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Buchholz M, Weber N, Rädke A, Faber J, Schmitz-Hübsch T, Jacobi H, Xie F, Klockgether T, Michalowsky B. Health-Related Quality of Life in Patients with Spinocerebellar Ataxia: a Validation Study of the EQ-5D-3L. Cerebellum 2024; 23:1020-1030. [PMID: 37713052 PMCID: PMC11102408 DOI: 10.1007/s12311-023-01597-3] [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] [Accepted: 08/17/2023] [Indexed: 09/16/2023]
Abstract
Although health-related quality of life (HRQoL) has developed into a crucial outcome parameter in clinical research, evidence of the EQ-5D-3L validation performance is lacking in patients with spinocerebellar ataxia (SCA) types 1, 2, 3, and 6. The objective of this study is to assess the acceptability, validity, reliability, and responsiveness of the EQ-5D-3L. For n = 842 predominantly European SCA patients of two longitudinal cohort studies, the EQ-5D-3L, PHQ-9 (Patient Health Questionnaire), and ataxia-specific clinical assessments (SARA: Scale for Assessment and Rating of Ataxia; ADL: activities of daily living as part of Friedreich's Ataxia Rating Scale; INAS: Inventory of Non-Ataxia Signs) were assessed at baseline and multiple annual follow-ups. The EQ-5D-3L was evaluated regarding acceptability, distribution properties, convergent and known-groups validity, test-retest reliability, and effect size measures to analyze health changes. The non-item response was low (EQ-5D-3L index: 0.8%; EQ-VAS: 3.4%). Ceiling effects occurred in 9.9% (EQ-5D-3L) and 3.0% (EQ-VAS) with a mean EQ-5D-3L index of 0.65 ± 0.21. In total, convergent validity showed moderate to strong Spearman's rho (rs > 0.3) coefficients comparing EQ-5D-3L and EQ-VAS with PHQ-9, SARA, ADL, and INAS. EQ-5D-3L could discriminate between groups of age, SARA, ADL, and INAS. Intra-class correlation coefficients (EQ-5D-3LICC: 0.95/EQ-VASICC: 0.88) and Kappa statistics (range 0.44 to 0.93 for EQ-5D-3L items) indicated tolerable reliability. EQ-5D-3L shows small (effect size < 0.3) to moderate (effect size 0.3-0.59) health changes regarding ataxia severity. The analysis confirms an acceptable, reliable, valid, and responsive recommended EQ-5D-3L in SCA patients, measuring the HRQoL adequately, besides well-established clinical instruments.
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Affiliation(s)
- Maresa Buchholz
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany.
| | - Niklas Weber
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Anika Rädke
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Jennifer Faber
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, a cooperation of Max-Delbrueck Center of Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Heike Jacobi
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Thomas Klockgether
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Bernhard Michalowsky
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
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Jones B, Ryan M, Cook NS, Gutzwiller FS. Development of a disease-specific health utility score for chronic obstructive pulmonary disease from a discrete choice experiment patient preference study. Int J Technol Assess Health Care 2024; 40:e30. [PMID: 38695141 DOI: 10.1017/s0266462324000242] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
OBJECTIVES While patient input to health technology assessment (HTA) has traditionally been of a qualitative nature, there is increasing interest to integrate quantitative evidence from patient preference studies into HTA decision making. Preference data can be used to generate disease-specific health utility data. We generated a health utility score for patients with chronic obstructive pulmonary disease (COPD) and consider its use within HTAs. METHODS Based on qualitative research, six symptoms were identified as important to COPD patients: shortness of breath, exacerbations, chronic cough, mucus secretion, sleep disturbance, and urinary incontinence. We employed a discrete choice experiment (DCE) and the random parameter logistic regression technique to estimate utility scores for all COPD health states. The relationship between patients' COPD health utility scores, self-perceived COPD severity, and EQ-5D-3L utility scores was analyzed, with data stratified according to disease severity and comorbidity subgroups. RESULTS The COPD health utility score had face validity, with utility scores negatively correlated with patients' self-perceived COPD severity. The correlation between the COPD health utility scores and EQ-5D-3L values was only moderate. While patient EQ-5D-3L scores were impacted by comorbidities, the COPD health utility score was less impacted by comorbid conditions. CONCLUSIONS Our COPD utility measure, derived from a DCE, provides a patient-centered health utility score and is more sensitive to the COPD health of the individual and less sensitive to other comorbidities. This disease-specific instrument should be considered alongside generic health-related quality of life instruments when valuing new COPD therapies in submissions to licensing and reimbursement agencies.
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Affiliation(s)
- Byron Jones
- Patient Engagement Science, Novartis Pharma AG, Basel, Switzerland
| | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Nigel S Cook
- Global Patient Engagement, Novartis Pharma AG, Basel, Switzerland
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Hao H, Yuan Y, Li J, Zhao D, Li P, Sun J, Zhou C. Association between physical activity and health-related quality of life among adults in China: the moderating role of age. Front Public Health 2024; 12:1334081. [PMID: 38601506 PMCID: PMC11005473 DOI: 10.3389/fpubh.2024.1334081] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/26/2024] [Indexed: 04/12/2024] Open
Abstract
Objective The aim of the study was to examine the association between physical activity (PA) and health-related quality of life (HRQOL) among adults and explore the role of age in the association between PA and HRQOL in Shandong, China. Methods We investigated the relationship between PA and HRQOL and examined the moderated role of age in this association among adults with different age groups and physical activity levels. Data were obtained from the sixth China National Health Services Survey conducted in Shandong province in 2018. The multi-stage-stratified cluster random sampling method was used to selected respondents, with individuals aged 18 and above included in the present study. The tool of assessing HRQOL was the three-level EuroQol Five Dimensions Questionnaire (EQ-5D-3L). Results The study found PA was significantly related to HRQOL (P < 0.05). The interaction analysis indicated that the relationship between PA and HRQOL was significantly different across young, middle-aged, and older adults (P < 0.05). Older adults with the sufficient PA (coefficient = 0.090, 95%CI: [0.081, 0.100]) and active PA (coefficient = 0.057, 95%CI: [0.043, 0.072]) had significantly higher HRQOL compared with young and middle-aged groups. Conclusion PA was positively associated with HRQOL among the adults. Age played a moderate role between the association between PA and HRQOL. Guidelines for PA should be specifically tailored to adults of different age groups in order to enhance their HRQoL.
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Affiliation(s)
- Hongying Hao
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Graduate School, Jinan, China
| | - Yemin Yuan
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Jie Li
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Dan Zhao
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Peilong Li
- Statistics and Evaluation Department of Shandong Health Commission Medical Management Service Center, Jinan, China
| | - Jingjie Sun
- Statistics and Evaluation Department of Shandong Health Commission Medical Management Service Center, Jinan, China
| | - Chengchao Zhou
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
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Durojaiye OC, Kritsotakis EI. Evaluation of health-related quality of life in patients receiving outpatient parenteral antimicrobial therapy (OPAT) in a UK setting. Expert Rev Anti Infect Ther 2024:1-9. [PMID: 38511820 DOI: 10.1080/14787210.2024.2334059] [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] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/20/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Studies assessing the benefits of outpatient parenteral antimicrobial therapy (OPAT) have paid less attention to patient-centered factors such as patients' experiences and their health-related quality of life (HRQoL). RESEARCH DESIGN AND METHODS Prospective before-and-after quasi-experimental study enrolled adult patients receiving OPAT at a tertiary hospital in Derbyshire, UK, between October 2022 and October 2023. Consenting patients completed paired EQ-5D-3 L questionnaires before OPAT initiation and upon completion of therapy or 30 days after its commencement (whichever occurred first). Changes and predictors of change in HRQoL indicators and associations with clinical outcomes (treatment failure, adverse events, and 30-day unplanned readmission) were examined. RESULTS Health state index and visual analogue scale (EQ VAS) scores of 162 enrolled patients at baseline were significantly lower than the UK population averages, but the patients experienced significant improvements in both scores and in four EQ-5D dimensions (mobility, self-care, usual activities, and pain/discomfort). Baseline health index and EQ VAS scores were significant independent predictors of positive changes in HRQoL scores. CONCLUSIONS OPAT is associated with improved patient-reported quality of life and facilitates early return to work or school. Nevertheless, it is crucial to closely monitor patients with a lower baseline quality of life to optimize their overall OPAT experience.
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Affiliation(s)
- Oyewole Christopher Durojaiye
- Department of Microbiology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, Derbyshire, UK
- Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Evangelos I Kritsotakis
- School of Medicine and Population Health, University of Sheffield, Sheffield, South Yorkshire, UK
- Laboratory of Biostatistics, School of Medicine, University of Crete, Heraklion, Greece
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Phillips T, Lugtenburg P, Kalsekar A, Mutebi A, Wang A, Blaedel J, Kosa K, Martin S, Sacchi M, Kilavuz N, Thieblemont C. Improvements in Patient-Reported Outcomes in Relapsed or Refractory Large B-Cell Lymphoma Patients Treated With Epcoritamab. Clin Lymphoma Myeloma Leuk 2024; 24:e78-e87.e2. [PMID: 38151388 DOI: 10.1016/j.clml.2023.11.005] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/21/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Patient-reported outcomes were evaluated in EPCORE NHL-1 in patients with relapsed or refractory (R/R) large B-cell lymphoma (LBCL) treated with epcoritamab monotherapy (NCT03625037). MATERIALS AND METHODS Adults with R/R CD20+ LBCL and ≥2 prior systemic antilymphoma therapies, including anti-CD20, completed the Functional Assessment of Cancer Therapy-Lymphoma (FACT-Lym) and EQ-5D-3L. A subgroup of patients provided additional feedback in one-on-one qualitative interviews. FACT-Lym and EQ-5D-3L score changes from baseline (CFB) to cycle 9 or end of treatment were interpreted using published minimally important differences (MID). RESULTS In total, 157 patients (88.5% with diffuse LBCL) were treated (median age, 64 years). In total, 70.7% had ≥3 prior treatments, 61.1% had primary refractory disease, and 82.8% were refractory to last systemic therapy. FACT-Lym scores exceeded MID thresholds: mean (SD) CFB were 4.4 (15.2), MID 3.0 to 7.0 (FACT-General); 5.9 (7.6), MID 2.9 to 5.4 (FACT-Lymphoma subscale); 8.4 (15.2), MID 5.5 to 11.0 (FACT-Trial Outcome Index); 10.3 (20.2), MID 6.5 to 11.2 (FACT-Lym total score). EQ-5D-3L index scores, 0.09 (0.20), MID 0.08, and EQ-VAS scores, 16.6 (22.8), MID 7.0, improved. In 20 qualitative interviews, 88.2% reported symptom improvements; 80.0% were "very satisfied" or "satisfied" with epcoritamab. CONCLUSIONS R/R LBCL patients reported consistent, clinically meaningful improvements in symptoms and HRQoL and satisfaction with epcoritamab.
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Affiliation(s)
- Tycel Phillips
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI.
| | - Pieternella Lugtenburg
- On behalf of the Lunenburg Lymphoma Phase I/II Consortium-HOVON/LLPC, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | | | | - Catherine Thieblemont
- Assistance Publique & Hôpitaux de Paris (APHP), Hôpital Saint-Louis, Hémato-Oncologie, Université de Paris, Paris, France
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Mukuria C, Rowen D, Acaster S, McGarry LJ, Lou Y, Sosnay PR, Quittner AL. Psychometric performance of the CFQ-R-8D compared to the EQ-5D-3L and SF-6D in people with cystic fibrosis. J Patient Rep Outcomes 2024; 8:24. [PMID: 38416239 PMCID: PMC10900011 DOI: 10.1186/s41687-024-00697-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 02/04/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE This study aimed to compare the psychometric performance of the Cystic Fibrosis Questionnaire-Revised-8 Dimensions (CFQ-R-8D), a new, condition-specific, preference-based measure, with that of generic preference-based measures EQ-5D-3L and Short Form 6 dimensions (SF-6D). METHODS Data from three trials of participants with CF aged ≥ 14 years who completed the CFQ-R and EQ-5D-3L or SF-6D were used. Analyses were undertaken to evaluate convergent validity based on correlations with CFQ-R domain scores. Known-group validity was assessed based on percent predicted forced expiratory volume in one second and pulmonary exacerbations. Responsiveness was based on correlation of change and sensitivity to change based on change in symptom severity. Effect sizes and standardized response means were estimated. RESULTS CFQ-R-8D utilities and dimensions were strongly correlated with most of the overlapping CFQ-R domain scores (ρ > 0.5); EQ-5D-3L and SF-6D utilities and dimensions had moderate (ρ > 0.3) to strong correlations in dimensions capturing similar concepts. All measures showed evidence of known-group validity (P < 0.05). Change correlations were strong for CFQ-R-8D utilities and dimensions and CFQ-R, but they were moderate for SF-6D and mostly weak ((ρ > 0.1) for EQ-5D-3L. The SF-6D had the largest mean change over time and effect sizes, followed by CFQ-R-8D and then EQ-5D-3L. Neither CFQ-R-8D or SF-6D utility scores had ceiling effects (< 9% responses in full health) compared with those of EQ-5D-3L (61-62%). In participants classified as being in full health by EQ-5D-3L, CFQ-R-8D captured CF-specific health problems, particularly cough, abdominal pain, and breathing difficulty. CONCLUSIONS The CFQ-R-8D reflected known-group differences and changes over time with stronger evidence of good psychometric performance than EQ-5D-3L and similar evidence as SF-6D. Additionally, the CFQ-R-8D captured more condition-specific symptoms than EQ-5D-3L or SF-6D, which are important determinants of health-related quality of life for people with CF.
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Affiliation(s)
- Clara Mukuria
- School of Health and Related Research, The University of Sheffield, Sheffield, UK.
| | - Donna Rowen
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | | | - Yiyue Lou
- Vertex Pharmaceuticals Incorporated, Boston, MA, USA
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Tura BR, da Costa MR, Lordello S, Barros D, Souza Y, da Silva Santos M. Health inequity assessment in Brazil: is EQ-5D-3L sensible enough to detect differences among distinct socioeconomic groups? Health Qual Life Outcomes 2024; 22:22. [PMID: 38409033 PMCID: PMC10898160 DOI: 10.1186/s12955-024-02235-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/07/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Multidimensional health-related quality of life (HRQOL) instruments, such as the EQ-5D, are increasingly used to assess inequalities in health. However, it is necessary to explore the ability of these instruments to capture differences between population groups, especially in low/middle-income countries. This study aimed to investigate whether the EQ-5D-3L instrument can detect differences in HRQOL between groups of different socioeconomic status (SES) in Brazil. METHODS Data collection occurred during the Brazilian EQ-5D-3L valuation study and included respondents aged 18 to 64 years enrolled in urban areas. SES was aggregated into three categories: "higher" (A and B), "intermediate" (C) and "lower" (D and E). EQ-5D-3L index was calculated considering the Brazilian value set. A mixed-effects regression model was estimated with random effects on individuals and marginal effects on SES, sex, and educational attainment. Odds ratios for the chance of reporting problems for each EQ-5D dimension were estimated by logistic regression. RESULTS A total of 9,148 respondents were included in the study. Mean age was 37.80 ± 13.13 years, 47.4% were men and the majority was ranked as classes B or C (38.4% and 50.7%, respectively). Participants in lower SES classes reported increasingly poorer health compared to individuals in higher classes. The mean EQ-5D-3L index decreased as SES deteriorates being significantly higher for classes A and B (0.874 ± 0.14) compared to class C (0.842 ± 0.15) and classes D and E (0.804 ± 0.17) (p < 0.001). The same was observed for the mean EQ-VAS scores (84.0 ± 13.8 in classes A and B, 81.0 ± 17 in class C and 78.3 ± 18.7 in class C [p < 0.001]). The multivariate analysis confirmed that SES is an independent factor that effects EQ-5D-3L index measures. Participants in intermediate and lower SES classes have a statistically significant lower EQ-5D-3L index compared to participants in classes A and B, regardless of age, sex, and educational attainment. CONCLUSION In a Brazilian population sample, the EQ-5D-3L instrument was able to detect important differences between groups with distinct socioeconomic statuses (SES). The EQ-5D-3L is useful for exploring inequities in health.
