Comparison of the Health Utilities Index Mark 3 (HUI3) and the EuroQol EQ-5D in patients treated for intermittent claudication

The Health Utilities Index Mark 3 (HUI3) and the EuroQol EQ-5D (EQ-5D) were compared to each other and to other quality-of-life (QoL) measures in patients treated for intermittent claudication. A total of 88 patients with intermittent claudication completed the HUI3, EQ-5D, RAND 36-Item Health Survey 1.0, time tradeoff, standard gamble, and rating scale before revascularization and at follow-up at 1 month, 3 months, and 1 year. The effect of treatment on the HUI3 and EQ-5D dimensions and the overall scores, calculated using published formulas based on societal preferences, were compared. After 1 month of treatment, the majority of patients showed improvement on the HUI3 dimensions ambulation and pain and on the EQ-5D dimensions mobility, usual activities, and pain/discomfort. The mean HUI3 score was significantly higher than the mean EQ-5D score (0.66 and 0.57, respectively, p < 0.01) before treatment. After treatment, however, they were not significantly different from each other (e.g., 12 months after treatment: 0.77 and 0.75, respectively (p > 0.05). After 1 month, the scores did not change significantly over time (p > 0.05). The intraclass correlation coefficient between changes over time in the HUI3 and EQ-5D scores was 0.30, with other health-related quality-of-life (HRQoL) measures the correlations for HUI3 and EQ-5D were very similar. In conclusion, both the HUI3 and EQ-5D demonstrated an effect of treatment in patients with intermittent claudication; in addition, they showed similar relationships with other (HRQoL) measures. To demonstrate the effect of revascularization in patients with intermittent claudication, however, clinicians and researchers should be aware of the differences in the mean HUI3 and EQ-5D scores. This revised version was published online in June 2006 with corrections to the Cover Date.     

A view from the bridge: agreement between the SF-6D utility algorithm and the Health Utilities Index

BACKGROUND: The SF-6D is a new health state classification and utility scoring system based on 6 dimensions ('6D') of the Short Form 36, and permits a "bridging" transformation between SF-36 responses and utilities. The Health Utilities Index, mark 3 (HUI3) is a valid and reliable multi-attribute health utility scale that is widely used. We assessed within-subject agreement between SF-6D utilities and those from HUI3. METHODS: Patients at increased risk of sudden cardiac death and participating in a randomized trial of implantable defibrillator therapy completed both instruments at baseline. Score distributions were inspected by scatterplot and histogram and mean score differences compared by paired t-test. Pearson correlation was computed between instrument scores and also between dimension scores within instruments. Between-instrument agreement was by intra-class correlation coefficient (ICC). RESULTS: SF-6D and HUI3 forms were available from 246 patients. Mean scores for HUI3 and SF-6D were 0.61 (95% CI 0.60-0.63) and 0.58 (95% CI 0.54-0.62) respectively; a difference of 0.03 (p<0.03). Score intervals for HUI3 and SF-6D were (-0.21 to 1.0) and (0.30-0.95). Correlation between the instrument scores was 0.58 (95% CI 0.48-0.68) and agreement by ICC was 0.42 (95% CI 0.31-0.52). Correlations between dimensions of SF-6D were higher than for HUI3. CONCLUSIONS: Our study casts doubt on the whether utilities and QALYs estimated via SF-6D are comparable with those from HUI3. Utility differences may be due to differences in underlying concepts of health being measured, or different measurement approaches, or both. No gold standard exists for utility measurement and the SF-6D is a valuable addition that permits SF-36 data to be transformed into utilities to estimate QALYs. The challenge is developing a better understanding as to why these classification-based utility instruments differ so markedly in their distributions and point estimates of derived utilities.     

Is the Health Utilities Index responsive in total hip arthroplasty patients?

OBJECTIVE: The purpose is to examine the responsiveness of the Health Utilities Index Mark 2 (HUI2), Mark 3 (HUI3), and other generic and disease-specific measures in osteoarthritis patients undergoing total hip arthroplasty (THA). METHODS: Ninety patients (mean age=68.13; SD=8.15) on a waiting list for THA completed measures that included the standard gamble, HUI2, HUI3, SF-36, Harris Hip Scale, WOMAC, and MACTAR. before and after THA. Responsiveness statistics (effect size, standardized response mean, Guyatt's responsiveness statistic, paired-sample t-tests, and relative efficiency statistic) were calculated. RESULTS: The disease-specific measures were more responsive than the generic measures. Rankings of the degree of responsiveness varied depending on the responsiveness statistic used. CONCLUSIONS: Disease-specific measures are the most responsive in THA patients. However, the SF-36, HUI2, and HUI3 had summary scores and domain/attributes scores that were also responsive and provided additional information. Among the generic measures, HUI3 was the most responsive.     

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.     

