Could the EQ-5D-3L predict all-cause mortality in older Chinese? Evidence from a 5-year longitudinal study in eastern China

Exploring the origin and conceptual framework of the EQ VAS

PURPOSE

The objective of this paper is to report on the origin of the EQ VAS and current understanding of the EQ VAS conceptual framework via a literature search based on the snowball approach.

METHODS

A review was conducted in two steps: (1) a citation search and (2) a search of the EuroQol group's grey literature.

RESULTS

The findings indicate that the EQ VAS was originally designed as a warm-up task for valuing hypothetical health states. The characters of the EQ VAS reflect its valuation origin, such as drawing a line (the previous version), vertical orientation, and choice of end labels. None of these design elements of the EQ VAS were chosen for the purpose of measuring self-reported overall health. Despite this, the EQ VAS proves to be a valid self-reported health status measure with its psychometric properties demonstrated in various general and clinical populations. We found a dearth of literature addressing the conceptual framework of EQ VAS as a measure of self-rated overall health.

CONCLUSION

With its potential as a powerful measure of overall health, further research into EQ VAS design, conceptual framework and empirical function is warranted.

Association Between Quality of Life Defined by EuroQol Group 5 Dimension and Composite Inferior Outcome Among Inpatients with Cirrhosis

Purpose

The utility of the EuroQol Group 5 Dimension (EQ-5D) measuring health-related quality of life (HRQoL) has been verified; however, knowledge gaps remain concerning predictive performance in cirrhosis. We aimed to identify the optimal threshold for risk stratification and the pronounced domain in the EQ-5D linked to inferior outcomes.

Patients and Methods

The X-tile project was used to obtain a threshold, considering the composite outcome of 1-year all-cause mortality or readmission. A restricted cubic spline (RCS) was performed to test the non-linear relationship between the EQ-5D utility value and the primary outcome. Six multivariate Cox regression models incorporating EQ-5D utility value and each of the five domains were constructed.

Setting/Participants

Totally, 420 patients with cirrhosis were recruited.

Results

The median utility value of the study population was 0.77 and 59.8% reported impairment in minimal one EQ-5D domain. RCS indicated a linear relationship between the utility value and composite inferior outcome. X-tile pinpointed a utility value of 0.59 stratifying populations into high- and low-risk groups based on the outcome. Inpatients with cirrhosis and deteriorated HRQoL (utility value ≤0.59) were at higher risk of death or readmission (adjusted HR: 2.18, P < 0.001). Furthermore, mobility and usual activities were the most pronounced domains associated with composite inferior outcome.

Conclusion

A utility value ≤0.59 can identify cirrhotic inpatients exhibiting compromised HRQoL and mortality/readmission risk. It is tempting to reverse the decreased HRQoL by applying longitudinal measurements and keeping surveillance on utility value, while interventions appear to mainly focus on improving mobility and usual activities.