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Affiliation(s)
- Bernardo Rangel Tura
- Centre of Health Technology Assessment, National Institute of Cardiology, Rio de Janeiro, Brazil
| | - Milene Rangel da Costa
- Centre of Health Technology Assessment, National Institute of Cardiology, Rio de Janeiro, Brazil
- Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | - Marisa da Silva Santos
- Centre of Health Technology Assessment, National Institute of Cardiology, Rio de Janeiro, Brazil.
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Ali M, Tibble H, Brady MC, Quinn TJ, Sunnerhagen KS, Venketasubramanian N, Shuaib A, Pandyan A, Mead G. Validation of general pain scores from multidomain assessment tools in stroke. Front Neurol 2024; 15:1328832. [PMID: 38333610 PMCID: PMC10851776 DOI: 10.3389/fneur.2024.1328832] [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] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/04/2024] [Indexed: 02/10/2024] Open
Abstract
Purpose We describe how well general pain reported in multidomain assessment tools correlated with pain-specific assessment tools; associations between general pain, activities of daily living and independence after stroke. Materials and methods Analyses of individual participant data (IPD) from the Virtual International Stroke Trials Archive (VISTA) described correlation coefficients examining (i) direct comparisons of assessments from pain-specific and multidomain assessment tools that included pain, (ii) indirect comparisons of pain assessments with the Barthel Index (BI) and modified Rankin Scale (mRS), and (iii) whether pain identification could be enhanced by accounting for reported usual activities, self-care, mobility and anxiety/depression; factors associated with pain. Results European Quality of Life 3- and 5-Level (EQ-5D-3L and EQ-5D-5L), RAND 36 Item Health Survey 1.0 (SF-36) or the 0-10 Numeric Pain Rating Scale (NPRS) were available from 10/94 studies (IPD = 10,002). The 0-10 NPRS was the only available pain-specific assessment tool and was a reference for comparison with other tools. Pearson correlation coefficients between the 0-10 NPRS and (A) the EQ-5D-3L and (B) EQ5D-5 L were r = 0.572 (n = 436) and r = 0.305 (n = 1,134), respectively. mRS was better aligned with pain by EQ-5D-3L (n = 8,966; r = 0.340) than by SF-36 (n = 623; r = 0.318). BI aligned better with pain by SF-36 (n = 623; r = -0.320). Creating a composite score using the EQ-5D 3 L and 5 L comprising pain, mobility, usual-activities, self-care and anxiety/depression did not improve correlation with the 0-10 NPRS. Discussion The EQ-5D-3L pain domain aligned better than the EQ-5D-5L with the 0-10 NPRS and may inform general pain description where resources and assessment burden hinder use of additional, pain-specific assessments.
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Affiliation(s)
- Myzoon Ali
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Holly Tibble
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Marian C. Brady
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Terence J. Quinn
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Katharina S. Sunnerhagen
- Department of Clinical Neuroscience, University of Gothenburg, Sweden and Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Anand Pandyan
- Faculty of Health and Social Sciences, Bournemouth University, Poole, United Kingdom
| | - Gillian Mead
- Geriatric Medicine, Division of Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Zhang H, Liu B, Gu W, Cao Y, Xu J, Tan RLY, Chang E, Zheng W, Li H, Zhou L, Jia Y, Yang H, Guo S, Huang W, Luo N. A head-to-head comparison of the measurement properties of EQ-5D-3L and EQ-5D-5L in Chinese family caregivers of cancer patients. Support Care Cancer 2023; 32:14. [PMID: 38060009 DOI: 10.1007/s00520-023-08231-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/03/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Although both EQ-5D-3L(3L) and EQ-5D-5L(5L) have demonstrated good measurement properties in several patient populations, there is currently limited evidence comparing the measurement properties of 3L and 5L in family caregivers (FCs) of cancer patients. PURPOSE This study aimed to compare the measurement properties of 3L and 5L in a sample of family caregivers of cancer patients. METHODS A consecutive sample of FCs of cancer patients recruited from three tertiary hospitals were invited to complete the two versions of the EQ-5D in two rounds of interviews. We compared i) the ceiling effect using the McNemar's test, ii) test-retest reliability using intraclass correlation coefficient (ICC) and Cohen's Kappa, iii) convergent validity using Spearman's rank correlation coefficient, iv) known-group validity using F-statistic, v) and discriminant capacity using ordinal logistic regression. RESULTS A total of 416 FCs completed the baseline questionnaire and 120 caregivers completed the follow-up questionnaire. Ceiling effects were smaller in 5L (12.5%) than in 3L (20.7%). The convergent validity (r = 0.344-0.771), known-groups validity (Fratio5L/3L = 2.06-4.09), discriminant capacity (ES = 0.341-0.396), and test-retest reliability (ICC = 0.725) of the 5L were slightly better than those of the 3L in China. CONCLUSION The current study found both 3L and 5L to be suitable for use by FCs of cancer patients. However, 5L showed superior measurement properties compared to 3L and therefore could be the preferred instrument when EQ-5D data of cancer patients FCs is required.
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Affiliation(s)
- Huan Zhang
- The Third Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - Bo Liu
- School of Health Management, Harbin Medical University, Harbin, 150081, China
| | - Wen Gu
- School of Health Management, Harbin Medical University, Harbin, 150081, China
| | - Yiyin Cao
- School of Health Management, Harbin Medical University, Harbin, 150081, China
| | - Juan Xu
- School of Health Management, Harbin Medical University, Harbin, 150081, China
| | - Rachel Lee-Yin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Enxue Chang
- School of Health Management, Harbin Medical University, Harbin, 150081, China
| | - Wanji Zheng
- School of Health Management, Harbin Medical University, Harbin, 150081, China
| | - Haofei Li
- School of Health Management, Harbin Medical University, Harbin, 150081, China
| | - Lan Zhou
- School of Health Management, Harbin Medical University, Harbin, 150081, China
| | - Yanni Jia
- School of Health Management, Harbin Medical University, Harbin, 150081, China
| | - Hongbin Yang
- The Third Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.
| | - Sheng Guo
- Changsha Stomatological Hospital, Changsha, 410029, Hunan Province, China.
| | - Weidong Huang
- School of Health Management, Harbin Medical University, Harbin, 150081, China.
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Stolz M, Albus C, Beutel ME, Deter HC, Fritzsche K, Herrmann-Lingen C, Michal M, Petrowski K, Ronel J, Schultz JH, Söllner W, Weber C, de Zwaan M, Krauth C. Assessment of health-related quality of life in individuals with depressive symptoms: validity and responsiveness of the EQ-5D-3L and the SF-6D. Eur J Health Econ 2023; 24:1297-1307. [PMID: 36385438 PMCID: PMC10533591 DOI: 10.1007/s10198-022-01543-w] [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: 05/24/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The EQ-5D and the SF-6D are examples of commonly used generic preference-based instruments for assessing health-related quality of life (HRQoL). However, their suitability for mental disorders has been repeatedly questioned. OBJECTIVE To assess the responsiveness and convergent validity of the EQ-5D-3L and SF-6D in patients with depressive symptoms. METHODS The data analyzed were from cardiac patients with depressive symptoms and were collected as part of the SPIRR-CAD (Stepwise Psychotherapy Intervention for Reducing Risk in Coronary Artery Disease) trial. The EQ-5D-3L and SF-6D were compared with the HADS (Hospital Anxiety and Depression Scale) and PHQ-9 (Patient Health Questionnaire) as disease-specific instruments. Convergent validity was assessed using Spearman's rank correlation. Effect sizes were calculated and ROC analysis was performed to determine responsiveness. RESULTS Data from 566 patients were analysed. The SF-6D correlated considerably better with the disease-specific instruments (|rs|= 0.63-0.68) than the EQ-5D-3L (|rs|= 0.51-0.56). The internal responsiveness of the SF-6D was in the upper range of a small effect (ES: - 0.44 and - 0.47), while no effect could be determined for the EQ-5D-3L. Neither the SF-6D nor the EQ-5D-3L showed acceptable external responsiveness for classifying patients' depressive symptoms as improved or not improved. The ability to detect patients whose condition has deteriorated was only acceptable for the EQ-5D-3L. CONCLUSION Overall, both the convergent validity and responsiveness of the SF-6D are better than those of the EQ-5D-3L in patients with depressive symptoms. The SF-6D appears, therefore, more recommendable for use in studies to evaluate interventions for this population.
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Affiliation(s)
- Maike Stolz
- Institute of Epidemiology Social Medicine and Health System Research, Hannover Medical School, Hanover, Germany.
- Center for Health Economics Research Hanover (CHERH), Hanover, Germany.
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Hans-Christian Deter
- Department of Psychosomatics and Psychotherapy, Charité Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Kurt Fritzsche
- Faculty of Medicine, Department of Psychosomatic Medicine and Psychotherapy, Medical Center-University of Freiburg, Freiburg, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Katja Petrowski
- Department of Psychotherapy and Psychosomatics, Technical University of Dresden, Dresden, Germany
| | - Joram Ronel
- Department of Psychosomatic Medicine and Psychotherapy, Clinic Barmelweid, Barmelweid, Switzerland
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts Der Isar, Technische Universitaet München, Munich, Germany
| | - Jobst-Hendrik Schultz
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolfgang Söllner
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Cora Weber
- Department of Psychosomatic Medicine and Psychotherapy, Oberhavel Clinic, Clinic Hennigsdorf, Hennigsdorf, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Christian Krauth
- Institute of Epidemiology Social Medicine and Health System Research, Hannover Medical School, Hanover, Germany
- Center for Health Economics Research Hanover (CHERH), Hanover, Germany
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11
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Cheng Q, Bajis S, Cunningham E, Shih STF, Schulz M, Marshall AD, Martin NK, Miners A, Hajarizadeh B, Wiseman V, Dore GJ, Grebely J. Health-related quality of life among people who inject drugs in Australia. Qual Life Res 2023; 32:3195-3207. [PMID: 37351701 PMCID: PMC10522523 DOI: 10.1007/s11136-023-03465-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/12/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE There is limited research on health-related quality of life (HRQoL) among people who inject drugs (PWID). We aimed to evaluate factors associated with HRQoL among a cohort of PWID in Australia. METHODS Participants were enrolled in an observational cohort study (the LiveRLife Study) between 2014 and 2018 at 15 sites in Australia. They provided fingerstick whole-blood samples for point-of-care HCV RNA testing and underwent transient elastography to assess liver disease. Participants completed the EQ-5D-3L survey at enrolment. Regression models were used to assess the impact of clinical and socioeconomic characteristics on the EQ-5D-3L scores. RESULTS Among 751 participants (median age, 43 years; 67% male), 63% reported injection drug use in the past month, 43% had current HCV infection, and 68% had no/mild liver fibrosis (F0/F1). The mean EQ-5D-3L and EQ-VAS scores were 0.67 and 62, respectively, for the overall study population. There was no significant difference in the EQ-5D-3L scores among people with and without recent injecting drug use (mean: 0.66 vs. 0.68, median: 0.73 vs. 0.78, P = 0.405), and among people receiving and not receiving opioid agonist therapy (mean: 0.66 vs. 0.68, median: 0.73 vs. 0.76, P = 0.215). Participants who were employed were found to have the highest mean EQ-5D-3L (0.83) and EQ-VAS scores (77). The presence of current HCV infection, liver fibrosis stage, and high-risk alcohol consumption had little impact on HRQoL. CONCLUSIONS The study findings provide important HRQoL data for economic evaluations, useful for guiding the allocation of resources for HCV elimination strategies and interventions among PWID.
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Affiliation(s)
- Qinglu Cheng
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia.
| | - Sahar Bajis
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Evan Cunningham
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Sophy T F Shih
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Marcel Schulz
- St Vincent's Clinical School, UNSW Medicine, Sydney, NSW, Australia
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Behzad Hajarizadeh
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Virginia Wiseman
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
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12
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Klapproth CP, Fischer F, Rose M. Scale agreement, ceiling and floor effects, construct validity, and relative efficiency of the PROPr and EQ-5D-3L in low back pain patients. Health Qual Life Outcomes 2023; 21:107. [PMID: 37759272 PMCID: PMC10523622 DOI: 10.1186/s12955-023-02188-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The PROMIS Preference score (PROPr) is a new health state utility (HSU) score that aims to comprehensively incorporate the biopsychosocial model of health and apply favorable psychometric properties from the descriptive PROMIS system to HSU measurements. However, minimal evidence concerning comparisons to the EQ-5D-3L and the PROPr's capability to differentiate clinical severity are available. Therefore, the aim of this study was to compare the PROPr to the EQ-5D-3L in terms of scale agreement, ceiling/floor effects, distribution, construct validity, discriminatory power, and relative efficiency (RE) in terms of the Oswestry Disability Index (ODI) for patients with low back pain (LBP). METHODS We used intra-class correlation coefficients (ICC) and Bland-Altman plots to compare the PROPr and EQ-5D-3L with regared to scale agreement in a cross-sectional routine sample of LBP patients. For distribution, we used the Pearson's coefficient for skewness and for ceiling/floor effects, a 15%-top/bottom threshold. For convergent validity, we used Pearson's correlation coefficients. For known-groups validity, we applied a linear regression with interaction terms (predictors sex, age, and ODI level) and an analysis of variance (ANOVA). For discriminatory power, we calculated the effect size (ES) using Cohen's d and the ratio of the area under the receiver-operating characteristics curves (AUROC-ratio = AUROCPROPr/AUROCEQ-5D-3L). RE was measured using the ratio of F-values (RE = FPROPr/FEQ-5D-3L). RESULTS Of 218 LBP patients, 50.0% were female and the mean age was 61.8 years. The mean PROPr (0.20, 95%CI: 0.18; 0.22) and EQ-5D-3L scores (0.55, 95%CI: 0.51; 0.58) showed low agreement (d = 0.35, p < 0.001; ICC 0.27, 95%CI: -0.09; 0.59). The PROPr's distribution was positively skewed, whereas the EQ-5D-3L's was negative. Neither tool showed ceiling/floor effects, but all EQ-5D-3L dimensions did. Pearson correlation was r = 0.66 (95%CI: 0.58; 0.73). Differences were invariant to sex and age but not to ODI severity: ESEQ-5D-3L > ESPROPr and RE < 1 in higher ODI severity; ESEQ-5D-3L < ESPROPr and RE > 1 in lower ODI severity. AUROC-ratios did not show significant differences in terms of ODI severity. CONCLUSIONS All PROPr and EQ-5D-3L biopsychosocial dimensions of health showed impairment in LPB patients. The capability of EQ-5D-3L and PROPr to differentiate ODI levels depends on ODI severity. Joint application of both tools may provide additional information.
