欧洲EQ-5D量表用于杭州市余杭区慢性淋巴丝虫病生命质量调查

目的:采用欧洲EQ-5D量表评价慢性淋巴丝虫病人生命质量。方法:对杭州市余杭区276例慢性丝虫病人进行自评量表式调查,内容包括一般情况问卷调查和EQ-5D量表测量。结果:目标人群中EQ-5D指数平均得分为0.77±0.13,单因素方差分析显示,不同性别、年龄、婚姻、工作状况、家庭年收入的目标人群在EQ-5D得分上差异具有统计学意义(P<0.01)。EQ-5D5个维度测量,问题报告率主要在疼痛/不舒服(47.8%)、日常活动(报告率44.9%)、行动(43.8%)3个维度出现较高。多元logistic逐步回归分析,疼痛/不舒服维度影响因素主要为性别、婚姻状况。日常活动维度为性别、年龄、婚姻状况。行动维度影响因素为家庭收入。焦虑/抑郁维度影响因素为婚姻状况。自我照顾维度影响因素为年龄、家庭年收入。结论:在目标人群中女性、老年人、丧偶、文盲、低经济收入状况的患者生命质量较次,是关怀照料工作的重点对象,干预的重点内容则应放在减轻病人病痛和提高病人日常活动及行动能力方面。     

欧洲五维健康量表中文版在我国的应用

介绍欧洲五维健康量表(EQ-5D)中文版两种不同水平量表3水平版本(EQ-5D-3L)和5水平版本(EQ-5D-5L)的构成和应用, 总结目前中国应用EQ-5D中文版的现况。整理目前基于我国人群开发的EQ-5D-3L和EQ-5D-5L量表效用指数值集, 为未来我国研究者选择适宜量表开展健康相关生命质量研究和卫生经济学成本-效用分析研究提供重要参考。     

妇科恶性肿瘤手术患者生存质量和心理状况调研

目的对妇科恶性肿瘤术后患者进行随访,调查患者术后生存质量以及心理健康状况。方法选择2016年5月至2017年5月在本院进行妇科恶性肿瘤手术治疗的132例患者作为研究对象,对患者进行生存质量与健康状况调查。调查所用工具主要为五维健康量表(EQ-5D量表)和癌症治疗功能评价表等。结果术后3个月EQ-5D量表各维度评分分别为99、98、97、89、96,6个月时EQ-5D量表各维度评分分别为125、124、126、85、121,各维度之间差异均有统计学意义(均P0.05);其中疼痛不适的患者比例明显低于其他各维度,差异均有统计学意义(均P0.05)。FACT-G量表结果显示,患者生理、功能、情感以及社会家庭等维度的评分均逐渐提高,尤其以生理和功能维度提高最为明显,但各个维度比较差异均无统计学意义(均P0.05)。结论应加强对妇科恶性肿瘤患者的心理照护,采取针对性方式提升患者心理健康状况水平,改善患者生存质量。     

城市育龄妇女生命质量评价及相关因素分析

目的:应用EQ-5D量表评价城市育龄妇女生命质量状况,分析影响其生命质量的相关因素。方法:采用多阶段分层整群随机抽样方法确定调查对象。应用欧洲五维度健康量表EQ-5D对城市育龄妇女的生命质量进行问卷调查,并对影响其生命质量的相关因素进行分析。结果:城市育龄妇女EQ-5D指数和EQ-VAS平均得分分别为(0.981±0.085)分、(86.290±11.735)分。在量表的五个维度测量中,维度2(自我照顾)方面没有困难的人最多,占98.8%,困难报告率较高的是维度4(疼痛/不舒服)和维度5(焦虑/抑郁),分别为3.8%和4.1%。单因素分析表明,不同年龄、婚姻状况、文化程度、就业状况以及患慢性病情况的城市育龄妇女在EQ-5D指数和EQ-VAS得分方面差异有统计学意义(P<0.05)。多因素Logistic回归分析表明,行动能力维度影响因素是患慢性病情况;自我照顾维度影响因素是婚姻状况和患慢性病情况;日常活动维度影响因素是文化程度和患慢性病情况;疼痛/不舒服维度影响因素主要为年龄、婚姻状况以及患慢性病情况;焦虑/抑郁维度影响因素主要为年龄、婚姻状况、就业状况以及患慢性病情况。结论:年龄、婚姻状态、文化程度、就业状况以及是否患有慢性病可影响城市育龄妇女的生命质量。     

