic conditions. Survey-weighted regression analyses for each index with all health conditions, age, and sex were used to estimate health condition impact estimates in terms of quality-adjusted life years (QALYs) lost over 10 years. All analyses were stratified by ages 35 to 69 and 70 to 89 years. RESULTS There were significant differences between the indexes for estimates of the absolute impact of most conditions. On average, condition impacts were the smallest with the SF-6D and EQ-5D-3L and the largest with the HALex and HUI3. Likewise, the estimated loss of QALYs varied across indexes. Condition impact estimates for EQ-5D-3L, HUI2, HUI3, and SF-6D generally had strong Spearman correlations across conditions (i.e., >0.69). LIMITATIONS This analysis uses cross-sectional data and lacks health condition severity information. CONCLUSIONS Health condition impact estimates vary substantially across the indexes. These results imply that it is difficult to standardize results across cost-utility analyses that use different utility measures.
Collapse
Affiliation(s)
- Janel Hanmer
- Department of Internal Medicine, University of Pittsburgh, Pittsburgh, PA (JH)
| | - Dasha Cherepanov
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA (DC)
| | - Mari Palta
- Population Health Sciences, University of Wisconsin-Madison, Madison, WI (MP, DF)
| | - Robert M Kaplan
- UCLA Department of Health Services, University of California, Los Angeles, CA (RMK)
| | - David Feeny
- Population Health Sciences, University of Wisconsin-Madison, Madison, WI (MP, DF),Department of Economics, McMaster University, Hamilton, ON, Canada (DF)
| | | |
Collapse
|
5
|
Craig BM, Brown DS, Reeve BB. Valuation of Child Behavioral Problems from the Perspective of US Adults. Med Decis Making 2015. [PMID: 26209476 DOI: 10.1177/0272989x15594370] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess preferences between child behavioral problems and estimate their value on a quality-adjusted life year (QALY) scale. METHODS Respondents, age 18 or older, drawn from a nationally representative panel between August 2012 and February 2013 completed a series of paired comparisons, each involving a choice between 2 different behavioral problems described using the Behavioral Problems Index (BPI), a 28-item instrument with 6 domains (Anxious/Depressed, Headstrong, Hyperactive, Immature Dependency, Anti-social, and Peer Conflict/Social Withdrawal). Each behavioral problem lasted 1 or 2 years for an unnamed child, age 7 or 10 years, with no suggested relationship to the respondent. Generalized linear model analyses estimated the value of each problem on a QALY scale, considering its duration and the child's age. RESULTS Among 5207 eligible respondents, 4155 (80%) completed all questions. Across the 6 domains, problems relating to antisocial behavior were the least preferred, particularly the items related to cheating, lying, bullying, and cruelty to others. CONCLUSIONS The findings are the first to produce a preference-based summary measure of child behavioral problems on a QALY scale. The results may inform both clinical practice and resource allocation decisions by enhancing our understanding of difficult tradeoffs in how adults view child behavioral problems. Understanding US values also promotes national health surveillance by complementing conventional measures of surveillance, survival, and diagnoses.
Collapse
Affiliation(s)
- Benjamin M Craig
- Health Outcomes and Behavior, Moffitt Cancer Center and University of South Florida, Tampa, FL, USA (BMC)
| | - Derek S Brown
- Brown School and Institute for Public Health, Washington University in St. Louis, St Louis, MO, USA (DSB)
| | - Bryce B Reeve
- Lineberger Comprehensive Cancer Center and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (BBR)
| |
Collapse
|
6
|
Craig BM, Brown DS, Reeve BB. The Value Adults Place on Child Health and Functional Status. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:449-56. [PMID: 26091599 PMCID: PMC4475576 DOI: 10.1016/j.jval.2015.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 02/17/2015] [Accepted: 02/19/2015] [Indexed: 05/20/2023]
Abstract
OBJECTIVES To summarize the value adults place on child health and functional status and provide a new quantitative tool that enhances our understanding of the benefits of new health technologies and illustrates the potential contributions of existing data sets for comparative effectiveness research in pediatrics. METHODS Respondents, ages 18 years and older, were recruited from a nationally representative panel between August 2012 and February 2013 to complete an online survey. The survey included a series of paired comparisons that asked respondents to choose between child health and functional status outcomes, which were described using the National Survey of Children with Special Health Care Needs, a 14-item descriptive system of child health outcomes. Using respondent choices regarding an unnamed 7- or 10-year-old child, generalized linear model analyses estimated the value of child health and functional status on a quality-adjusted life-year scale. RESULTS Across the domains of health and functional status, repeated or chronic physical pain, feeling anxious or depressed, and behavioral problems (such as acting out, fighting, bullying, or arguing) were most valuable, as indicated by adult respondents' preference of other health problems to avoid outcomes along these domains. DISCUSSION These findings may inform comparative effectiveness research, health technology assessments, clinical practice guidelines, and public resource allocation decisions by enhancing understanding of the value adults place on the health and functional status of children. CONCLUSIONS Improved measurement of public priorities can promote national child health by drawing attention to what adults value most and complementing conventional measures of public health surveillance.