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Affiliation(s)
- Christoph Paul Klapproth
- Center for Patient-Centered Outcomes Research (CPCOR), Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Felix Fischer
- Center for Patient-Centered Outcomes Research (CPCOR), Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Rose
- Center for Patient-Centered Outcomes Research (CPCOR), Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Olariu E, Caplescu R, Vale L, Niculescu-Aron IG, Oluboyede Y, Paveliu MS. Population norms for the EQ-5D-3L and EQ-5D-5L in Romania. Health Qual Life Outcomes 2023; 21:80. [PMID: 37507760 PMCID: PMC10386277 DOI: 10.1186/s12955-023-02144-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 06/05/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The majority of patient reported outcome measures (PROMs) don't have population norms in Romania. This is the case with the EQ-5D as well. Therefore, we aimed to estimate population norms for the Romanian versions of the EQ-5D-5L, EQ-5D-3L, their indexes, and the EQ-VAS. METHODS A cross-sectional survey was conducted in all regions of Romania from November 2018 to November 2019. A three-stage probability sampling procedure stratified by region and settlement size was used to select a representative sample. Interviews were computer-assisted and conducted in respondents' homes by trained interviewers. Health status was assessed with the EQ-5D-5L, the EQ-5D-3L and the EQ VAS. Descriptive statistics were used to estimate population norms by age groups and sex for the EQ-5D-5L, the EQ-5D-3L, their indexes and the EQ VAS. Population norms were weighted using survey weights. Indexes for the EQ-5D questionnaires were estimated using the recently developed Romanian value sets. RESULTS Data from 1,649 interviews was analysed in the present study. Survey weights were used so that sex and place of residence ratios for the weighted sample matched the Romanian general population distribution. Participants' mean age was 47.4 years (SE = 1.157) and 50.3% of them reported being in good health. The dimension for which people reported the highest number of problems for both questionnaires was the pain/discomfort dimension. Men aged 35 plus reported fewer problems with pain/discomfort than women for both the EQ-5D-5L and EQ-5D-3L. Health decreased with age as shown by the decrease from age group 18-24 to age group 75 plus in the indexes of both questionnaires: from 0.977 (SE = 0.005) to 0.765 (SE = 0.017) for EQ-5D-5L and from 0.981 (SE = 0.005) to 0.784 (SE = 0.019) for EQ-5D-3L. There was 29.9 points drop in the EQ VAS score between the youngest and oldest group. CONCLUSIONS Population norms for the Romanian versions of the EQ-5D-5L, EQ-5D-3L, their indexes, and the EQ VAS are now available. These can now be used as reference values by healthcare professionals, researchers and decision-makers leading to a further development of health-related quality of life research in Romania.
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Affiliation(s)
- Elena Olariu
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - Raluca Caplescu
- Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, 010374, Romania
| | - Luke Vale
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Yemi Oluboyede
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Marian Sorin Paveliu
- Department of Pharmacology, Titu Maiorescu University, Bucharest, 031593, Romania
- Romanian Academic Society, Bucharest, 020071, Romania
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Khan FU, Khan FU, Aqeel MT, Hayat K, Chang J, Rehman AU, Fang Y. A randomized controlled trial to evaluate the impact of pharmacist-led clinical interventions on the health-related quality of life among TB patients. Front Pharmacol 2023; 14:1171985. [PMID: 37292150 PMCID: PMC10246751 DOI: 10.3389/fphar.2023.1171985] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/03/2023] [Indexed: 06/10/2023] Open
Abstract
Background: The study was designed to evaluate the impact of pharmacist-led clinical interventions on the health-related quality of life among tuberculosis patients in Pakistan. Methods: A randomized, controlled prospective study was carried out in a Pakistan Institute of Medical Sciences hospital tuberculosis (TB) control center. Participants who visited the TB center between September 2020 and December 2021 were randomly assigned to two clusters, the usual care group (UC group) vs. the intervention group (pharmaceutical care group), in a 1:1 ratio by a simple envelope technique. In the intervention group, a patient received centered care that encompassed informed decision-making, which can increase the quality of care and monitoring of adverse drug events. However, the control group received routine TB treatment at the hospital. The EuroQol-5D-3L instrument was used to assess the health-related quality of life (HRQoL) at the baseline and in the third and sixth months of the treatment time period. Results: A total of 503 patients were eligible, of which only 426 patients were included in this study. At the end of the study, n = 205 of the patients in the intervention group and n = 185 of those in the control group were analyzed. In the intervention group, the EQ-5D-3L health utility score improved significantly (p < 0.001) (from the baseline mean ± SD, 0.40 ± 0.36, to 6 months of treatment, 0.89 ± 0.09, while in the control group from 0.42 ± 0.35 to 0.78 ± 0.27). In multivariate regression analysis, the variables that remained statistically associated (p < 0.001) with the HRQoL (unstandardized β [95% confidence interval]) of the control group were as follows: gender, female vs. male (-0.039 [-0.076 to -0.003]); body weight, less than 40 kg vs. more than 40 kg (-0.109 [-0.195 to -0.024]); patients with any comorbidity vs. without comorbidity (-0.136 [-0.252 to -0.020]); and smokers vs. non-smokers (-0.204 [-0.291 to -0.118]). The study did not find any statistically significant associations between the intervention group's variables and the HRQoL. Conclusion: Patient-centered care interventions led by pharmacists as part of care coordination enhanced the HRQoL for TB patients significantly. According to this study, clinical pharmacists should be included in the interdisciplinary clinical staff for TB patient management.
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Affiliation(s)
- Farman Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Xi’an, China
- Faculty of Pharmacy, Hamdard University Islamabad Campus, Islamabad, Pakistan
| | - Faiz Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Xi’an, China
| | | | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Xi’an, China
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Xi’an, China
| | - Asim ur Rehman
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Xi’an, China
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Weng G, Hong Y, Luo N, Mukuria C, Jiang J, Yang Z, Li S. Comparing EQ-5D-3L and EQ-5D-5L in measuring the HRQoL burden of 4 health conditions in China. Eur J Health Econ 2023; 24:197-207. [PMID: 35538178 DOI: 10.1007/s10198-022-01465-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 08/04/2021] [Accepted: 04/05/2022] [Indexed: 05/24/2023]
Abstract
BACKGROUND EQ-5D-3L has been used in the National Health Services Survey of China since 2008 to monitor population health. The five-level version of EQ-5D was developed, but there lacks evidence to support the use of five-level version of EQ-5D in China. This study was conducted to compare the measurement properties of both the EQ-5D-3L and EQ-5D-5L in quantifying health-related quality of life (HRQoL) burden for 4 different health conditions in China. METHODS Participants from China were recruited to complete the 3L and 5L questionnaire via Internet. Quota was set to recruit five groups of individuals, with one group of individuals without any health condition and one group of generalized anxiety disorder (GAD), HIV/AIDS, chronic Hepatitis B (CHB), or depression, respectively. The 3L and 5L were compared in terms of response distributions, percentages of reporting 'no problems', index value distributions, known-group validity and their relative efficiency. RESULTS In total, 500 individuals completed the online survey, including 140 healthy individuals, 122 individuals with hepatitis B, 107 with depression, 90 individuals with GAD and 101 with HIV/AIDS. 5L also had smoother and less clustered index value distributions. Healthy group showed different response distributions to the four condition groups. The percentage of reporting 'no problems' decreased significantly in the 5L in all domains (P < 0.01), especially in the pain/discomfort dimension (relative difference: 43.10%). Relative efficiency suggested that 5L had a higher absolute discriminatory power than the 3L version between healthy participant and the other 4 condition groups, especially for the HIV/AIDS group when the 3L results was not significant. CONCLUSIONS The 5L version may be preferable to the 3L, as it demonstrated superior performance with respect to higher sensitivity to mild health problems, better relative efficiency and responses and index value distributions.
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Affiliation(s)
- Guizhi Weng
- College of Pharmacy, Jinan University, 601 West Huangpu avenue, 510632, Guangzhou, People's Republic of China
| | - Yanming Hong
- College of Pharmacy, Jinan University, 601 West Huangpu avenue, 510632, Guangzhou, People's Republic of China
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Clara Mukuria
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jie Jiang
- College of Pharmacy, Jinan University, 601 West Huangpu avenue, 510632, Guangzhou, People's Republic of China
- Dongguan Institute of Jinan University, Dongguan, People's Republic of China
| | - Zhihao Yang
- College of Pharmacy, Jinan University, 601 West Huangpu avenue, 510632, Guangzhou, People's Republic of China.
- Health Services Management Department, Guizhou Medical University, Guiyang, People's Republic of China.
| | - Sha Li
- College of Pharmacy, Jinan University, 601 West Huangpu avenue, 510632, Guangzhou, People's Republic of China.
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Faraj S, de Windt TS, van Hooff ML, van Hellemondt GG, Spruit M. Custom-made acetabular revision arthroplasty for pelvic discontinuity: Can we handle the challenge? : a prospective cohort study. Bone Jt Open 2023; 4:53-61. [PMID: 36718581 PMCID: PMC10011926 DOI: 10.1302/2633-1462.42.bjo-2022-0159.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: 02/01/2023] Open
Abstract
AIMS The aim of this study was to assess the clinical and radiological results of patients who were revised using a custom-made triflange acetabular component (CTAC) for component loosening and pelvic discontinuity (PD) after previous total hip arthroplasty (THA). METHODS Data were extracted from a single centre prospective database of patients with PD who were treated with a CTAC. Patients were included if they had a follow-up of two years. The Hip Disability and Osteoarthritis Outcome Score (HOOS), modified Oxford Hip Score (mOHS), EurQol EuroQoL five-dimension three-level (EQ-5D-3L) utility, and Numeric Rating Scale (NRS), including visual analogue score (VAS) for pain, were gathered at baseline, and at one- and two-year follow-up. Reasons for revision, and radiological and clinical complications were registered. Trends over time are described and tested for significance and clinical relevance. RESULTS A total of 18 females with 22 CTACs who had a mean age of 73.5 years (SD 7.7) were included. A significant improvement was found in HOOS (p < 0.0001), mOHS (p < 0.0001), EQ-5D-3L utility (p = 0.003), EQ-5D-3L NRS (p = 0.013), VAS pain rest (p = 0.008), and VAS pain activity (p < 0.0001) between baseline and final follow-up. Minimal clinically important improvement in mOHS and the HOOS Physical Function Short Form (HOOS-PS) was observed in 16 patients (73%) and 14 patients (64%), respectively. Definite healing of the PD was observed in 19 hips (86%). Complications included six cases with broken screws (27%), four cases (18%) with bony fractures, and one case (4.5%) with sciatic nerve paresthesia. One patient with concurrent bilateral PD had revision surgery due to recurrent dislocations. No revision surgery was performed for screw failure or implant breakage. CONCLUSION CTAC in patients with THA acetabular loosening and PD can result in stable constructs and significant improvement in functioning and health-related quality of life at two years' follow-up. Further follow-up is necessary to determine the mid- to long-term outcome.Cite this article: Bone Jt Open 2023;4(2):53-61.
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Affiliation(s)
- Sayf Faraj
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Tommy S de Windt
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Miranda L van Hooff
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands.,Department of Orthopedic Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Maarten Spruit
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
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Koszorú K, Hajdu K, Brodszky V, Bató A, Gergely LH, Kovács A, Beretzky Z, Sárdy M, Szegedi A, Rencz F. Comparing the psychometric properties of the EQ-5D-3L and EQ-5D-5L descriptive systems and utilities in atopic dermatitis. Eur J Health Econ 2023; 24:139-152. [PMID: 35412162 PMCID: PMC9877050 DOI: 10.1007/s10198-022-01460-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a common chronic inflammatory skin disorder affecting up to 10% of adults. The EQ-5D is the most commonly used generic preference-accompanied measure to generate quality-adjusted life years (QALYs) for economic evaluations. OBJECTIVES We aimed to compare psychometric properties of the three-level and five-level EQ-5D (EQ-5D-3L and EQ-5D-5L) in adult patients with AD. METHODS In a multicentre cross-sectional study, 218 AD patients with a broad range of severity completed the EQ-5D-3L, EQ-5D-5L, Dermatology Life Quality Index (DLQI) and Skindex-16. Disease severity outcomes included the Investigator Global Assessment, Eczema Area and Severity Index and the objective SCORing Atopic Dermatitis. RESULTS A good agreement was established between the two EQ-5D versions with an intraclass correlation coefficient of 0.815 (95% CI 0.758-0.859, p < 0.001). Overall, 33 different health state profiles occurred in the EQ-5D-3L and 84 in the EQ-5D-5L. Compared to the EQ-5D-3L, ceiling effect was reduced for the mobility, self-care, usual activities and pain/discomfort dimensions by 4.6-11.5%. EQ-5D-5L showed higher average relative informativity (Shannon's evenness index: 0.64 vs. 0.59). EQ-5D-5L demonstrated better convergent validity with EQ VAS, DLQI and Skindex-16. The two measures were similar in distinguishing between groups of patients based on disease severity and skin-specific quality of life with a moderate or large effect size (η2 = 0.083-0.489). CONCLUSION Both instruments exhibited good psychometric properties in AD; however, the EQ-5D-5L was superior in terms of ceiling effects, informativity and convergent validity. We recommend the use of the EQ-5D-5L to measure health outcomes in clinical settings and for QALY calculations in AD.
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Affiliation(s)
- Kamilla Koszorú
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, Budapest, Hungary
| | - Krisztina Hajdu
- Department of Dermatological Allergology, University of Debrecen, Debrecen, Hungary
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, 8 Fővám tér, Budapest, 1093, Hungary
| | - Alex Bató
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, Budapest, Hungary
- Department of Health Economics, Corvinus University of Budapest, 8 Fővám tér, Budapest, 1093, Hungary
| | - L Hunor Gergely
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Anikó Kovács
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Beretzky
- Department of Health Economics, Corvinus University of Budapest, 8 Fővám tér, Budapest, 1093, Hungary
| | - Miklós Sárdy
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Andrea Szegedi
- Department of Dermatological Allergology, University of Debrecen, Debrecen, Hungary
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, 8 Fővám tér, Budapest, 1093, Hungary.
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Savadkoohi H, Barasteh S, Ebadi A, Ashrafizadeh H, Akbarzadeh Amirdehi M, Safdari A, Mollahadi M, Oghli SH. Psychometric properties of Persian version of wound-QOL questionnaire among older adults suffering from chronic wounds. Front Psychol 2023; 13:1041754. [PMID: 36778173 PMCID: PMC9909697 DOI: 10.3389/fpsyg.2022.1041754] [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] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/10/2022] [Indexed: 01/28/2023] Open
Abstract
Background Patients with chronic wounds experience various biopsychosocial problems which severely affects their quality of life (QoL). Thus, a Persian instrument to assess the QoL of these patients is required. This study aimed to determine the psychometric properties of the Persian version of the wound-QOL questionnaire. Methods This methodological study was performed on Iranian patients during 2021-2022. The translation was carried out via forward-backward method. Face validity was addressed with 10 patients and content validity with 12 wound specialists. Construct validity was also assessed by performing exploratory factor analysis (EFA) (n = 100) and convergent validation with EQ-5D-3L plus Pain VAS Score and known-groups validity. The reliability was assessed by internal consistency using Cronbach's alpha coefficient and test-retest. Results A total of 100 patients with chronic wounds were included in the study. Two factors with cumulative variance of 65.39% were extracted during EFA. The results revealed a significant and high correlation between the total scores of wound-QOL questionnaire, the Persian version of EQ-5D-3L (p = 0.000, r = 0.502), and Pain score (0-10; p = 0.000, r = 0.627). The Cronbach's alpha was 0.743 and stability of the questionnaire (α = 0.872) was confirmed. In confirming the known-groups validity, the results showed that this tool can differentiate the QOL of patients with different wounds. Conclusion The Persian version of the wound-QOL questionnaire is a valid and reliable questionnaire which can measure the QoL of patients with chronic wounds. This instrument can be used in clinical evaluation as well as research purposes across the Iranian population.