生命质量量表EQ-5D与SF-6D的比较

目的:了解欧洲五维健康量表(EQ-5D)和六维度健康调查简表(SF-6D)之间的差异及适用范围,以期为我国药物经济学评价成本-效用分析中测量的工具选择及使用提供参考。方法:通过对该两量表进行比较研究,从维度结构、信息性、偏好估算方法、效用值计算公式和量表的可操作性进行对比分析。结果:两量表具有差异性及重叠性。结论:SF-6D在较为温和的疾病中,对活力影响较高容易使人疲惫的疾病中可能较为适用,调查对象最好具备一定的文化及理解能力。EQ-5D在较差的健康状态中可能较为适用且操作容易。     

EQ-5D自报健康调查中的代答效应分析

目的探讨国家卫生服务调查中代答对自报健康问卷(EQ-5D)调查结果的影响。方法比较自答人群与代答人群的人口学特征、健康行为习惯并进行单变量差异性分析。应用logistic多因素模型研究代答对EQ-5D量表五个维度调查结果的影响。结果代答人群多为年轻、未婚或外出务工人员。在吸烟、饮酒、患病、住院等生活方式和健康状况方面,代答人群与自答人群存在差异。在EQ-5D量表的行动、自我照顾、日常活动、疼痛/不适、焦虑/抑郁五个维度上,多因素logistic回归模型结果显示,代答的OR值及95%可信区间分别为1.64(1.48,1.81)、2.29(2.03,2.59)、1.96(1.77,2.18)、1.21(1.11,1.32)、1.42(1.29,1.56)。结论在自报健康调查中,代答者明显地存在将被代答者的健康问题严重化的倾向,应该从调查实施和数据分析两个阶段采取有效措施降低代答带来的偏倚。     

急性上呼吸道感染人群生存质量调查与影响因素分析

目的为了了解急性上呼吸道感染人群的生存质量,以及其生存质量的影响因素。方法运用EQ-5D量表对湖北省武汉市、安徽省合肥市以及浙江省金华市5家医院急性上呼吸道感染门诊病人进行问卷调查,分别运用中国、韩国和英国的积分体系计算EQ-5D得分,比较不同国家积分体系的差异,并对三个地区的EQ-5D得分进行比较,最后运用计量模型对EQ-5D得分的影响因素进行回归分析。结果纳入研究总样本659例,其中武汉319例,合肥235例,金华105例。在EQ-5D量表的五个维度中,前三个维度患者基本不存在问题,在疼痛/不舒服维度81.94%的患者存在问题,在焦虑/抑郁维度47.80%的患者存在问题。在回归分析中地区、疾病严重程度、是否有慢性病三个因素对EQ-5D得分有影响。与其他疾病健康效用值比较结果,急性上呼吸道感染的健康效用值低于脑卒中、高血压、冠心病、糖尿病患者,高于慢性淋巴丝虫病、慢性阻塞性肺炎、类风湿性关节炎患者。结论急性上呼吸道感染人群主要在疼痛/不舒服、焦虑/抑郁两个维度存在问题。相比英国的EQ-5D积分体系,韩国的积分体系更加适合中国人群。急性上呼吸道感染人群的健康效用低于一般人群以及无明显症状慢性病人群的健康效用,高于有明显症状的慢性疾病人群。     

城市社区老年高血压患者生命质量及护理需求研究

目的调查潍坊市社区老年高血压患者生命质量以及对社区卫生服务的护理需求。方法于2015年9—10月在潍坊市某些社区采用分层随机抽样方法,随机抽取符合要求的≥60岁的老年人共1 208人进行问卷调查。计量资料采用t检验,计数资料采用χ~2检验,P0.05为差异有统计学意义。结果潍坊市社区老年人共调查1 208人,高血压患者481人。欧洲五维健康量表(Euro Qol five dimensions questionnaire,EQ-5D)生命质量量表维度下的焦虑或抑郁和EQ-5D得分对健康促进的护理需求对比差异均有统计学意义(均P0.05),生命质量各个维度对疾病护理和总体的护理需求对比差异均有统计学意义(均P0.05)。结论 EQ-5D生命质量量表各个维度下的"没有问题"和"有问题"老年高血压患者对社区护理需求存在差异,应全面完善针对老年高血压患者的社区护理项目,以提高患病老年人的生命质量。     

