The construct validity of the health utilities index mark 3 in assessing health status in lung transplantation

Purpose  

To assess the cross-sectional construct validity of the Health Utilities Index Mark 3 (HUI3) in lung transplantation.     

A cohort study found the RAND-12 and Health Utilities Index Mark 3 demonstrated construct validity in high-risk primary care patients

OBJECTIVE: The Short Form 12 (SF-12) is widely used in primary care settings. The RAND-12 Health Status Inventory (HSI) and the Health Utilities Index Mark 3 (HUI3) have not been as widely used in such settings. The objective of this study was to examine the construct validity of the RAND-12 and HUI3 in the context of high-risk primary care patients. STUDY DESIGN AND SETTING: The SF-12, HUI2, and HUI3 were administered to a cohort of high-risk primary care patients. RAND-12 summary scores for physical and mental health were generated. Single-attribute utility scores for each dimension of health status and overall health in HUI3 were computed. A priori hypotheses were specified. RESULTS: In general, the relationships among RAND-12 and HUI3 scores were consistent with construct validity. Twelve of 24 a priori predictions were confirmed. However, predictions about the correlations between the number of medical conditions and the number of medications and the measures of health-related quality of life were, in general, not confirmed. CONCLUSIONS: The RAND-12 and HUI3 seem to be useful among primary care patients with diverse chronic conditions. Further investigation is warranted.     

Evidence on the construct validity of the Health Utilities Index Mark 2 and Mark 3 in patients with chronic kidney disease

OBJECTIVE: This study assessed the construct validity of the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) in the context of chronic kidney disease (CKD) and compared their ability to discriminate between groups of patients with varying disease severity. STUDY DESIGN AND SETTING: The HUI2 and HUI3 were correlated with the Medical Outcomes 36-Item Short-Form, Kidney Disease Quality of Life Questionnaire, and the Beck Depression Inventory II in 185 patients with stage 4 and 5 CKD. RESULTS: About 86% of a priori hypotheses were confirmed for HUI2 and 95% for HUI3, providing support for the construct validity of both measures. Mean (SD) overall utility score for the HUI2 was 0.74 (0.20), significantly higher than that for the HUI3, 0.58 (0.26) (P<0.001). The cognitive, emotion, and pain attributes of the HUI3 were able to identify a significantly greater proportion of patients with impairment compared to the HUI2. CONCLUSION: The results are consistent with construct validity for the HUI2 and HUI3 in patients with stage 4 and 5 CKD. However, the HUI3 appears to have superior psychometric properties compared with the HUI2 in this patient population.     

Health Utilities Index mark 3 demonstrated construct validity in a population-based sample with type 2 diabetes

OBJECTIVE: To assess the cross-sectional construct validity of the Health Utilities Index mark 3 (HUI3) in type 2 diabetes using population health survey data. STUDY DESIGN AND SETTING: Data used were from 5,134 adult respondents of Cycle 1.1 (2000-2001) of the Canadian Community Health Survey (CCHS) with type 2 diabetes. Analyses of covariance models were used to assess differences in overall and single-attribute HUI3 scores between groups hypothesized a priori to differ in HRQL. The association between health-care resource use (i.e., hospitalizations and physician and emergency room visits) and overall HUI3 scores was assessed using logistic regression models. RESULTS: For overall HUI3 scores, clinically important and statistically significant differences were observed between all groups expected to differ in HRQL. Depression was the comorbidity associated with the largest deficit (-0.17; 95% confidence interval CI=-0.22, -0.12), followed by stroke (-0.15; 95% CI=-0.21, -0.10) and heart disease (-0.08; 95% CI=-0.11, -0.05). Insulin use and comorbidities were associated with clinically important deficits in pain. Overall HUI3 scores were significantly predictive of all three categories of health-care resource use. CONCLUSION: Observed differences between groups contribute further evidence of the construct validity of the HUI3 in type 2 diabetes.     

