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Voigt JD, Potter BK, Souza J, Forsberg J, Melton D, Hsu JR, Wilke B. Lifetime cost-effectiveness analysis osseointegrated transfemoral versus socket prosthesis using Markov modelling. Bone Jt Open 2024; 5:218-226. [PMID: 38484760 PMCID: PMC10949340 DOI: 10.1302/2633-1462.53.bjo-2023-0089.r1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Aims Prior cost-effectiveness analyses on osseointegrated prosthesis for transfemoral unilateral amputees have analyzed outcomes in non-USA countries using generic quality of life instruments, which may not be appropriate when evaluating disease-specific quality of life. These prior analyses have also focused only on patients who had failed a socket-based prosthesis. The aim of the current study is to use a disease-specific quality of life instrument, which can more accurately reflect a patient's quality of life with this condition in order to evaluate cost-effectiveness, examining both treatment-naïve and socket refractory patients. Methods Lifetime Markov models were developed evaluating active healthy middle-aged male amputees. Costs of the prostheses, associated complications, use/non-use, and annual costs of arthroplasty parts and service for both a socket and osseointegrated (OPRA) prosthesis were included. Effectiveness was evaluated using the questionnaire for persons with a transfemoral amputation (Q-TFA) until death. All costs and Q-TFA were discounted at 3% annually. Sensitivity analyses on those cost variables which affected a change in treatment (OPRA to socket, or socket to OPRA) were evaluated to determine threshold values. Incremental cost-effectiveness ratios (ICERs) were calculated. Results For treatment-naïve patients, the lifetime ICER for OPRA was $279/quality-adjusted life-year (QALY). For treatment-refractory patients the ICER was $273/QALY. In sensitivity analysis, the variable thresholds that would affect a change in the course of treatment based on cost (from socket to OPRA), included the following for the treatment-naïve group: yearly replacement components for socket > $8,511; cost yearly replacement parts OPRA < $1,758; and for treatment-refractory group: yearly replacement component for socket of > $12,467. Conclusion The use of the OPRA prosthesis in physically active transfemoral amputees should be considered as a cost-effective alternative in both treatment-naïve and treatment-refractory socket prosthesis patients. Disease-specific quality of life assessments such as Q-TFA are more sensitive when evaluating cost-effectiveness.
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Affiliation(s)
- Jeffrey D. Voigt
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Benjamin K. Potter
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethseda, Maryland, USA
| | - Jason Souza
- Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jonathan Forsberg
- Johns Hopkins University, Baltimore, Maryland, USA
- Sibley Memorial Hospital, Washington DC, USA
| | - Danielle Melton
- University Colorado School of Medicine, Aurora, Colorado, USA
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Lewin AM, Cashman K, Harries D, Ackerman IN, Naylor JM, Harris IA. First knee for pain and function versus second knee for quality of life. Bone Jt Open 2024; 5:202-209. [PMID: 38461859 PMCID: PMC10924693 DOI: 10.1302/2633-1462.53.bjo-2023-0035.r1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Aims The aim of this study was to describe and compare joint-specific and generic health-related quality of life outcomes of the first versus second knee in patients undergoing staged bilateral total knee arthroplasty (BTKA) for osteoarthritis. Methods This retrospective cohort study used Australian national arthroplasty registry data from January 2013 to January 2021 to identify participants who underwent elective staged BTKA with six to 24 months between procedures. The primary outcome was Oxford Knee Score (OKS) at six months postoperatively for the first TKA compared to the second TKA, adjusted for age and sex. Secondary outcomes compared six-month EuroQol five-dimension five-level (EQ-5D-5L) domain scores, EQ-5D index scores, and the EQ visual analogue scale (EQ-VAS) between knees at six months postoperatively. Results The cohort included 635 participants (1,270 primary procedures). Preoperative scores were worse in the first knee compared to the second for all instruments; however, comparing the first knee at six months postoperatively with the second knee at six months postoperatively, the mean between-knee difference was minimal for OKS (-0.8 points; 95% confidence interval (CI) -1.4 to -0.2), EQ-VAS (3.3; 95% CI 1.9 to 4.7), and EQ-5D index (0.09 points; 95% CI 0.07 to 0.12). Outcomes for the EQ-5D-5L domains 'mobility', 'usual activities', and 'pain/discomfort' were better following the second TKA. Conclusion At six months postoperatively, there were no clinically meaningful differences between the first and second TKA in either the joint-specific or overall generic health-related quality of life outcomes. However, individual domain scores assessing mobility, pain, and usual activities were notably higher after the second TKA, likely reflecting the cumulative improvement in quality of life after both knees have been replaced.
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Affiliation(s)
- Adriane M. Lewin
- South West Clinical Campuses, School of Clinical Medicine, UNSW Medicine & Health, Liverpool, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Kara Cashman
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Dylan Harries
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Ilana N. Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Justine M. Naylor
- South West Clinical Campuses, School of Clinical Medicine, UNSW Medicine & Health, Liverpool, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, Australia
- South West Sydney Local Health District, NSW Health, Sydney, Australia
| | - Ian A. Harris
- South West Clinical Campuses, School of Clinical Medicine, UNSW Medicine & Health, Liverpool, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, Australia
- South West Sydney Local Health District, NSW Health, Sydney, Australia
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, Australia
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Ernstsson O, Heintz E, Nordenskjöld A, Johnson JA, Korkmaz S, Zethraeus N. Association between pulse width and health-related quality of life after electroconvulsive therapy in patients with unipolar or bipolar depression: an observational register-based study. Nord J Psychiatry 2024; 78:137-145. [PMID: 38079191 DOI: 10.1080/08039488.2023.2289915] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/12/2023] [Indexed: 02/02/2024]
Abstract
AIMS To examine the association between pulse width and HRQoL measured within one week after electroconvulsive therapy (ECT) and at six-month follow-up in patients with unipolar or bipolar depression. METHODS This was an observational register study using data from the Swedish National Quality Registry for ECT (2011-2019). Inclusion criteria were: age ≥18 years; index treatment for unipolar/bipolar depression; unilateral electrode placement; information on pulse width; EQ-5D measurements before and after ECT. Multiple linear regressions were performed to investigate the association between pulse width (<0.5 ms; 0.5 ms; >0.5 ms) and HRQoL (EQ-5D-3L index; EQ VAS) one week after ECT (primary outcome) and six months after ECT (secondary outcome). RESULTS The sample included 5,046 patients with unipolar (82%) or bipolar (18%) depression. At first ECT session, 741 patients (14.7%) had pulse width <0.5 ms, 3,639 (72.1%) had 0.5 ms, and 666 (13.2%) had >0.5 ms. There were no statistically significant associations between pulse width and HRQoL one week after ECT. In the subsample of patients with an EQ-5D index recorded six months after ECT (n = 730), patients receiving 0.5 ms had significantly lower HRQoL (-0.089) compared to <0.5 ms, after adjusting for demographic and clinical characteristics (p = .011). The corresponding analysis for EQ VAS did not show any statistically significant associations. CONCLUSION No robust associations were observed between pulse width and HRQoL after ECT. On average, significant improvements in HRQoL were observed one week and six months after ECT for patients with unipolar or bipolar disease, independent of the pulse width received.
