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Heather A, Goodwin E, Green C, Morrish N, Ukoumunne OC, Middleton RM, Hawton A. Multiple sclerosis health-related quality of life utility values from the UK MS register. Mult Scler J Exp Transl Clin 2023; 9:20552173231178441. [PMID: 37324245 PMCID: PMC10265354 DOI: 10.1177/20552173231178441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/11/2023] [Indexed: 06/17/2023] Open
Abstract
Background New interventions for multiple sclerosis (MS) commonly require a demonstration of cost-effectiveness using health-related quality of life (HRQoL) utility values. The EQ-5D is the utility measure approved for use in the UK NHS funding decision-making. There are also MS-specific utility measures - e.g., MS Impact Scale Eight Dimensions (MSIS-8D) and MSIS-8D-Patient (MSIS-8D-P). Objectives Provide EQ-5D, MSIS-8D and MSIS-8D-P utility values from a large UK MS cohort and investigate their association with demographic/clinical characteristics. Methods UK MS Register data from 14,385 respondents (2011 to 2019) were analysed descriptively and using multivariable linear regression, with self-report Expanded Disability Status Scale (EDSS) scores. Results The EQ-5D and MSIS-8D were both sensitive to differences in demographic/clinical characteristics. An inconsistency found in previous studies whereby mean EQ-5D values were higher for an EDSS score of 4 rather than 3 was not observed. Similar utility values were observed between MS types at each EDSS score. Regression showed EDSS score and age were associated with utility values from all three measures. Conclusions This study provides generic and MS-specific utility values for a large UK MS sample, with the potential for use in cost-effectiveness analyses of treatments for MS.
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Affiliation(s)
- A Heather
- PenCHORD (The Peninsula Collaboration for Health Operational Research and Data Science), Department of Health and Community Sciences, University of Exeter, Exeter, UK
| | - E Goodwin
- Health Economics Group, Department of Health and Community Sciences, University of Exeter,
Exeter, UK
| | - C Green
- Health Economics Group, Department of Health and Community Sciences, University of Exeter,
Exeter, UK
- Department for Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Solna, Sweden
- Biogen UK & Ireland, Berkshire, UK
| | - N Morrish
- Health Economics Group, Department of Health and Community Sciences, University of Exeter,
Exeter, UK
| | - OC Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula, Department of Health and Community Sciences, University of Exeter, Exeter, UK
| | | | - A Hawton
- Health Economics Group, Department of Health and Community Sciences, University of Exeter,
Exeter, UK
- NIHR Applied Research Collaboration South West Peninsula, Department of Health and Community Sciences, University of Exeter, Exeter, UK
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Marsden J, Pavlou M, Dennett R, Gibbon A, Knight-Lozano R, Jeu L, Flavell C, Freeman J, Bamiou DE, Harris C, Hawton A, Goodwin E, Jones B, Creanor S. Vestibular rehabilitation in multiple sclerosis: study protocol for a randomised controlled trial and cost-effectiveness analysis comparing customised with booklet based vestibular rehabilitation for vestibulopathy and a 12 month observational cohort study of the symptom reduction and recurrence rate following treatment for benign paroxysmal positional vertigo. BMC Neurol 2020; 20:430. [PMID: 33243182 PMCID: PMC7694922 DOI: 10.1186/s12883-020-01983-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/28/2020] [Indexed: 01/21/2023] Open
Abstract
Background Symptoms arising from vestibular system dysfunction are observed in 49–59% of people with Multiple Sclerosis (MS). Symptoms may include vertigo, dizziness and/or imbalance. These impact on functional ability, contribute to falls and significant health and social care costs. In people with MS, vestibular dysfunction can be due to peripheral pathology that may include Benign Paroxysmal Positional Vertigo (BPPV), as well as central or combined pathology. Vestibular symptoms may be treated with vestibular rehabilitation (VR), and with repositioning manoeuvres in the case of BPPV. However, there is a paucity of evidence about the rate and degree of symptom recovery with VR for people with MS and vestibulopathy. In addition, given the multiplicity of symptoms and underpinning vestibular pathologies often seen in people with MS, a customised