Why Do Patients with Inflammatory Arthritis Often Score States “Worse than Death” on the EQ-5D? An Investigation of the EQ-5D Classification System

Objective:  Using inflammatory arthritis patients as an example, we investigate EuroQol-5D (EQ-5D) profiles resulting in states worse than death (WTD), and the heath status of patients occupying these states.
Methods:  Baseline data from two UK trials were used that reflected the range of arthritis states/severity found in routine practice. EQ-5D profiles resulting in negative valuations (i.e., states WTD) based on UK weights were identified. EQ-5D scores for these profiles from alternative valuation sets, including a reanalysis of the UK weights, were compared. The health status and characteristics of patients, and factors associated with patients in the low distribution of the EQ-5D and those with WTD EQ-5D scores were identified.
Results:  Seven hundred patients were included in the analysis. Sixty-two (9%) patients occupied states WTD. Patients occupied 9 of the possible 84health profiles with negative scores (53% occupied one profile); this profile was not rated WTD by any of the alternative EQ-5D scoring algorithms. All WTD profiles included severe pain/discomfort plus moderate problems in ≥3 other domains. Patients with WTD valuations reported higher levels of pain, and feeling downhearted and low on alternative health status measures.
Conclusions:  Pain was the predominant factor in the WTD EQ-5D profiles occupied by arthritis patients. Patients occupying states WTD have poorer health-related quality of life than patients in low "better than death" states. Valuations of profiles vary according to how sets of preference weights for health profiles were developed. Further research should explore whether WTD valuations are supported by qualitative evidence and reflect the patient's health and experience of disease.     

The Impact of 29 Chronic Conditions on Health-related Quality of Life: A General Population Survey in Finland Using 15D and EQ-5D

Background Health-related quality of life (HRQoL) is an essential outcome of health care, but there is no gold standard of HRQoL measurement. We investigated the impact of major chronic conditions on HRQoL using 15D and EQ-5D in a representative sample of Finns.Methods Information on chronic somatic conditions was obtained by interviews. Psychiatric disorders were diagnosed using a structured interview (M-CIDI). Tobit and CLAD regression analysis was used to estimate the impact of conditions on HRQoL at the individual and population level.Main results Adjusted for other conditions and sociodemographic variables, Parkinson’s disease had the largest negative impact on HRQoL at the individual level, followed by anxiety disorders, depressive disorders and arthrosis of the hip and knee. Based on prevalence, arthrosis of the hip or knee, depression, back problems and urinary incontinence caused the greatest loss of HRQoL at the population level. The results obtained with the two HRQoL measures differed markedly for some conditions and the EQ-5D results also varied with the regression method used.Conclusions Musculoskeletal disorders are associated with largest losses of HRQoL in the Finnish population, followed by psychiatric conditions. Different HRQoL measures may systematically emphasize different conditions.     

慢性病流行现状与基层防治对策

  目的  了解宁夏地区农村慢性病患者健康相关生命质量及其影响因素,为农村地区慢性病管理及预防控制提供参考依据。  方法  于2019年2月采用分层随机整群抽样方法在宁夏彭阳和盐池2个县抽取3267户农村居民进行问卷调查,分析其中年龄 ≥ 15岁且患有 ≥ 1种慢性病的2700例慢性病患者的健康相关生命质量及其影响因素。  结果  宁夏地区2700例农村慢性病患者中,存在自觉疼痛/不适问题1146例（42.4 %）,存在焦虑/沮丧问题677例（25.1 %）,存在行动能力问题664例（24.6 %）,存在日常活动能力问题618例（22.9 %）,存在自我照顾能力问题369例（13.7 %）;宁夏地区农村慢性病患者的健康效用值为（0.93 ± 0.12）;Tobit回归模型分析结果显示,女性健康效用值低于男性,年龄51～60岁、61～70岁和 > 70岁者健康效用值均低于年龄 < 50岁者,小学文化程度者健康效用值高于未上过学者。  结论  宁夏地区农村慢性病患者的健康相关生命质量较差,性别、年龄和文化程度是该地区农村慢性病患者健康效用值的主要影响因素。     