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Affiliation(s)
- Olivia Ernstsson
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Emelie Heintz
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- Centre for Health Economics, Informatics and Health Services Research, Stockholm Health Care Services, Stockholm, Sweden
| | - Axel Nordenskjöld
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | | | - Seher Korkmaz
- Department of Digitalization and IT, Health and Care Administration, Stockholm, Sweden
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
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van den Heuvel S, Penning D, Sanders F, van Veen R, Sosef N, van Dijkman B, Schepers T. Functional outcome of routine versus on-demand removal of the syndesmotic screw. Bone Jt Open 2023; 4:957-963. [PMID: 38108322 PMCID: PMC10726379 DOI: 10.1302/2633-1462.412.bjo-2023-0061] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Aims The primary aim of this study was to present the mid-term follow-up of a multicentre randomized controlled trial (RCT) which compared the functional outcome following routine removal (RR) to the outcome following on-demand removal (ODR) of the syndesmotic screw (SS). Methods All patients included in the 'ROutine vs on DEmand removal Of the syndesmotic screw' (RODEO) trial received the Olerud-Molander Ankle Score (OMAS), American Orthopaedic Foot and Ankle Hindfoot Score (AOFAS), Foot and Ankle Outcome Score (FAOS), and EuroQol five-dimension questionnaire (EQ-5D). Out of the 152 patients, 109 (71.7%) completed the mid-term follow-up questionnaire and were included in this study (53 treated with RR and 56 with ODR). Median follow-up was 50 months (interquartile range 43.0 to 56.0) since the initial surgical treatment of the acute syndesmotic injury. The primary outcome of this study consisted of the OMAS scores of the two groups. Results The median OMAS score was 85.0 for patients treated with RR, and 90.0 for patients treated with ODR (p = 0.384), indicating no significant difference between ODR and RR. The secondary outcome measures included the AOFAS (88.0 in the RR group and 90.0 for ODR; p = 0.722), FAOS (87.5 in the RR group and 92.9 for ODR; p = 0.399), and EQ-5D (0.87 in the RR group and 0.96 for ODR; p = 0.092). Conclusion This study demonstrated no functional difference comparing ODR to RR in syndesmotic injuries at a four year follow-up period, which supports the results of the primary RODEO trial. ODR should be the standard practice after syndesmotic screw fixation.
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Affiliation(s)
- Stein van den Heuvel
- Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Diederick Penning
- Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Fay Sanders
- Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Ruben van Veen
- Department of Trauma Surgery, OLVG, Amsterdam, the Netherlands
| | - Nico Sosef
- Department of Trauma Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Bart van Dijkman
- Department of Trauma Surgery, Flevoziekenhuis, Almere, the Netherlands
| | - Tim Schepers
- Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - On behalf of the RODEO Collaborator group
- Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Trauma Surgery, OLVG, Amsterdam, the Netherlands
- Department of Trauma Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
- Department of Trauma Surgery, Flevoziekenhuis, Almere, the Netherlands
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Liu CK, Miao S, Giffuni J, Katzel LI, Fielding RA, Seliger SL, Weiner DE. Geriatric Syndromes and Health-Related Quality of Life in Older Adults with Chronic Kidney Disease. Kidney360 2023; 4:e457-e465. [PMID: 36790849 PMCID: PMC10278840 DOI: 10.34067/kid.0000000000000078] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023]
Abstract
Key Points In older adults with CKD, geriatric syndromes are common and are associated with reduced quality of life. Addressing geriatric syndromes could potentially improve quality of life for older adults with CKD. Background Geriatric syndromes, which are multifactorial conditions common in older adults, predict health-related quality of life (HRQOL). Although CKD is associated with lower HRQOL, whether geriatric syndromes contribute to HRQOL in CKD is unknown. Our objective was to compare associations of geriatric syndromes and medical conditions with HRQOL in older adults with CKD. Methods This was a secondary analysis of a parallel-group randomized controlled clinical trial evaluating a 12-month exercise intervention in persons 55 years or older with CKD stage 3b–4. Participants were assessed for baseline geriatric syndromes (cognitive impairment, poor appetite, dizziness, fatigue, and chronic pain) and medical conditions (diabetes, hypertension, coronary artery disease, cancer, or chronic obstructive pulmonary disease). Participants' HRQOL was assessed with the Short Form Health Survey-36 (SF-36), EuroQol 5-Dimensions 5-Level, and the EuroQol Visual Analogue Scale. We examined the cross-sectional and longitudinal associations of geriatric syndromes and medical conditions with HRQOL using multiple linear regression. Results Among 99 participants, the mean age was 68.0 years, 25% were female, and 62% were Black. Participants had a baseline mean of 2.0 geriatric syndromes and 2.1 medical conditions; 49% had ≥ two geriatric syndromes and ≥ two medical conditions concurrently. Sixty-seven (68%) participants underwent 12-month assessments. In models using geriatric syndromes and medical conditions as concurrent exposures, the number of geriatric syndromes was cross-sectionally associated with SF-36 scores for general health (β =−0.385) and role limitations because of physical health (β =−0.374) and physical functioning (β =−0.300, all P <0.05). The number of medical conditions was only associated with SF-36 score for role limitations because of physical health (β =−0.205). Conclusions In older adults with CKD stage 3b–4, geriatric syndromes are common and are associated with lower HRQOL. Addressing geriatric conditions is a potential approach to improve HRQOL for older adults with CKD. Clinical Trial registry name and registration number: NCT01462097 ; Registration Date–October 26, 2011.
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Affiliation(s)
- Christine K. Liu
- Section of Geriatric Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
- Geriatric Research and Education Clinical Center, Veteran Affairs Palo Alto Health Care System, Palo Alto, California
- Nutrition Exercise Physiology and Sarcopenia Team, Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Shiyuan Miao
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Jamie Giffuni
- Geriatric Research Education and Clinical Center, Veterans Affairs Maryland Healthcare System, Baltimore, Maryland
| | - Leslie I. Katzel
- Geriatric Research Education and Clinical Center, Veterans Affairs Maryland Healthcare System, Baltimore, Maryland
- Division of Gerontology, Geriatrics, and Palliative Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Roger A. Fielding
- Nutrition Exercise Physiology and Sarcopenia Team, Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Stephen L. Seliger
- Geriatric Research Education and Clinical Center, Veterans Affairs Maryland Healthcare System, Baltimore, Maryland
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Daniel E. Weiner
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
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Muacevic A, Adler JR, Pammi S, Kariya A. Functional Outcomes, Survival Rate, and Complications of Patellofemoral Arthroplasty: Mid-Term Results From Independent Center. Cureus 2022; 14:e31945. [PMID: 36582575 PMCID: PMC9794910 DOI: 10.7759/cureus.31945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background Patellofemoral arthroplasty (PFA) is indicated for isolated patellofemoral arthritis. PFA is a less invasive, bone-preserving procedure with faster recovery when compared to total knee replacement. We aim to present the functional outcome, survival rate, and complications of PFA from our center. Methods A total of 45 consecutive PFA performed (mean age 58.02 ± 9.2 years; 34 females and 11 males; Avon prosthesis) during the study period was included. Prosthesis survivorship was measured using revision as the endpoint, and functional outcome was assessed using Oxford knee scores (OKSs), EQ-5D, and satisfaction scores. Postoperative complications, the number of revisions, and the reasons causing them were collected. Results The mean follow-up was 48.7 (range 16-66) months. As compared to preoperative scores, OKS and Eq5d showed significant improvements (p<0.001). The satisfaction scores indicated that 28 patients (62%) were very satisfied, 10 (26.7%) were satisfied, and seven (15.5%) were dissatisfied. Four patients (8.9%) underwent revision surgery with a total knee replacement. Out of four patients requiring revision, two had progressive arthritis of the medial compartment, one had aseptic loosening of the implants, and one had trauma. Five patients showed persistent anteromedial knee pain (12.2%); one patient had maltracking requiring lateral release; one patient developed stiffness with knee flexion less than 60 degrees requiring manipulation under anesthesia. Conclusion Our results indicated that good or excellent functional outcomes can be expected in >80% of patients with survivorship of 91.1% at mid-term. Careful patient selection and counseling should be done informing of the risk of dissatisfaction/persistent pain and revision surgery in the mid and long term. Long-term outcomes and factors determining good outcomes need to be evaluated in future research.
