Validity and reliability of the EQ-5D-3L (a generic preference-based instrument used for calculating quality-adjusted life -years) for patients with type 2 diabetes in Iran

BACKGROUND AND AIMS

The psychometric properties of the EQ-5D-3L (a generic preference-based instrument used for calculating quality-adjusted Life -years) have not been known for any type of disease in Iran. This study aimed to assess its validity and reliability in patients with type 2 diabetes.

METHODS

Data of 579 patients were collected from the Diabetes Research Center and Clinics in Yazd using EQ-5D-3L, SF-36, and DQoL instruments. The ceiling effects were computed for the EQ-5D-3L index and EQ VAS. The construct validity was assessed by using convergent validity, discriminant validity, and known-groups validity. Reliability was assessed using Cohen's kappa value, Cronbach's alpha, and intra-class correlation coefficient.

RESULTS

The ceiling effects of EQ-5D-3L and EQ VAS were 20.18% and 15.33%, respectively. The highest degree of correlation was found between the pain/discomfort of EQ-5D and the BP scale of the SF-36 (0.55). Higher scores of all scales of the DQoL were associated with patients reporting no problems in each EQ-5D dimension. The mean of EQ-5D-3L index and EQ VAS scores were significantly higher in the male, married, and employed patients, and they did not have retinopathy, nephropathy, IHD, hypertension, DFU. The range of kappa values was from 0.39 to 0.71, and value of ICC for the EQ-5D-3L index and EQ VAS was 0.76 and 0.64, respectively. Cronbach's alpha was 0.87 for EQ-5D-3L and 0.74 for EQ VAS.

CONCLUSIONS

Our findings demonstrated good construct validity and moderate to good levels of reliability of the EQ-5D-3L for using in the patients with diabetes, and it can be used in research or clinical practice in Iran and other regions of the Middle East.

Health related quality of life and its impacts by chronic diseases in urban community population, Shanghai, China in 2015

This survey aimed to describe the health-related quality of life (HRQoL) and to explore the relationship between chronic diseases and HRQoL among urban residents in Shanghai, China. A cross-sectional study of 9 426 adults was conducted in Xuhui District of Shanghai, China in 2015. The EuroQol five-dimension three-level (EQ-5D-3 L) was used to measure HRQoL. The average age of subjects was 55.6 ± 17.4 years and 53% were female. Their mean values of utility and visual analogue scale (VAS) were 0.974 ± 0.099 and 80.00 ± 12.36, respectively, which were above the Chinese norm values. Women had lower scores compared with men. The utility value decreased with age, which accelerated after the age of 55 years. Chronic conditions including diabetes, tumor, cardiovascular disease, and respiratory disease, were significantly related to HRQoL, and the reported proportions of problems in the five dimensions increased with the number of chronic diseases (p < 0.05). Chronic diseases except for respiratory disease had a negative effect on HRQoL utility value and VAS score after the adjustment for covariates (p < 0.05). Chronic diseases had a negative impact on both EQ-5D-3 L utility and VAS scores, although the health-related quality of life for the study was above the national average.

Multiplicative modelling of EQ-5D-3L TTO and VAS values

OBJECTIVE

This study aimed to test multiplicative modelling with EQ-5D-3L time-trade-off (TTO) and visual analogue scale (VAS) values.

METHODS

A multi-stage sampling design was adopted for the study and data collection took place in three phases in 2010, 2011, and 2012 in the Northern region of Malaysia. Face-to-face interviews involved respondents answering both 13 TTO and 15 VAS valuation tasks were carried out. Both additive and multiplicative model specifications were explored using the valuation data. Model performance was evaluated using out-of-sample predictive accuracy by applying the cross-validation technique. The distribution of the model values was also graphically compared on Bland-Altman plots and kernel density distribution curves.

RESULTS

Data from 630 and 611 respondents were included for analyses using TTO and VAS models, respectively. In terms of main-effects specifications, cross-validation results revealed a slight superiority of multiplicative models over its additive counterpart in modelling TTO values. However, both main-effects models had roughly equal predictive accuracy for VAS models. The non-linear multiplicative model with I32 term, MULT7_TTO, performed best for TTO models; while, the linear additive model with N3 term, ADD11_VAS, outperformed the other VAS models. Multiplicative modelling neither altered the dimensional rankings of importance nor did it change the distribution of values of the health states.

CONCLUSION

Using EQ-5D-3L valuation data, multiplicative modelling was shown to improve out-of-sample predictive accuracy of TTO models but not of VAS models.

The impact of overactive bladder on health-related quality of life in Korea: based on the results of a Korean Community Health Survey

PURPOSE

This study aimed to assess the impact of overactive bladder on health-related quality of life (HRQoL) in a community-based sample of Korean population.

METHODS

The data of adults aged 19 and over that who participated in the 2012 Korean Community Health Survey were analyzed. Overactive bladder severity was classified as normal, mild, moderate, or severe using the Overactive Bladder Symptom scores, and HRQoL was evaluated using EQ-5D-3L. Relations between HRQoL and the severities and symptoms of OAB were investigated. Sampling weighted adjusted multiple regression analysis was performed to determine the effect of OAB symptom severity on HRQoL.

RESULTS

Of the 226,867 study subjects, 12,303 (5.4%) had OAB, and 552 (0.2%) had an OABSS of ≥ 12, indicating severe OAB. The problem -reporting rate significantly increased in all EQ-5D-3L dimensions as OAB severity increased. After adjusting for other variables, OAB severity had a significant effect on EQ-5D-3L index. Urge incontinence had greatest impact on quality of life.

CONCLUSIONS

As the severity of OAB increased from mild to severe, quality of life decreased significantly. OAB was found to negatively affect HRQoL.

