Mapping FACT-P and EORTC QLQ-C30 to Patient Health Status Measured by EQ-5D in Metastatic Hormone-Refractory Prostate Cancer Patients

OBJECTIVES: To construct and validate a prediction model of preference-adjusted health status (EQ-5D) for metastatic hormone-refractory prostate cancer (HRPCA) patients using cancer-specific health-related quality of life (HRQoL) measures. METHODS: Data were obtained from a multicenter, multinational observational study of metastatic HRPCA patients conducted during 2002 to 2004. In addition to clinical and resource utilization, preference-adjusted health status (EQ-5D) and HRQoL (Functional Assessment of Cancer Therapy-Prostate [FACT-P] and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ-C30]) data were collected. Predictive validity of ordinary least square (OLS) and median regressions of various model specifications were tested using cross-validation samples. The selected specification was then further refined and tested for alternative model specifications and restrictions. RESULTS: OLS regression with both HRQoL measures as individual components and patient demographics was the best-performing model. It explained 58.2% of the observed EQ-5D variation in the validation sample. A model including only the prostate cancer-specific HRQoL measure, FACT-P, explained 53.5% of the observed EQ-5D variation. CONCLUSIONS: The models developed have good predictive validity. These algorithms enable researchers to translate cancer-specific HRQoL measures to preference-adjusted health status in metastatic HRPCA patients. The findings will help perform health status adjustments in cost-utility analyses.     

Health problems are more common,but less severe when measured using newer EQ-5D versions

ObjectivesThe EuroQol Group recently released youth (Y) and 5-level (5L) versions of its 3-level EQ-5D instrument (3L) that measures health-related quality of life. In this study, we (1) compare 3L, Y, and 5L responses among US adults and (2) assess construct validity.Study Design and SettingUsing a nationally representative sample of US adults (N = 2,619), we collected 3L, Y, and 5L responses in random order and estimated their associations and their relationship with a 0 to 100 numerical visual analog scale.ResultsThe prevalence of US adults in the best possible EQ-5D state (i.e., 11111) was lower for the Y (38%) and 5L (35%) than for the 3L (44%), capturing more health problems. However, the prevalence of extreme responses in pain/discomfort and anxiety/depression decreased substantially between the 3L and 5L (from 44% to 17% and from 29% to 13%, respectively).ConclusionCompared with the 3L, the Y and 5L versions describe population health as having more, yet milder, health problems. Although the 5L may have advantages in patient populations in which extreme problems are more prevalent, population studies or studies that follow patients from childhood may consider using the Y.     

Health Utility Assessment Using EQ-5D among Caregivers of Children with Autism

ObjectivesHealth utility of caregivers of children with autism was assessed by using the EuroQol five-dimensional (EQ-5D) questionnaire. Utility scores of autism caregivers were compared with norms for the general adult US population. Predictors of health utility were identified.MethodsA cross-sectional online survey design was used. Caregivers registered with the Interactive Autism Network were approached for participation in the online survey. Three hundred and sixteen usable responses were received. Health utility among caregivers was calculated and compared with the US population norms by using Student’s t test. Problems in EQ-5D questionnaire domains and utility scores were analyzed by study characteristics by using Kruskal-Wallis analysis of variance. Factors predicting health utility were identified by using ordinary least square regression.ResultsRoughly 94% of the caregivers who participated in the study were females. As compared to their counterparts in the general US population, caregivers who were aged 18 to 44 years and were females had lower utility scores (P < 0.001). Significant differences in utility scores were observed among caregivers. When compared to males, females had lower health utility. Caregivers of lower socioeconomic status had lower utility scores and reported more problems in EQ-5D questionnaire domains than did those from higher socioeconomic status. Caregiver burden was inversely correlated with health utility. Caregiver physical and mental health status, objective strain, education, and relationship with the care recipient were found to significantly predict health utility (adjusted R² ~57%).ConclusionsAutism caregivers had lower health utility than did the general adult US population. There is an immediate need to address health concerns among this growing population.     