体质指数与健康相关生命质量关联性

目的研究湖北省≥18岁居民体质指数(BMI)与健康相关生命质量(HRQOL)的关系。方法于2013年运用多阶段分层整群随机抽样方法,在湖北省共纳入研究对象27 814人。采用欧洲5维健康量表(EQ-5D)对居民HRQOL进行评价;分析不同BMI分组与HRQOL得分以及EQ-5D各维度之间的关系。结果不同性别低体重人群EQ-5D和EQ-VAS得分均低于正常体重人群,而超重或肥胖人群EQ-5D和EQ-VAS得分与正常体重人群没有明显差异。相对于正常体重者,不同性别低体重人群在EQ-5D各维度出现问题的风险均增加;超重男性出现"焦虑或抑郁"问题的风险降低(OR=0.776,95%CI=0.626～0.961),超重女性出现"疼痛或不适"的风险升高(OR=1.150,95%CI=1.105～1.303);不同性别肥胖人群出现"行动能力"和"自我照顾能力"方面问题的风险较大,且肥胖女性更容易出现"焦虑或抑郁"问题(OR=1.381,95%CI=1.028～1.856)。结论低体重人群HRQOL较差,超重和肥胖人群也存在一定的影响其生命质量的生理和心理问题。     

杭州市空巢老人健康相关生命质量评价

目的分析杭州市空巢老人的健康相关生命质量及其影响因素,为空巢老人健康养老提供依据。方法采用分层整群随机抽样法抽取杭州市2个城区(拱墅和上城)和3个郊县(淳安、建德和临安)各200名空巢老人进行欧洲五维度健康量表(EQ-5D)问卷调查,根据量表得分分析其健康相关生命质量及影响因素。结果共调查992名空巢老人,其中男性451人,女性541人,平均(74.78±6.71)岁。"行动""自己照顾自己""日常生活""疼痛/不适"和"焦虑/抑郁"5个维度上有困难或有问题者分别占16.13%、11.09%、19.76%、48.49%和29.84%,其中"日常生活""疼痛/不适"和"焦虑/抑郁"维度有困难或有问题的比例农村均高于城市(P0.05)。EQ-5D效用值最高为0.85分,最低为-0.11分,平均为(0.75±0.13)分,未患慢性病、遇到烦恼会倾诉、遇到困难会求助、参加党团和社区等组织活动的空巢老人EQ-5D效用值相对较高(均P0.05);收入够用的空巢老人EQ-5D效用值最高,其次是收入一般够用和有困难者(均P0.01);选择子女赡养为最佳养老方式的空巢老人EQ-5D效用值最高,其次是选择个人自养和社会养老为最佳养老方式者(均P0.01)。结论杭州市空巢老人日常生活能力和健康状况较差,患慢性病、不倾述、不求助、不参加社会活动以及收入不高是其健康相关生命质量低的影响因素。     

An Exploratory Study to Test the Impact on Three “Bolt-On” Items to the EQ-5D

BackgroundGeneric preference-based measures were criticized for being inappropriate in some conditions. One solution is to include “bolt-on” dimensions describing additional specific health problems.ObjectivesThis study aimed to develop bolt-on dimensions to the EuroQol five-dimensional questionnaire (EQ-5D) and assess their impact on health state values.MethodsBolt-on dimensions were developed for vision problems, hearing problems, and tiredness. Each bolt-on dimension had three severity levels to match the EQ-5D. Three “core” EQ-5D states across a range of severity were selected, and each level of a bolt-on item was added, resulting in nine states in each condition. Health states with and without the bolt-on dimensions were valued by 300 members of the UK general public using time trade-off in face-to-face interviews, and mean health state values were compared using t tests. Regression analysis examined the impact of the bolt-on variants and the level of the bolt-on items after controlling for sociodemographic characteristics.ResultsBolt-on dimensions had an impact on health state values of the EQ-5D; however, the size, direction, and significance of the impact depend on the severity of the core EQ-5D state and of the bolt-on dimension. Regression analysis demonstrated that after controlling for possible differences in sociodemographic characteristics between the groups, there were no significant differences in health state values between the three bolt-on dimensions but confirmed that the impact depended on the severity of the EQ-5D health state and the levels of bolt-on dimensions.ConclusionsThe impact of a bolt-on dimension on the EQ-5D depends on the core health state and the level of the bolt-on dimension. Further research in this area is encouraged.     