How the EQ-5D utilities are derived matters in Chinese diabetes patients: a comparison based on different EQ-5D scoring functions for China

OBJECTIVES

In China, multiple approaches to calculating EQ-5D utilities are available, including the two EQ-5D-3L (3L₂₀₁₄ and 3L₂₀₁₈) scoring functions, the EQ-5D-5L (5L) scoring function, and the crosswalk function linking the 3L utilities and 5L health states. The study compared utilities derived from them in terms of agreement and discriminative power; and assessed whether the use of different approaches may affect QALY estimation in Chinese type 2 diabetes (T2D) patients.

METHODS

Cross-sectional data of 289 T2D patients who self-completed both the 5L and 3L questions were used. Agreement were examined using intraclass correlation coefficient (ICC) and Bland-Altman plots. The ability of the EQ-5D utilities in differentiating the patients with and without clinical conditions was evaluated using F-statistics. Their influence on QALY estimation was assessed adopting mean absolute difference (MAD) in utility values between the patients.

RESULTS

The ICC values were 0.881 (3L₂₀₁₄-3L₂₀₁₈), 0.958 (5L-c5L₂₀₁₄), and 0.806 (5L-c5L₂₀₁₈). The two 3L utilities and the three 5L utilities had poor agreement at the lower end of utility scale according to Bland-Altman plots. The 3L₂₀₁₈ utilities had lower F-statistics compared to the 3L₂₀₁₄ utilities; the two c5L utilities had larger or similar F-statistics compared to the 5L utilities. The mean MADs were 0.138 (5L), 0.116 (3L₂₀₁₄), 0.115 (c5L₂₀₁₄), 0.055 (c5L₂₀₁₈), and 0.055 (3L₂₀₁₈).

CONCLUSION

The 3L₂₀₁₄ utilities is more discriminative than the 3L₂₀₁₈ utilities; and the two c5L utilities have no worse discriminative power compared with the 5L utilities. The choice of the approach to calculating the EQ-5D utilities is likely to affect QALY estimates.

More Severe Radiographic Osteoarthritis Is Associated With Increased Improvement in Patients' Health State Following a Total Knee Arthroplasty

BACKGROUND

To assess whether preoperative radiological severity of osteoarthritis (OA) is related to the level of improvement in patients' health state measured 1 year after total knee arthroplasty (TKA).

METHODS

Radiographic severity of OA was graded using the Kellgren-Lawrence (KL) classification. Two independent observers were blinded to patients' outcome scores. Health-related quality of life was measured using EQ-5D-3L preoperatively and at 12-month follow-up. The 5 dimensions of the EQ-5D were converted into a health state index score. The association between KL grade and improvement in health state score was analyzed using multiple linear regression.

RESULTS

Among 156 consecutive patients (68% females, mean age 69 years) who underwent primary TKA, 3 knees (2%) were classified as KL grade 2, 115 as KL grade 3 (74%), and 38 as KL grade 4 (24%). Follow-up rate was 77%. There was substantial intra-rater and inter-rater agreement (Cohen's kappa = 0.80 and 0.79). Most patients (64%) had clinically significant improvement in their health state score 1 year after TKA. However, after adjusting for relevant covariates, patients with severe OA (KL grade 4) were found to have significantly more improvement in their health state score than patients with mild or moderate OA (KL grade 2 or 3, respectively). Separate analysis of the 5 EQ-5D dimensions showed that the KL group differences were most evident in the "usual activities" and "pain/discomfort" dimensions.

CONCLUSION

Patients with severe OA have significantly more improvement in their usual activities and pain/discomfort 1 year after TKA than patients with less severe OA.

Validity of the EQ-5D-5L questionnaire among the general population of Poland

Purpose

We aim to compare the psychometric properties of the EQ-5D-5L questionnaire with the EQ-5D-3L version and EQ VAS, based on a survey conducted in a sample representing the general adult population of Poland.

Methods

The survey comprised health-related quality of life (HRQoL) questionnaires: EQ-5D-5L, EQ VAS, SF-12 and EQ-5D-3L, together with demographic and socio-economic characteristics items. The EQ-5D index values were estimated based on a directly measured value set for Poland. The following psychometric properties were analysed: feasibility, distribution of responses, redistribution from EQ-5D-3L to EQ-5D-5L, inconsistencies, ceiling effects, informativity power and construct validity. We proposed a novel approach to the construct validity assessment, based on the use of a machine learning technique known as the random forest algorithm.

Results

From March to June 2014, 3978 subjects (aged 18–87, 53.2% female) were surveyed. The EQ-5D-5L questionnaire had a lower ceiling effect compared to EQ-5D-3L (38.0% vs 46.6%). Redistribution from EQ-5D-3L to EQ-5D-5L was similar for each dimension, and the mean inconsistency did not exceed 5%. The results of known-groups validation confirmed the hypothesis concerning the relationship between the EQ-5D index values and age, sex and occurrence of diabetes.

Conclusions

The EQ-5D-5L, in comparison with its EQ-5D-3L equivalent, showed similar or better psychometric properties within the general population of a country. We assessed the construct validity of the questionnaire with a novel approach that was based on a machine learning technique known as the random forest algorithm.

Acceptable health and ageing: results of a cross-sectional study from Hungary

BACKGROUND

We aimed to investigate the acceptability of imperfect health states in relation to age in Hungary and analyse its determinants. Results are contrasted to age-matched actual population health scores and to findings from a previous study in The Netherlands.

METHODS

A cross-sectional online survey was performed. The same survey questions were applied as in a previous study in The Netherlands in order to enable inter-country comparisons. The descriptive system of the EQ-5D-3L health status questionnaire was used to assess the acceptability of moderate and severe health problems at ages from 30 to 80 by 10-year age-groups. Descriptive statistics were performed and linear regression analysis was used to investigate the determinants of acceptability.