A Bayesian Approach for Incorporating the EQ-5D Visual Analog Scale When Estimating the Health-Related Quality of Life

ObjectivesThe EuroQoL 3-level version of EQ-5D and 5-level version of EQ-5D questionnaires are often used to quantify health states. They include ordinal responses across 5 health dimensions (EQ-5D index) and an EQ-visual analog scale (EQ-VAS) overall health rating. We investigated the value of incorporating the EQ-VAS to update health utility estimates using a Bayesian framework.MethodsWe created a joint bivariate normal EQ-VAS and EQ-5D index utility model and compared this to a univariate normal EQ-5D index utility model. We tested these models for 1026 Sri Lankan patients with chronic kidney disease and 94 Australian patients with wounds. We validated our approach by simulating EQ-VAS and EQ-5D index responses and applying our Bayesian model and then comparing the modeled estimates to our observed data.ResultsThe combined model showed a reduction in estimate uncertainty for all respondents. Compared with the EQ-5D index-only model, the mean utility for Sri Lankan respondents dropped from 0.556 (0.534-0.579) to 0.540 (0.521-0.559) in men and increased from 0.489 (0.461-0.518) to 0.528 (0.506-0.550) in women, with reduced credible interval width by 13% and 23%, respectively. The mean utility in Australian respondents moved from 0.715 (0.633-0.800) to 0.716 (0.652-0.782) in men, and 0.652 (0.581-0.723) to 0.652 (0.593-0.711) in women, with reduced credible interval width by 23% and 17%, respectively. The credible interval width for simulated data also narrowed, ranging from 8.3 to 8.5%.ConclusionsIncluding the EQ-VAS through Bayesian methods can add value by reducing requisite sample sizes and decision uncertainty using small amounts of additional data that is often collected but rarely used.     

EQ-5D和SF-6D测量同期健康效用值的比较研究

目的:比较EQ-5D和SF-6D两个量表的适用性,为药物经济学评价过程中效用值测量工具的选择提供参考。方法:基于已有文献,从效用均值的分布、差异、可交换性及适用性、敏感性分析四个方面,对两个量表进行比较。结果:EQ-5D的效用均值略呈左偏分布,SF-6D较符合正态分布;两个量表在不同分段的效用均值存在差异,一致性较差。结论:两个量表不具有可互换性,在应用过程中应充分考虑两者差异,根据疾病特点选择合适的量表,SF-6D多适用于进程缓慢的疾病,EQ-5D多适用于测量较差的健康状态。     

Instrument-Defined Estimates of the Minimally Important Difference for EQ-5D-5L Index Scores

Background

The five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) is a preference-based measure of health-related quality of life (HRQOL), which yields an index score anchored at 0 (dead) and 1 (full health). We lack evidence on estimates for the minimally important difference (MID) of the EQ-5D-5L that will help in interpreting differences or changes in HRQOL measured by this scale score.

Acceptability and Validity of the EQ-5D in Patients Living With Dementia

ObjectivesTo assess the acceptability and validity of the 3 levels of the EQ-5D (EQ-5D-3L) compared with the Quality of Life in Alzheimer’s Diseases (QoL-AD) in patients living with dementia.MethodsThe analysis was based on 560 dyads of persons with dementia and their caregivers of the multicenter observational study of dementia care networks in Germany (DemNet-D). Health-related quality of life was assessed by face-to-face interviews using the EQ-5D-3L (self-rating) and the QoL-AD (self- and proxy-rating). The number of missing values, the score ranges (observed vs possible range) and the floor and ceiling effects were used to assess the acceptability. We used one-way analyses of variance and multivariate linear regression models to evaluate the discriminative ability. The convergent validity was assessed using Spearman's correlation coefficient (r_s) and multivariate regression models.ResultsThe EQ-5D index had a higher response rate (89% vs 84%) and a comparable floor (>1%) but a higher ceiling effect (18% vs >1%) compared with the QoL-AD. Both measures can significantly differentiate between different stages of general health, instrumental activities of daily living, and depression. The EQ-5D index and the visual analog scale self-rating scores strongly correlated with the QoL-AD self-rating (r_s = 0.644 and 0.553, respectively) but not with the proxy-rating score (r_s = 0.314 and r_s = 0.170, respectively), which was confirmed by multivariate regression analyses.ConclusionThe results satisfy acceptability, discriminative ability, and convergent validity for moderately cognitively and functionally impaired patients living with dementia. The EQ-5D-3L performed comparably with the QoL-AD, and could, therefore, be used in economic evaluations in dementia. The differences between self- and proxy-ratings should be evaluated and considered in the interpretation of health-related quality of life scores.     