Personality and EQ-5D scores among individuals with chronic conditions

BACKGROUND: Personality is associated with self-rated health, but prior studies have not examined associations with preference-based measures. We hypothesized similar associations would exist with preference-based health. METHODS: We analyzed baseline data from chronically ill individuals enrolled in a self-management intervention. We conducted regression analyses with the EQ-5D summary index score and dimension scores (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) as dependent variables, The key independent variables were NEO-Five Factor Inventory (NEO-FFI) personality factors (Neuroticism, Conscientiousness, Extraversion, Openness, Agreeableness), adjusting for age, gender, educational level, minority status, and chronic conditions. RESULTS: Of 415 participants, 245 (59%) had > or =2 chronic conditions, 384 (94%) completed the NEO-FFI and 397 (96%) the EQ-5D. After adjustment, Neuroticism was associated with EQ-5D summary index scores [-0.04 per 1 SD increase in Neuroticism (95% CI -0.06, -0.01)]. Neuroticism [AOR 2.99 (95% CI 2.06, 4.35; P < 0.001)] and Openness [1.32 (95% CI 1.00, 1.75; P = 0.05)] were associated with worse anxiety/depression scores, while Conscientiousness was associated with better usual activities scores [0.66 (95% CI 0.49, 0.89; P = 0.01)]. CONCLUSIONS: The associations between personality factors and self-rated health appear to extend to preference-based measures. Future studies should explore whether personality affects preference-based health estimates in cost-effectiveness analyses.     

Mapping the EORTC QLQ C-30 onto the EQ-5D Instrument: The Potential to Estimate QALYs without Generic Preference Data

Objectives:  The aim of this article is to map the European Organization for Research and Treatment of Cancer (EORTC) QLQ C-30 onto the EQ-5D measure to enable the estimation of health state values based on the EORTC QLQ C-30 data. The EORTC QLQ C-30 is of interest because it is the most commonly used instrument to measure the quality of life of cancer patients.
Methods:  Regression analysis is used to establish the relationship between the two instruments. The performance of the model is assessed in terms of how well the responses to the EORTC QLQ C-30 predict the EQ-5D responses for a separate data set.
Results:  The results showed that the model explaining EQ-5D values predicted well. All of the actual values were within the 95% confidence intervals of the predicted values. More importantly, predicted difference in quality-adjusted life-years (QALYs) between the arms of the trial was almost identical to the actual difference.
Conclusion:  There is potential to estimate EQ-5D values using responses to the disease-specific EORTC QLQ C-30 measure of quality of life. Such potential implies that in studies that do not include disease-specific measures, it might still be possible to estimate QALYs.     

A Program of Methodological Research to Arrive at the New International EQ-5D-5L Valuation Protocol

ObjectivesTo describe the research that has been undertaken by the EuroQol Group to improve current methods for health state valuation, to summarize the results of an extensive international pilot program, and to outline the key elements of the five-level EuroQol five-dimensional (EQ-5D-5L) questionnaire valuation protocol, which is the culmination of that work.MethodsTo improve on methods of health state valuation for the EQ-5D-5L questionnaire, we investigated the performance of different variants of time trade-off and discrete choice tasks in a multinational setting. We also investigated the effect of three modes of administration on health state valuation: group interviews, online self-completion, and face-to-face interviews.ResultsThe research program provided the basis for the EQ-5D-5L questionnaire valuation protocol. Two different types of tasks are included to derive preferences: a newly developed composite time trade-off task and a forced-choice paired comparisons discrete choice task. Furthermore, standardized blocked designs for the selection of the states to be valued by participants were created and implemented together with all other elements of the valuation protocol in a digital aid, the EuroQol Valuation Technology, which was developed in conjunction with the protocol.ConclusionsThe EuroQol Group has developed a standard protocol, with accompanying digital aid and interviewer training materials, that can be used to create value sets for the EQ-5D-5L questionnaire. The use of a well-described, consistent protocol across all countries enhances the comparability of value sets between countries, and allows the exploration of the influence of cultural and other factors on health state values.     

Cross-cultural adaptation and validation of the Korean version of the EQ-5D in patients with rheumatic diseases

Objectives: This study aimed to determine the cross-cultural adaptation and validation of the Korean version of the EQ-5D in rheumatic conditions. Methods: Translation, back-translation and cognitive debriefing were performed according to the EuroQol groups guidelines. For validity, 508 patients were recruited and administered the EQ-5D, Short-Form 36 and condition-specific measures. Construct validity and sensitivity were evaluated by testing a-priori hypotheses. For reliability, another 57 patients repeated the EQ-5D at 1-week interval, and intra-class correlations (ICC) and kappa statistics were estimated. For responsiveness, another 60 patients repeated it at 12-week interval within the context of clinical trial, and standardized response mean(SRM) were calculated. Results: The cross-cultural adaptation produced no major modifications in the scale. The associations of the EQ-5D with the generic- and condition-specific measures were observed as expected in hypotheses the higher: EQ-5D_index and EQ-5D_VAS scores, the better health status by generic- or condition-specific measures, and the better functional class. The ICCs were 0.751 and 0.767, respectively, and kappa ranged from 0.455 to 0.772. The SRM were 0.649 and 0.410, respectively. Conclusion: The Korean EQ-5D exhibits good validity and sensitivity in various rheumatic conditions. Although its reliability and responsiveness were not excellent, it seems acceptable if condition-specific measures are applied together.     