RESULTS

Altogether 9281 (female 32.8%) were involved with mean age 36.0 years and EQ-5D-3L index score of 0.852 (SD 0.177). Acceptability of health problems increased with age, differed per health domain and with severity of the problems. Except for 'Self-care', moderate health problems were acceptable by the majority from age 70 and acceptability scores were lower than EQ-5D-3L population norms from that age. The lowest average acceptability age was found in the 'Anxiety/depression' and dimension the highest in the 'Self-care' dimension. Respondents' age, current health, and lifestyle were significant determinants (R²: 0.041-0.130). With a few minor exceptions in some health dimensions, acceptability levels and patterns were strikingly similar to the Dutch findings.

CONCLUSION

In Hungary, acceptability of health problems increases with age and the majority found severe problems never acceptable. Views on acceptability of health problems seem to be fairly generalizable across European countries with different health and economic indicators.

Association of smoking status and health-related quality of life: difference among young, middle-aged, and older adults in Shandong, China

PURPOSE

Few studies explored the relationship between smoking status and health-related quality of life (HRQOL) among adults in China. This study aims to explore the relationship between smoking status and HRQOL among adults (18 +) and examine whether there is a difference in this relationship among young, middle-aged, and older adults in China.

METHODS

A total of 23,021 respondents were included in this study. The HRQOL is measured by EQ-5D-3L. The smoking status is divided into never smokers, current smokers, and former smokers. Tobit regression and Logistic regression are employed to explore the association between smoking status and HRQOL. The interaction term is included to explore the difference among young, middle-aged, and older adults.

RESULTS

This study finds smoking status is significantly associated with HRQOL. An interaction analysis shows that the association between smoking status and HRQOL is significantly different among young, middle-aged, and older adults (P < 0.05). The smoking status is only significantly associated with HRQOL in middle-aged and older adults, but not for young adults. Compared with never smokers, former smokers report significantly lower EQ-5D-3L utility value in middle-aged adults (coefficient =  - 0.089; 95%CI - 0.128 to - 0.050), current smokers report significantly higher EQ-5D-3L utility value in older adults (coefficient = 0.041; 95%CI 0.005 to 0.076).

CONCLUSIONS

This study demonstrates a significant association between smoking status and HRQOL among adults in China, and there is a difference in this relationship among young, middle-aged, and older adults. The government should take efforts to formulate a variety of measures to control tobacco use among adults.

A head-to-head comparison of measurement properties of the EQ-5D-3L and EQ-5D-5L in acute myeloid leukemia patients

PURPOSE

This study aimed to compare the measurement properties of EQ-5D-3L(3L) and EQ-5D-5L(5L) in patients with acute myeloid leukemia (AML) in China.

METHODS

We consecutively recruited 168 patients with AML from three tertiary hospitals to complete two rounds of interviews using the two versions of the EQ-5D. We compared (i) the ceiling effect using the McNemar's test, (ii) test-retest reliability using intraclass correlation coefficient (ICC) and Cohen's weighted Kappa, (iii) convergent validity using Spearman's rank correlation coefficient (r) and iv) discriminatory ability using F statistic and area under the receiver operating characteristics curve (AUROC) of the 5L and the 3L.

RESULTS

The 5L descriptive system showed significantly lower ceiling effects in comparison to the 3L descriptive system (p < 0.001). While 5L showed superior reproducibility (Cohen's weighted Kappa = 0.56-0.67 and ICC = 0.89), both instruments exhibited good test-retest reliability. Even though both 3L and 5L showed good convergent and known-groups validity, 5L showed better convergent validity and discriminatory ability.

CONCLUSION

The current study found both 3L and 5L to be suitable for use in AML patients. However, 5L showed superior measurement properties compared to 3L. Thus, 5L could be the preferred instrument over 3L for use in AML patients.

Comparing EQ-5D-3L and EQ-5D-5L performance in common cancers: suggestions for instrument choosing

PURPOSE

To compare the performance of three-level EuroQol five-dimensions (EQ-5D-3L) and five-level EuroQol five-dimensions (EQ-5D-5L) among common cancer patients in urban China.

METHODS

A hospital-based cross-sectional survey was conducted in three provinces from 2016 to 2018 in urban China. Patients with breast cancer, colorectal cancer, or lung cancer were recruited to complete the EQ-5D-3L and EQ-5D-5L questionnaires. Response distribution, discriminatory power (indicator: Shannon index [H'] and Shannon evenness index [J']), ceiling effect (the proportion of full health state), convergent validity, and health-related quality of life (HRQoL) were compared between the two instruments.

RESULTS

A total of 1802 cancer patients (breast cancer: 601, colorectal cancer: 601, lung cancer: 600) were included, with the mean age of 55.6 years. The average inconsistency rate was 4.4%. Compared with EQ-5D-3L (average: H' = 1.100, J' = 0.696), an improved discriminatory power was observed in EQ-5D-5L (H' = 1.473, J' = 0.932), especially contributing to anxiety/depression dimensions. The ceiling effect was diminished in EQ-5D-5L (26.5%) in comparison with EQ-5D-3L (34.5%) (p < 0.001), mainly reflected in the pain/discomfort and anxiety/depression dimensions. The overall utility score was 0.790 (95% CI 0.778-0.801) for EQ-5D-3L and 0.803 (0.790-0.816) for EQ-5D-5L (p < 0.001). A similar pattern was also observed in the detailed cancer-specific analysis.