Patient Self-Reported Health,Clinical Quality,and Patient Satisfaction in English Primary Care: Practice-Level Longitudinal Observational Study

ObjectivesTo examine the association of self-reported health of patients in general practices, as measured by the EQ-5D-5L, with practice clinical quality and patient-reported satisfaction with accessibility and consultations.MethodsWe used data from the General Practitioner (GP) Patient Survey to construct a practice-level EQ-5D-5L index as the health outcome. Key explanatories were patient-reported measures of satisfaction with access and consultations (also derived from the GP Patient Survey) and clinical quality measured by the achievement of clinical quality indicators reported in the Quality and Outcomes Framework. We estimated practice-level linear panel data models with random and fixed practice effects and practice and patient covariates using 2012/13 to 2016/17 data on more than 7500 English general practices.ResultsBivariate correlations of the EQ-5D-5L index with quality measures were 0.048 for clinical quality, 0.071 for satisfaction with access, and 0.107 for satisfaction with GP consultations (all with P<.001). In both fixed effects regressions, which allow for unobserved time invariant practice characteristics, and random effects regressions which do not, the EQ-5D-5L index was positively associated with 1-year lags of patient satisfaction with access and GP consultations. Patient-reported health was positively associated with clinical quality in the fixed effects regressions. The implied effects were small in all cases.ConclusionPractice-level EQ-5D-5L is positively associated with clinical quality and with 1-year lags of patient-reported satisfaction with access and GP consultations.     

Health-Related Quality of Life Measured with EQ-5D in Patients Treated for Depression in Primary Care

OBJECTIVE: The objective of the present study was to assess the impact of depression on patients' health-related quality of life (HRQL) with the EQ-5D instrument over 6 months while on antidepressant treatment. METHODS: A total of 447 patients were recruited at 56 primary care centers to this naturalistic longitudinal observational study. Patients older than 18 years with depressive symptoms, and who initiated an antidepressant therapy because of depression were included in the study. Data on patients' sociodemographics, daily activity, and quality of life (EQ-5D) were collected using questionnaires completed during outpatient general practitioner visits for a follow-up period of 6 months. RESULTS: The mean EQ-5D utility score at baseline was 0.47 (0.44-0.49). Milder cases of depression reported a health utility of 0.60, whereas moderately and severely depressed patients reported utility values of 0.46 and 0.27, respectively (P < 0.01). At end of follow up the average utility was 0.69 (0.67-0.72), corresponding to an increase of 0.23 over 6 months (P < 0.01). Regression analyses showed that, all else equal, patients who were on sick leave were associated with 10% lower utility. CONCLUSIONS: Depression has a substantial impact on HRQL. Our results indicate that treatments for depression are associated with significant improvement in EQ-5D index score over a course of 6 months. Self-reported patient valuations are important outcomes for cost-utility analysis of new treatments for depression and the present study provides important evidence for future economic evaluations.     