Swedish population health-related quality of life results using the EQ-5D

Health-related quality of life (HRQoL) measured on population level may be useful to guide policies for health. This study aims to describe the HRQoL; in EQ-5D dimensions, mean rating scale (RS) scores and mean EQ-5D index values, in the general population, by certain disease and socio-economic groups, in Stockholm County 1998. The EQ-5D self-classifier and a RS were included in the 1998 cross-sectional postal Stockholm County public health survey to a representative sample (n = 4950, 20-88 years), 63% response rate. Mean RS score ranged from 0.90 (20-29 years) to 0.69 (80-88 years), mean EQ-5D index value ranged from 0.89 (20-29 years) to 0.74 (80-88 years). For different diseases mean RS scores ranged from 0.80 (asthma) to 0.69 (angina pectoris), mean EQ-5D index values ranged from 0.79 (asthma) to 0.66 (low back pain). The mean health state scores (RS and EQ-5D index) were 0.06 lower in the unskilled manual group than in the higher non-manual group after controlling for age and sex (p < 0.0001). This difference was 0.03 after controlling also for different diseases (p < 0.0001). In conclusion, our results show that the HRQoL varies greatly between socio-economic and disease groups. Furthermore, after controlling for age, sex and disease, HRQoL is lower in manual than in non-manual groups.     

Measuring the effects of unintended pregnancy on women's quality of life

BACKGROUND: This study was conducted to assess the potential impact of an unintended pregnancy on women's quality of life. STUDY DESIGN: We asked 192 nonpregnant women to report how they would feel if they learned that they were pregnant using a visual analog scale (VAS), a time trade-off (TTO) metric, a standard gamble (SG) metric and a willingness-to-pay (WTP) metric. RESULTS: Women's anticipated responses to an unintended pregnancy varied widely. Using a VAS, 8% reported pregnancy would make them feel like they were dying. To avoid pregnancy, 28% of women were willing to trade time from the end of their life (TTO), 16% of women were willing to accept an immediate risk of death (SG) and 60% of women were willing to pay some amount of money (WTP). On average, women, using the VAS, TTO and SG metrics, reported that an unintended pregnancy would create a health utility state (where 0 represents death and 1 represents perfect health) of 0.487, 0.992 and 0.997, respectively. CONCLUSION: The anticipated effects of pregnancy on women's quality of life should be integrated into cost-effectiveness analyses of family planning services.     

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

ObjectivesThere 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.MethodsData 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.ResultsCompared 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.ConclusionsThe 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.     

Validity and reliability of the EQ-5D self-report questionnaire in English-speaking Asian patients with rheumatic diseases in Singapore

Validity and reliability of a Singaporean English EQ-5D self-report questionnaire (EQ-5D) were evaluated among consecutive outpatients with rheumatic diseases attending a tertiary referral hospital in Singapore (a multi-ethnic, urban Asian country). Subjects were interviewed twice within a 2-week period using a standardized questionnaire containing the EQ-5D, Short Form 36 Health Survey (SF-36) and assessing demographic and psychosocial characteristics. To assess validity of the EQ-5D, 13 hypotheses relating responses to EQ-5D dimension/Visual Analogue Scale (EQ-VAS) to SF-36 scores or other variables were examined using the Mann–Whitney test, Kruskal–Wallis test, or Spearman's correlation coefficient. Test–retest reliability was assessed using Cohen's . Sixty-six subjects were studied (osteoarthritis: 9, rheumatoid arthritis: 26, systemic lupus erythematosus: 23, spondyloarthropathy: 8; female: 72.7%; mean age: 44.3 years). Ten of 13 a-priori hypotheses relating EQ-5D responses to external variables were fulfilled, supporting the validity of the EQ-5D. Cohen's for test–retest reliability (n = 52) ranged from 0.29 to 0.61. The Singaporean English EQ-5D appears to be valid in measuring quality of life in Singaporeans with rheumatic diseases; however, its reliability requires further investigation. These data provide a basis for further studies assessing the validity of the EQ-5D in Singapore.     

2型糖尿病患者的EQ-5D量表结构效度分析

目的 分析2型糖尿病患者的EQ-5D结构效度,以进一步认识和应用.方法 资料来自于2010年全国23个省（市）的103个临床试验中心调查资料,对象为9872例15岁及以上的口服降糖药物的2型糖尿病患者.采用验证性因子分析进行结构效度分析,并用PA-OV递归模型（Path analysis with observed variables）来探索生活质量影响因素.结果 量表5个维度可以提取出2个公因子,分别命名为＂主动生活质量＂和＂感知生活质量＂.行动、平常活动和自我照顾三维度在＂主动生活质量＂上因子载荷分别为0.82、0.84和0.88,而疼痛、不舒服在＂感知生活质量＂上因子载荷分别为0.71和0.56,自我照顾存在跨因子现象.主动和感知生活质量2个初阶因子在＂整体生活质量＂上的因子载荷分别为0.66和0.88.一阶和二阶验证性因子分析模型适配度均较好,模型稳定.结论 验证性因子分析能较好地评价EQ-5D结构效度,并能应用于2型糖尿病患者生活质量影响因素的探索.     