CONCLUSIONS

With greater discriminatory power, convergent validity and lower ceiling, EQ-5D-5L may be preferable to EQ-5D-3L for the assessment of HRQoL among cancer patients. However, higher utility scores derived form EQ-5D-5L may also lead to lower QALY gains than those of 3L potentially in cost-utility studies and underestimation in the burden of disease.

Health-related productivity of the Hungarian population. A cross-sectional survey

INTRODUCTION

Health disorders may affect negatively work productivity of individuals, leading to absence from work (absenteeism) and/or decreased functioning in the workplace (presenteeism).

AIM

To assess the health-related work productivity of the adult population in Hungary by the Work Productivity and Activity Impairment questionnaire (WPAI).

METHOD

A cross-sectional survey was performed in 2019 involving a sample (n = 2023) representative for the adult population of Hungary. Socio-demographic characteristics were recorded. Health-related productivity of the participants was assessed by the WPAI questionnaire, health status was measured by the EQ-5D-3L measurement tool and the Minimum European Health Module (MEHM).

STATISTICAL ANALYSES

Descriptive statistics were performed, subgroups were compared by Mann-Whitney and Kruskal-Wallis tests. Spearman's rank correlation was applied to analyze the relationship between WPAI, age and EQ-5D-3L index score.

RESULTS

Among those in a paid job (n = 1194, 59%), altogether 70 respondents (6%) were absent from work during the week before the survey, which resulted in an average 1.9 (SD = 8.5) work hours loss per week. Presenteeism occurred in 166 (14%) cases. The average absenteeism was 3.6%, presenteeism was 4.4%, and activity impairment in the total sample was 9.5%. Absenteeism did not correlate with age and did not differ significantly across socio-demographic subgroups. Presenteeism was the highest among actively working retired people, disability pensioners and part-time employees. Presenteeism correlated moderately (r = -0.379), absenteeism weakly (r = -0.113) with EQ-5D-3L index. Correlation was significant between activity impairment and age (r = 0.412) as well as the EQ-5D-3L index score (r = -0.592). All WPAI items showed significant worsening across MEHM status levels.

CONCLUSION

This is the first study in Hungary to present population reference values with the WPAI. Productivity loss due to presenteeism deserves special attention from the employers as well as from decision makers in the labour, health and social sectors. Orv Hetil. 2020; 161(36): 1522-1533.

A translation and preliminary validation of the Dutch Wound-QoL questionnaire

BACKGROUND

Chronic wounds have a major impact on patients' health-related quality of life (HRQoL). Therefore, measuring HRQoL is an indispensable part of the treatment of patients with chronic wounds. The aim of this study was to translate and validate the Wound-QoL, a wound-specific HRQoL questionnaire, in a Dutch population.

METHODS

The Wound-QoL was translated into Dutch according to the international standards. Patients with chronic wounds were asked to complete questionnaires at baseline (T0) and after six weeks (T1), including Wound-QoL, EQ-5D-3L (a generic questionnaire to measure HRQoL) and a visual analogue scale (VAS) measuring wound pain. If patients were not able to complete the questionnaire by themselves, it was read out to them by a nurse. Further data were obtained from medical records.

RESULTS

Of the 120 patients included, 64 (53.3%) completed the questionnaire by themselves. To 55 patients (45.8%), the questionnaire was read out. The internal consistency of the Wound-QoL global score was high at both time points (T0: Cronbach's α = 0.89, T1: Cronbach's α = 0.92). The item selectivity for global score ranged from r = 0.25 to r = 0.77 at T0 and from r = 0.40 to r = 0.79 at T1. Overall, the self-completion and read-out subgroups showed similar internal consistency and item selectivity scores. With regard to convergent validity, significant correlations were found between Wound-QoL and EQ-5D-3L (T0: r = - 0.45, p < 0.001, T1: r = - 0.50, p < 0.001) as well as between Wound-QoL and pain VAS (T0: r = 0.23, p = 0.012, T1: r = 0.37, p = 0.001) at both time points. Responsiveness analyses showed significant correlations between changes in Wound-QoL and changes in EQ-5D-3L (r = - 0.37, p < 0.001), pain VAS (r = 0.24, p = 0.044) and wound size (r = 0.24, p = 0.013). The self-completion and read-out subgroups showed differences in convergent validity and responsiveness.

CONCLUSIONS

The results indicate that the Dutch version of the Wound-QoL has positive psychometric properties. However, more research is needed to further explore the differences between self-completed and read-out questionnaires.

Psychometric properties comparison between EQ-5D-5L and EQ-5D-3L in the general Thai population

PURPOSE

Evidence for the EQ-5D-5L's psychometric properties in the general Thai population is limited. This study aimed to compare ceiling effect, discriminatory power, response redistribution, validity, reliability between the EQ-5D-5L (5L) and the EQ-5D-3L (3L) in the general Thai population.

METHODS

1200 participants were randomly selected. The Shannon index ([Formula: see text] and Shannon evenness index ([Formula: see text] determining discriminatory power of both EQ-5D versions in each dimension were compared. Test-retest reliability was evaluated using weighted kappa (k) and intraclass correlation coefficients (ICCs). Validity was evaluated by correlations between similar dimensions of the EQ-5D, WHOQOL-BREF, and SF-12v2 and known-groups validity. The ceiling effects for the 3L and for the 5L were compared.

RESULTS

The 5L had lower ceiling effects than the 3L (49.08% vs 57.17%, p < 0.01). [Formula: see text] was higher for the 5L than for the 3L, but [Formula: see text] showed otherwise. Moderate correlations were detected between similar dimensions of the EQ-5D and the WHOQOL-BREF and SF-12v2. ICCs and k of the 3L were slightly higher than those of the 5L (ICCs: 0.78 vs 0.71) and (k: 0.42-0.63 vs 0.48-0.61), respectively. Older, female participants and those with comorbidities reported a lower utility index for both versions.