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SAMPOGNA F, ABENI D, GIELER U, TOMAS-ARAGONES L, LIEN L, POOT F, JEMEC GBE, SZABO C, LINDER D, VAN MIDDENDORP H, HALVORSEN JA, BALIEVA F, SZEPIETOWSKI JC, ROMANOV DV, MARRON SE, ALTUNAY IK, FINLAY AY, SALEK SS, KUPFER J, MISERY L, DALGARD FJ. Exploring the EQ-5D Dimension of Pain/Discomfort in Dermatology Outpatients from a Multicentre Study in 13 European Countries. Acta Derm Venereol 2020; 100:5734. [PMCID: PMC9128924 DOI: 10.2340/10.2340/00015555-3477] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Pain and discomfort are important symptoms in dermatology. The aim of this cross-sectional, multicentre study was to describe the prevalence of pain/discomfort and its associations in patients with several dermatological conditions across 13 European countries. The outcome was the prevalence of pain/discomfort according to a question of the EQ-5D questionnaire. Data collected from November 2011 to February 2013 were complete for 3,509 consecutive outpatients. Moderate or extreme pain/discomfort was reported by 55.5% of patients and 31.5% of controls with no skin conditions. The highest proportions were reported by patients with hidradenitis suppurativa (92.9%), leg ulcer (81.4%), prurigo (80%) and lichen planus (75.6%). Pain/discomfort was associated with older age, low educational level, clinical severity, flare on scalp or hands, itch, depression, anxiety, low quality of life, and thoughts of suicide. It is important to enquire specifically about pain/discomfort during clinical consultations and to address it when planning a patient’s care.
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Affiliation(s)
- Francesca SAMPOGNA
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy, Departments of Dermatology:
| | - Damiano ABENI
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy, Departments of Dermatology:
| | - Uwe GIELER
- Justus Liebig University, Giessen, Germany
| | | | - Lars LIEN
- Department of Public Health, Hedmark University College, Elverum,National Center for Dual Diagnosis, Innlandet Hospital Trust, Brumundal, Norway
| | | | - Gregor B. E. JEMEC
- Zealand University Hospital, Roskilde, University of Copenhagen, Copenhagen, Denmark
| | - Csanad SZABO
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Dennis LINDER
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Henriet VAN MIDDENDORP
- Department of Health, Medical and Neuropsychology, Leiden University, Leiden, The Netherlands
| | - Jon Anders HALVORSEN
- Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo
| | | | | | - Dmitry V. ROMANOV
- Department of Psychiatry and Psychosomatics, I. M. Sechenov First Moscow State Medical University (Sechenov University); Mental Health Research Center, Moscow, Russia
| | | | - Ilknur K. ALTUNAY
- University of Health Sciences, Etfal Training and Research Hospital, Dermatology, Istanbul, Turkey
| | | | - Sam S. SALEK
- Department of Pharmacy, Pharmacology and Postgraduate Medicine, School of Life & Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Jörg KUPFER
- Institute of Medical Psychology, Justus Liebig University, Giessen, Germany
| | | | - Florence J. DALGARD
- National Center for Dual Diagnosis, Innlandet Hospital Trust, Brumundal, Norway
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Yang F, Devlin N, Luo N. Impact of mapped EQ-5D utilities on cost-effectiveness analysis: in the case of dialysis treatments. Eur J Health Econ 2019; 20:99-105. [PMID: 29948432 PMCID: PMC6394787 DOI: 10.1007/s10198-018-0987-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/06/2018] [Indexed: 05/12/2023]
Abstract
Objectives This study aimed to evaluate the performance of EQ-5D data mapped from SF-12 in terms of estimating cost effectiveness in cost-utility analysis (CUA). The comparability of SF-6D (derived from SF-12) was also assessed. Methods Incremental quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated based on two Markov models assessing the cost effectiveness of haemodialysis (HD) and peritoneal dialysis (PD) using utility values based on EQ-5D-5L, EQ-5D using three direct-mapping algorithms and two response-mapping algorithms (mEQ-5D), and SF-6D. Bootstrap method was used to estimate the 95% confidence interval (percentile method) of incremental QALYs and ICERs with 1000 replications for the utilities. Results In both models, compared to the observed EQ-5D values, mEQ-5D values expressed much lower incremental QALYs (range − 14.9 to − 33.2%) and much higher ICERs (range 17.5 to 49.7%). SF-6D also estimated lower incremental QALYs (− 29.0 and − 14.9%) and higher ICERs (40.9 and 17.5%) than did the observed EQ-5D. The 95% confidence interval of incremental QALYs and ICERs confirmed the lower incremental QALYs and higher ICERs estimated using mEQ-5D and SF-6D. Conclusion Compared to observed EQ-5D, EQ-5D mapped from SF-12 and SF-6D would under-estimate the QALYs gained in cost-utility analysis and thus lead to higher ICERs. It would be more sensible to conduct CUA studies using directly collected EQ-5D data and to designate one single preference-based measure as reference case in a jurisdiction to achieve consistency in healthcare decision-making. Electronic supplementary material The online version of this article (10.1007/s10198-018-0987-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fan Yang
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD UK
| | | | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Abstract
STUDY DESIGN Systematic review. OBJECTIVE This systematic review examines validity and responsiveness of three generic preference-based measures in patients with low back pain (LBP). SUMMARY OF BACKGROUND DATA LBP is a very common incapacitating disease with a significant impact on health-related quality of life (HRQoL). Health state utility values can be derived from various preference-based HRQoL instruments, and among them the most widely ones are EuroQol 5 dimensions (EQ-5D), Short Form 6 Dimensions (SF-6D), and Health Utilities Index 3 (HUI III). The ability of these instruments to reflect HRQoL has been tested in various contexts, but never for LBP populations. METHODS A systematic search on electronic literature databases was undertaken to identify studies of patients with LBP where health state utility values were reported. Records were screened using a set of predefined eligibility criteria. Data on validity (correlations and known group methods) and responsiveness (effect sizes, standardized response means, tests of statistical significance) of instruments were extracted using a customized extraction template, and assessed using predefined criteria. RESULTS There were substantial variations in the 37 included papers identified in relation to study design and outcome measures used. EQ-5D demonstrated good convergent validity, as it was able to distinguish between known groups. EQ-5D was also able to capture changes of health states as results of different interventions. Evidence for SF-6D and HUI III was limited to allow an appropriate evaluation. CONCLUSION EQ-5D performs well in LBP population and its scores seem to be suitable for economic evaluation of LBP interventions. However, the paucity of information on the other instruments makes it impossible to determine its relative validity and responsiveness compared with them.
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Maheswaran H, Petrou S, MacPherson P, Choko AT, Kumwenda F, Lalloo DG, Clarke A, Corbett EL. Cost and quality of life analysis of HIV self-testing and facility-based HIV testing and counselling in Blantyre, Malawi. BMC Med 2016; 14:34. [PMID: 26891969 PMCID: PMC4759936 DOI: 10.1186/s12916-016-0577-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 02/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV self-testing (HIVST) has been found to be highly effective, but no cost analysis has been undertaken to guide the design of affordable and scalable implementation strategies. METHODS Consecutive HIV self-testers and facility-based testers were recruited from participants in a community cluster-randomised trial ( ISRCTN02004005 ) investigating the impact of offering HIVST in addition to facility-based HIV testing and counselling (HTC). Primary costing studies were undertaken of the HIVST service and of health facilities providing HTC to the trial population. Costs were adjusted to 2014 US$ and INT$. Recruited participants were asked about direct non-medical and indirect costs associated with accessing either modality of HIV testing, and additionally their health-related quality of life was measured using the EuroQol EQ-5D. RESULTS A total of 1,241 participants underwent either HIVST (n = 775) or facility-based HTC (n = 446). The mean societal cost per participant tested through HIVST (US$9.23; 95 % CI: US$9.14-US$9.32) was lower than through facility-based HTC (US$11.84; 95 % CI: US$10.81-12.86). Although the mean health provider cost per participant tested through HIVST (US$8.78) was comparable to facility-based HTC (range: US$7.53-US$10.57), the associated mean direct non-medical and indirect cost was lower (US$2.93; 95 % CI: US$1.90-US$3.96). The mean health provider cost per HIV positive participant identified through HIVST was higher (US$97.50) than for health facilities (range: US$25.18-US$76.14), as was the mean cost per HIV positive individual assessed for anti-retroviral treatment (ART) eligibility and the mean cost per HIV positive individual initiated onto ART. In comparison to the facility-testing group, the adjusted mean EQ-5D utility score was 0.046 (95 % CI: 0.022-0.070) higher in the HIVST group. CONCLUSIONS HIVST reduces the economic burden on clients, but is a costlier strategy for the health provider aiming to identify HIV positive individuals for treatment. The provider cost of HIVST could be substantially lower under less restrictive distribution models, or if costs of oral fluid HIV test kits become comparable to finger-prick kits used in health facilities.