Health Utilities Index Mark 3 showed valid in Alzheimer disease, arthritis, and cataracts

OBJECTIVE: To assess the cross-sectional construct validity of the Health Utilities Index Mark 3 (HUI3) in Alzheimer disease (AD), arthritis (AR), and cataracts (CA). STUDY DESIGN AND SETTING: The 1996-97 Canadian National Population Health Survey for community and institution-dwelling respondents aged 40 years and above was used in the study. Adjusted means for overall and single-attribute HUI3 scores of five subgroups were compared: (1) AD only, (2) AR only, (3) CA only, (4) at least two of the three conditions, and (5) none of the three (reference group). Regression analyses were conducted for community and institutional data to obtain adjusted mean utility scores. RESULTS: Of the 76 a priori hypotheses, 55 were confirmed. HUI3 was able to describe overall burdens of AD, AR, and CA as well as vision problems associated with CA, speech and cognition problems associated with AD, and ambulation and pain problems associated with AR. Adjusted mean differences in overall HUI3 scores between AD, AR, or CA only groups and reference group ranged from -0.04 to -0.42 (P<0.05); all differences were quantitatively important. CONCLUSION: HUI3 is useful in assessing the health-related quality of life of AD, AR, and CA of those living in the community and institutions.     

A Study of the Construct Validity of the Health Utilities Index Mark 3 (HUI3) in Patients with Schizophrenia

This study assessed the construct validity of the Health Utilities Index Mark 3 (HUI3) in patients with schizophrenia. Patients with schizophrenia recruited from a tertiary mental hospital in Singapore completed the HUI3, the Short-Form 36 Health Survey (SF-36) and the Schizophrenia Quality of Life Scale (SQLS). Patients were assessed for presence and absence of 22 common psychiatric symptoms. Construct validity was assessed using 6 a priori hypotheses. Two hundred and two patients (mean age: 37.8 years, female: 52%) completed the survey. As hypothesized, overall HUI3 utility scores were correlated with SF-36 measures (Spearman’s rho: 0.19 to 0.51), SQLS scales (Spearman’s rho: −0.56 to −0.36), and the number of psychiatric symptoms (Spearman’s rho: −0.49). The HUI3 emotion attribute was moderately correlated with SF-36 mental health (Spearman’s rho: 0.45) and SQLS psychosocial scales (Spearman’s rho: −0.43), and HUI3 pain attribute was strongly correlated with SF-36 bodily pain scale (Spearman’s rho: 0.58). The mean HUI3 overall, emotion, cognition, and speech scores for patients with schizophrenia were 0.07, 0.09, 0.04 and 0.04 points lower than respective age-, sex- and ethnicity-adjusted population norms (p<0.001 for all, ANCOVA). This study provides evidence for the construct validity of the HUI3 in patients with schizophrenia.     

Longitudinal construct validity of the Health Utilities Indices Mark 2 and Mark 3 in hip fracture

Purpose

The objective of this study is to evaluate the longitudinal construct validity of the Health Utilities Index Mark 2 (HUI2) and Health Utilities Index Mark 3 (HUI3) using a convergent/divergent validity approach in patients recovering from hip fracture, with the Functional Independence Measure (FIM) as the comparator.

Methods

A total of 278 patients with a primary diagnosis of hip fracture were interviewed 3–5 days after surgery and then at 1 and 6 months using the HUI2, HUI3 and the FIM and a Likert-type rating of hip pain. A priori hypotheses were formulated. Convergent and divergent correlations between HUI2, HUI3 and FIM change scores for the baseline to 1-month and baseline to 6-month intervals were examined.

Results

Overall HUI2 detected continued gain in health-related quality of life between 1 and 6 months after fracture, as the change increased from 0.20 to 0.29 units. The correlation between change in the overall HUI2 score and total FIM score was moderate (r = 0.50) over the 6-month interval, but larger than the observed correlation over the 1-month interval (r = 0.36). The correlation between change in overall HUI3 score and total FIM over the 1-month interval was small (r = 0.32), and the correlation between change in overall HUI3 score and total FIM was moderate (r = 0.37) over the 6-month interval. All hypotheses for the divergent correlations were supported.

Conclusions

Weaker correlations were reported for change over 1 month as compared to change over the 6 months after fracture. Findings supported the longitudinal construct validity of the overall HUI2 and HUI3 for the assessment of recovery following hip fracture, particularly for change over the 6 months following fracture.     