CONCLUSION

Evidence supported use of both EQ-5D versions in the general Thai population. The 5L had better ceiling effects and discriminant activity, while it showed comparable known-groups validity with the 3L. Nevertheless, evidence is limited for the superiority of reliability between these two versions, so more future research is required to investigate it.

Does the magnitude of injuries affect the outcome of proximal humerus fractures treated by locked plating (PHILOS)?

PURPOSE

Health-related quality of life (HRQoL) becomes increasingly relevant in an aging society. Functional outcome (FO) and the patient-reported outcome (PRO) after surgical treatment of proximal humerus fractures (PHF) depends on numerous factors, including patient- and injury-specific factors. There is little evidence on how the FO and the PRO vary in different settings such as monotrauma or multiple injuries, even though the PHF is one of the more frequent fractures. In addition, to a previous study, on multiple injured patients and upper extremity injuries, the aim of the current study was to investigate the impact of multiple injuries, quantified by the ISS, on the FO and PRO after surgically treated PHF by PHILOS.

METHODS

A retrospective cohort-study was conducted with an additional follow-up by a questionnaire. HRQoL tools such as range of motion (ROM), the Quick-Disability of Arm Shoulder and Hand score (DASH), EuroQol Five Dimension Three Levels (EQ-5D-3L), and EuroQol VAS (EQ-VAS) were used. The study-population was stratified according to ISS obtained based on information at discharge into Group I/M-H (ISS < 16 points) and Group PT-H (ISS ≥ 16). Median outcome scores were calculated and presented.

INCLUSION CRITERIA

adult patients (> 18 years) with PHF treated at one academic Level 1 trauma center between 2007 and 2017 with Proximal Humeral Inter-Locking System (PHILOS) and preoperative CT-scan. Group stratification according Injury Severity Score (ISS): Group PT-H (ISS ≥ 16 points) and Group I/M-H (ISS < 16 points).

EXCLUSION CRITERIA

oncology patients, genetic disorders affecting the musculoskeletal system, paralysis or inability to move upper extremity prior or after injury, additional ipsilateral upper limb fractures, open injuries, associated vascular injuries as well brachial plexus injuries and nerve damages. Follow-up 5-10 years including PRO: EQ-5D-3L and EQ-VAS. FO, including DASH and ROM. The ROM was measured 1 year after PHILOS.

RESULTS

Inclusion of 75 patients, mean age at injury was 49.9 (± 17.6) years. The average follow-up period in Group I/M-H was 6.18 years (± 3.5), and in Group PT-H 5.58 years (± 3.1). The ISS in the Group I/M-H was 6.89 (± 2.5) points, compared to 21.7 (± 5.3) points in Group PT-H (p ≤ 0.001). The DASH-score in Group I/M-H was 9.86 (± 13.12 and in Group PT-H 12.43 (± 15.51, n.s.). The EQ-VAS in Group I/M-H was 78.13 (± 19.77) points compared with 74.13 (± 19.43, n.s.) in Group PT-H. DASH, EQ-VAS as well as ROM were comparable in Groups I/M-H and PT-H (9.9 ± 13.1 versus 12.4 ± 15.5, n.s.). The EQ-5D-3L in Group I/M-H was 0.86 (± 0.23) points compared to Group PT-H 0.72 (± 0.26, p ≤ 0.017). No significant differences could be found in Group I/M-H and PT-H in the severity of traumatic brain injury (TBI). A multivariable regression analyses was performed for DASH, EQ-5D-3L and EQ-VAS. All three outcome metrics were correlated. There was a significant difference between the EQ-5D-3L and the ISS (Beta-Coefficient was 0.86, 95% low was 0.75, 95% high was 0.99, p ≤ 0.041). No significant correlation could be found comparing DASH, EQ-5D-3L and EQ-VAS to age, gender and TBIs.

CONCLUSION

Multiple injuries did not affect the DASH, ROM or EQ-VAS after PHILOS; but a higher ISS negatively affected the EQ-5D-EL. While the ROM and DASH aim to be objective measurements of functionality, EQ-5D-3L and EQ-VAS represent the patients' PRO. The FO and PRO outcomes are not substitutable, and both should be taken into consideration during follow-up visits of multiple injured patients. Future research should prospectively explore whether the findings of this study can be recreated using a larger study population and investigate if different FO and PRO parameters come to similar conclusions. The gained information could be used for an enhanced long-term evaluation of patients who suffered a PHF from multiple injuries to meet their multifarious conditions.

LEVEL OF EVIDENCE

II.

Evaluation of the performance of algorithms mapping EORTC QLQ-C30 onto the EQ-5D index in a metastatic colorectal cancer cost-effectiveness model

Background

Cost-effectiveness models require quality of life utilities calculated from generic preference-based questionnaires, such as EQ-5D. We evaluated the performance of available algorithms for QLQ-C30 conversion into EQ-5D-3L based utilities in a metastatic colorectal cancer (mCRC) patient population and subsequently developed a mCRC specific algorithm. Influence of mapping on cost-effectiveness was evaluated.

Methods

Three available algorithms were compared with observed utilities from the CAIRO3 study. Six models were developed using 5-fold cross-validation: predicting EQ-5D-3L tariffs from QLQ-C30 functional scale scores, continuous QLQ-C30 scores or dummy levels with a random effects model (RE), a most likely probability method on EQ-5D-3L functional scale scores, a beta regression model on QLQ-C30 functional scale scores and a separate equations subgroup approach on QLQ-C30 functional scale scores. Performance was assessed, and algorithms were tested on incomplete QLQ-C30 questionnaires. Influence of utility mapping on incremental cost/QALY gained (ICER) was evaluated in an existing Dutch mCRC cost-effectiveness model.