VR approach may be more clinically appropriate and cost effective than generic booklet-based approaches. Likewise, BPPV should be identified and treated appropriately. Methods/ design People with MS and symptoms of vertigo, dizziness and/or imbalance will be screened for central and/or peripheral vestibulopathy and/or BPPV. Following consent, people with BPPV will be treated with re-positioning manoeuvres over 1–3 sessions and followed up at 6 and 12 months to assess for any re-occurrence of BPPV. People with central and/or peripheral vestibulopathy will be entered into a randomised controlled trial (RCT). Trial participants will be randomly allocated (1:1) to either a 12-week generic booklet-based home programme with telephone support or a 12-week VR programme consisting of customised treatment including 12 face-to-face sessions and a home exercise programme. Customised or booklet-based interventions will start 2 weeks after randomisation and all trial participants will be followed up 14 and 26 weeks from randomisation. The primary clinical outcome is the Dizziness Handicap Inventory at 26 weeks and the primary economic endpoint is quality-adjusted life-years. A range of secondary outcomes associated with vestibular function will be used. Discussion If customised VR is demonstrated to be clinically and cost-effective compared to generic booklet-based VR this will inform practice guidelines and the development of training packages for therapists in the diagnosis and treatment of vestibulopathy in people with MS. Trial registration ISRCTN Number: 27374299 Date of Registration 24/09/2018 Protocol Version 15 25/09/2019 Supplementary Information The online version contains supplementary material available at 10.1186/s12883-020-01983-y.
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Affiliation(s)
- J Marsden
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Science, Peninsula Allied Health Centre, Derriford Rd, Derriford, Plymouth, PL6 8BH, UK.
| | - M Pavlou
- Academic Department of Physiotherapy, King's College London, Room 3.5 Shepherd's House, Guy's Campus, London, SE1 1UL, UK
| | - R Dennett
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Science, Peninsula Allied Health Centre, Derriford Rd, Derriford, Plymouth, PL6 8BH, UK
| | - A Gibbon
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Science, Peninsula Allied Health Centre, Derriford Rd, Derriford, Plymouth, PL6 8BH, UK
| | - R Knight-Lozano
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Science, Peninsula Allied Health Centre, Derriford Rd, Derriford, Plymouth, PL6 8BH, UK
| | - L Jeu
- Academic Department of Physiotherapy, King's College London, Room 3.5 Shepherd's House, Guy's Campus, London, SE1 1UL, UK
| | - C Flavell
- Academic Department of Physiotherapy, King's College London, Room 3.5 Shepherd's House, Guy's Campus, London, SE1 1UL, UK
| | - J Freeman
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Science, Peninsula Allied Health Centre, Derriford Rd, Derriford, Plymouth, PL6 8BH, UK
| | - D E Bamiou
- EAR Institute University College London, 332 Gray's Inn Rd, London, WC1X 8EE, UK
| | - C Harris
- Royal Eye Infirmary, Derriford Hospital, Plymouth, PL6 8DH, UK.,School of Psychology, University of Plymouth, Drakes Circus, Plymouth, PL4 8AA, UK
| | - A Hawton
- Health Economics Group, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - E Goodwin
- Health Economics Group, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - B Jones
- Medical Statistics Group and Peninsula Clinical Trials Unit, Faculty of Health: Medicine, Dentistry and Human Science, Plymouth Science Park, 1 Davy Rd, Derriford, Plymouth, PL6 8BX, UK
| | - S Creanor
- Medical Statistics Group and Peninsula Clinical Trials Unit, Faculty of Health: Medicine, Dentistry and Human Science, Plymouth Science Park, 1 Davy Rd, Derriford, Plymouth, PL6 8BX, UK
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Goodwin E, Hawton A, Green C. Using the Fatigue Severity Scale to inform healthcare decision-making in multiple sclerosis: mapping to three quality-adjusted life-year measures (EQ-5D-3L, SF-6D, MSIS-8D). Health Qual Life Outcomes 2019; 17:136. [PMID: 31382960 PMCID: PMC6683407 DOI: 10.1186/s12955-019-1205-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/25/2019] [Indexed: 01/12/2023] Open
Abstract