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Affiliation(s)
- Hamed Savadkoohi
- Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Salman Barasteh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran,Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran,Salman Barasteh, ✉
| | - Abbas Ebadi
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran,Behavioral Sciences Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hadis Ashrafizadeh
- Student Research Committee, Faculty of Nursing, Dezful University of Medical Sciences, Dezful, Iran
| | - Mahdi Akbarzadeh Amirdehi
- The Head of Wound and Ostomy Department, Baqiyatallah Hospital (IIWCC-EWMA-ICW-WOC-ET Nurse), Tehran, Iran
| | - Ali Safdari
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohsen Mollahadi
- Exercise Physiology Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Saeid Hossein Oghli
- Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran,*Correspondence: Saeid Hossein Oghli, ✉
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Sajjad A, Versteegh MM, Santi I, Busschbach J, Simon J, Roijen LHV. In search of a 'pan-European value set'; application for EQ-5D-3L. BMC Med Res Methodol 2023; 23:13. [PMID: 36635625 PMCID: PMC9835298 DOI: 10.1186/s12874-022-01830-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Country-specific value sets for the EQ-5D are available which reflect preferences for health states elicited from the general population. This allows the transformation of responses on EQ-5D to health state utility values. Only twelve European countries possess country-specific value sets and no value set reflecting the preferences of Europe exists. We aim to estimate a 'pan-European' value set for the EQ-5D-3L, reflecting the preferences for health states of the European population that could help to evaluate health care from the perspective of the European decision-maker. METHODS We systematically assessed and compared the methodologies of available EQ-5D-3L time trade-off (TTO) value sets from twelve European countries: Denmark, France, Germany, Hungary, Italy, Netherlands, Poland, Portugal, Romania, Slovenia, Spain and UK. Using their published coefficients, a dataset with utility values for all 243 health states was simulated. Different modelling techniques and model specifications including interaction terms were tested. Model selection was based on goodness-of-fit criteria. We also explored results with application of population size weights. RESULTS Methodological, procedural and analytical characteristics of the included EQ-5D-3L valuation studies were quite comparable. An OLS based model was the preferred model to represent European preferences. Weighting with population size made little difference. CONCLUSIONS EQ-5D-3L valuation studies were considered of sufficient comparability to form the basis for a new 'pan-European' value set. The method used allows for an easy update when new national value sets become available.
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Affiliation(s)
- Ayesha Sajjad
- grid.6906.90000000092621349Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Matthijs M. Versteegh
- grid.6906.90000000092621349Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Irene Santi
- grid.6906.90000000092621349Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jan Busschbach
- grid.5645.2000000040459992XSection of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
| | - Judit Simon
- grid.22937.3d0000 0000 9259 8492Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria ,grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Leona Hakkaart-van Roijen
- grid.6906.90000000092621349Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands ,grid.6906.90000000092621349Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
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20
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Szende A, Janssen MF, Cabases J, Ramos-Goni JM, Burström K. Socio-demographic indicators of self-reported health based on EQ-5D-3L: A cross-country analysis of population surveys from 18 countries. Front Public Health 2023; 10:959252. [PMID: 36684894 PMCID: PMC9853521 DOI: 10.3389/fpubh.2022.959252] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/25/2022] [Indexed: 01/07/2023] Open
Abstract
Background Generic health-related quality of life instruments, such as the EQ-5D, are increasingly used by countries to monitor population health via general population health surveys. Our aim was to demonstrate analytic options to measure socio-demographic differences in self-reported health using the EuroQol Group's archive of EQ-5D-3L population surveys that accumulated over the past two decades. Methods Analyses captured self-reported EQ-5D-3L data on over 100,000 individuals from 18 countries with nationally representative population surveys. Socio-demographic indicators employed were age, sex, educational level and income. Logistic regression odds ratios and the health concentration index methodology were used in the socio-demographic analysis of EQ-5D-3L data. Results Statistically significant socio-demographic differences existed in all countries (p < 0.01) with the EQ VAS based health concentration index varying from 0.090 to 0.157 across countries. Age had generally the largest contributing share, while educational level also had a consistent role in explaining lower levels of self-reported health. Further analysis in a subset of 7 countries with income data showed that, beyond educational level, income itself had an additional significant impact on self-reported health. Among the 5 dimensions of the EQ-5D-3L descriptive system, problems with usual activities and pain/discomfort had the largest contribution to the concentration of overall self-assessed health measured on the EQ VAS in most countries. Conclusion The EQ-5D-3L was shown to be a powerful multi-dimensional instrument in the analyses of socio-demographic differences in self-reported health using various analytic methods. It offered a unique insight of inequalities by health dimensions.
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Affiliation(s)
- Agota Szende
- Global Health Economics and Outcomes Research, Labcorp, Leeds, United Kingdom
| | - Mathieu F. Janssen
- Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, Netherlands
- EuroQol Group, Rotterdam, Netherlands
| | - Juan Cabases
- Department of Economics, Public University of Navarra, Pamplona, Spain
| | | | - Kristina Burström
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
- Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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21
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Shah C, Keerthi BY, Gali JH. An observational study on health-related quality of life and persistent symptoms in COVID-19 patients after hospitalization at a tertiary care centre. Lung India 2023; 40:12-18. [PMID: 36695253 PMCID: PMC9894290 DOI: 10.4103/lungindia.lungindia_126_22] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 10/23/2022] [Accepted: 11/02/2022] [Indexed: 01/01/2023] Open
Abstract
Aim The study aims to determine persistent symptoms and effects of COVID-19 infection on the quality of life (QOL) at 1 and 3 months after the acute phase of the disease in mild, moderate and severe cases. Methods The prospective observational study was conducted among patients with confirmed COVID-19 who had been treated and discharged after hospitalization from February 2021 to June 2021. All patients were interviewed at 1 and 3 months post discharge to assess persisting symptoms and health-related QOL. QOL was assessed using European Quality Of Life 5-Dimensions 3-Levels (EQ-5D-3L) and EuroQol-visual analogue scales (EQ-VAS). Results In total, 388 out of 479 discharged following COVID-19 infection were included. The median age of patients was 48 years, with 62.6% male predominance. Most of the COVID-19 cases were mild (67.01%). Most common presenting symptom was fever (69.8%). EQ-5D-3L showed that the problems reported at 3-month follow-up were significantly less when compared to 1-month follow-up (p < 0.001), and QOL significantly improved after 3 months in non-intensive care unit (ICU) patients when compared to ICU patients (p = 0.007). The mean EQ-VAS score significantly improved at 3 months when compared to 1 month (80.34 ± 12.77 vs. 91.69 ± 12.34; P < 0.001). The severity of illness was correlated with QOL (p < 0.007). Conclusion The study results demonstrate ongoing improvement in the QOL and persistent symptoms, while a minority still were symptomatic after 3 months post-COVID-19 illness.
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Affiliation(s)
- Chirali Shah
- Department of Pulmonary Medicine, Telangana Institute of Medical Sciences and Research, Gachibowli, Hyderabad, Telangana, India
| | - B. Y Keerthi
- Department of General Medicine, Telangana Institute of Medical Sciences and Research, Gachibowli, Hyderabad, Telangana, India
| | - Jayasri Helen Gali
- Department of Pulmonary Medicine, Telangana Institute of Medical Sciences and Research, Gachibowli, Hyderabad, Telangana, India
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22
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Hu J, Zhu L, Bao H, Liu Y, Xing H, Kang Q, Jin C. Utility estimations of different health states of patients with type I, II, and III spinal muscular atrophy in China: A mixed approach study with patient and proxy-reported data. Front Public Health 2022; 10:1054931. [PMID: 36605247 PMCID: PMC9809905 DOI: 10.3389/fpubh.2022.1054931] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Spinal muscular atrophy (SMA) is a rare autosomal-recessive neuromuscular disease. Health state utility values (HSUV) are used in health economic evaluation regarding the desirability of health outcomes such as a certain health state or change in health states over time. There is no utility data of Chinese patients with SMA. Materials and methods Vignettes were developed for 10 pediatric neurologists to value the utility of Chinese patients with Type I SMA. A mixed patient/proxy derived approach using EQ-5D-Y-3L, EQ-5D-3L, and CHU9D was adopted to estimate the HSUV data of patients with Type II and III SMA, including 112 patients and 301 caregivers. Result The utility of Type I SMA patients ranged from 0.19 to 0.72 with the health state improved from "permanent ventilation" to "walking". The utility of children patients with Type II and III SMA derived from EQ-5D-Y-3L ranged from 0.33 to 0.82 while that derived from CHU9D ranged from 0.46 to 0.75. The utility of adult patients with Type II and III SMA measured by EQ-5D-3L ranged from 0.30 to 0.83. Conclusion The better health states the patients with SMA were in, the higher were the HSUV. The utilities derived from population with different age and disease subtypes were not statistically different when patients with SMA were in the same health states. We recommend further studies on the Chinese specific value set for EQ-5D-Y-3L and other PBMs for children to derive more robust utility data.
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Affiliation(s)
- Jiahao Hu
- Shanghai Health Development Research Centre (Shanghai Medical Information Centre), Shanghai, China
| | - Lin Zhu
- Shanghai Health Development Research Centre (Shanghai Medical Information Centre), Shanghai, China
| | - Han Bao
- Institute of Pharmaceutical Economics, Sun Yat-sen University, Guangzhou, China
| | - Yuhan Liu
- Shanghai Health Development Research Centre (Shanghai Medical Information Centre), Shanghai, China
| | - Huanping Xing
- Meier Advocacy & Support Centre for SMA, Beijing, China
| | - Qi Kang
- Shanghai Health Development Research Centre (Shanghai Medical Information Centre), Shanghai, China,*Correspondence: Qi Kang
| | - Chunlin Jin
- Shanghai Health Development Research Centre (Shanghai Medical Information Centre), Shanghai, China,Chunlin Jin
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Wang L, Lu Y, Dai Z, Shi P, Xu J, Chang F, Lu Y. Obtaining EQ-5D-3L utility index from the health status scale of traditional Chinese medicine (TCM-HSS) based on a mapping study. Health Qual Life Outcomes 2022; 20:164. [PMID: 36522665 PMCID: PMC9753309 DOI: 10.1186/s12955-022-02076-9] [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] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Almost all traditional Chinese medicine (TCM) quality of life measures are non-preference-based measures (non-PBMs), which do not provide utilities for cost-utility analysis in pharmacoeconomic evaluation. Whereas the mapping has become a new instrument to obtain utilities, which builds a bridge between non-PBMs and PBMs. PURPOSE To develop mapping algorithms from the health status scale of traditional Chinese medicine (TCM-HSS) onto the three-level EuroQol five-dimensional questionnaire (EQ-5D-3L). METHODS The cross-sectional data were collected by questionnaire survey from a tertiary hospital visit population and community residents in China, and randomly divided into training and validation set by 2:1. Based on the training set, direct and indirect mapping methods (7 regression methods and 4 model specifications) were conducted to establish alternative models, which were comprehensively evaluated based on the validation set by mean absolute error, root mean square error, and Spearman correlation coefficient between predicted and observed values. Based on the whole sample, the preferred mapping algorithm was developed. RESULTS A total of 639 samples were included, with an average age of 45.24 years and 61.66% of respondents were female. The mean EQ-5D-3L index was 0.9225 [SD = 0.1458], and the mean TCM-HSS index was 3.4144 [SD = 3.1154]. The final mapping algorithm was a two-part regression model including the TCM-HSS subscales, interaction terms, and demographic covariates (age and gender). The prediction performance was good. The mean error was 0.0003, the mean absolute error was 0.0566, the root mean square error was 0.1039, and 83.10% of the prediction errors were within 0.1; the Spearman correlation coefficient between predicted and observed EQ-5D-3L values was 0.6479. CONCLUSION It is the first study to develop a mapping algorithm between the TCM-HSS and EQ-5D-3L, which demonstrates excellent prediction accuracy and estimates utility value for economic evaluation from TCM quality of life measures.
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Affiliation(s)
- Li Wang
- grid.254147.10000 0000 9776 7793Center for Health Care Policy Research, School of International Pharmaceutical Business, China Pharmaceutical University, 639 Longmian Avenue, Jiangning District, Nanjing, 211198 Jiangsu China
| | - Yuqiong Lu
- grid.254147.10000 0000 9776 7793Center for Health Care Policy Research, School of International Pharmaceutical Business, China Pharmaceutical University, 639 Longmian Avenue, Jiangning District, Nanjing, 211198 Jiangsu China
| | - Zhanjing Dai
- grid.254147.10000 0000 9776 7793Center for Health Care Policy Research, School of International Pharmaceutical Business, China Pharmaceutical University, 639 Longmian Avenue, Jiangning District, Nanjing, 211198 Jiangsu China
| | - Penghua Shi
- grid.254147.10000 0000 9776 7793Center for Health Care Policy Research, School of International Pharmaceutical Business, China Pharmaceutical University, 639 Longmian Avenue, Jiangning District, Nanjing, 211198 Jiangsu China
| | - Jiayi Xu
- grid.254147.10000 0000 9776 7793Center for Health Care Policy Research, School of International Pharmaceutical Business, China Pharmaceutical University, 639 Longmian Avenue, Jiangning District, Nanjing, 211198 Jiangsu China
| | - Feng Chang
- grid.254147.10000 0000 9776 7793Center for Health Care Policy Research, School of International Pharmaceutical Business, China Pharmaceutical University, 639 Longmian Avenue, Jiangning District, Nanjing, 211198 Jiangsu China
| | - Yun Lu
- grid.254147.10000 0000 9776 7793Center for Health Care Policy Research, School of International Pharmaceutical Business, China Pharmaceutical University, 639 Longmian Avenue, Jiangning District, Nanjing, 211198 Jiangsu China
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Moradi N, Poder TG, Safari H, Mojahedian MM, Ameri H. Psychometric properties of the EQ-5D-5L compared with EQ-5D-3L in cancer patients in Iran. Front Oncol 2022; 12:1052155. [PMID: 36568223 PMCID: PMC9782428 DOI: 10.3389/fonc.2022.1052155] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
Background and Objective Psychometric evidence to support the validity and reliability of the EuroQol-5 Dimensions (EQ-5D) in cancer patients is limited. This study aimed to test the validity and reliability of the EQ-5D-5L (5L) in comparison with EQ-5D-3L (3L) in cancer patients. Methods Data of 650 cancer patients were collected through consecutive sampling method from three largest governmental cancer centers in Iran between June 2021 and January 2022. The data were gathered using the 3L, 5L, and the European Organization for Research and Treatment of Cancer quality of life questionnaire (QLQ-C30) instruments. The 3L and 5L were compared in terms of ceiling effect, discriminatory power, convergent and known-groups validity, relative efficiency, inconsistency, agreement, and reliability. Results Compared with the 3L, ceiling effect decreased by 27.86%. Absolute and relative informativity of discriminatory power improved by 45.93% and 22.92% in the 5L, respectively. All convergent validity coefficients with 5L were stronger than with 3L. Both 3L and 5L demonstrated good known-groups validity, and the relative efficiency was higher for 5L in 4 out of 7 patients' characteristics. The two instruments showed low overall inconsistency (1.45%) and 92.57% of the differences of observations between the 3L and 5L were within the 95% limit of agreement. The interclass correlation coefficient (ICC) for 3L and 5L indexes were 0.88 and 0.85, respectively, and kappa coefficients in the 3L dimensions (range=0.66-0.92) were higher than the 5L(range=0.64-0.79). Conclusions The 5L demonstrated to be better than the 3L in terms of ceiling effect, inconsistency, discriminatory power, convergent validity, relative efficiency.