Methods Used to Identify,Test, and Assess Impact on Preferences of Bolt-Ons: A Systematic Review

ObjectivesThe question of whether additional dimensions should be added to the EQ-5D, so-called bolt-ons, has been researched since the 1990s. Several candidate bolt-ons have been tested. The aim of this systematic review was to provide an overview of EQ-5D bolt-on studies, including the origin of possible suitable bolt-ons, their format, and methods that were used to examine their value.MethodsStudies were identified through database search and reference screening and assessed based on a set of inclusion criteria. All studies that investigated bolt-ons for the EQ-5D were eligible for inclusion. Two reviewers independently extracted information from all included studies on objectives, study design, EQ-5D version used, the investigated bolt-ons, methods used to achieve objectives, and outcomes.ResultsOf 308 initially identified studies, 28 studies met the inclusion criteria. Of these studies, 3 identified potentially suitable bolt-on dimensions, 13 investigated the psychometric performance of EQ-5D + bolt-on(s), and 6 investigated the impact of the bolt-on on health state preferences. In total, 26 bolt-ons were identified, of which cognition was the most frequently mentioned. A wide variety of bolt-on identification methods, psychometric performance tests, and health state valuation methods were used in the included studies.ConclusionA range of bolt-on dimensions has been investigated using diverse methods. Guidelines are needed to standardize the wording of the bolt-on dimension and response options, evaluate minimal important gain of the bolt-on, and facilitate quality assessment of bolt-on studies. Subsequently, guidelines will facilitate decision making on whether or not to implement a bolt-on dimension to the EQ-5D.     

Development of a Disease-Specific Version of the EQ-5D-5L for Use in Patients Suffering from Psoriasis: Lessons Learned from a Feasibility Study in the UK

ObjectivesThe EuroQol five-dimensional (EQ-5D) questionnaire is a generic measure widely used for the assessment of health status. Research has suggested that it may be insensitive to the burdens associated with particular conditions. This study was designed to explore the feasibility of developing and valuing a disease-specific “bolt-on” version of the EQ-5D questionnaire for use in psoriasis.MethodsA series of steps were undertaken to develop, test, and evaluate dimensions for a psoriasis-specific version of the EQ-5D questionnaire (hereafter referred to as the EQ-PSO questionnaire). Candidate dimensions were explored through a review of published literature, in-depth qualitative interviews with patients, and consultation with a clinical expert. A psychometric validation exercise was then undertaken to establish how well dimensions functioned. Two dimensions were selected for inclusion in a draft measure alongside the existing EQ-5D questionnaire dimensions: “skin irritation” and “self-confidence.” Last, a time trade-off valuation exercise was conducted with 300 members of the UK general public to derive utilities for health states described by the measure.ResultsThe psychometric analyses indicated that the two new candidate dimensions captured additional variance over and above the existing five dimensions. Data from the valuation exercise were analyzed by using different models. A collapsed random effects model was put forward as a parsimonious and accurate approach. Based on this model, estimated utilities ranged from 0.98 ± 0.02 for state “1111111” to 0.03 ± 0.29 for state “5555555.”ConclusionsThis study has developed the EQ-PSO questionnaire to support future psoriasis research and has informed the development of future bolt-on versions of the EQ-5D questionnaire.     

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.     

Translation and validation of non-English versions of the Ankylosing Spondylitis Quality of Life (ASQOL) questionnaire

Background

The EQ-5D is a reliable tool for measuring Health-Related Quality of Life (HRQoL). However, concern has been expressed that it may ignore elements of HRQoL, particularly cognition. In response to this concern, the EQ-5D has been extended with a cognitive dimension (EQ-5D+C). The aim of this study was to compare the performance of the EQ-5D and the EQ-5D+C in elderly patients with cognitive impairments by assessing their construct validity and responsiveness.

Methods

Data from the MEDICIE study (n = 196) were used, in which all questionnaires were rated by proxies.

Results

Regarding construct validity, we found similar correlations between the EQ-5D and the Mini Mental State Examination (MMSE) and between the EQ-5D+C and the MMSE. Furthermore, both the EQ-5D and the EQ-5D+C were responsive to changes in the MMSE, with the EQ-5D performing slightly better.

Conclusion

We conclude that the EQ-5D performs well for evaluating HRQoL in a population with cognitive impairments. Based on the results of this explorative study, it does not seem necessary to adjust the current classification system by adding a cognitive dimension. However, in order to compare both instruments regarding utility values, it is necessary to develop a new scoring algorithm for the EQ-5D+C by conducting a general population study. Considering the explorative nature of this study, it is recommended that more aspects of the validity of both the EQ-5D and the EQ-5D+C are explored in patients with cognitive impairments using a more tailored study design.