Background Fatigue has a major influence on the quality of life of people with multiple sclerosis. The Fatigue Severity Scale is a frequently used patient-reported measure of fatigue impact, but does not generate the health state utility values required to inform cost-effectiveness analysis, limiting its applicability within decision-making contexts. The objective of this study was to use statistical mapping methods to convert Fatigue Severity Scale scores to health state utility values from three preference-based measures: the EQ-5D-3L, SF-6D and Multiple Sclerosis Impact Scale-8D. Methods The relationships between the measures were estimated through regression analysis using cohort data from 1056 people with multiple sclerosis in South West England. Estimation errors were assessed and predictive performance of the best models as tested in a separate sample (n = 352). Results For the EQ-5D and the Multiple Sclerosis Impact Scale-8D, the best performing models used a censored least absolute deviation specification, with Fatigue Severity Scale total score, age and gender as predictors. For the SF-6D, the best performing model used an ordinary least squares specification, with Fatigue Severity Scale total score as the only predictor. Conclusions Here we present algorithms to convert Fatigue Severity Scales scores to health state utility values based on three preference-based measures. These values may be used to estimate quality-adjusted life-years for use in cost-effectiveness analyses and to consider the health-related quality of life of people with multiple sclerosis, thereby informing health policy decisions. Electronic supplementary material The online version of this article (10.1186/s12955-019-1205-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E Goodwin
- Health Economics Group, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - A Hawton
- Health Economics Group, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK. .,South West Collaboration for Leadership in Applied Health Research and Care (CLAHRC), University of Exeter Medical School, University of Exeter, Exeter, UK.
| | - C Green
- Health Economics Group, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK.,South West Collaboration for Leadership in Applied Health Research and Care (CLAHRC), University of Exeter Medical School, University of Exeter, Exeter, UK
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Hawton A, Green C, Telford CJ, Wright DE, Zajicek JP. The use of multiple sclerosis condition-specific measures to inform health policy decision-making: mapping from the MSWS-12 to the EQ-5D. Mult Scler 2011; 18:853-61. [DOI: 10.1177/1352458511429319] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Walking impairment has a major influence on the quality of life of people with multiple sclerosis (MS). The Multiple Sclerosis Walking Scale (MSWS-12) assesses the impact of MS on walking ability from the patient’s perspective, but in its current form, is not amenable for use in many policy decision-making settings. Objectives: Statistical ‘mapping’ methods were used to convert MSWS-12 scores to EQ-5D health state values. Methods: The relationship between the measures was estimated using cohort data from people with MS in South West England. Regression analyses were conducted, estimation errors assessed, and predictive performance of the best models tested using longitudinal data. Results: Model performance was in line with that of other mapping studies, with the best-performing models being an ordinary least squares (OLS) model using MSWS-12 item scores, and an OLS model using the total MSWS-12 score and its squared term. Conclusions: A process has been described whereby data from a patient-reported outcome measure (MSWS-12) can be converted to (EQ-5D) health state values. These values may be used to consider the health-related quality of life of people with MS, to estimate quality adjusted life-years for use in effectiveness and cost-effectiveness analyses, and to inform health policy decisions.
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Affiliation(s)
- A Hawton
- Health Economics Group, PenCLAHRC, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, UK
| | - C Green
- Health Economics Group, PenCLAHRC, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, UK
| | - CJ Telford
- Health Economics Group, PenCLAHRC, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, UK
| | - DE Wright
- Centre for Health & Environmental Statistics, University of Plymouth, Plymouth, UK
| | - JP Zajicek
- Clinical Neurology Research Group, Peninsula College of Medicine and Dentistry, University of Plymouth, Plymouth, UK
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