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Affiliation(s)
- Nasrin Moradi
- Department of Health Management and Economics, School of Public Health, Iran University of Medical Science, Tehran, Iran
| | - Thomas G. Poder
- Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal, Montreal, QC, Canada,Centre de recherche de l’Institut universitaire en santé mentale de Montréal, CIUSSS de l’Est de l’île de Montréal, Montreal, QC, Canada
| | - Hossein Safari
- Health Promotion Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad M. Mojahedian
- Department of Pharmacoeconomics, School of Pharmacy, Iran University of Medical Science, Tehran, Iran
| | - Hosein Ameri
- Health Policy and Management Research Center, Department of Health Management and Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran,*Correspondence: Hosein Ameri,
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Agerholm J, Teni FS, Sundbye J, Rolfson O, Burström K. Patient-reported outcomes among patients undergoing total hip replacement in an integrated care system and in a standard care system in Region Stockholm, Sweden. BMC Health Serv Res 2022; 22:1414. [PMID: 36434638 PMCID: PMC9694819 DOI: 10.1186/s12913-022-08722-8] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Coordination, cooperation and efficient use of resources is vital for the health- and social care sector if it is to meet the needs of an aging population. Integrated care is a patient-centred approach to provision of care aiming to improve quality of care and overcome fragmented care through co-productive partnerships and may positively affect quality of care and health outcomes, especially among those in need of highly coordinated care services. AIM To compare patient-reported outcomes (PROs) among patients undergoing total hip replacement (THR) in the integrated care system in Norrtälje Municipality and in the standard care system in other municipalities in Region Stockholm, Sweden. METHODS Swedish Hip Arthroplasty Register PRO data during 2008-2015 were compared 1 year after THR among patients (≥50 years) in integrated care (n = 407) and standard care (n = 3501) systems using linear (EQ VAS score), logistic (EQ-5D-3L dimensions) and negative binomial (hip pain VAS score) regressions. Analyses were adjusted for the preoperative factors age, sex, BMI, ASA class and type of incision. RESULTS 1-year postoperatively, patients in the integrated care system did not report their health significantly different from patients receiving standard care. Exceptions: Female patients in integrated care reported less problems with self-care (OR:0.52; 0.29-0.96) and patients above 70 years reported more problems with mobility (OR: 1.37; 1.01-1.87). CONCLUSION No significant differences were found between the two care systems for postoperative PROs. A longer follow-up time and analyses by socioeconomic groups would be valuable.
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Affiliation(s)
- J. Agerholm
- grid.4714.60000 0004 1937 0626Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Tomtebodavägen 18A, SE – 171 77 Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - F. S. Teni
- grid.4714.60000 0004 1937 0626Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - J. Sundbye
- grid.4714.60000 0004 1937 0626Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - O. Rolfson
- grid.8761.80000 0000 9919 9582Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg University, Gothenburg, Sweden ,grid.512495.eSwedish Arthroplasty Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - K. Burström
- grid.4714.60000 0004 1937 0626Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Rego de Figueiredo I, Carvalho Vasques M, Cunha N, Martins D, Silva-Nunes J. Quality of Life in Obese Patients from a Multidisciplinary Bariatric Consultation: A Cross-Sectional Study Comparing to a Non-Bariatric Population and to the General Population. Int J Environ Res Public Health 2022; 19:12029. [PMID: 36231331 PMCID: PMC9564586 DOI: 10.3390/ijerph191912029] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Obesity is a chronic disease defined by a body mass index of ≥30 kg/m2, which can result in a decrease in quality of life (QoL). Our study aim was to assess the QoL of an obese population of bariatric surgery (BS) candidates, and to compare it to both that of a non-bariatric obese population (C) and that of the general population. This was a cross-sectional study using: (1) the EQ-5D-3L instrument: comparing BS with the C population and with the Portuguese general population; and (2) the Bariatric Quality of Life (BQL) Index: comparing the two groups of obese patients. We included 228 BS and 68 C obese patients. BS patients had higher BMI (44 ± 6 kg/m2 vs. 41 ± 6.5 kg/m2; p < 0.001), higher waist circumference (130 ± 13 cm vs. 123 ± 17 cm; p = 0.03), and higher total body fat mass (49.9 ± 6.7% vs. 45 ± 6.7%; p < 0.001). QoL as evaluated by EQ-5D-3L was similar, but the BQL index showed lower QoL in BS patients (40.9 ± 8.9 vs. 44.2 ± 11.2; p = 0.01). Compared to the Portuguese general population, BS patients had lower QoL (VAS: 55 ± 19 vs. 74.9; p < 0.001; index: 0.33 ± 0.2 vs. 0.76; p < 0.001). Despite higher adiposity in the BS group, QoL was similar between the groups by EQ-5D-3L. Nevertheless, there was a decrease in the QoL for the BS patients as determined using the BQL, a tool with higher sensitivity to bariatric patients.
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Affiliation(s)
- Inês Rego de Figueiredo
- Multidisciplinary Unit for Bariatric and Metabolic Surgery, Centro Hospitalar Universitário Lisboa Central, 1069-166 Lisbon, Portugal
- Transplantation Unit, Centro Hospitalar Universitário Lisboa Central, 1069-166 Lisbon, Portugal
- NOVA Medical School/Faculdade de Ciencias Medicas, New University of Lisbon/Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | - Miguel Carvalho Vasques
- Multidisciplinary Unit for Bariatric and Metabolic Surgery, Centro Hospitalar Universitário Lisboa Central, 1069-166 Lisbon, Portugal
- NOVA Medical School/Faculdade de Ciencias Medicas, New University of Lisbon/Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, 1069-166 Lisbon, Portugal
| | - Nelson Cunha
- Multidisciplinary Unit for Bariatric and Metabolic Surgery, Centro Hospitalar Universitário Lisboa Central, 1069-166 Lisbon, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, 1069-166 Lisbon, Portugal
| | - Diana Martins
- Multidisciplinary Unit for Bariatric and Metabolic Surgery, Centro Hospitalar Universitário Lisboa Central, 1069-166 Lisbon, Portugal
- NOVA Medical School/Faculdade de Ciencias Medicas, New University of Lisbon/Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, 1069-166 Lisbon, Portugal
| | - José Silva-Nunes
- Multidisciplinary Unit for Bariatric and Metabolic Surgery, Centro Hospitalar Universitário Lisboa Central, 1069-166 Lisbon, Portugal
- NOVA Medical School/Faculdade de Ciencias Medicas, New University of Lisbon/Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, 1069-166 Lisbon, Portugal
- Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, 1990-096 Lisbon, Portugal
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Zrubka Z, Csabai I, Hermann Z, Golicki D, Prevolnik-Rupel V, Ogorevc M, Gulácsi L, Péntek M. Predicting Patient-Level 3-Level Version of EQ-5D Index Scores From a Large International Database Using Machine Learning and Regression Methods. Value Health 2022; 25:1590-1601. [PMID: 35300933 DOI: 10.1016/j.jval.2022.01.024] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/30/2021] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to evaluate the performance of machine learning and regression methods in the prediction of 3-level version of EQ-5D (EQ-5D-3L) index scores from a large diverse data set. METHODS A total of 30 studies from 3 countries were combined. Predictions were performed via eXtreme Gradient Boosting classification (XGBC), eXtreme Gradient Boosting regression (XGBR) and ordinary least squares (OLS) regression using 10-fold cross-validation and 80%/20% partition for training and testing. We evaluated 6 prediction scenarios using 3 samples (general population, patients, total) and 2 predictor sets: demographic and disease-related variables with/without patient-reported outcomes. Model performance was evaluated by mean absolute error and percent of predictions within clinically irrelevant error range and within correct health severity group (EQ-5D-3L index <0.45, 0.45-0.926, >0.926). RESULTS The data set involved 26 318 individuals (clinical settings n = 6214, general population n = 20 104) and 26 predictor variables plus diagnoses. Using all predictors and the total sample, mean absolute error values were 0.153, 0.126, and 0.131, percent of predictions within clinically irrelevant error range were 47.6%, 39.5%, and 37.4%, and within the correct health severity group were 56.3%, 64.9%, and 63.3% by XGBC, XGBR, and OLS, respectively. The performance of models depended on the applied evaluation criteria, the target population, the included predictors, and the EQ-5D-3L index score range. CONCLUSIONS Regression models (XGBR and OLS) outperformed XGBC, yet prediction errors were outside the clinically irrelevant error range for most respondents. Our results highlight the importance of systematic patient-reported outcome (EQ-5D) data collection. Dialogs between artificial intelligence and outcomes research experts are encouraged to enhance the value of accumulating data in health systems.
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Affiliation(s)
- Zsombor Zrubka
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary; Corvinus Institue for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary.
| | - István Csabai
- Department of Physics of Complex Systems, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Zoltán Hermann
- Institute of Economics, Centre for Economic and Regional Studies, Budapest, Hungary; Institute of Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Dominik Golicki
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | | | - Marko Ogorevc
- Institute for Economic Research, Ljubljana, Slovenia
| | - László Gulácsi
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary; Corvinus Institue for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
| | - Márta Péntek
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
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Abstract
AIMS The aim of this study was to report the meaningful values of the EuroQol five-dimension three-level questionnaire (EQ-5D-3L) and EuroQol visual analogue scale (EQ-VAS) in patients undergoing primary knee arthroplasty (KA). METHODS This is a retrospective study of patients undergoing primary KA for osteoarthritis in a university teaching hospital (Royal Infirmary of Edinburgh) (1 January 2013 to 31 December 2019). Pre- and postoperative (one-year) data were prospectively collected for 3,181 patients (median age 69.9 years (interquartile range (IQR) 64.2 to 76.1); females, n = 1,745 (54.9%); median BMI 30.1 kg/m2 (IQR 26.6 to 34.2)). The reliability of the EQ-5D-3L was measured using Cronbach's alpha. Responsiveness was determined by calculating the anchor-based minimal clinically important difference (MCID), the minimal important change (MIC) (cohort and individual), the patient-acceptable symptom state (PASS) predictive of satisfaction, and the minimal detectable change at 90% confidence intervals (MDC-90). RESULTS The EQ-5D-3L demonstrated good internal consistency with an overall Cronbach alpha of 0.75 (preoperative) and 0.88 (postoperative), respectively. The MCID for the Index score was 0.085 (95% confidence interval (CI) 0.042 to 0.127) and EQ-VAS was 6.41 (95% CI 3.497 to 9.323). The MICCOHORT was 0.289 for the EQ-5D and 5.27 for the EQ-VAS. However, the MICINDIVIDUAL for both the EQ-5D-3L Index (0.105) and EQ-VAS (-1) demonstrated poor-to-acceptable reliability. The MDC-90 was 0.023 for the EQ-5D-3L Index and 1.0 for the EQ-VAS. The PASS for the postoperative EQ-5D-3L Index and EQ-VAS scores predictive of patient satisfaction were 0.708 and 77.0, respectively. CONCLUSION The meaningful values of the EQ-5D-3L Index and EQ-VAS scores can be used to measure clinically relevant changes in health-related quality of life in patients undergoing primary KA.Cite this article: Bone Joint Res 2022;11(9):619-628.
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Affiliation(s)
- Liam Z Yapp
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.,Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Chloe E H Scott
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.,Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Colin R Howie
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.,Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Deborah J MacDonald
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.,Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Hamish R W Simpson
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.,Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nick D Clement
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.,Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
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Abstract
BackgroundNotwithstanding unequivocal consensus on the disproportionate effect of severe asthma (SA) on asthma morbidity, healthcare utilisation, quality of life, work impairment and socioeconomic burden, the burden of SA patients in Singapore has not been appraised.ObjectivesTo determine the burden of disease and extent of quality of life impairment in SA patients in Singapore.MethodsA cross-sectional analysis of SA patients seen in Singapore General Hospital (2020-2021) to investigate emergency healthcare utilization, oral corticosteroid (OCS) burden and health-related quality of life (HRQoL) with primary endpoint EuroQoL-5 Dimension three-level (EQ-5D-3L) scores. The empirical measurement properties of the EQ-5D utility index in SA were comprehensively assessed through multivariate regression analyses.ResultsA total of 336 SA patients were recruited, 51.2% of SA patients had at least one acute healthcare resource utilization during the previous year, with 25.6% of patients having an emergency healthcare visit to the hospital. Overall mean (SD) EQ-5D-3L and EQ-5D-3L utility scores in SA patients were 6.22 (1.51) and 0.77 (0.30), respectively. EQ-5D utility scores were 0.14 lower in uncontrolled vs controlled asthma and 0.09 lower in the presence of severe exacerbation, whereas barely changed by maintenance OCS dose and airflow limitation.ConclusionSA patients were found to have high disease burden, high healthcare resource utilization and OCS use, low biologics usage, poor HRQoL and utility in comparison with other chronic diseases.
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Affiliation(s)
| | | | - Pei Yee Tiew
- Duke-NUS Medical School, Singapore.,Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Mariko Siyue Koh
- Duke-NUS Medical School, Singapore.,Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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Kontodimopoulos N, Stamatopoulou E, Gazi S, Moschou D, Krikelis M, Talias MA. A Comparison of EQ-5D-3L, EQ-5D-5L, and SF-6D Utilities of Patients with Musculoskeletal Disorders of Different Severity: A Health-Related Quality of Life Approach. J Clin Med 2022; 11. [PMID: 35887861 DOI: 10.3390/jcm11144097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/01/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022] Open
Abstract
This study compares EQ-5D-3L, EQ-5D-5L, and SF-6D utilities in patients with different musculoskeletal (MSK) disorders, also differing in disease severity as defined by valid clinical indexes. Utilities were measured from a cross-sectional sample of rheumatoid arthritis (N = 114), psoriatic arthritis (N = 57), ankylosing spondylitis (N = 49), and osteopenia/osteoporosis (N = 95) patients. For the first three groups, disease activity (severity) was measured with the DAS-28, DAPSA, and BASDAI clinical indexes, respectively. Mean differences and effect sizes were measured, and agreement between utilities was estimated with the intraclass correlation coefficient and Bland−Altman plots. Higher agreement was observed between EQ-5D-5L and SF-6D, compared to EQ-5D-3L and SF-6D, in all MSK disorder groups and severity levels. In groups with moderate to high severity, agreement between EQ-5D-3L/SF-6D and EQ-5D-5L/SF-6D was between low and fair, and both EQ-5D-3L and 5L utilities were lower than SF-6D (p < 0.001). On the other hand, in remission or low activity groups, agreement was excellent, and SF-6D utilities were again typically higher than EQ-5D-3L/5L, but not significantly. In more severe patients, SF-6D generated significantly higher utilities than EQ-5D-3L and 5L, which is consistent with most previous studies. Such discrepancies could have implications on economic evaluations of interventions targeting patients with MSK disorders.
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Innocenti M, Smulders K, Willems JH, Goosen JHM, van Hellemondt G. Patient-reported outcome measures, complication rates, and re-revision rates are not associated with the indication for revision total hip arthroplasty : a prospective evaluation of 647 consecutive patients. Bone Joint J 2022; 104-B:859-866. [PMID: 35775171 DOI: 10.1302/0301-620x.104b7.bjj-2021-1739.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: 11/05/2022]
Abstract
AIMS The aim of this study was to explore the relationship between reason for revision total hip arthroplasty (rTHA) and outcomes in terms of patient-reported outcome measures (PROMs). METHODS We reviewed a prospective cohort of 647 patients undergoing full or partial rTHA at a single high-volume centre with a minimum of two years' follow-up. The reasons for revision were classified as: infection; aseptic loosening; dislocation; structural failure; and painful THA for other reasons. PROMs (modified Oxford Hip Score (mOHS), EuroQol five-dimension three-level health questionnaire (EQ-5D-3L) score, and visual analogue scales for pain during rest and activity), complication rates, and failure rates were compared among the groups. RESULTS The indication for revision influenced PROMs improvement over time. This finding mainly reflected preoperative differences between the groups, but diminished between the first and second postoperative years. Preoperatively, patients revised due to infection and aseptic loosening had a lower mOHS than patients with other indications for revision. Pain scores at baseline were highest in patients being revised for dislocation. Infection and aseptic loosening groups showed marked changes over time in both mOHS and EQ-5D-3L. Overall complications and re-revision rates were 35.4% and 9.7% respectively, with no differences between the groups (p = 0.351 and p = 0.470, respectively). CONCLUSION Good outcomes were generally obtained regardless of the reason for revision, with patients having the poorest preoperative scores exhibiting the greatest improvement in PROMs. Furthermore, overall complication and reoperation rates were in line with previous reports and did not differ between different indications for rTHA. Cite this article: Bone Joint J 2022;104-B(7):859-866.