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Affiliation(s)
- Hendramoorthy Maheswaran
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry, CV4 7AL, UK. .,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
| | - Stavros Petrou
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Peter MacPherson
- Department of Public Health and Policy, University of Liverpool, Liverpool, Merseyside, L69 3BX, UK.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, L3 5QA, UK
| | - Augustine T Choko
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Felistas Kumwenda
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - David G Lalloo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, L3 5QA, UK
| | - Aileen Clarke
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Elizabeth L Corbett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,London School of Hygiene and Tropical Medicine, London, UK
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Wu M, Brazier JE, Kearns B, Relton C, Smith C, Cooper CL. Examining the impact of 11 long-standing health conditions on health-related quality of life using the EQ-5D in a general population sample. Eur J Health Econ 2015; 16:141-51. [PMID: 24408476 PMCID: PMC4339694 DOI: 10.1007/s10198-013-0559-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/18/2013] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Health-related quality of life (HRQoL) measures have been increasingly used in economic evaluations for policy guidance. We investigate the impact of 11 self-reported long-standing health conditions on HRQoL using the EQ-5D in a UK sample. METHODS We used data from 13,955 patients in the South Yorkshire Cohort study collected between 2010 and 2012 containing the EQ-5D, a preference-based measure. Ordinary least squares (OLS), Tobit and two-part regression analyses were undertaken to estimate the impact of 11 long-standing health conditions on HRQoL at the individual level. RESULTS The results varied significantly with the regression models employed. In the OLS and Tobit models, pain had the largest negative impact on HRQoL, followed by depression, osteoarthritis and anxiety/nerves, after controlling for all other conditions and sociodemographic characteristics. The magnitude of coefficients was higher in the Tobit model than in the OLS model. In the two-part model, these four long-standing health conditions were statistically significant, but the magnitude of coefficients decreased significantly compared to that in the OLS and Tobit models and was ranked from pain followed by depression, anxiety/nerves and osteoarthritis. CONCLUSIONS Pain, depression, osteoarthritis and anxiety/nerves are associated with the greatest losses of HRQoL in the UK population. The estimates presented in this article should be used to inform economic evaluations when assessing health care interventions, though improvements can be made in terms of diagnostic information and obtaining longitudinal data.
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Affiliation(s)
- Mengjun Wu
- Institute of Mental Health, University of Nottingham, Innovation Park, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU, UK,
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Liang Y, Wu W. Exploratory analysis of health-related quality of life among the empty-nest elderly in rural China: an empirical study in three economically developed cities in eastern China. Health Qual Life Outcomes 2014; 12:59. [PMID: 24766880 PMCID: PMC4016644 DOI: 10.1186/1477-7525-12-59] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 04/09/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Along with rapid economic development, the aging process in China is gradually accelerating. The living conditions of empty-nest rural elderly are worrisome. As a more vulnerable group, empty-nest elderly are facing more urgent health problems. This study explores the health-related quality of life (HRQOL) of empty-nest elderly in rural China and aims to arouse more social concern for their HRQOL. METHODS Research subjects were empty-nest rural elderly from three cities: Nanjing, Suzhou, and Wenzhou (ages ≥ 60, n = 967). This study used the five-dimensional European quality of health scale (EQ-5D) and the 12-item Short Form Health Survey (SF-12) to measure the HRQOL of the respondents. Spearman correlation coefficient, stereotype logistic regression, ordered probit regression and multinomial logistic regression, and Structural equation model (SEM) methods are employed to study the relationship. RESULTS (1) The Spearman correlation coefficient shows that the correlations of similar domains between the SF-12 and the EQ-5D scales are relatively strong. (2) Men's scores are higher than that of women's in general health (GH) and anxiety/depression (AD) models. (3) The scores of physical component summary (PCS), physical functioning (PF), mental health (MH), and usual activities (UA) decline with age. (4) Apart from PCS, vitality (VT), and role-emotional (RE) as dependent variables, the education passes all the significance tests. The higher the education is, the higher the scores of physical or psychological health are. (5) The scores of PCS and bodily pain (BP) of empty-nest elderly are divorced or higher in other marital status. (6) In SEM analysis, the effect of basic information of empty-nest elderly on SF-12 scale is more significant. CONCLUSIONS First, the frequency histograms of EQ-5D show that the scores of empty-nest elderly in rural China are generally low. Second, in all SF-12 items, the HRQOL is low. Third, men's scores are higher than that of women's. The elderly with higher education reported higher scores than those with lower education. Fourth, the effect of socio-demographic variables of the rural Chinese empty-nest elderly on SF-12 scores is more significant, whereas the effect on EQ-5D scores is less significant.
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Affiliation(s)
- Ying Liang
- Department of Social Work and Social Policy, School of Social and Behavioral Sciences, Nanjing University, Nanjing 210023, Jiangsu province, People’s Republic of China
| | - Wei Wu
- School of Social and Behavioral Sciences, Nanjing University, Nanjing 210023, Jiangsu province, People’s Republic of China
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13
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Mulhern B, Meadows K. The construct validity and responsiveness of the EQ-5D, SF-6D and Diabetes Health Profile-18 in type 2 diabetes. Health Qual Life Outcomes 2014; 12:42. [PMID: 24661350 PMCID: PMC4304018 DOI: 10.1186/1477-7525-12-42] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interest in the measurement of health related quality of life and psychosocial functioning from the patient's perspective in diabetes mellitus has grown in recent years. The aim of this study is to investigate the psychometric performance of and agreement between the generic EQ-5D and SF-6D and diabetes specific DHP-18 in Type 2 diabetes. This will support the future use of the measures by providing further evidence regarding their psychometric properties and the conceptual overlap between the instruments. The results will inform whether the measures can be used with confidence alongside each other to provide a more holistic profile of people with Type 2 diabetes. METHODS A large longitudinal dataset (n = 1,184) of people with Type 2 diabetes was used for the analysis. Convergent validity was tested by examining correlations between the measures. Known group validity was tested across a range of clinical and diabetes severity indicators using ANOVA and effect size statistics. Agreement was examined using Bland-Altman plots. Responsiveness was tested by examining floor and ceiling effects and standardised response means. RESULTS Correlations between the measures indicates that there is overlap in the constructs assessed (with correlations between 0.1 and 0.7 reported), but there is some level of divergence between the generic and condition specific instruments. Known group validity was generally good but was not consistent across all indicators included (with effect sizes from 0 to 0.74 reported). The EQ-5D and SF-6D displayed a high level of agreement, but there was some disagreement between the generic measures and the DHP-18 dimensions across the severity range. Responsiveness was higher in those who self-reported change in health (SRMs between 0.06 and 0.25). CONCLUSIONS The psychometric assessment of the relationship between the EQ-5D, SF-6D and DHP-18 shows that all have a level of validity for use in Type 2 diabetes. This suggests that the measures can be used alongside each other to provide a more holistic assessment of with the quality of life impacts of Type 2 diabetes.