International Comparisons in Valuing EQ-5D Health States: A Review and Analysis

Objective:  To identify the key methodological issues in the construction of population-level EuroQol 5-dimensions (EQ-5D)/time trade-off (TTO) preference elicitation studies.
Method:  This study involved three components. The first was to identify existing population-level EQ-5D TTO studies. The second was to illustrate and discuss the key areas of divergence between studies, including the international comparison of tariffs. The third was to portray the relative merits of each of the approaches and to compare the results of studies across countries.
Results:  While most articles report use of the protocol developed in the original UK study, we identified three key areas of divergence in the construction and analysis of surveys. These are the number of health states valued to determine the algorithm for estimating all health states, the approach to valuing states worse than immediate death, and the choice of algorithm. The evidence on international comparisons suggests differences between countries although it is difficult to disentangle differences in cultural attitudes with random error and differences as a result of methodological divergence.
Conclusions:  Differences in methods may obscure true differences in values between countries. Nevertheless, population-specific valuation sets for countries engaging in economic evaluation would better reflect cultural differences and are therefore more likely to accurately represent societal attitudes.     

Mapping From Visual Acuity to EQ-5D,EQ-5D With Vision Bolt-On,and VFQ-UI in Patients With Macular Edema in the LEAVO Trial

ObjectivesMappings to convert clinical measures to preference-based measures of health such as the EQ-5D-3L are sometimes required in cost-utility analyses. We developed mappings to convert best-corrected visual acuity (BCVA) to the EQ-5D-3L, the EQ-5D-3L with a vision bolt-on (EQ-5D V), and the Visual Functioning Questionnaire-Utility Index (VFQ-UI) in patients with macular edema caused by central retinal vein occlusion.MethodsWe used data from Lucentis, Eylea, Avastin in vein occlusion (LEAVO), which is a phase-3 randomized controlled trial comparing ranibizumab, aflibercept, and bevacizumab in 463 patients with observations at 6 time points. We estimated adjusted limited dependent variable mixture models consisting of 1 to 4 distributions (components) using BCVA in each eye, age, and sex to predict utility within the components and BCVA as a determinant of component membership. We compared model fit using mean error, mean absolute error, root mean square error, Akaike information criteria, Bayesian information criteria, and visual inspection of mean predicted and observed utilities and cumulative distribution functions.ResultsMean utility scores were 0.82 for the EQ-5D-3L, 0.79 for the EQ-5D V, and 0.88 for the VFQ-UI. The best-fitting models for the EQ-5D and EQ-5D V had 2 components (with means of approximately 0.44 and 0.85), and the best-fitting model for VFQ-UI had 3 components (with means of approximately 0.95, 0.74, and 0.90).ConclusionsModels with multiple components better predict utility than those with single components. This article provides a valuable addition to the literature, in which previous mappings in visual acuity have been limited to linear regressions, resulting in unfounded assumptions about the distribution of the dependent variable.     

Italian Population-Based Values of EQ-5D Health States

ObjectiveTo estimate a value set for the calculation of Italian-specific quality-adjusted life years (QALYs), based on preferences elicited on EuroQol five-dimensional (EQ-5D) questionnaire health states using the time trade-off technique.MethodsThe revised standard Measurement and Valuation of Health protocol was followed. Twenty-five health states, divided into three groups and given to 450 subjects, were selected to obtain 300 observations per state. Subjects aged 18 to 75 years were recruited to be representative of the Italian general adult population for age, sex, and geographical distribution. To improve efficiency, face-to-face interviews were conducted by using the Computer Assisted Personal Interviewing approach. Several random effects regression models were tested to predict the full set of EQ-5D questionnaire health states. Model selection was based on logical consistency of the estimates, sign and magnitude of the regression coefficients, goodness of fit, and parsimony.ResultsThe model that satisfied the criteria of logical consistency and was more efficient includes 10 main effect dummy variables for the EQ-5D questionnaire domain levels and the D1 interaction term, which accounts for the number of dimensions at levels 2 or 3 beyond the first. This model has an R² of 0.389 and a mean absolute error of 0.03, which are comparable to or better than those of models used in other countries. The utility estimates after state 11111 range from 0.92 (21111) to −0.38 (33333). Italian utility estimates are higher than those estimated in the United Kingdom and Spain and used so far to assess QALYs and conduct cost-utility evaluations in Italy.ConclusionsA specific value set is now available to calculate QALYs for the conduction of health economic studies targeted at the Italian health care system.     