Results

The available algorithms yielded mean utilities of 1: 0.87 ± sd:0.14,2: 0.81 ± 0.15 (both Dutch tariff) and 3: 0.81 ± sd:0.19. Algorithm 1 and 3 were significantly different from the mean observed utility (0.83 ± 0.17 with Dutch tariff, 0.80 ± 0.20 with U.K. tariff). All new models yielded predicted utilities drawing close to observed utilities; differences were not statistically significant. The existing algorithms resulted in an ICER difference of €10,140 less and €1765 more compared to the observed EQ-5D-3L based ICER (€168,048). The preferred newly developed algorithm was €5094 higher than the observed EQ-5D-3L based ICER. Disparity was explained by minimal diffences in incremental QALYs between models.

Conclusion

Available mapping algorithms sufficiently accurately predict utilities. With the commonly used statistical methods, we did not succeed in developping an improved mapping algorithm. Importantly, cost-effectiveness outcomes in this study were comparable to the original model outcomes between different mapping algorithms. Therefore, mapping can be an adequate solution for cost-effectiveness studies using either a previously designed and validated algorithm or an algorithm developed in this study.

An evaluation of EQ-5D-3L health utility scores using five country-specific tariffs in a rural population aged 45-69 years in Hua county, Henan province, China

BACKGROUND

This study aims to compare the performance of the recently developed Chinese (city) tariff of the EQ-5D-3L against the UK, US, Japanese and Korean tariffs in a general rural population in China.

METHODS

From November 2015 to September 2016, 12,085 permanent residents aged 45-69 from 257 villages randomly selected from Hua County, Henan Province, China, were interviewed using EQ-5D-3L, and a one-on-one questionnaire investigation was used to collect data on factors associated with HRQOL. The health utility scores were calculated using the UK, US, Japanese, Korean and Chinese (city) tariffs. The agreement, known-groups validity and sensitivity of these five tariffs were evaluated. Transition scores for pairs of observed EQ-5D-3L health states were calculated and compared.

RESULTS

The Korean tariff yielded the highest mean health utility score (0.963), followed by the Chinese (city) (0.948), US (0.943), UK (0.930) and Japanese (0.921) tariffs, but the differences in the scores of any two tariffs did not exceed the MCID. The Chinese (city) tariff showed higher ICC values (ICCs> 0.89, 95% CI:0.755-0.964) and narrower limits of agreement (0.099-0.167) than the Korean tariff [(ICCs> 0.71, 95% CI:0.451-0.955); (0.146-0.253)]. The Chinese (city) tariff had a higher relative efficiency and effect size statistics in 10 out of 11 variables as compared to the UK, US and Japanese tariffs. The Chinese (city) tariff (0.215) was associated with moderate mean absolute transition scores compared with the UK (0.342), US (0.230), Japanese (0.149) and Korean (0.189) tariffs for 1485 observed pairs of the EQ-5D-3L health states.

CONCLUSIONS

Health utility scores derived from the five tariffs differed. The Chinese (city) tariff was the most suitable of these tariffs and was without obvious weakness. We recommend adopting the Chinese (city) tariff when applying EQ-5D-3L to assess quality of life among the elderly in China's agricultural region with socio-economic status similar to Hua County. Results of this study had provided a crucial basis for health surveys, health promotion projects, health intervention trials, and health economic evaluation taking HRQOL as a target in rural areas of China.

EQ-5D-Derived Health State Utility Values in Hematologic Malignancies: A Catalog of 796 Utilities Based on a Systematic Review

OBJECTIVES

We performed a systematic review of health state utility values (HSUVs) obtained using the EQ-5D questionnaire for patients with hematologic malignancies.

METHODS

The following databases were searched up to September 2018: MEDLINE, EMBASE, The Cochrane Library, and the EQ-5D publications database on the EuroQol website. Additional references were extracted from reviewed articles. Only studies presenting EQ-Index results were incorporated. In view of the heterogeneity across the included publications, we limited ourselves to a narrative synthesis of original HSUVs found.

RESULTS

Fifty-nine studies (described in 63 articles) met the inclusion criteria. Data from 21 635 respondents provided 796 HSUV estimates for hematologic malignancy patients. EQ-Index scores ranged from -0.025 to 0.980. The most represented area was multiple myeloma (4 studies, 11 112 patients, and 249 HSUVs). In clinical areas such as chronic myeloid leukemia, acute myeloid leukemia, chronic lymphocytic leukemia, non-Hodgkin lymphoma, and mantle cell lymphoma, we described over 50 health utilities in each. In contrast, we identified only 13 HSUVs (based on 4 studies and the data of 166 patients) for Hodgkin lymphoma. Areas without EQ-5D-based health utilities comprised: polycythemia vera, primary myelofibrosis, essential thrombocythemia, mastocytosis, myeloid sarcoma, chronic myelomonocytic, eosinophilic leukemia, and neutrophilic leukemia.

CONCLUSIONS

There is a wide range of HSUVs available for hematologic cancer patients with different indications. The review provides a catalog of utility values for use in cost-effectiveness models for hematologic malignancies.

Similar responses to EQ-5D-3L by two elicitation methods: visual analogue scale and time trade-off

Background

Health-related quality of life (HRQoL) is often measured using EQ-5D-3L by the elicitation methods of visual analogue scale (VAS) and time trade-off (TTO). Although many countries have constructed both national VAS and TTO value sets, the fact that VAS and TTO value sets produces different values bewilders researchers and policymakers. The aim of this study is to explore certain conditions which could yield similar value sets using VAS and TTO.