The concurrent validity and responsiveness of the health utilities index (HUI 3) among patients with advanced HIV/AIDS

Objectives  To assess the concurrent validity and responsiveness of the Health Utility Index 3 (HUI3) in patients with advanced HIV/AIDS, and to determine the responsiveness of this measure, the MOS-HIV and EQ-5D to HIV-related clinical events. Methods  Data from the OPTIMA (OPTions In Management with Antiretrovirals) trial was analyzed. Two aspects of the validity of the HUI3 were considered: concurrent validity was evaluated using Spearman correlations with MOS-HIV component and summary scores. Responsiveness to AIDS-defining events (ADE) and all adverse events (our external change criterion) was assessed using area under the receiver operating characteristic (AUROC) curves. Results  The study enrolled 368 patients (mean follow-up: 3.66 years); 82% had at least one severe adverse event and 27% had at least one ADE. The HUI3 scale and items showed good concurrent validity, with 85% of the expected relationships with the MOS-HIV subscales verified. The HUI3 was responsive to both adverse events (AUROC [95%CI]: 0.68 [0.57, 0.80]) and ADEs (0.62 [0.51, 0.74]). The EQ-5D was responsive to ADEs (0.66 [0.56, 0.76]), but not responsive to adverse events (0.56 [0.46, 0.68]). Conclusion  The HUI3 is a valid and responsive measure of the change in HRQoL associated with clinical events in an advanced HIV/AIDS population.     

A comparison of the health utilities indices Mark 2 and Mark 3 in type 2 diabetes.

PURPOSE: Past research into health-related quality of life (HRQL) in diabetes using preference-based measures, such as the Health Utilities Index Mark 2 (HUI2) or the Health Utilities Index Mark 3 (HUI3), is sparse. Important differences between the HUI2 and HUI3 could lead to differences in their abilities to capture HRQL deficits in type 2 diabetes. This analysis compared the extent to which the HUI2 and HUI3 detect differences associated with varying levels of disease severity or advancement in type 2 diabetes. METHODS. This analysis was conducted as part of using baseline, cross-sectional data from a larger, prospective, controlled study of an intervention to improve care for individuals with type 2 diabetes in rural communities in Alberta, Canada. The HU12 and HUI3 were self-administered to 372 community-dwelling individuals with type 2 diabetes. RESULTS: Relative to HUI2 scores, larger differences in overall HUI3 scores were seen for comparisons for individuals presumed to have more advanced disease. The pain attribute of the HUI3 categorized a larger proportion of individuals as moderately to severely impaired (41.5% v. 24.2%, P < 0.001), as did the emotion attribute (20.5% v. 7.7%, P < 0.001). For individuals with negative overall HUI3 scores, differences between overall HUI2 and HUI3 scores persisted after rescaling (mean difference = 0.33, P = 0.009). CONCLUSIONS: The greater range of possible scores on the HUI3, its relative ability to assess the utility of states worse than dead, and its relative superiority in discriminating moderate to severe impairment from mild or no impairment might favor its use over the HUI2 in type 2 diabetes.     

Consistency between education reported in health survey and recorded in death certificate

Background  

Education level is one indicator of socioeconomic position which, in several countries including South Korea, is provided though death certificate data. Its validity determines the usefulness of death certificate data for exploring the association between socioeconomic position and mortality. This study was to compare education recorded on the death certificate with that reported before death in a nationally representative cohort of participants in the National Health and Nutrition Examination Survey (NHANES).     