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Affiliation(s)
- Brendan Mulhern
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Regent Court S1 4DA, UK
| | - Keith Meadows
- DHP Research and Consultancy, Bloxham Mill Business Centre, Barford Road, Bloxham, Banbury OX15 4FF, UK
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Kularatna S, Whitty JA, Johnson NW, Scuffham PA. Study protocol for valuing EQ-5D-3L and EORTC-8D health states in a representative population sample in Sri Lanka. Health Qual Life Outcomes 2013; 11:149. [PMID: 24070162 PMCID: PMC3766133 DOI: 10.1186/1477-7525-11-149] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 08/12/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Economic evaluations to inform decisions about allocation of health resources are scarce in Low and Middle Income Countries, including in Sri Lanka. This is in part due to a lack of country-specific utility weights, which are necessary to derive appropriate Quality Adjusted Life Years. The EQ-5D-3 L, a generic multi-attribute instrument (MAUI), is most widely used to measure and value health states in high income countries; nevertheless, the sensitivity of generic MAUIs has been criticised in some conditions such as cancer. This article describes a protocol to produce both a generic EQ-5D-3 L and cancer specific EORTC-8D utility index in Sri Lanka. METHOD EQ-5D-3 L and EORTC-8D health states will be valued using the Time Trade-Off technique, by a representative population sample (n = 780 invited) identified using stratified multi-stage cluster sampling with probability proportionate to size method. Households will be randomly selected within 30 clusters across four districts; one adult (≥ 18 years) within each household will be selected using the Kish grid method.Data will be collected via face-to-face interview, with a Time Trade-Off board employed as a visual aid. Of the 243 EQ-5D-3 L and 81,290 EORTC-8D health states, 196 and 84 respectively will be directly valued. In EQ-5D-3 L, all health states that combine level 3 on mobility with either level 1 on usual activities or self-care were excluded. Each participant will first complete the EQ-5D-3 L, rank and value 14 EQ-5D-3 L states (plus the worst health state and "immediate death"), and then rank and value seven EORTC-8D states (plus "immediate death"). Participant demographic and health characteristics will be also collected.Regression models will be fitted to estimate utility indices for EQ-5D-3 L and EORTC-8D health states for Sri Lanka. The dependent variable will be the utility value. Different specifications of independent variables will be derived from the ordinal EQ-5D-3 L to test for the best-fitting model. DISCUSSION In Sri Lanka, a LMIC health state valuation will have to be carried out using face to face interview instead of online methods. The proposed study will provide the first country-specific health state valuations for Sri Lanka, and one of the first valuations to be completed in a South Asian Country.
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Affiliation(s)
- Sanjeewa Kularatna
- Centre for Applied Health Economics, School of Medicine, Griffith University, University Drive, Meadowbrook, Queensland, Australia
- Population and Social Health Research Programme, Griffith Health Institute, Griffith University, Brisbane, Australia
| | - Jennifer A Whitty
- Centre for Applied Health Economics, School of Medicine, Griffith University, University Drive, Meadowbrook, Queensland, Australia
- Population and Social Health Research Programme, Griffith Health Institute, Griffith University, Brisbane, Australia
| | - Newell W Johnson
- Population and Social Health Research Programme, Griffith Health Institute, Griffith University, Brisbane, Australia
| | - Paul A Scuffham
- Centre for Applied Health Economics, School of Medicine, Griffith University, University Drive, Meadowbrook, Queensland, Australia
- Population and Social Health Research Programme, Griffith Health Institute, Griffith University, Brisbane, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Shah KK, Lloyd A, Oppe M, Devlin NJ. One-to-one versus group setting for conducting computer-assisted TTO studies: findings from pilot studies in England and the Netherlands. Eur J Health Econ 2013; 14 Suppl 1:S65-73. [PMID: 23900666 PMCID: PMC3728432 DOI: 10.1007/s10198-013-0509-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We compare two settings for administering time trade-off (TTO) tasks in computer-assisted interviews (one-to-one, interviewer-led versus group, self-complete) by examining the quality of the data generated in pilot studies undertaken in England and the Netherlands. The two studies used near-identical methods, except that in England, data were collected in one-to-one interviews with substantial amounts of interviewer assistance, whereas in the Netherlands, the computer aid was used as a self-completion tool in group interviews with lesser amounts of interviewer assistance. In total, 801 members of the general public (403 in England; 398 in the Netherlands) each completed five TTO valuations of EQ-5D-5L health states. Respondents in the Netherlands study showed a greater tendency to give 'round number' values such as 0 and 1 and to complete tasks using a minimal number of iterative steps. They also showed a greater tendency to skip the animated instructions that preceded the first task and to take into account assumptions that they were specifically asked not to take into account. When faced with a pair of health states in which one state dominated the other, respondents in the Netherlands study were more likely than those in the England study to give a higher value to the dominant health state. On the basis of these comparisons, we conclude that the one-to-one, interviewer-led setting is superior to the group, self-complete setting in terms of the quality of data generated and that the former is more suitable than the latter for TTO studies being used to value EQ-5D-5L.
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Affiliation(s)
- Koonal K Shah
- Office of Health Economics, 7th Floor Southside, 105 Victoria Street, London SW1E 6QT, UK.
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Abstract
INTRODUCTION This study was designed to test the feasibility and face validity of the composite time trade-off (composite TTO), a new approach to TTO allowing for a more consistent elicitation of negative health state values. METHODS The new instrument combines a conventional TTO to elicit values for states regarded better than dead and a lead-time TTO for states worse than dead. RESULTS A total of 121 participants completed the composite TTO for ten EQ-5D-5L health states. Mean values ranged from -0.104 for health state 53555 to 0.946 for 21111. The instructions were clear to 98 % of the respondents, and 95 % found the task easy to understand, indicating feasibility. Further, the average number of steps taken in the iteration procedure to achieve the point of indifference in the TTO and the average duration of each task were indicative of a deliberate cognitive process. CONCLUSION Face validity was confirmed by the high mean values for the mild health states (>0.90) and low mean values for the severe states (<0.42). In conclusion, this study demonstrates the feasibility and face validity of the composite TTO in a face-to-face standardized computer-assisted interview setting.
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Affiliation(s)
- Bas M F Janssen
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Dolan P, Kavetsos G, Tsuchiya A. Sick but satisfied: the impact of life and health satisfaction on choice between health scenarios. J Health Econ 2013; 32:708-14. [PMID: 23665539 PMCID: PMC3690474 DOI: 10.1016/j.jhealeco.2013.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/04/2013] [Accepted: 04/12/2013] [Indexed: 05/07/2023]
Abstract
Preference elicitation methods require respondents to predict the impact a change in health might have on their future selves. The focus on the change in health is at the possible expense of other experiences of life once in that health state. We analyse personal preferences to a pairwise choice task involving trade-offs between quality and length of life, where satisfaction levels with life or health are introduced in the description of the health states. We find that a health scenario including low levels of satisfaction increases the likelihood of preferring to die sooner in full health, whereas scenarios including high levels of satisfaction increase the likelihood of preferring to live for longer in poor health. The differences highlight the sensitivity of preferences to what is described in health states and therefore show the importance of on-going discussions about precisely what respondents should be asked to consider in preference elicitation studies.
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Affiliation(s)
- Paul Dolan
- Department of Social Policy, London School of Economics, Houghton Street, London WC2A 2AE, UK
| | - Georgios Kavetsos
- Department of Social Policy, London School of Economics, Houghton Street, London WC2A 2AE, UK
- Corresponding author. Tel.: +44 02079557453.
| | - Aki Tsuchiya
- Department of Economics, University of Sheffield, Sheffield S1 4DT, UK
- School of Health and Related Research, University of Sheffield, S1 4DA, UK
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Abstract
The study objective was to ascertain outcomes with the Swedish adjustable gastric band (SAGB) on an intention-to-treat basis in multiple centers across the French social health insurance system. SAGB results at 3-year follow-up are reported. The noncomparative, observational, prospective, consecutive cohort study design sought a 500-patient minimum recruitment geographically representative of continental France. Safety (adverse events [AEs], device-related morbidity, and mortality) and effectiveness (change in body mass index [BMI, kilograms per square meter], percentage excess weight loss, comorbidities, quality of life [QoL]) were assessed. Adjustable gastric band survival was calculated. Thirty-one surgeons in 28 multidisciplinary teams/sites enrolled patients between September 2, 2007 and April 30, 2008. SAGB was successfully implanted in 517 patients: 88.0 % female; mean age, 37.5 years; obesity duration, 15.3 years (baseline: mean BMI, 41.0; comorbidities, 773 in 74.3 % of patients; Bariatric Analysis and Reporting Outcome System (BAROS), 1.4; EuroQoL 5-Dimensions (EQ-5D), 0.61; EuroQoL-visual analog scale (EQ-VAS), 52.3). At 3 years: BMI, 32.2 (mean change, -9.0; p < 0.0001); excess weight loss, 47.4 %; comorbidities, 161 in 27.2 %; BAROS, 3.6 (+2.2, p < 0.0001); EQ-5D, 0.84 (+0.22, p < 0.0001); EQ-VAS, 73.4 (+21.4, p < 0.0001). SAGB-induced weight loss was associated with substantially improved QoL. One death occurred and was unrelated to the treatment. No AE was reported in 68.3 % of patients, and no confirmed device-related AE in 77.0 %. Overall AE rate was 0.19 per patient year. Device retention was 87.0 %. Analysis of patients lost to follow-up showed a nonsignificant effect on overall study results. In a prospective, consecutive cohort, "real-world", nationwide study, the Swedish Adjustable Gastric Band was found safe and effective at 3-year follow-up.