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Affiliation(s)
- Matteo Innocenti
- Department of Orthopaedic Surgery, University of Florence, Florence, Italy
| | - Katrijn Smulders
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Jore H Willems
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Jon H M Goosen
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Gijs van Hellemondt
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
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Clement ND, Afzal I, Peacock CJH, MacDonald D, Macpherson GJ, Patton JT, Asopa V, Sochart DH, Kader DF. Mapping analysis to predict the associated EuroQol five-dimension three-level utility values from the Oxford Knee Score : a prediction and validation study. Bone Jt Open 2022; 3:573-581. [PMID: 35837809 PMCID: PMC9350693 DOI: 10.1302/2633-1462.37.bjo-2022-0054.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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aims The aims of this study were to assess mapping models to predict the three-level version of EuroQoL five-dimension utility index (EQ-5D-3L) from the Oxford Knee Score (OKS) and validate these before and after total knee arthroplasty (TKA). Methods A retrospective cohort of 5,857 patients was used to create the prediction models, and a second cohort of 721 patients from a different centre was used to validate the models, all of whom underwent TKA. Patient characteristics, BMI, OKS, and EQ-5D-3L were collected preoperatively and one year postoperatively. Generalized linear regression was used to formulate the prediction models. Results There were significant correlations between the OKS and EQ-5D-3L preoperatively (r = 0.68; p < 0.001) and postoperatively (r = 0.77; p < 0.001) and for the change in the scores (r = 0.61; p < 0.001). Three different models (preoperative, postoperative, and change) were created. There were no significant differences between the actual and predicted mean EQ-5D-3L utilities at any timepoint or for change in the scores (p > 0.090) in the validation cohort. There was a significant correlation between the actual and predicted EQ-5D-3L utilities preoperatively (r = 0.63; p < 0.001) and postoperatively (r = 0.77; p < 0.001) and for the change in the scores (r = 0.56; p < 0.001). Bland-Altman plots demonstrated that a lower utility was overestimated, and higher utility was underestimated. The individual predicted EQ-5D-3L that was within ± 0.05 and ± 0.010 (minimal clinically important difference (MCID)) of the actual EQ-5D-3L varied between 13% to 35% and 26% to 64%, respectively, according to timepoint assessed and change in the scores, but was not significantly different between the modelling and validation cohorts (p ≥ 0.148). Conclusion The OKS can be used to estimate EQ-5D-3L. Predicted individual patient utility error beyond the MCID varied from one-third to two-thirds depending on timepoint assessed, but the mean for a cohort did not differ and could be employed for this purpose. Cite this article: Bone Jt Open 2022;3(7):573–581.
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Affiliation(s)
- Nick D Clement
- South West London Elective Orthopaedic Centre, Epsom, UK.,Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Irrum Afzal
- South West London Elective Orthopaedic Centre, Epsom, UK
| | | | | | - Gavin J Macpherson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
| | - James T Patton
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Vipin Asopa
- South West London Elective Orthopaedic Centre, Epsom, UK
| | | | - Deiary F Kader
- South West London Elective Orthopaedic Centre, Epsom, UK
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He Z, Liang W, Xu W, Huang W, Wang X, Huang K, Yang L. Mapping the FACT-G to EQ-5D-3L utility index in cancer with the Chinese values set. Expert Rev Pharmacoecon Outcomes Res 2022; 22:1103-1116. [PMID: 35711123 DOI: 10.1080/14737167.2022.2091546] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of this research was to create a function for mapping the cancer-specific instrument (FACT-G) to a preference-based measure (EQ-5D-3L) utility index for health-related quality of life, with utility scores generated using the Chinese value set. METHOD A cross-sectional study among 243 Chinese patients with cancer was conducted through EQ-5D-3L and FACT-G questionnaires survey. The EQ-5D-3L utility index values wad predicted based on OLS, GLM, CLAD, and Tobit model regression approaches. The performance and predictive power of each model were also evaluated using r2 and adj- r2, MAE, RMSE, ICC, and MID. Linear equating was used to avoid regression of the OLS model to mean. The model was validated using a 10-fold cross-validation method. RESULTS Among all regression models for the FACT-G, the OLS 5 model predicted mean EQ-5D-3L values the best, in terms of model goodness of fit (r2= 0.6230, r2= 58.93%, MAE = 0.0448, RMSE = 0.0624). The OLS model proved to be the most accurate for the mean, and the linear equating scores were much closer to observed scores. CONCLUSION Our results suggest that the best algorithm for FACT-G mapping to EQ-5D-3L utility index is OLS model, based on the survey of Chinese patients with cancer.
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Affiliation(s)
- ZhiKui He
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi Province, P.R. China
| | - WenJie Liang
- Department of Social Medicine, School of Public Health, Guangxi Medical University, Nanning, Guangxi Province, P.R. China
| | - WenJia Xu
- Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, Guangxi Province, P.R. China
| | - WenXiu Huang
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi Province, P.R. China
| | - XiaoMin Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, Nanning, Guangxi Province, P.R. China
| | - KaiYong Huang
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi Province, P.R. China
| | - Li Yang
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi Province, P.R. China
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Marten O, Greiner W. Feasibility properties of the EQ-5D-3L and 5L in the general population: evidence from the GP Patient Survey on the impact of age. Health Econ Rev 2022; 12:28. [PMID: 35593942 PMCID: PMC9121571 DOI: 10.1186/s13561-022-00374-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/11/2022] [Indexed: 05/09/2023]
Abstract
BACKGROUND There is evidence to suggest that the proportion of missing values is slightly higher in the older population resulting in lower completion rates of the EQ-5D. However, existing studies rarely provide a within-sample comparison of feasibility properties across age groups to quantify this difference. Hence, this study examines feasibility properties of the EQ-5D-3L and 5L in the general population and explores the impact of age on the completion of EQ-5D instruments. METHODS We pool five waves from the English GP Patient Survey, where respondents self-report their health in either EQ-5D-3L or 5L. Descriptive analysis was undertaken to analyse the distribution and proportion of missing values and completion rates stratified by age and EQ-5D version; logistic regression models were specified to quantify the impact of age, gender and potential long-term conditions on the completion of each of the EQ-5D instruments. RESULTS The total sample comprises ~ 4.36 million observations, of which 2.88 million respondents report their health in 5L and 1.47 million in 3L, respectively. Respondents over 64 years have slightly more missing values in each dimension than younger respondents. The highest share was observed for the oldest age group in the dimension anxiety/depression (3L 9.1% vs. 5L 7.6%), but was otherwise below 5%. Consequently, completion rates (observed and predicted) decreased with older age and at a higher rate after the age of 64; this was more pronounced for the 3L. CONCLUSION Evidence from our study suggests that both the EQ-5D-3L and 5L have good feasibility properties. In comparison to younger populations there appears to be a higher proportion of respondents with incomplete responses beyond the age of 64 years. Overall, the 5L version compares more favourably in terms of missing values, completion rates as well as with regard to the expected probability of an incomplete descriptive system.
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Affiliation(s)
- Ole Marten
- School of Public Health, Department of Health Economics and Health Care Management, Bielefeld University, Universitaetsstrasse 25, Bielefeld, Germany.
| | - Wolfgang Greiner
- School of Public Health, Department of Health Economics and Health Care Management, Bielefeld University, Universitaetsstrasse 25, Bielefeld, Germany
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Zhang RY, Wang W, Zhou HJ, Xuan JW, Luo N, Wang P. A head-to-head comparison of the EQ-5D-3L index scores derived from the two EQ-5D-3L value sets for China. Health Qual Life Outcomes 2022; 20:80. [PMID: 35590333 PMCID: PMC9118844 DOI: 10.1186/s12955-022-01988-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/01/2022] [Indexed: 12/04/2022] Open
Abstract
Objective Two EQ-5D-3L (3L) value sets (developed in 2014 and 2018) co-exist in China. The study examined the level of agreement between index scores for all the 243 health states derived from them at both absolute and relative levels and compared the responsiveness of the two indices. Methods Intraclass correlations coefficient (ICC) and Bland–Altman plot were adopted to assess the degree of agreement between the two indices at the absolute level. Health gains for 29,403 possible transitions between pairs of 3L health states were calculated to assess the agreement at the relative level. Their responsiveness for the transitions was assessed using Cohen effect size. Results The mean (SD) value was 0.427 (0.206) and 0.649 (0.189) for the 3L2014 and 3L2018 index scores, respectively. Although the ICC value showed good agreement (i.e., 0.896), 88.9% (216/243) of the points were beyond the minimum important difference limit according to the Bland–Altman plot. The mean health gains for the 29,403 health transitions was 0.234 (3L2014 index score) and 0.216 (3L2018 index score). The two indices predicted consistent transitions in 23,720 (80.7%) of 29,403 pairs. For the consistent pairs, Cohen effective size value was 1.05 (3L2014 index score) or 1.06 (3L2018 index score); and the 3L2014 index score only yielded 0.007 more utility gains. However, the results based on the two measures varied substantially according to the direction and magnitude of health change. Conclusion The 3L2014 and 3L2018 index scores are not interchangeable. The choice between them is likely to influence QALYs estimations.
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Affiliation(s)
- Ruo-Yu Zhang
- Shanghai Centennial Scientific Co., Ltd, Shanghai, China
| | - Wei Wang
- School of Public Health, Fudan University, 130 Dong An Road, Shanghai, 200032, China
| | - Hui-Jun Zhou
- Business School, University of Shanghai for Science and Technology, Shanghai, China
| | - Jian-Wei Xuan
- Health Economic Research Institute, Sun Yat-Sen University, Guangzhou, China
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Pei Wang
- School of Public Health, Fudan University, 130 Dong An Road, Shanghai, 200032, China. .,Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), Shanghai, China.
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Costa ML, Achten J, Parsons NR. Five-year outcomes for patients sustaining severe fractures of the lower limb : mid-term results from the Wound management for Open Lower Limb Fracture (WOLLF) trial. Bone Joint J 2022; 104-B:633-639. [PMID: 35491582 DOI: 10.1302/0301-620x.104b5.bjj-2021-1568.r2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/05/2022]
Abstract
AIMS The aim of this study was to report the outcomes of patients with severe open fractures of the lower limb in the five years after they took part in the Wound management for Open Lower Limb Fracture (WOLLF) trial. METHODS The WOLLF trial compared standard dressings to negative pressure wound therapy (NPWT) applied at the end of the first surgical wound debridement, and patients were followed-up for 12 months. At 12 months, 170 of the original 460 participants agreed to take part in this medium-term follow-up study. Patients reported their Disability Rating Index (DRI) (0 to 100, where 100 is total disability) and health-related quality of life (HRQoL) using the EuroQol five-dimension three-level health questionnaire (EQ-5D-3L) annually by self-reported questionnaire. Further surgical interventions related to the open fracture were also recorded. RESULTS There was no evidence of a difference in patient-reported disability, HRQoL, or the need for further surgery between patients treated with NPWT versus standard dressings at five years. Considering the combined results for all participants, there was a small but statistically significant change in DRI scores over time (1.6 units per year; p = 0.005), but no evidence that EQ-5D-3L scores changed significantly during years two to five (p = 0.551). CONCLUSION This study shows that the high levels of disability and reduced HRQoL reported by patients 12 months after severe open fractures of the lower limb persist in the medium term, with little evidence of improvement between years two and five. Cite this article: Bone Joint J 2022;104-B(5):633-639.
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Affiliation(s)
- Matt L Costa
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Juul Achten
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nick R Parsons
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Burström B, Irestig R, Burström K. EQ-5D-3L Health Status Among Homeless People in Stockholm, Sweden, 2006 and 2018. Front Public Health 2022; 9:780753. [PMID: 34988055 PMCID: PMC8720753 DOI: 10.3389/fpubh.2021.780753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Homeless people are a socially excluded group whose health reflects exposures to intersecting social determinants of health. The aim of this study was to describe and compare the demographic composition, certain social determinants of health, and self-reported health among homeless people in Stockholm, Sweden, in 2006 and 2018. Methods: Analysis of data from face-to-face interviews with homeless people in Stockholm 2006 (n = 155) and 2018 (n = 148), based on a public health survey questionnaire adapted to the group, including the EQ-5D-3L instrument. The chi-squared test was employed to test for statistical significance between groups and the independent t-test for comparison of mean scores and values. Ordinary Least Squares (OLS) regression, with Robust Standard Errors (RSE) was performed on merged 2006 and 2018 data with mean observed EQ VAS score as outcome variable. Results: In 2018 more homeless people originated from countries outside Europe, had temporary social assistance than long-term social insurance, compared to in 2006. In 2018 more respondents reported lack of social support, exposure to violence, and refrained from seeking health care because of economic reasons. Daily smoking, binge drinking, and use of narcotic drugs was lower 2018 than 2006. In 2018 a higher proportion reported problems in the EQ-5D-3L dimensions, the mean TTO index value and the VAS index value was significantly lower than in 2006. In the regression analysis of merged data there was no significant difference between the years. Conclusions: Homeless people are an extremely disadvantaged group, have high rates of illness and disease and report poor health in all EQ-5D-3L dimensions. The EQ VAS score among the homeless people in 2018 is comparable to the score among persons aged 95-104 years in the general Swedish population 2017. The EQ-5D-3L instrument was easily administered to this group, its use allows comparison with larger population groups. Efforts are needed regarding housing, but also intensified collaboration by public authorities with responsibilities for homeless people's health and social welfare. Further studies should evaluate the impact of such efforts by health and social care services on the health and well-being of homeless people.
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Affiliation(s)
- Bo Burström
- Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Kristina Burström
- Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Health Outcomes and Economic Evaluation Research Group, Department of Learning, Informatics, Management and Ethics, Stockholm Centre for Healthcare Ethics, Karolinska Institutet, Stockholm, Sweden
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Qu S, Wang A, Wang X, Yang Y, Pan X, Zhang T. Health-Related Quality of Life of HIV-Positive and HIV-Negative Pregnant Women in an Impoverished Area: Cross-sectional Study. JMIR Public Health Surveill 2022; 8:e29906. [PMID: 35380543 PMCID: PMC9019641 DOI: 10.2196/29906] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 10/13/2021] [Accepted: 02/21/2022] [Indexed: 11/21/2022] Open
Abstract
Background Liangshan prefecture of Sichuan province was an impoverished mountainous area in China, where the annual number of HIV-positive pregnant women accounted for approximately 10% of China’s total population in the decades before 2020. In general, pregnant women living here are likely to be physically and mentally different from those in other places. Objective This study aims to explore the health-related quality of life (HRQoL) of pregnant women living with HIV in an impoverished area. Methods From December 2018 to January 2019, HIV-positive and HIV-negative parturients within 18 months after delivery were recruited in Liangshan Prefecture, Sichuan Province. Questionnaires were designed to collect their demographic data, while the EuroQol 5-Dimension, 3-Level questionnaire was used to measure their HRQoL when they were in the second trimester from 4 to 6 months of pregnancy, and their quantitative health scores were converted to corresponding healthy utility values by using the Chinese Utility Value Integral System (time trade-off coefficient). Results A total of 250 pregnant women (133 HIV-positive and 117 HIV-negative) were enrolled in the study. Among them, 55 (41.35%) and 75 (64.10%) of HIV-positive and HIV-negative pregnant women self-reported full health (healthy state 11111), respectively. The median health utility value of the 250 pregnant women was 0.961 (IQR –0.046 to 0.961), and those of the HIV-positive and HIV-negative pregnant women were 0.875 (0.424-0.961) and 0.961 (IQR –0.046 to 0.961), respectively. We observed a significant difference only in the dimension of anxiety or depression between the two groups (P=.002) and no significant difference in the distribution of health utility indices between the two groups in terms of maternal age, education level, occupation, annual household income, prenatal care visits, family size, and medical insurance category. Multivariate ordinal logistic regression analysis showed that age (odds ratio [OR] 0.62, P<.05) and prenatal care visit (OR 0.29, P<.01) were independent risk factors for health status. Conclusions Most pregnant women self-reported satisfactory HRQoL in this impoverished mountainous area. HIV-negative pregnant women had an edge over HIV-positive pregnant women, and there were significant differences in anxiety or depression dimensions between the two groups.