Methods

A homogeneous sample of medical school students was selected to value 18 hypothetical health states using VAS and TTO methods. The 18 hypothetical health states were produced by orthogonal design (L18, 2*3^7). The range of rescaled values was transformed into − 1 ~ 0 ~ 1. The investigations via different methods were carried out by computer-assisted personal interviewing with a wash-time interval of 72 h. Value sets for VAS and TTO were constructed using general least square regression models. Independent variables were composed of 10 dummy variables from 5 dimensions and including or omitting both constant and N3 terms.

Results

Three hundred thirteen medical students participated. The mean age was 21.03 ± 0.44 years and 56.2% were female. The four regression models (for each method with and without constant and N3 terms) were all statistically significant (P < 0.05) with high goodness-of-fit (Adj. R² > 0.94 and MAE < 0.033). Differences between the coefficients of the 10 dummy variables corresponding to each model were all less than 0.059. Pearson correlation coefficients between observed means and predicted values exceeded 0.981. Fitted curves of VAS and TTO largely coincided.

Conclusions

VAS and TTO can generate similar responses under certain conditions, suggesting that the two valuation methods could be equivalent intrinsically. The VAS method appears a more valid approach for valuation in the general population due to its greater simplicity and feasibility.

Long-term outcomes after open reduction and internal fixation of bicondylar tibial plateau fractures

INTRODUCTION

To establish normative data, long-term patient-reported functional outcome and health-related quality of life (HrQoL) after operative treatment of bicondylar tibial plateau fractures. Secondly, to identify risk factors associated with functional outcome and HrQoL.

PATIENTS AND METHODS

We performed a retrospective cohort study at two Level I trauma centers. All adult patients with AO/OTA 41-C or Schatzker V/ VI tibial plateau fractures treated between 2001 and 2016 (n = 450) by open reduction internal fixation (ORIF). The survey was completed by 214 patients (48%). Primary outcome was patient-reported functional outcome assessed with the PROMIS Physical Function (PROMIS PF). Secondary outcomes were HrQoL measured with the EuroQol 5-Dimensions 3-Levels (EQ-5D-3 L), infection rate, and total knee arthroplasty (TKA) rate.

RESULTS

Infection occurred in 26 cases (12%) and TKA was performed in 6 patients (3%). The median PROMIS PF scores was 49.8 (IQR;42-54). The median EQ-5D-3 L was 0.83 (IQR;0.78-1.0).%). The multivariable regression model revealed female gender, diabetes, and worse HrQoL were correlated with worse functional outcome. The multivariable regression model revealed smoking, diabetes, and the subsequent need for TKA to be correlated with worse HrQoL.

CONCLUSION

The PROMIS PF and EQ-5D-3L did not reach a minimum clinically important difference. The PROMIS PF items revealed patients had no difficulty in walking more than a mile or climbing a flight of stairs. However, patients were limited in doing vigorous activities and patients should be counseled about the expected long-term outcomes. This study emphasizes the correlation between injury specific functional outcome measures and general health measures.

LEVEL OF EVIDENCE

Therapeutic Level III.

Does the child's health influence the caregiver's health using the EQ-5D instruments?

Background

Health- related quality of life (HRQoL) is an important aid in medical decision making. The child’s health may influence the caregiver’s health due to their intimate relationship.

Objectives

The aim of this study was to investigate the influence of the child’s health on the caregiver’s health as measured on the EuroQoL Youth and Adult instruments.

Method

A sample of 50 caregivers and their acutely-ill children, aged 3–6 years, was recruited from a paediatric hospital. Each caregiver completed the EQ-5D-Y, a proxy rating of their child’s HRQoL, and the EQ-5D-3L, a self-report measure of their own HRQoL, at baseline, 24 and 48 hours. The correlation between the caregiver and the child’s health over time was established. Forward stepwise multiple regression analysis was performed to establish the relative contribution of the child’s VAS score to the caregiver’s VAS score.

Results

The results indicated that the child’s and the caregiver’s VAS ratings were significantly correlated over time, with an improvement in HRQoL scores over 48 hours. The child’s proxy VAS rating accounted for 21% and 18% of the variance in the caregiver’s VAS score at baseline and 24 hours, respectively, which was higher than self-reported problems on the caregivers EQ-5D-3L dimensions.

Conclusion

The health of the caregiver is reported to improve as the perceived health of the child improves. The proxy rating of the child’s health influences the caregiver’s self-reported health more than their reported problems on the EQ-5D-3L.

Clinical implications

Improving the HRQoL of the child will lead to improved HRQoL in the caregiver.

Health-related quality of life in patients with esophageal cancer or precancerous lesions assessed by EQ-5D: A multicenter cross-sectional study

Background

We aimed to obtain a set of health state utility scores of patients with esophageal cancer (EC) and precancerous lesions in China, and to explore the influencing factors of health‐related quality of life (HRQoL).

Methods

A hospital‐based multicenter cross‐sectional study was conducted. From 2013 to 2014, patients with EC or precancerous lesions were enrolled. HRQoL was assessed using a European quality of life‐5 dimension (EQ‐5D‐3L) instrument. Multivariable linear regression analysis was performed to explore the influencing factors of the EQ‐5D utility scores.

Results

A total of 2090 EC patients and 156 precancer patients were included in the study. The dimension of pain/discomfort had the highest rate of self‐reported problems, 60.5% in EC and 51.3% in precancer patients. The mean visual analog scale (VAS) score for EC and precancer patients were 68.4 ± 0.7 and 64.5 ± 3.1, respectively. The EQ‐5D utility scores for EC and precancer patients were estimated as 0.748 ± 0.009 and 0.852 ± 0.022, and the scores of EC at stage I, stage II, stage III, and stage IV were 0.693 ± 0.031, 0.747 ± 0.014, 0.762 ± 0.015, and 0.750 ± 0.023, respectively. According to the multivariable analyses, the factors of region, occupation, household income in 2012, health care insurance type, pathological type, type of therapy, and time points of the survey were statistically associated with the EQ‐5D utility scores of EC patients.