The Impact of Differences between Patient and General Population EQ-5D-3L Values on the Mean Tariff Scores of Different Patient Groups

BackgroundHealth states can be valued by those who currently experience a health state (experienced health states [EHS]) or by the general public, who value a set of given health states (GHS) described to them. There has been debate over which method is more appropriate when making resource allocation decisions.ObjectiveThis article informs this debate by assessing whether differences between these methods have an effect on the mean EQ-5D-3L tariff scores of different patient groups.MethodsThe European tariff based on GHS valuations was compared with a German EHS tariff. Comparison was made in the context of EQ-5D-3L health states describing a number of diagnosed chronic diseases (stroke, diabetes, myocardial infarction, and cancer) taken from the Cooperative Health Research in the Augsburg Region population surveys. Comparison was made of both the difference in weighting of the dimensions of the EQ-5D-3L and differences in mean tariff scores for patient groups.ResultsWeighting of the dimensions of the EQ-5D-3L were found to be systematically different. The EHS tariff gave significantly lower mean scores for most, but not all, patient groups despite tariff scores being lower for 213 of 243 EQ-5D-3L health states using the GHS tariff. Differences were found to vary between groups, with the largest change in difference being 5.45 in the multiple stoke group.ConclusionsThe two tariffs have systematic differences that in certain patient groups could drive the results of an economic evaluation. Therefore, the choice as to which is used may be critical when making resource allocation decisions.     

Generating EQ-5D-3L Utility Scores from the Dermatology Life Quality Index: A Mapping Study in Patients with Psoriasis

Objectives

To develop an algorithm to predict the three-level EuroQol five-dimensional questionnaire (EQ-5D-3L) utility scores from the Dermatology Life Quality Index (DLQI) in psoriasis.

基于EQ-5D量表的子宫颈癌患者生命质量评价

目的:测算子宫颈癌患者生命质量,为临床实践中子宫颈癌治疗方案的选择和子宫颈癌患者生命质量的提高提供参考依据。方法:选取276名子宫颈癌患者为研究对象,所有病例均经病理学确诊。采用欧洲五维度健康量表(EQ-5D)评价子宫颈癌患者生命质量。结果:子宫颈癌CIN2及以下患者量表指数(Index)评分为(0.916 5±0.013 3)分、视觉模拟尺度(VAS)评分为(86.23±11.13)分,接近正常女性人群评分。但随着子宫颈癌病理和临床分期的提高,Index评分逐渐降低,分别由0.916 5分降至0.872 3分和由0.913 8分降至0.868 9分;VAS评分亦逐渐降低,分别由83.09分降至64.97分和86.23分降至65.37分。不同的治疗方法后子宫颈癌患者的生命质量亦有差异。Index得分由低到高依次为:子宫颈癌根治术+化疗、单纯化疗、子宫颈癌根治术、子宫全切术、子宫颈锥切术。VAS得分由低到高依次为:子宫颈癌根治术+化疗、子宫颈癌根治术、单纯化疗、子宫全切术、子宫颈锥切术。除子宫颈癌根治术与单纯化疗略有交叉外,其他治疗方案得分顺序相同。结论:随着子宫颈癌患者病情的加重,生命质量不断降低,提示子宫颈癌早期诊断和治疗可以显著改善子宫颈癌患者的生命质量。实施不同治疗方案的子宫颈癌患者的生命质量不同,提示患者生命质量也应作为临床实践中治疗方案的选择依据。     

Predicting Patient-Level 3-Level Version of EQ-5D Index Scores From a Large International Database Using Machine Learning and Regression Methods

ObjectivesThis 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.MethodsA 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).ResultsThe 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.ConclusionsRegression 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.     

EQ-5D量表附加维度及应用述评

欧洲五维健康量表(EQ-5D)已成为世界上应用最为广泛的量表之一,为进一步提高EQ-5D量表在某些状况下的敏感度,附加维度(bolt-on dimension)的概念应运而生.文章系统介绍了EQ-5D附加维度的概念、产生背景、研究现状,并梳理目前研究的主要问题,对其研究前景进行展望,以期为国内学者开展相关研究提供参考.