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Affiliation(s)
- G Ribaric
- Ethicon Endo-Surgery (Europe), European Surgical Institute, Hamburg, Germany.
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Brettschneider C, König HH, Herzog W, Kaufmann C, Schaefert R, Konnopka A. Validity and responsiveness of the EQ-5D in assessing and valuing health status in patients with somatoform disorders. Health Qual Life Outcomes 2013; 11:3. [PMID: 23305192 PMCID: PMC3547767 DOI: 10.1186/1477-7525-11-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 12/18/2012] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The EQ-5D is a generic questionnaire providing a preference-based index score applicable to cost-utility analysis. This is the first study to validate the EQ-5D in patients with somatoform disorders. METHODS Data of the EQ-5D descriptive system, the British and the German EQ-5D index and the EQ Visual Analogue Scale, the Patient Health Questionnaire 15, the Patient Health Questionnaire 9, the Whiteley Index 7 and the Short Form 36 were collected from 294 patients at baseline, 244 at 6 months and 256 at 12 months after baseline. The discriminative ability of the EQ-5D was evaluated by comparison with a general population sample and by the ability to distinguish between different symptom severities. Convergent validity was analysed by assessing associations between the EQ-5D and the other instruments. Responsiveness was evaluated by analysing the effects on scores between two measurements in groups of patients reporting worse, same or better health. The Bonferroni correction was employed. RESULTS For all items of the EQ-5D except 'self-care', patients with somatoform disorders reported more problems than the general population. The EQ-5D showed discriminative ability in patients with different symptom severities. For nearly all reference instruments there were significant differences in mean scores between respondents with and without problems in the various EQ-5D items and strong correlations with the EQ Visual Analogue Scale and the EQ-5D index scores. Evidence for the responsiveness of the EQ-5D could only be found for patients with better health; effects were medium at the utmost. CONCLUSIONS The EQ-5D showed a considerable validity and a limited responsiveness in patients with somatoform disorders. TRIAL REGISTRATION Current Controlled Trials ISRCTN55280791.
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Affiliation(s)
- Christian Brettschneider
- Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Hans-Helmut König
- Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Claudia Kaufmann
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Rainer Schaefert
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Alexander Konnopka
- Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Vogl M, Wenig CM, Leidl R, Pokhrel S. Smoking and health-related quality of life in English general population: implications for economic evaluations. BMC Public Health 2012; 12:203. [PMID: 22429454 PMCID: PMC3352300 DOI: 10.1186/1471-2458-12-203] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 03/19/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known as to how health-related quality of life (HRQoL) when measured by generic instruments such as EQ-5D differ across smokers, ex-smokers and never-smokers in the general population; whether the overall pattern of this difference remain consistent in each domain of HRQoL; and what implications this variation, if any, would have for economic evaluations of tobacco control interventions. METHODS Using the 2006 round of Health Survey for England data (n = 13,241), this paper aims to examine the impact of smoking status on health-related quality of life in English population. Depending upon the nature of the EQ-5D data (i.e. tariff or domains), linear or logistic regression models were fitted to control for biology, clinical conditions, socio-economic background and lifestyle factors that an individual may have regardless of their smoking status. Age- and gender-specific predicted values according to smoking status are offered as the potential 'utility' values to be used in future economic evaluation models. RESULTS The observed difference of 0.1100 in EQ-5D scores between never-smokers (0.8839) and heavy-smokers (0.7739) reduced to 0.0516 after adjusting for biological, clinical, lifestyle and socioeconomic conditions. Heavy-smokers, when compared with never-smokers, were significantly more likely to report some/severe problems in all five domains--mobility (67%), self-care (70%), usual activity (42%), pain/discomfort (46%) and anxiety/depression (86%). 'Utility' values by age and gender for each category of smoking are provided to be used in the future economic evaluations. CONCLUSION Smoking is significantly and negatively associated with health-related quality of life in English general population and the magnitude of this association is determined by the number of cigarettes smoked. The varying degree of this association, captured through instruments such as EQ-5D, may need to be fed into the design of future economic evaluations where the intervention being evaluated affects (e.g. tobacco control) or is affected (e.g. treatment for lung cancer) by individual's (or patients') smoking status.
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Affiliation(s)
- Matthias Vogl
- Helmholtz Zentrum München, German Research Centre for Environmental Health, Member of the German Centre for Lung Research, Institute of Health Economics and Health Care Management, Ingolstädter Landstrasse 1, 85764 Neuherberg, Germany
- Ludwig-Maximilians-Universität München, Institute of Health Economics and Health Care Management & Munich Centre of Health Sciences, Ludwigstrasse 28, 80539 Munich, Germany
| | - Christina M Wenig
- Ludwig-Maximilians-Universität München, Institute of Health Economics and Health Care Management & Munich Centre of Health Sciences, Ludwigstrasse 28, 80539 Munich, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München, German Research Centre for Environmental Health, Member of the German Centre for Lung Research, Institute of Health Economics and Health Care Management, Ingolstädter Landstrasse 1, 85764 Neuherberg, Germany
- Ludwig-Maximilians-Universität München, Institute of Health Economics and Health Care Management & Munich Centre of Health Sciences, Ludwigstrasse 28, 80539 Munich, Germany
| | - Subhash Pokhrel
- Health Economics Research Group, Brunel University, West London, UK
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Cherepanov D, Palta M, Fryback DG, Robert SA, Hays RD, Kaplan RM. Gender differences in multiple underlying dimensions of health-related quality of life are associated with sociodemographic and socioeconomic status. Med Care 2011; 49:1021-30. [PMID: 21945974 PMCID: PMC3687080 DOI: 10.1097/mlr.0b013e31822ebed9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the study was to examine whether gender differences in summary health-related quality of life (HRQoL) are due to differences in specific dimensions of health, and whether they are explained by sociodemographic and socioeconomic (SES) variation. METHODS The National Health Measurement Study collected cross-sectional data on a national sample of 3648 black and white noninstitutionalized adults ages 35 to 89 years. Data included the Short Form 36-Item survey, which yielded separate Mental and Physical Component Summary scores (MCS and PCS, respectively), and five HRQoL indexes: Short Form 6 dimension, EuroQol 5 dimension, the Health Utilities Indexes Mark 2 and 3, and the Quality of Well-Being Scale Self-Administered form. Structural equation models were used to explore gender differences in physical, psychosocial, and pain latent dimensions of the 5 indexes, adjusting for sociodemographic and SES indicators. Observed MCS and PCS scores were examined in regression models to judge robustness of latent results. RESULTS Men had better estimated physical and psychosocial health and less pain than women with similar trends on the MCS and PCS scores. Adjustments for marital status or income reduced gender differences more than did other indicators. Adjusting results for partial factorial invariance of HRQoL attributes supported the presence of gender differentials, but also indicated that these differences are impacted by dimensions being related to some HRQoL attributes differently by gender. CONCLUSIONS Men have better estimated health on 3 latent dimensions of HRQoL-physical, psychosocial, and pain-comparable to gender differences on the observed MCS and PCS scores. Gender differences are partly explained by sociodemographic and SES factors, highlighting the role of socioeconomic inequalities in perpetuating gender differences in health outcomes across multiple domains. These results also emphasize the importance of accounting for measurement invariance for meaningful comparison of group differences in estimated means of self-reported measures of health.