Conclusions

There were remarkable decrements of utility scores among esophageal cancer patients, compared with precancer patients. The specific utility scores of EC would support further cost‐utility analysis in populations in China.

Valuation of EQ-5D-3l Health States in Slovenia: VAS Based and TTO Based Value Sets

INTRODUCTION

The two primary objectives of this paper were (a) to develop first logically consistent TTO based EQ-5D-3L value sets for Slovenia and (b) to revisit earlier developed VAS based EQ-5D-3L value sets.

METHODS

Between September 2005 and April 2006, face-to-face interviews with 225 individuals in Slovenia were conducted. Protocols from the Measurement and Value of Health study were followed closely. Each respondent valued 15 health states out of a total of 23. Model selection was informed by the criteria monotonicity/logical consistency. Predictive accuracy was assessed in terms of mean square difference between out-of-sample predictions and corresponding observed means, as well as Lin's Concordance Correlation Coefficient.

RESULTS

Modelling was based on 2,717 VAS and 2,831 TTO values elicited from 225 respondents. A 6-parameter constrained regression model with a supplementary power term was selected for VAS and TTO value sets, as it produces monotonic values, and proved superior in terms of out-of-sample predictive accuracy over the tested alternatives.

CONCLUSION

This is the first EQ-5D-3L TTO based value set in Slovenia and the second in Central and Eastern Europe (besides Poland). It is also the first monotonic and logically consistent VAS value set in Central and Eastern Europe. Comparisons with Polish and UK TTO values show considerable differences, mostly due to mobility with having a substantially greater weight in Slovenia. The UK value set generally produces lower values and the Polish value set higher values for mild states.

Evaluation of Health-Related Quality of Life in Women with Community-Acquired Urinary Tract Infections Using the EQ-5D-3L in Saudi Arabia

PURPOSE

Community-acquired urinary tract infection (CA-UTI) is a common and costly condition in females. Currently, there are no data on CA-UTI and quality of life (QoL) in Saudi Arabia. The aim of this study was to evaluate the impact of UTI and related socio-demographic characteristics on health-related quality of life (HRQoL) of Saudi females using the EuroQol 5-Dimension, 3-Level (EQ-5D-3L) instrument before and after treatment.

PATIENTS AND METHODS

This was a cross-sectional questionnaire study conducted in the emergency department (ED) of a tertiary hospital over a three-month period.

RESULTS

A total of 339 out of 524 females with a mean age of 36.2 years (SD: 9.57 years; range 19-59 years) completed both the baseline and follow-up questionnaires of the EQ-5D-3L for a response rate of 64.7%. The baseline utility index for the worst health state "33333" was -0.495 representing 1.18% of the patients, and the full health state "11111" was 1 corresponding to 30.68% of the patients. The utility index after treatment for the moderate health state "22222" was 0.524 corresponding to 0.88% of the total patients, and the full health state "11111" was 1 corresponding to 80.24% of the patients. The mean EuroQol Visual Analogue Scale (EQ-VAS) was 73 ± 26 before treatment and 87.46 ± 18.55 after treatment. The frequency of patients reporting problems in the EQ-5D dimensions of mobility, self-care, usual activities, pain/discomfort and anxiety/depression decreased following treatment (27.43% vs 0.88%, 4.42% vs 0.88%, 25.96% vs 6.78%, 61.95% vs 13.27%, 39.52% vs 15.63%, respectively; all P < 0.001). There were statistically significant associations between HRQoL and socio-demographic characteristics, chronic diseases, and herbal supplements.

CONCLUSION

Community-acquired tract infections (CA-UTIs) have a significant negative impact on the HRQoL of Saudi females with a varying effect depending on the socio-demographic characteristics and chronic diseases.

Health-Related Quality of Life and Associated Factors among Oldest-Old in China

OBJECTIVES

The oldest old population has become the fastest growing segment with excess need of care and social support, it is crucial to improve the health-related quality of life (HRQoL) of these populations. This study seeks to evaluate the health status and to investigate modifiable factors associated with health-related quality of life for oldest old adults in China.

DESIGN

A cross-sectional population-based study.

SETTING

Hainan Province in the south of China.

PARTICIPANTS

1,278 adults aged 80 years or older.

METHODS

HRQoL was assessed by three-level EuroQol-5D scale (EQ-5D-3L) and a visual analogue scale (VAS). Demographic and health-related variables were analysed by estimating mean values and standard deviations for continuous variables, percentages and standard deviations for categorical variables. Tobit regressions, ordinary least Squared (OLS) regressions and ordered probit regressions were adopted to determine the associated factors for overall HRQoL and for each health dimension.

RESULTS

Anxiety/depression was the least reported problem while mobility was the most frequently reported with problem. Female respondents had lower EQ-5D score (0.76 vs. 0.86) and VAS score (66.55 vs. 69.84) than male respondents. Better health-related quality of life was significantly associated with higher BMI, no drinking habit, more leisure activities, living with family members, good sleeping quality, closer social and family connections, fewer numbers of drugs consumed per day, without having hearing or visual impairment, and fewer chronic conditions, after controlling for potential confounders.

CONCLUSION

Findings from this study suggested that quality of life was not only associated with age-related diseases, but also correlated with a range of health-related lifestyles, and factors indicating social and family support.