Choosing between measures: comparison of EQ-5D,HUI2 and HUI3 in persons with hearing complaints

Objectives To generate insight into the differences between utility measures EuroQol 5D (EQ-5D), Health Utilities Index Mark II (HUI2) and Mark III (HUI3) and their impact on the incremental cost-effectiveness ratio (ICER) for hearing aid fitting Methods Persons with hearing complaints completed EQ-5D, HUI2 and HUI3 at baseline and, when applicable, after hearing aid fitting. Practicality, construct validity, agreement, responsiveness and impact on the ICER were examined. Results All measures had high completion rates. HUI3 was capable of discriminating between clinically distinctive groups. Utility scores (n = 315) for EQ-5D UK and Dutch tariff (0.83; 0.86), HUI2 (0.77) and HUI3 (0.61) were significantly different, agreement was low to moderate. Change after hearing aid fitting (n = 70) for HUI2 (0.07) and HUI3 (0.12) was statistically significant, unlike the EQ-5D UK (0.01) and Dutch (0.00) tariff. ICERs varied from €647,209/QALY for the EQ-5D Dutch tariff to €15,811/QALY for HUI3. Conclusion Utility scores, utility gain and ICERs heavily depend on the measure that is used to elicit them. This study indicates HUI3 as the instrument of first choice when measuring utility in a population with hearing complaints, but emphasizes the importance of a clear notion of what constitutes utility with regard to economic analyses.     

Validity of a modified standard gamble elicited from parents of a hospital-based cohort of children

OBJECTIVES: To examine the validity of a modified standard gamble (Mod SG) (nondeath baseline) by comparing these scores to SG (death baseline), time trade off (TTO), visual analog scale (VAS), Health Utilities Index (HUI), and Child Health Questionnaire (CHQ). METHODS: Respondents were parents of in-patients with cancer receiving chemotherapy and parents of children without cancer attending outpatient clinics. Construct validity was determined by comparing a priori hypotheses to actual correlations between measures. Discriminant validity was examined by anticipating that in-patients with cancer would have lower HRQL than outpatients. RESULTS: 85 families were included. Both Mod SG and SG were moderately correlated with TTO (r=0.50 and r=0.49; P<.01 for both). Both Mod SG and SG were moderately correlated with TTO (r=0.47 and r=0.05, P<0.002 for both). CONCLUSION: The Mod SG did not perform better than SG. Two nonoverlapping groups of HRQL measures were demonstrated.     

The psychometric testing of the Thai version of the health utilities index in patients with ischemic heart disease

The HEALTH UTILITIES INDEX^® (HUI^®) is a family of systems designed to measure utility scores of health-related quality of life for comprehensive health states. There are two current HUI systems: HUI2 and HUI3. Since no Thai version of self-administered HUI was available, the study objective was to translate and test the psychometric properties of the HUI self-complete Thai-language questionnaire in terms of practicality, reliability, validity and responsiveness. A convenience sample of 216 outpatients with ischemic heart disease (IHD) was selected. Mean age was 60.3 ± 7.2 (range 37–77) and 37.2 % were males. The floor and ceiling effects of the total scores for both HUI were <15 %. The intraclass correlation coefficients were from moderate to high for all attributes and total scores. The correlations of HUI2 and HUI3 when compared with the EQ-5D and MacNew global scores were high (Spearman’s rho > 0.5, P < 0.001). Discriminant validity was proved among three groups of different specific activity scale classes (P < 0.001). The effect size was the highest (0.92) in the patients reporting worsened health status assessed by the HUI2. In conclusion, both of the HUIs demonstrated conditionally satisfactory psychometric properties in the patients with IHD.     

Do the determinants of health differ between people living in the community and in institutions?

Determinants of health studies have mainly dealt with samples of community-dwelling subjects. We utilized the 1996/97 Canadian National Population Health Survey community and institutional surveys to identify factors associated with the selection of individuals to institutions. We also assessed whether the same determinants of health variables explain variations in health in those living in the community and those living in institutions. Logistic regression analysis was used to investigate factors associated with selection to institutions. Results showed that health status, age, chronic conditions, education, race, marital status, smoking and alcohol were associated with the probability of being in an institution. Multiple linear regression analyses (dependent variable: Health Utilities Index Mark 3 [HUI3] score) with individual characteristics, socio-economic status, and health risk factors were also estimated. Results showed that advanced age, higher number of chronic conditions, lower education, smoking and being an alcohol non-drinker were negatively and significantly associated with HUI3 scores for the community sample. Except for age, chronic conditions and being an alcohol non-drinker, none of these factors were significantly associated with HUI3 for the institutional sample. Moreover, the association between age and HUI3 was weaker for the institutional sample in comparison to the community sample. Implications are that, for those who are institutionalized, the usual determinants of health factors are less important. In conclusion, there appears to be important heterogeneity in determinants of health between persons living in the institution and community.     