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Affiliation(s)
- Shuiling Qu
- Chinese Center for Disease Control and Prevention, Beijing, China.,National Center for Women and Children's Health Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ailing Wang
- National Center for Women and Children's Health Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoyan Wang
- National Center for Women and Children's Health Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yehuan Yang
- National Center for Women and Children's Health Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoping Pan
- National Center for Women and Children's Health Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tong Zhang
- Capital Institute of Pediatrics, Beijing, China
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Elcock KL, Carter TH, Yapp LZ, MacDonald DJ, Howie CR, Stoddart A, Berg G, Clement ND, Scott CEH. Total knee arthroplasty in patients with severe obesity provides value for money despite increased complications. Bone Joint J 2022; 104-B:452-463. [PMID: 35360945 DOI: 10.1302/0301-620x.104b4.bjj-2021-0353.r3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/30/2022]
Abstract
AIMS Access to total knee arthroplasty (TKA) is sometimes restricted for patients with severe obesity (BMI ≥ 40 kg/m2). This study compares the cost per quality-adjusted life year (QALY) associated with TKA in patients with a BMI above and below 40 kg/m2 to examine whether this is supported. METHODS This single-centre study compared 169 consecutive patients with severe obesity (BMI ≥ 40 kg/m2) (mean age 65.2 years (40 to 87); mean BMI 44.2 kg/m2 (40 to 66); 129/169 female) undergoing unilateral TKA to a propensity score matched (age, sex, preoperative Oxford Knee Score (OKS)) cohort with a BMI < 40 kg/m2 in a 1:1 ratio. Demographic data, comorbidities, and complications to one year were recorded. Preoperative and one-year patient-reported outcome measures (PROMs) were completed: EuroQol five-dimension three-level questionnaire (EQ-5D-3L), OKS, pain, and satisfaction. Using national life expectancy data with obesity correction and the 2020 NHS National Tariff, QALYs (discounted at 3.5%), and direct medical costs accrued over a patient's lifetime, were calculated. Probabilistic sensitivity analysis (PSA) was used to model variation in cost/QALY for each cohort across 1,000 simulations. RESULTS All PROMs improved significantly (p < 0.05) in both groups without differences between groups. Early complications were higher in BMI ≥ 40 kg/m2: 34/169 versus 52/169 (p = 0.050). A total of 16 (9.5%) patients with a BMI ≥ 40 kg/m2 were readmitted within one year with six reoperations (3.6%) including three (1.2%) revisions for infection. Assuming reduced life expectancy in severe obesity and revision costs, TKA in patients with a BMI ≥ 40 kg/m2 costs a mean of £1,013/QALY (95% confidence interval £678 to 1,409) more over a lifetime than TKA in patients with BMI < 40 kg/m2. In PSA replicates, the maximum cost/QALY was £3,921 in patients with a BMI < 40 kg/m2 and £5,275 in patients with a BMI ≥ 40 kg/m2. CONCLUSION Higher complication rates following TKA in severely obese patients result in a lifetime cost/QALY that is £1,013 greater than that for patients with BMI < 40 kg/m2, suggesting that TKA remains a cost-effective use of healthcare resources in severely obese patients where the surgeon considers it appropriate. Cite this article: Bone Joint J 2022;104-B(4):452-463.
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Affiliation(s)
| | - Thomas H Carter
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Liam Z Yapp
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Colin R Howie
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
| | - Andrew Stoddart
- Usher Institute, Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Guy Berg
- Healthcare Improvement Scotland, Edinburgh, UK
| | - Nick D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Chloe E H Scott
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
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Shimels T, Kassu RA, Bogale G, Muleta MB, Akalu GT, Getachew A, Shewamene Z, Getnet M, Abraha M. Health-Related Quality of Life of Patients with Type 2 Diabetes Mellitus and Hypertension in Addis Ababa, Ethiopia. Ethiop J Health Sci 2022; 32:381-392. [PMID: 35693563 PMCID: PMC9175229 DOI: 10.4314/ejhs.v32i2.19] [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] [Received: 04/07/2021] [Accepted: 11/03/2021] [Indexed: 11/09/2022] Open
Abstract
Background The aim of this study was to assess the health-related quality of life of patients with T2DM and hypertension attending public health facilities in Addis Ababa, Ethiopia. Methods A cross-sectional study was conducted from 1st through 30th August 2020 at the selected institutions. Health facilities were chosen purposively based on patient load. Participants were drawn after proportional to size allocation. A translated EQ-5D-3L, and EQ-VAS instrument was used to collect the data. Analysis was done using SPSS v.26.0. Both parametric and non-parametric models were applied in the analysis. Results Of the 409 participants included, the majority were in the age group of 46-60 (36.0%), females (56.0%), from hospitals (54.8%), jobless (25.4%), and married (63.3%). Over two-thirds of the patients reported no problems with self-care, usual activity, and depression/anxiety. All dimensions showed an increasing proportion of moderate to severe problems in the age group beyond 45. Facility type, comorbid condition and age showed a statistically significant score difference for QoL. The overall prevalence of any problem was 59.0%. Education level, visit to a health center, and marriage showed lower odds of affected HRQoL whereas, lower monthly income and presence of comorbidities were opposite. Conclusion HRQoL of patients in the study settings was suboptimal and below the general population. Attributes, such as education, facility type, marital status, income level, and comorbid status have a statistically significant association with HRQoL. Arrangement of a safe and quality health services is paramount, especially, during the COVID-19 pandemic.
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Affiliation(s)
- Tariku Shimels
- Research Directorate, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Rodas Asrat Kassu
- Department of Neurology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Gelila Bogale
- United Vision Medical Services, Addis Ababa, Ethiopia
| | - Mahteme Bekele Muleta
- Research Directorate, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Gizachew Tadesse Akalu
- Depertment of Microbiology, Immunology, and Parasitology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abrham Getachew
- Research Directorate, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Melsew Getnet
- Research Directorate, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mebratu Abraha
- Research Directorate, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Abstract
Purpose To undertake the first testing and comparison of measurement properties for the EuroQol EQ-5D-3L and 5L in patients with ankle problems. Methods The cross-sectional postal survey of 959 patients aged ≥ 18 years, who underwent surgical treatment (ORIF) for unstable and closed ankle fractures in Eastern Norway. Both the EQ-5D-3L and 5L were included in a postal questionnaire in 2015, 3–6 years post surgery. Missing data, floor and ceiling effects, and response consistency were assessed. Tests of validity included comparisons with scores for the SF-36 and widely used ankle-specific instruments. The 5L version was assessed for test–retest reliability. Results There were 567 (59%) respondents; 501 completed both versions and 182 (61%) the 5L retest questionnaire. The 5L outperformed the 3L in tests of data quality and classification efficiency. Correlations with scores for other instruments largely met expectations, those for the 5L being slightly higher. All 5L scores had acceptable levels of reliability. For the 5L index, the smallest detectable differences for group and individual comparisons were 0.02 and 0.20, respectively. Conclusion The 5L outperformed the 3L in terms of data quality, number of health states assessed and tests of validity. The 5L is recommended in research and other applications following surgery for ankle fracture but further testing including responsiveness to change is recommended at clinically relevant follow-up periods.
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Mannan A, Akter KM, Akter F, Chy NUHA, Alam N, Pinky SD, Chowdhury AFMN, Biswas P, Chowdhury AS, Hossain MA, Rana MM. Association between comorbidity and health-related quality of life in a hypertensive population: a hospital-based study in Bangladesh. BMC Public Health 2022; 22:181. [PMID: 35081905 PMCID: PMC8793199 DOI: 10.1186/s12889-022-12562-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/06/2021] [Accepted: 01/11/2022] [Indexed: 12/22/2022] Open
Abstract
Background Hypertension is a known risk factor for several chronic conditions including diabetes and cardiovascular diseases. However, little is known about its impact on Health-related quality of life (HRQoL) in the context of Bangladesh. This study aimed to evaluate the association of hypertension on HRQoL among Bangladeshi patients corresponding to the socio-demographic condition, comorbid conditions, treatment, and health outcomes. Methods A hospital based cross-sectional study was conducted using a pre-tested structured questionnaire among patients with hypertension in 22 tertiary medical college hospitals in Bangladesh. The study recruited male and female hypertensive patients of age ≥18 years between July 2020 to February 2021 using consecutive sampling methods. Health related quality of life was measured using the widely-used index of EQ-5D that considers 243 different health-related attributes and uses a scale in which 0 indicates a health state equivalent to death and 1 indicates perfect health status. The five dimensions of the quality index included mobility, self-care, usual activities, pain or discomfort, and anxiety or depression. Ordered logit regression and linear regression models were used to estimate the predictors of comorbidity and HRQoL. Results Of the 1,912 hypertensive patients, 56.2% were female, 86.5% were married, 70.7% were either overweight or obese, 67.6% had a family history of hypertension, and 85.5% were on anti-hypertensive medication. Among the individuals with comorbidities, 47.6% had diabetes, 32.3% were obese, 16.2% had heart disease, 15% were visually impaired, and 13.8% were suffering from psychological diseases. HRQoL was found to be inversely proportional to the number of comorbidities. The most frequent comorbidities of diabetes and obesity showed the highest EQ- 5D mean utilities of 0.59 and 0.64, respectively. Conclusions Prevalent comorbidities, diabetes and obesity were found to be the significant underlying causes of declining HRQoL. It is recommended that the comorbidities should be adequately addressed for better HRQoL. Special attention should be given to address mental health issues of patients with hypertension. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12562-w.
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Affiliation(s)
- Adnan Mannan
- Department of Genetic Engineering & Biotechnology, Faculty of Biological Sciences, University of Chittagong, Chattogram, 4331, Bangladesh.
| | - Kazi Mahmuda Akter
- Department of Obstetrics and Gynaecology, Sir Salimullah Medical College Mitford Hospital, Dhaka, 1206, Bangladesh
| | - Farhana Akter
- Department of Endocrinology, Chittagong Medical College, Chattogram, 4203, Bangladesh
| | - Naim Uddin Hasan A Chy
- Health Economics Research Group, Department of Economics, University of Chittagong, Chattogram, 4331, Bangladesh
| | - Nazmul Alam
- Department of Public Health, Asian University for Women, Chattogram, 4000, Bangladesh
| | - Susmita Dey Pinky
- Department of Medicine, Chittagong Medical College, Chattogram, 4203, Bangladesh
| | | | - Parijat Biswas
- Department of Medicine, Chittagong Medical College, Chattogram, 4203, Bangladesh
| | - Afrin Sultana Chowdhury
- Department of Biotechnology and Genetic Engineering, Noakhali Science and Technology University, Noakhali, 3814, Bangladesh
| | | | - Md Mashud Rana
- Department of Pharmacology and Therapeutics, Chittagong Medical College, 4203, Chattogram, Bangladesh
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Maclennan B, Wyeth E, Samaranayaka A, Derrett S. Predictors of EQ-5D-3L outcomes amongst injured Māori: 1-year post-injury findings from a New Zealand cohort study. Qual Life Res 2022; 31:1689-1701. [PMID: 35076826 PMCID: PMC8787030 DOI: 10.1007/s11136-022-03085-3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Māori, the Indigenous population of New Zealand (NZ), are at higher risk of problems with health-related quality of life (HRQoL) 12 months following injury. This paper examines pre-injury sociodemographic and health characteristics and injury-related factors, including healthcare access, and their association with HRQoL outcomes 12 months after injury. METHODS The Prospective Outcomes of Injury Study recruited 2856 injured New Zealanders aged 18-64 years from the entitlement claims register of the country's no-fault injury insurance agency. One-fifth (n = 566) of the cohort were Māori. Information on predictors and outcomes, with the exception of injury and hospitalisation, was obtained directly from participants at approximately 3 and 12 months post-injury. The outcomes of interest were responses to the five dimensions of the EQ-5D-3L and a dichotomous measure obtained by summing scored responses to each question. Modified Poisson regression was used to identify predictors of each outcome at 12 months post-injury. RESULTS Predictors differed by outcome. Being female, experiencing EQ-5D-3L problems pre-injury, having ≥ 2 chronic conditions pre-injury, perceiving one's injury to be a threat of long-term disability, and having trouble accessing health services for injury were common predictors of EQ-5D-3L problems at 12 months post-injury for Māori. CONCLUSION Opportunities exist to improve HRQoL outcomes by identifying individuals in the early stages of injury recovery who may benefit from further treatment and support.
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Affiliation(s)
- Brett Maclennan
- Department of Preventive and Social Medicine, Dunedin School of Medicine, Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Emma Wyeth
- Department of Preventive and Social Medicine, Dunedin School of Medicine, Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Ari Samaranayaka
- Biostatistics Centre, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Department of Preventive and Social Medicine, Dunedin School of Medicine, Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), University of Otago, PO Box 56, Dunedin, 9054, New Zealand
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Kalayou Haftu H, Hailemariam D, Tassew B, Hagos Gufue Z, Aberhe W. Health-Related Quality of Life Using EQ-5D-3L Utility Score Among Type 2 Diabetes Patients: Experiences from Tigray Region, Northern Ethiopia. Patient Prefer Adherence 2022; 16:3143-3155. [PMID: 36483918 PMCID: PMC9724574 DOI: 10.2147/ppa.s324586] [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] [Received: 06/24/2021] [Accepted: 08/19/2022] [Indexed: 12/05/2022] Open
Abstract
PURPOSE To assess the health-related quality of life and associated factors among type 2 diabetic patients in Ayder Comprehensive Specialized Hospital, Northern Ethiopia, 2019. PATIENTS AND METHODS A hospital-based cross-sectional study was conducted among 415 type 2 diabetic patients coming to receive their routine outpatient follow-up service during the study period, from January 1, 2019, to March 31, 2019, in Ayder Comprehensive Specialized Hospital, Northern Ethiopia. The EQ-5D-3L instrument was used to assess the patients' self-reported health status and a multivariable ordinal logistic regression model was used to determine the independent factors associated with the health-related quality of life and P-value <0.05 was used to declare statistical significance. RESULTS The total mean quality of life score was 0.73 ± 0.23 with the total quality-adjusted life year of 2172.60 per life years and an average of 7.4 years of follow-up with type 2 diabetic treatments. Quality of life of type 2 diabetic patients with level two and three anxious patients were 77% and almost three times more likely to be affected than level one anxious patients (AOR = 1.77; 95% CI 1.23-1.86) and (AOR = 2.74; 95% CI 1.24-2.84) respectively. Older age, occupational status, lower monthly income, long waiting time, and presence of diabetic complications were significantly associated with impaired health-related quality of life. CONCLUSION The results of this study revealed a relatively low health status among type 2 diabetic patients. Quality of life of type 2 diabetic patients was mostly affected in the anxiety and depression component. It could be worthwhile if hospitals assign psychiatric professionals for the regular and effective counseling of diabetic patients.