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Affiliation(s)
- Dasha Cherepanov
- Department of Health Services, University of California, School of Public Health, Los Angeles, CA, USA.
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Papaioannou D, Brazier J, Parry G. How valid and responsive are generic health status measures, such as EQ-5D and SF-36, in schizophrenia? A systematic review. Value Health 2011; 14:907-20. [PMID: 21914513 PMCID: PMC3179985 DOI: 10.1016/j.jval.2011.04.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 04/07/2011] [Accepted: 04/08/2011] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Generic health status measures such as the short form health survey (SF-36) and EuroQol-5D (EQ-5D) are increasingly being used to inform health policy. They are claimed to be applicable across disease areas and have started to be used within mental health research. This review aims to assess the construct validity and responsiveness of four generic health status measures in schizophrenia, including the preference-based SF-6D and EQ-5D. METHOD A systematic review of the literature was undertaken. Ten databases were searched from inception to August 2009 and reference lists scrutinized to identify relevant studies. Studies were appraised and data extracted. A narrative synthesis was performed of the evidence on construct validity including known groups validity (detecting a difference in health-related quality of life (HRQL) scores between two different groups such as samples from the general population and people with schizophrenia), convergent validity (strength of association between generic HRQL and other measures (e.g., symptom or functional), and responsiveness. Responsiveness was considered by: 1) differences in generic HRQL measure scores in responders/non-responders and 2) correlation between changes on generic HRQL measures and changes in specific measures obtained from patients and clinicians. RESULTS Thirty-three studies were identified that provided data on the validity and/or responsiveness of the instruments. Most of the evidence concerns the SF-36 and EQ-5D, and for these instruments there was evidence for known group validity. The evidence for convergent validity and responsiveness was mixed, with studies presenting contradictory results. CONCLUSION Although the evidence base is limited in a number of important respects, including problems with the measures used to develop constructs in the validation studies, it is sufficient to raise doubts about the use of generic measures of health like the EQ-5D and SF-36 in patients with schizophrenia.
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Affiliation(s)
- Diana Papaioannou
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
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Sun S, Chen J, Johannesson M, Kind P, Xu L, Zhang Y, Burström K. Population health status in China: EQ-5D results, by age, sex and socio-economic status, from the National Health Services Survey 2008. Qual Life Res 2011; 20:309-20. [PMID: 21042861 PMCID: PMC3052443 DOI: 10.1007/s11136-010-9762-x] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2010] [Indexed: 01/10/2023]
Abstract
PURPOSE To measure and analyse national EQ-5D data and to provide norms for the Chinese general population by age, sex, educational level, income and employment status. METHODS The EQ-5D instrument was included in the National Health Services Survey 2008 (n = 120,703) to measure health-related quality of life (HRQoL). All descriptive analyses by socio-economic status (educational level, income and employment status) and by clinical characteristics (discomfort during the past 2 weeks, diagnosed with chronic diseases during the past 6 months and hospitalised during the past 12 months) were stratified by sex and age group. RESULTS Health status declines with advancing age, and women reported worse health status than men, which is in line with EQ-5D population health studies in other countries and previous population health studies in China. The EQ-5D instrument distinguished well for the known groups: positive association between socio-economic status and HRQoL was observed among the Chinese population. Persons with clinical characteristics had worse HRQoL than those without. CONCLUSIONS This study provides Chinese population HRQoL data measured by the EQ-5D instrument, based on a national representative sample. The main findings for different subgroups are consistent with results from EQ-5D population studies in other countries, and discriminative validity was supported.
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Affiliation(s)
- Sun Sun
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Nobels väg 15a, 171 77 Stockholm, Sweden
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Nobels väg 15a, 171 77 Stockholm, Sweden
| | - Jiaying Chen
- School of Health Policy and Management, Nanjing Medical University, Hanzhong Rd 140, 210 029 Nanjing, P. R. China
| | - Magnus Johannesson
- Department of Economics, Stockholm School of Economics, Box 6501, 113 83 Stockholm, Sweden
| | - Paul Kind
- Centre for Health Economics, University of York, York, YO10 5DD UK
| | - Ling Xu
- Centre for Health Statistics and Information, Ministry of Health, Xizhimenwainanlu 1, 100 044 Beijing, P. R. China
| | - Yaoguang Zhang
- Centre for Health Statistics and Information, Ministry of Health, Xizhimenwainanlu 1, 100 044 Beijing, P. R. China
| | - Kristina Burström
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Nobels väg 15a, 171 77 Stockholm, Sweden
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Nobels väg 15a, 171 77 Stockholm, Sweden
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Cherepanov D, Palta M, Fryback DG, Robert SA. Gender differences in health-related quality-of-life are partly explained by sociodemographic and socioeconomic variation between adult men and women in the US: evidence from four US nationally representative data sets. Qual Life Res 2010; 19:1115-24. [PMID: 20496168 PMCID: PMC2940034 DOI: 10.1007/s11136-010-9673-x] [Citation(s) in RCA: 134] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2010] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to describe gender differences in self-reported health-related quality-of-life (HRQoL) and to examine whether differences are explained by sociodemographic and socioeconomic status (SES) differentials between men and women. METHODS Data were from four US nationally representative surveys: US Valuation of the EuroQol EQ-5D Health States Survey (USVEQ), Medical Expenditure Panel Survey (MEPS), National Health Measurement Study (NHMS) and Joint Canada/US Survey of Health (JCUSH). Gender differences were estimated with and without adjustment for sociodemographic and SES indicators using regression within and across data sets with SF-6D, EQ-5D, HUI2, HUI3 and QWB-SA scores as outcomes. RESULTS Women have lower HRQoL scores than men on all indexes prior to adjustment. Adjusting for age, race, marital status, education and income reduced but did not remove the gender differences, except with HUI3. Adjusting for marital status or income had the largest impact on estimated gender differences. CONCLUSIONS There are clear gender differences in HRQoL in the United States. These differences are partly explained by sociodemographic and SES differentials.
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Affiliation(s)
- Dasha Cherepanov
- Department of Health Services, University of California Los Angeles School of Public Health, PO Box 90095-1772, Los Angeles, CA, USA.
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26
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Freedman GM, Li T, Anderson PR, Nicolaou N, Konski A. Health states of women after conservative surgery and radiation for breast cancer. Breast Cancer Res Treat 2010; 121:519-26. [PMID: 19768651 PMCID: PMC2874617 DOI: 10.1007/s10549-009-0552-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 09/10/2009] [Indexed: 11/28/2022]
Abstract
The aim of the study is to use the EQ-5D instrument to evaluate the long-term health states of women with early stage breast cancer treated by breast-conserving surgery and radiation. A total of 1,050 women treated with conservative surgery and radiation with or without systemic therapy completed 2,480 questionnaires during follow-up visits. The EQ-5D is a standardized and validated instrument for measuring quality of life outcomes. The descriptive system uses 5 dimensions of health with three possible levels of response that combine into 243 (3(5)) possible unique health states that are each assigned a values-based index score from 0 to 1. The visual analog scale (VAS) rates health on a simple vertical line from 0 to 100. Higher scores correspond to better health status. The mean index scores were 0.89 (95% CI: 0.87-0.91) at 5 years, 0.9 (95% CI: 0.86-0.94) at 10 years, and 0.9 (95% CI: 0.83-1.0) at 15 years. There were no significant differences in health states between patients by age when compared with U.S. controls. There was a statistically significant positive correlation between the results of the VAS and descriptive system. Significant trends in health dimensions over 15 years were increased problems with self-care and decreased problems with anxiety/depression, pain/discomfort, and performing usual activities. This study of EQ-5D is unique and demonstrates very high quality of life in patients long-term after breast-conserving surgery and radiation. These health states are comparable to the adult female U.S. population. These data will provide valuable patient utility information for informing decision analyses investigating new treatments in women with breast cancer.