Construct validity of the RAND-12 and Health Utilities Index Mark 2 and 3 in type 2 diabetes

OBJECTIVE: To assess the cross-sectional construct validity of the RAND-12 and the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) in type 2 diabetes. METHODS: Parametric tests were used to test for differences in HRQL scores between known groups with type 2 diabetes, defined in terms of treatment intensity, duration of diabetes and glycemic control. RESULTS: The PHC of the RAND-12 was significantly lower for individuals treated with insulin (40.28 +/- 10.97) than diet alone (45.18 +/- 12.02, p < 0.01), as was the MHC (42.83 +/- 10.75 vs. 46.87 +/- 10.89, p < 0.05). MHC (43.56 +/- 10.20 vs. 46.18 +/- 9.94, p < 0.05) and PHC (41.04 +/- 10.64 vs. 45.62 +/- 10.48, p < 0.001) were both lower for those with longer duration of diabetes. Overall HUI3 scores were lower in individuals above the median duration of diabetes (5.0 years) as compared to those with a shorter duration (0.60 +/- 0.29 vs. 0.67 +/- 0.29, p < 0.01) and for individuals whose diabetes was managed using insulin compared to diet alone (0.59 +/- 0.30 vs. 0.69 +/- 0.30, p < 0.05). Disease severity was associated with impairment on the ambulation, dexterity and pain attributes of the HUI3. Similar results were found for the HUI2. Overall HUI2 scores were highest for individuals managed with diet alone compared to those managed with insulin. Disease severity was associated with the mobility and self-care attributes of the HUI2. No relationship was found between any of the measures of HRQL and glycemic control. CONCLUSIONS: Scores for individuals presumed to have more severe or advanced disease were significantly lower for many comparisons using the RAND-12, HUI2 and HUI3. The results of this study contribute evidence of construct validity of the HUI2, HUI3 and RAND-12 in type 2 diabetes.     

The association of survey language (Spanish vs. English) with Health Utilities Index and EQ-5D index scores in a United States population sample

Objective  

To explore whether variations in the EQ-5D, Health Utilities Index (HUI) Mark II (HUI2), and HUI Mark III (HUI3) index scores were associated with the survey language (Spanish vs. English) in the US Valuation of the EQ-5D Health States study.     

Health-related quality of life and utilities in primary-care patients with generalized anxiety disorder

Background  Generalized anxiety disorder (GAD) is prevalent and significantly impacts patient health-related quality of life (HRQL) and disability. Purpose  This study evaluated the effect of GAD and anxiety symptom severity on the HRQL of primary-care patients with GAD. Methods  Patients 18 years or older with GAD were recruited from an integrated health care delivery system. Clinical assessments included the Hamilton Anxiety Rating Scale (HAM-A), GAD Questionnaire-IV (GAD-Q-IV), and the Patient Health Questionnaire depression module (PHQ). HRQL was assessed by the Quality of Life Enjoyment and Satisfaction Questionnaire—Short Form (Q-LES-Q-SF), Sheehan Disability Scale (SDS), SF-12 Health Survey (SF-6D), and the Health Utilities Index (HUI2, HUI3). Results  The sample included 297 patients, 72% women with mean ± standard deviation (SD) age of 47.6 ± 13.7 years. At baseline, the mean HAM-A score was 16.8 ± 7.6 (suggesting the presence of moderate anxiety symptoms). Anxiety and depression symptoms were significantly correlated with mental component summary (MCS), Q-LES-Q-SF, SDS, SF-6D, HUI2, and HUI3 scores (all P < 0.001). The mean HRQL and all of the preference-based measures varied significantly by anxiety severity groups (all P < 0.001). Anxiety and depression symptoms significantly predicted HRQL and preference-based scores (R ² values ranged from 0.22 to 0.57). Conclusions  Anxiety symptoms reported by GAD patients resulted in significant impairment to HRQL and functional outcomes.