Collapse
Affiliation(s)
- Benjamin M Craig
- Moffitt Cancer Center, Tampa, FL, USA; University of South Florida, Tampa, FL, USA.
| | - Derek S Brown
- Brown School, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
| | - Bryce B Reeve
- UNC Lineberger Comprehensive Cancer Center and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
7
|
Grosse SD, Chaugule SS, Hay JW. Estimates of utility weights in hemophilia: implications for cost-utility analysis of clotting factor prophylaxis. Expert Rev Pharmacoecon Outcomes Res 2015; 15:267-83. [PMID: 25585817 DOI: 10.1586/14737167.2015.1001372] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Estimates of preference-weighted health outcomes or health state utilities are needed to assess improvements in health in terms of quality-adjusted life-years. Gains in quality-adjusted life-years are used to assess the cost-effectiveness of prophylactic use of clotting factor compared with on-demand treatment among people with hemophilia, a congenital bleeding disorder. Published estimates of health utilities for people with hemophilia vary, contributing to uncertainty in the estimates of cost-effectiveness of prophylaxis. Challenges in estimating utility weights for the purpose of evaluating hemophilia treatment include selection bias in observational data, difficulty in adjusting for predictors of health-related quality of life and lack of preference-based data comparing adults with lifetime or primary prophylaxis versus no prophylaxis living within the same country and healthcare system.
Collapse
Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mail Stop E-64, Atlanta, GA 30333, USA
| | | | | |
Collapse
|
8
|
Gray J, Lie MLS, Murtagh MJ, Ford GA, McMeekin P, Thomson RG. Health state descriptions to elicit stroke values: do they reflect patient experience of stroke? BMC Health Serv Res 2014; 14:573. [PMID: 25413030 PMCID: PMC4254212 DOI: 10.1186/s12913-014-0573-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 11/03/2014] [Indexed: 11/10/2022] Open
Abstract
Background To explore whether stroke health state descriptions used in preference elicitation studies reflect patients’ experiences by comparing published descriptions with qualitative studies exploring patients’ lived experience. Methods Two literature reviews were conducted: on stroke health state descriptions used in direct preference elicitation studies and the qualitative literature on patients’ stroke experience. Content and comparative thematic analysis was used to identify characteristics of stroke experience in both types of study which were further mapped onto health related quality of life (HRQOL) domains relevant to stroke. Two authors reviewed the coded text, categories and domains. Results We included 35 studies: seven direct preference elicitation studies and 28 qualitative studies on patients’ experience. Fifteen coded categories were identified in the published health state descriptions and 29 in the qualitative studies. When mapped onto domains related to HRQOL, qualitative studies included a wider range of categories in every domain that were relevant to the patients’ experience than health state descriptions. Conclusions Variation exists in the content of health state descriptions for all levels of stroke severity, most critically with a major disjuncture between the content of descriptions and how stroke is experienced by patients. There is no systematic method for constructing the content/scope of health state descriptions for stroke, and the patient perspective is not incorporated, producing descriptions with major deficits in reflecting the lived experience of stroke, and raising serious questions about the values derived from such descriptions and conclusions based on these values.
Collapse
|
9
|
Boye KS, Matza LS, Feeny DH, Johnston JA, Bowman L, Jordan JB. Challenges to time trade-off utility assessment methods: when should you consider alternative approaches? Expert Rev Pharmacoecon Outcomes Res 2014; 14:437-50. [DOI: 10.1586/14737167.2014.912562] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
10
|
Craig BM, Reeve BB, Cella D, Hays RD, Pickard AS, Revicki DA. Demographic differences in health preferences in the United States. Med Care 2014; 52:307-13. [PMID: 24374420 PMCID: PMC4031273 DOI: 10.1097/mlr.0000000000000066] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The United States has a culturally and demographically diverse populace, and the aim of this study was to examine differences in health preferences by sex, age, ethnicity, and race. METHODS We assessed preferences for health outcomes defined by the PROMIS-29 survey in a sample of the US population. On the basis of the survey's 540 paired-comparisons trading off lifespan and 7 domains of health-related quality of life (HRQoL), we compared the choices between men and women, adults age 18-54 years and 55 years and older, Hispanics and non-Hispanics, and non-Hispanic blacks and whites. For each subgroup, we estimated the value of 122 HRQoL outcomes on a quality-adjusted life year scale and tested for subgroup differences. RESULTS Compared with men, women preferred reduced lifespan over losses in HRQoL, particularly for depression. Compared with the younger adults, older adults preferred reduced lifespan over the symptoms of depression, anxiety, and fatigue. Compared with non-Hispanic whites, Hispanics preferred reduced lifespan over depression and sleep disturbance, but held similar values on losses in physical functioning. Among non-Hispanics, blacks preferred reduced lifespan over losses in ability to climb stairs and to fall asleep compared with whites, but held similar values on mental health outcomes. CONCLUSIONS With the growing emphasis on patient-centeredness and culturally sensitive treatment, it is important to recognize the diversity in values placed on potential losses in HRQoL, particularly mental health outcomes. Demographic differences in preferences may influence comparative or cost effectiveness of treatments as perceived by one or another subgroup.
Collapse
Affiliation(s)
- Benjamin M. Craig
- Health Outcomes and Behavior, Moffitt Cancer Center and University of South Florida
| | - Bryce B. Reeve
- Health Policy and Management, University of North Carolina at Chapel Hill, 1101 E McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill, NC 27599-7411 Phone: 919-843-8793; Fax: 919-843-6362;
| | - David Cella
- Medical Social Sciences, Northwestern University, 710 North Lake Shore Drive, Suite 729, Chicago, IL 60611-3435 Phone: 312-503-1086; Fax: 312-503-9800;
| | - Ron D. Hays
- Health Services, University of California, Los Angeles and RAND, Santa Monica, CA, 911 Broxton Avenue, Los Angeles, CA 90024-1736 and RAND, Santa Monica, CA Phone: 310-794-2294; Fax: 310-794-0732;
| | - A. Simon Pickard
- Pharmacy Practice, University of Illinois at Chicago, 833 South Wood Street, Chicago, IL 60612-7230 Phone: 312-413-3357; Fax: 312-996-0379;
| | - Dennis A. Revicki
- United BioSource Corporation, 5656 Eastwind Drive, Sarasota, FL 34233
| |
Collapse
|