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Affiliation(s)
- Gary M Freedman
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
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Lips P, Jameson K, Bianchi ML, Goemaere S, Boonen S, Reeve J, Stepan J, Johnell O, van Schoor NM, Dennison E, Kanis JA, Cooper C. Validation of the IOF quality of life questionnaire for patients with wrist fracture. Osteoporos Int 2010; 21:61-70. [PMID: 19504036 PMCID: PMC2788146 DOI: 10.1007/s00198-009-0946-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Accepted: 03/27/2009] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Wrist fracture causes pain and decreased physical, social and emotional function. The International Osteoporosis Foundation has developed a specific questionnaire to assess quality of life in patients with wrist fracture. This questionnaire, including 12 questions, was validated in a multicentre study and compared with an osteoporosis-specific questionnaire (Qualeffo-41) and a generic questionnaire (EQ-5D). METHODS The study included 105 patients with a recent wrist fracture and 74 sex- and age-matched control subjects. The questionnaire was administered as soon as possible after the fracture, at 6 weeks, 3 months, 6 months and 1 year after the fracture. Test-retest reproducibility, internal consistency and sensitivity to change were assessed. RESULTS AND DISCUSSION The results showed adequate repeatability and internal consistency of the International Osteoporosis Foundation (IOF) wrist fracture questionnaire. The discriminatory capacity between patients and control subjects was very high, with significant odds ratios for each question and domain. The IOF-wrist fracture questionnaire domain scores showed significant improvement after 3 and 6 months and some improvement from 6 months up to 1 year. The sensitivity to change was much higher for the IOF-wrist fracture total score than for Qualeffo-41 and EQ-5D. CONCLUSION In conclusion, the IOF-wrist fracture questionnaire appears to be a reliable and responsive quality of life questionnaire.
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Affiliation(s)
- P Lips
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
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Hays RD, Bjorner JB, Revicki DA, Spritzer KL, Cella D. Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res 2009; 18:873-80. [PMID: 19543809 PMCID: PMC2724630 DOI: 10.1007/s11136-009-9496-9] [Citation(s) in RCA: 1138] [Impact Index Per Article: 75.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Accepted: 05/28/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND The use of global health items permits an efficient way of gathering general perceptions of health. These items provide useful summary information about health and are predictive of health care utilization and subsequent mortality. METHODS Analyses of 10 self-reported global health items obtained from an internet survey as part of the Patient-Reported Outcome Measurement Information System (PROMIS) project. We derived summary scores from the global health items. We estimated the associations of the summary scores with the EQ-5D index score and the PROMIS physical function, pain, fatigue, emotional distress, and social health domain scores. RESULTS Exploratory and confirmatory factor analyses supported a two-factor model. Global physical health (GPH; 4 items on overall physical health, physical function, pain, and fatigue) and global mental health (GMH; 4 items on quality of life, mental health, satisfaction with social activities, and emotional problems) scales were created. The scales had internal consistency reliability coefficients of 0.81 and 0.86, respectively. GPH correlated more strongly with the EQ-5D than did GMH (r = 0.76 vs. 0.59). GPH correlated most strongly with pain impact (r = -0.75) whereas GMH correlated most strongly with depressive symptoms (r = -0.71). CONCLUSIONS Two dimensions representing physical and mental health underlie the global health items in PROMIS. These global health scales can be used to efficiently summarize physical and mental health in patient-reported outcome studies.
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Affiliation(s)
- Ron D Hays
- Department of Medicine, UCLA, Los Angeles, CA, USA.
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Lubetkin EI, Jia H. Health-related quality of life, quality-adjusted life years, and quality-adjusted life expectancy in new york city from 1995 to 2006. J Urban Health 2009; 86:551-61. [PMID: 19283489 PMCID: PMC2704267 DOI: 10.1007/s11524-009-9344-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 02/09/2009] [Indexed: 11/24/2022]
Abstract
We applied our previously developed estimation equation to predict EQ-5D index scores from the Centers for Disease Control and Prevention's Healthy Days measures for the New York City (NYC) adult population from 1995 to 2006 and compared these trends over time with the US general population. Such scores enabled us to examine the burden of disease attributable to smoking and overweight/obesity at both the local and national levels. We employed the estimation equation to the 1993-2007 Behavioral Risk Factor Surveillance System (BRFSS) data to obtain EQ-5D index scores for all survey respondents based on their age, self-rated health status, and overall number of unhealthy days. With the combination of mortality data, we calculated trends of quality-adjusted life years (QALYs), life expectancy (LE), and quality-adjusted life expectancy (QALE) as well as the percent of QALYs and QALE lost contributed by smoking and overweight/obesity. Mean EQ-5D index scores for NYC adults decreased from 0.874 to 0.852 but, more recently, have increased to 0.869. The LE of an 18-year-old living in NYC increased 4.7 years and QALE increased 2.6 years. The contribution of smoking to the proportion of QALYs lost decreased from 6.7% to 3.5%, while the contribution of overweight/obesity to the proportion of QALYs lost increased from 4.5% to 16.9%. The proportion of QALEs lost due to smoking decreased from 5.5% to 4.5%, while the proportion of QALEs lost due to overweight/obesity increased from 3.5% to 11.8%. Because the Healthy Days measures have been included in the BRFSS since 1993, translating Healthy Days Measures to a preference-based measure is a useful method for longitudinal tracking of population health at the local, state, and national level.
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Affiliation(s)
- Erica I Lubetkin
- Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education at The City College of New York, 160 Convent Avenue, H404B, New York, NY 10031, USA.
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Abstract
The value of a health state may depend on how long an individual has had to endure the health state (i.e. hedonic load). In this paper, we test the constant proportionality (CP) assumption and determine the sign of relationship between duration and health state value for 42 health states using the nationally representative data from the United Kingdom Measurement and Valuation of Health study. The results reject the CP assumption and suggest that the relationship is negative for optimal health (i.e. fair innings argument) and that the relationship is positive for poorer health states (i.e. adaptation). We find no evidence of the maximum endurable time hypothesis using these data. This evidence on the duration effect has important implications for outcomes research and the economic evaluation of interventions.
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Affiliation(s)
- Benjamin M Craig
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL 33612-9416, USA.
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Sauerland S, Weiner S, Hausler E, Dolezalova K, Angrisani L, Noguera CM, García-Caballero M, Immenroth M. Validity of the Czech, German, Italian, and Spanish version of the Moorehead-Ardelt II questionnaire in patients with morbid obesity. Obes Facts 2009; 2 Suppl 1:57-62. [PMID: 20124781 PMCID: PMC6450048 DOI: 10.1159/000198262] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The Moorehead-Ardelt II (MA-II) questionnaire is the most frequently applied instrument to assess quality of life (QoL) in bariatric surgery patients. Our aim was to validate the Czech, German, Italian, and Spanish version of the MA-II. METHODS A total of 893 patients were enroled in a prospective cross-sectional European study. Two thirds of the patients(n = 591) were postsurgical cases. In addition to demographicand clinical data, QoL data was collected using the MA-II questionnaire, the EuroQoL-5D (EQ-5D), and the Short Form 36 Health Survery (SF-36). Statistical parameters for contingency (Cronbach's alpha), construct and criterion validity(Pearson's r), and responsiveness (standardised effect sizes) were calculated for each language version. RESULTS In the different languages, Cronbach's alpha ranged from 0.817 to 0.885 for the MA-II. These values were higher than those obtained for the SF-36 (0.418-0.607). The MA-II was well correlated to the EQ-5D (r = 0.662) and to 3 of the 8 health domains of the SF-36 (0.615, 0.548, and 0.569 for physical functioning,physical role, and general health, respectively). As expected, there was a negative correlation between the MA-II and the BMI (r = -0.404 for all patients), but no significant correlation with age was found.When comparing both the heaviest and the lightest third of the patients, mean responsiveness was higher for the MA-II (-1.138) than for the domains of the SF-36 (range -0.111 to -1.070) and the EQ-5D (-0.874). CONCLUSION The Czech, German, Italian, and Spanish version of the MA-II questionnaire are valid instruments and should be preferred to generic questionnaires as they provide better responsiveness.
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Affiliation(s)
- Stefan Sauerland
- Institute for Research in Operative Medicine, University of Witten/Herdecke, Germany.
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