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Affiliation(s)
- Hiluf Kalayou Haftu
- Department of Curative and Rehabilitative Services, Health Care Reforms, Tigray Regional Health Bureau, Tigray, Ethiopia
- Correspondence: Hiluf Kalayou Haftu, Email
| | - Damen Hailemariam
- Department of Reproductive Health and Health Services Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Berhan Tassew
- Department of Reproductive Health and Health Services Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zenawi Hagos Gufue
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Tigray, Ethiopia
| | - Woldu Aberhe
- Department of Adult Health Nursing, School of Nursing, College of Health Sciences, Aksum University, Tigray, Ethiopia
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Shahedifar N, Sadeghi-Bazargani H, Asghari-Jafarabadi M, Farahbakhsh M, Bazargan-Hejazi S, Razzaghi A, Golestani M, Pourasghar F. Psychometric Properties of EQ-5D-3L Applied through Phone Follow-Ups: An Experience in PERSIAN Traffic Cohort. Bull Emerg Trauma 2022; 10:181-188. [PMID: 36568715 PMCID: PMC9758709 DOI: 10.30476/beat.2022.95972.1375] [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] [Received: 06/28/2022] [Revised: 09/12/2022] [Accepted: 09/25/2022] [Indexed: 12/27/2022] Open
Abstract
Objective To assess psychometric properties of the European Quality of Life 5-Dimension 3-Level Version (EQ-5D-3L) commonly used tool for measuring road traffic injury (RTI) patients' quality of life. Methods The psychometric study assessed the reliability and applicability of EQ-5D-3L through phone surveys, based on a national cohort platform. Data of 150 RTI patients recruited from the cohort study were included as 50 patients per each follow-up phase (one, six, and twelve months after discharge). A 12- day-time span was between test and retest. We measured psychometric properties (internal consistency reliability and stability reliability) and agreement using Kappa coefficients and percentages of agreement and Bland-Altman method. Data were analysed using software STATA statistical package. Results The majority of patients were men (80%) with mean age (SD) of 41(14.7%), employed (78%) and educated (86%). The Persian version represented high internal consistency reliability at total level (Cronbach's α=0.81) and moderate to good reliability at phase levels (0.62-0.87). The stability reliability was excellent at total (ICC=0.98, 95% CI: 0.97, 0.98) and phase levels (0.97-0.98. The kappa agreement coefficients were valued moderate to perfect (0.6-0.8, p>0.0001). The Bland-altman plot illustrated high agreement between test and retest scores. No floor and ceiling effects were found. Conclusion The study revealed that EQ-5D-3L was highly reliable and responsive to be applied through phone interviews at three different times post injury and discharge, as no previous study considered its psychometric properties at various phone follow-ups after RTIs.
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Affiliation(s)
- Nasrin Shahedifar
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran ,Injury Epidemiology and Prevention Research Group, Turku Brain Injury Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Homayoun Sadeghi-Bazargani
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran ,Corresponding author: Homayoun Sadeghi-Bazargani Address: Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz 5167846311, East Azerbaijan, Iran. e-mail:
| | - Mohammad Asghari-Jafarabadi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran ,Cabrini Research, Cabrini Health, Melbourne, VIC, 3144, Australia ,School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, 3800, Australia
| | - Mostafa Farahbakhsh
- Research Center of Psychiatry and Behavioural Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahrzad Bazargan-Hejazi
- College of Medicine, Charles Drew University of Medicine and Science, Los Angeles, California, USA
| | - Alireza Razzaghi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mina Golestani
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Faramarz Pourasghar
- Department of Medical Informatics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Makaram NS, Goudie EB, Robinson CM. Outcomes associated with secondary implant removal and arthrolysis in patients with a painful stiff shoulder after proximal humeral fracture fixation. Bone Joint J 2022; 104-B:157-167. [PMID: 34969266 DOI: 10.1302/0301-620x.104b1.bjj-2021-0675.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: 11/05/2022]
Abstract
AIMS Open reduction and plate fixation (ORPF) for displaced proximal humerus fractures can achieve reliably good long-term outcomes. However, a minority of patients have persistent pain and stiffness after surgery and may benefit from open arthrolysis, subacromial decompression, and removal of metalwork (ADROM). The long-term results of ADROM remain unknown; we aimed to assess outcomes of patients undergoing this procedure for stiffness following ORPF, and assess predictors of poor outcome. METHODS Between 1998 and 2018, 424 consecutive patients were treated with primary ORPF for proximal humerus fracture. ADROM was offered to symptomatic patients with a healed fracture at six months postoperatively. Patients were followed up retrospectively with demographic data, fracture characteristics, and complications recorded. Active range of motion (aROM), Oxford Shoulder Score (OSS), and EuroQol five-dimension three-level questionnaire (EQ-5D-3L) were recorded preoperatively and postoperatively. RESULTS A total of 138 patients underwent ADROM; 111 patients were available for long-term follow-up at a mean of 10.9 years (range 1 to 20). Mean age was 50.8 years (18 to 75);79 (57.2%) were female. Mean time from primary ORPF to ADROM was 11.9 months (6 to 19). Five patients developed superficial wound infection; ten developed symptomatic osteonecrosis/post-traumatic arthrosis (ON/PTA); four underwent revision arthrolysis. Median OSS improved from 17 (interquartile range (IQR) 12.0 to 22.0) preoperatively to 40.0 (IQR 31.5 to 48.0) postoperatively, and 39.0 (IQR 31.5 to 46.5) at long-term follow-up (p < 0.001). Median EQ-5D-3L improved from 0.079 (IQR -0.057 to 0.215) to 0.691 (IQR 0.441 to 0.941) postoperatively, and 0.701 (IQR 0.570 to 0.832) at long-term follow-up (p < 0.001). We found that aROM improved in all planes (p < 0.001). Among the variables assessed on multivariable analysis, a manual occupation, worsening Charlson Comorbidity Index and increasing socioeconomic deprivation were most consistently predictive of worse patient-reported outcome scores. Patients who subsequently developed ON/PTA reported significantly worse one-year and late OSS. CONCLUSION ADROM in patients with persistent symptomatic stiffness following ORPF can achieve excellent short- and long-term outcomes. More deprived patients, those in a manual occupation, and those with worsening comorbidities have worse outcomes following ADROM. Cite this article: Bone Joint J 2022;104-B(1):157-167.
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Affiliation(s)
- Navnit S Makaram
- Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ewan B Goudie
- Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Edinburgh, UK
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Abstract
Background The types of outcomes measured collected in clinical studies and those required for cost-effectiveness analysis often differ. Decision makers routinely use quality adjusted life years (QALYs) to compare the benefits and costs of treatments across different diseases and treatments using a common metric. QALYs can be calculated using preference-based measures (PBMs) such as EQ-5D-3L, but clinical studies often focus on objective clinician or laboratory measured outcomes and non-preference-based patient outcomes, such as QLQ-C30. We model the relationship between the generic, preference-based EQ-5D-3L and the cancer specific quality of life questionnaire, QLQ-C30 in patients with breast cancer. This will result in a mapping that allows users to convert QLQ-C30 scores into EQ-5D-3L scores for the purposes of cost-effectiveness analysis or economic evaluation. Methods We use data from a randomized trial of 602 patients with HER2-positive advanced breast cancer provided 3766 EQ-5D-3L observations. Direct mapping using adjusted, limited dependent variable mixture models (ALDVMM) is compared to a random effects linear regression and indirect mapping using seemingly unrelated ordered probit models. EQ-5D-3L was estimated as a function of the summary scales of the QLQ-C30 and other patient characteristics. Results A four component mixture model outperformed other models in terms of summary fit statistics. A close fit to the observed data was observed across the range of disease severity. Simulated data from the model closely aligned to the original data and showed that mapping did not significantly underestimate uncertainty. In the simulated data, 22.15% were equal to 1 compared to 21.93% in the original data. Variance was 0.0628 in the simulated data versus 0.0693 in the original data. The preferred mapping is provided in Excel and Stata files for the ease of users. Conclusion A four component adjusted mixture model provides reliable, non-biased estimates of EQ-5D-3L from the QLQ-C30, to link clinical studies to economic evaluation of health technologies for breast cancer. This work adds to a growing body of literature demonstrating the appropriateness of mixture model based approaches in mapping. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08964-5.
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Affiliation(s)
- Laura A Gray
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Monica Hernandez Alava
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Allan J Wailoo
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
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Shaw JW, Bennett B, Trigg A, DeRosa M, Taylor F, Kiff C, Ntais D, Noon K, King MT, Cocks K. A Comparison of Generic and Condition-Specific Preference-Based Measures Using Data From Nivolumab Trials: EQ-5D-3L, Mapping to the EQ-5D-5L, and European Organisation for Research and Treatment of Cancer Quality of Life Utility Measure-Core 10 Dimensions. Value Health 2021; 24:1651-1659. [PMID: 34711366 DOI: 10.1016/j.jval.2021.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/02/2021] [Accepted: 05/24/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES There is growing interest in condition-specific preference measures, including the European Organisation for Research and Treatment of Cancer Quality of Life Utility Measure-Core 10 Dimensions (QLU-C10D). This research assessed the implications of using utility indices on the basis of the EQ-5D-3L, a mapping of EQ-5D-3L to the EQ-5D-5L, and the QLU-C10D, and compared their psychometric properties. METHODS Data were taken from 8 phase 3 randomized controlled trials of nivolumab with or without ipilimumab for the treatment of solid tumors. Utilities for progression-related states were calculated using the UK and English value sets and incremental quality-adjusted life-years (QALYs) derived from established UK cost-effectiveness models. The psychometric properties of the utility indices were assessed using pooled trial data. RESULTS Compared with the EQ-5D-3L index, the mapped EQ-5D-5L index yielded an average of 6% more and the QLU-C10D index an average of 2% fewer incremental QALYs for nivolumab versus comparators. All indices could differentiate between groups defined by performance status, cancer stage, or self-reported health status at baseline and detect meaningful changes in performance status, tumor response, health status, and quality of life over approximately 12 weeks of treatment. CONCLUSIONS The lower QALY yield of the QLU-C10D was balanced by evidence of greater validity and responsiveness. Benefits gained from using the QLU-C10D may be apparent when treatments affect targeted symptoms and functional aspects, including sleep, bowel function, appetite, nausea, and fatigue. The observed differences in QALYs may not be sufficiently large to affect health technology assessment decisions.
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Affiliation(s)
- James W Shaw
- Worldwide Health Economics and Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA.
| | - Bryan Bennett
- Bristol Myers Squibb Pharmaceuticals Ltd, Uxbridge, England, UK
| | - Andrew Trigg
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, England, UK
| | - Michael DeRosa
- Patient-Centered Outcomes, Adelphi Values, Boston, MA, USA
| | - Fiona Taylor
- Patient-Centered Outcomes, Adelphi Values, Boston, MA, USA
| | | | - Dionysios Ntais
- Bristol Myers Squibb Pharmaceuticals Ltd, Uxbridge, England, UK
| | - Katie Noon
- Bristol Myers Squibb Pharmaceuticals Ltd, Uxbridge, England, UK
| | | | - Kim Cocks
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, England, UK
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Bulamu NB, Vissapragada R, Chen G, Ratcliffe J, Mudge LA, Smithers BM, Isenring EA, Smith L, Jamieson GG, Watson DI. Responsiveness and convergent validity of QLU-C10D and EQ-5D-3L in assessing short-term quality of life following esophagectomy. Health Qual Life Outcomes 2021; 19:233. [PMID: 34600554 PMCID: PMC8487554 DOI: 10.1186/s12955-021-01867-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/26/2021] [Accepted: 09/17/2021] [Indexed: 11/12/2022] Open
Abstract
Aim This study assessed the responsiveness and convergent validity of two preference-based measures; the newly developed cancer-specific EORTC Quality of Life Utility Measure-Core 10 dimensions (QLU-C10D) relative to the generic three-level version of the EuroQol 5 dimensions (EQ-5D-3L) in evaluating short-term health related quality of life (HRQoL) outcomes after esophagectomy. Methods Participants were enrolled in a multicentre randomised controlled trial to determine the impact of preoperative and postoperative immunonutrition versus standard nutrition in patients with esophageal cancer. HRQoL was assessed seven days before and 42 days after esophagectomy. Standardized Response Mean and Effect Size were calculated to assess responsiveness. Ceiling effects for each dimension were calculated as the proportion of the best level responses for that dimension at follow-up/post-operatively. Convergent validity was assessed using Spearman’s correlation and the level of agreement was explored using Bland–Altman plots. Results Data from 164 respondents (mean age: 63 years, 81% male) were analysed. HRQoL significantly reduced on both measures with large effect sizes (> 0.80), and a greater mean difference (0.29 compared to 0.16) on QLU-C10D. Both measures had ceiling effects (> 15%) on all dimensions at baseline. Following esophagectomy, ceiling effects were observed with self-care (86%), mobility (67%), anxiety/depression (55%) and pain/discomfort (19%) dimensions on EQ-5D-3L. For QLU-C10D ceiling effects were observed with emotional function (53%), physical function (16%), nausea (35%), sleep (31%), bowel problems (21%) and pain (20%). A strong correlation (r = 0.71) was observed between EQ-5D-3L anxiety and QLU-C10D emotional function dimensions. Good agreement (3.7% observations outside the limits of agreement) was observed between the utility scores. Conclusion The QLU-C10D is comparable to the more widely applied generic EQ-5D-3L, however, QLU-C10D was more sensitive to short-term utility changes following esophagectomy. Cognisant of requirements by policy makers to apply generic utility measures in cost effectiveness studies, the disease-specific QLU-C10D should be used alongside the generic measures like EQ-5D-3L. Trial registration: The trial was registered with the Australian New Zealand Clinical Trial Registry (ACTRN12611000178943) on the 15th of February 2011. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01867-w.
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Affiliation(s)
- Norma B Bulamu
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Ravi Vissapragada
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Louise A Mudge
- Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia
| | - B Mark Smithers
- Upper GI and Soft Tissue Unit, Academy of Surgery, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | | | - Lorelle Smith
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Glyn G Jamieson
- Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia
| | - David I Watson
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia. .,Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.
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Teni FS, Rolfson O, Berg J, Leidl R, Burström K. Concordance among Swedish, German, Danish, and UK EQ-5D-3L Value Sets: Analyses of Patient-Reported Outcomes in the Swedish Hip Arthroplasty Register. J Clin Med 2021; 10:4205. [PMID: 34575317 DOI: 10.3390/jcm10184205] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Application of different value sets to health-related quality of life (HRQoL) measured with the EQ-5D-3L may lead to different results due to differences in methods, perspectives, and countries used. Focusing on concordance, this study aimed at understanding the implications of applying EQ-5D-3L value sets from Sweden, Germany, Denmark, and the UK to evaluate HRQoL of patients undergoing total hip replacement (THR) in Sweden before and after surgery. Methods: We performed a longitudinal study of patients in the Swedish Hip Arthroplasty Register from preoperative stage to 1-year follow-up (n = 73,523) using data collected from 2008 to 2016. Eight EQ-5D-3L value sets from the four countries were compared based on a valuation method (visual analogue scale (VAS) or time trade-off (TTO)), perspective (experience-based or hypothetical), and country. Concordance among the value sets with patient-reported EQ VAS score was also assessed. Longitudinal changes in EQ-5D-3L index over the 1-year follow-up were compared across value sets by method, perspective, and country. Results: Value sets based on the same method and perspective showed higher concordance in EQ-5D-3L index at both measurement time points than other comparisons. In the comparisons by perspective, VAS value sets showed higher concordance than TTO value sets. The Swedish VAS and the Danish TTO value sets showed the highest levels of concordance with patient-reported EQ VAS scores. Generally, value sets based on the same method and perspective had the smallest mean differences between changes in EQ-5D-3L indices from preoperative to 1-year postoperative follow-up. Conclusion: Among THR patients value sets based on the same method and perspective, a direct transfer of results across countries could be meaningful. In cases of differences in methods and perspectives among value sets, transfer of value sets across settings would have to consider conversion through crosswalk.
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