The health-related quality-of-life impact of chronic conditions varied with age in general population

OBJECTIVE: To estimate the individual- and population-level impact of major chronic conditions on health-related quality of life (HRQoL) at different ages, to test whether the HRQoL impact of conditions varies with age, and to predict future changes of quality-adjusted life years (QALYs) lost due to morbidity. STUDY DESIGN AND SETTING: HRQoL was measured using two preference-based instruments, the 15D and the EQ-5D, in a representative sample of 8,028 Finns. Information on chronic somatic conditions was obtained by interviews. Psychiatric disorders were diagnosed using a structured interview (Munich version of the Composite International Diagnostic Interview). RESULTS: The impact of chronic conditions on HRQoL increased fourfold when comparing people aged 30-44 years to people over 75 years. This was mostly due to increase in prevalence, but the severity of some conditions also varied with age. Musculoskeletal disorders had the largest and rather stable impact across ages on the population level. Psychiatric disorders placed the largest burden on HRQoL at 30-44 years, but their impact declined after 55 years. The aging of the Finnish population was predicted to increase annual QALYs lost due to morbidity by one quarter by year 2040. CONCLUSION: The impact of conditions on HRQoL varied with age for each condition.     

Measuring health-related quality of life in bipolar disorder: Relationship of the EuroQol (EQ-5D) to condition-specific measures

Generic utility measures of health-related quality of life provide an independent net valuation of health states. They are increasingly used with condition-specific outcome measures in assessing treatments. In Bipolar Disorder, a few studies indicate poorer quality of life for depressed vs. euthymic patients. A single study suggests mania is less negative than depression. This analysis examines the relationship of one such scale, the EuroQol (EQ-5D), to objective and subjective measures of depression and mania in 221 Bipolar subjects, recently or still in an episode of illness. Results: Depressed patients showed a very poor quality of life (median EQ-5D Index score 0.41). Index and Visual Analogue scores improved significantly as level of depression decreased (Jonckheere–Terpstra test p<0.001). Both scores were significantly negatively related to all depression measures. Patients reported problems across all areas of life covered by the EQ-5D. No such relationships were observed between EQ-5D scores and mania measures, though all mania measures were inter-related. However, the range of mania shown was quite restricted. Conclusions: The EQ-5D is a useful measure of quality of life for Bipolar patients suffering from depression. Conclusions about the role of the EQ-5D in mania are restricted by the limited range of mania observed.     

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.     

Estimating an EQ-5D population value set: the case of Japan

Quality adjustment weights for quality-adjusted life years (QALYs) are available with the EQ-5D Instrument, which are based on a survey that quantified the preferences of the British public. However, the extent to which this British value set is applicable to other, especially non-European, countries is yet unclear. The objectives of this study are (a) to compare the valuations obtained in Japan and Britain, and (b) to explore a local Japanese value set. A diminished study design is employed, where 17 hypothetical EQ-5D health states are evaluated as opposed to 42 in the British study. The official Japanese version of the instrument and the Time Trade-Off method are used to interview 543 members of the public. The results are: firstly, the evaluations obtained in Japan and those from Britain differ by 0.24 on average on a [-1, +1] scale, and mean absolute error (MAE) in predicting the Japanese preferences with the British value set is 0.23. Secondly, comparable regressions suggest that the two peoples have systematically different preference structures (p<0.001 for 8 of 12 coefficients; F-test). Thirdly, using alternative models, the predictions are improved so that the local Japanese value set achieves MAE in the order of 0.01.     

EQ-5D与SF-12量表在安徽省农村糖尿病患者生命质量评估中的应用

目的对比EQ-SD与SF-12量表对农村糖尿病患者生命质量评估效果,探索生命质量相关影响因素。方法采用EQ-SD与SF-12量表对安徽省农村糖尿病患者生命质量进行评估,使用多元线性回归等统计学方法对比两量表评估结果,分析生命质量影响因素。结果EQ-SD量表具有较好的可行性与实用性,但敏感性略低于SF-12。SF-12条目与维度较多,在生命质量评价中敏感性更高。年龄、性别、文化程度、糖化血红蛋白测定值、胰岛素使用及医疗保险对糖尿病患者生命质量有不同程度的影响。结论两量表均能在一定程度上较好地反映糖尿病患者的生命质量,其评估结果是可比和互补的。