Comparing the Health Utilities Index Mark 3 (HUI3) with the Short Form-36 Preference-Based SF-6D in Chronic Kidney Disease

Objective:  Assess within-subject agreement and compare discriminative abilities between the SF-6D and the Health Utilities Index Mark 3 (HUI3) in patients with chronic kidney disease (CKD).
Methods:  The HUI3 and Short Form-36 were self-completed by 185 CKD patients enrolled in a prospective study of incident patients with stage 4 and 5 CKD.
Results:  The mean preference-based score for the SF-6D was 0.67 ± 0.13 compared to 0.58 ± 0.26 for the HUI3 ( P  < 0.01). There was a strong association between SF-6D and HUI3 scores (Pearson correlation coefficient 0.55, 95% CI 0.43–0.65) and moderate agreement with an intraclass correlation coefficient of 0.44. The HUI3 was better able to capture more severe burden of illness with fewer floor effects. The SF-6D was better at capturing differences among patients at the top range of the scale with fewer ceiling effects. Both the HUI3 and SF-6D were able to discriminate between patient groups differing in disease severity defined as predialysis versus dialysis dependent and depressive symptoms using a Beck Depression Inventory II score of ≥14 as the cutoff. The HUI3 was better able to discriminate greater depressive symptoms.
Conclusion:  The SF-6D and the HUI3 generate different preference-based scores for patients with CKD and any comparison between their scores should be made with caution. The HUI3 appears more suitable for measuring the health of populations with greater disability such as patients with CKD. It remains to be determined whether these differences will remain when one compares within-instrument differences in preference scores over time.     

Comparing Short Form 6D,Standard Gamble,and Health Utilities Index Mark 2 and Mark 3 utility scores: Results from total hip arthroplasty patients

Objective: The objectives are to compare SF-6D, standard gamble (SG), and Health Utilities Index (HUI) utility scores, compare change scores, and compare responsiveness. Methods: A cohort of osteoarthritis patients referred for total hip arthroplasty (THA) were evaluated at the time of referral and followed until 3months after THA. Patients were assessed using the SF-36, HUI2, HUI3, and the SG. Agreement is assessed using the intra-class correlation (ICC). Responsiveness is assessed using effect size, standardized response mean, and paired t-test. Results: Data was available for 86 patients at baseline and for 63 at both pre- and post-surgery. At baseline mean SF-6D (0.61), SG (0.62), and HUI2 (0.62) scores were similar; the mean HUI3 score (0.52) was lower. Standard deviations were 0.10, 0.32, 0.19, and 0.22. At baseline, agreement between SF-6D and SG scores was 0.13, agreement between SF-6D and HUI2 was 0.47, and agreement between SF-6D and HUI3 was 0.28. Agreement at pre- and post-surgery was similar. The change in scores between post- and pre-surgery was 0.10 for SF-6D, 0.16 for SG, 0.22 for HUI2, and 0.23 for HUI3. Effect sizes were 1.10 for HUI2, 1.08 for HUI3, 1.06 for SF-6D, and 0.48 for the SG. Conclusions: Agreement between SG scores and SF-6D and HUI scores was low. The estimate of change in utility associated with THA was lowest for SF-6D. Additional longitudinal studies to compare utility measures appear to be warranted.     

The effect of weight loss on changes in health-related quality of life among overweight and obese women with urinary incontinence

Objective

To estimate the effect of change in weight and change in urinary incontinence (UI) frequency on changes in preference-based measures of health-related quality of life (HRQL) among overweight and obese women with UI participating in a weight loss trial.

Methods

We conducted a longitudinal cohort analysis of 338 overweight and obese women with UI enrolled in a randomized clinical trial comparing a behavioral weight loss intervention to an educational control condition. At baseline, 6, and 18?months, health utilities were estimated using the Health Utilities Index Mark 3 (HUI3), a transformation of the SF-36 to the preference-based SF-6D, and the estimated Quality of Well-Being (eQWB) score (a summary calculated from the SF-36 physical functioning, mental health, bodily pain, general health perceptions, and role limitations?Cphysical subscale scores). Potential predictors of changes in these outcomes were examined using generalized estimating equations.

Results

In adjusted multivariable models, weight loss was associated with improvement in HUI3, SF-6D, and eQWB at 6 and 18?months (P?<?0.05). Increases in physical activity also were independently associated with improvement in HUI3 (P?=?0.01) and SF-6D (P?=?0.006) scores at 18?months. In contrast, reduction in UI frequency did not predict improvements in HRQL at 6 or 18?months.

Conclusion

Weight loss and increased physical activity, but not reduction in UI frequency, were strongly associated with improvements in health utilities measured by the HUI3, SF-6D, and eQWB. These findings provide important information that can be used to inform cost?Cutility analyses of weight loss interventions.     

The feasibility and responsiveness of the health utilities index in patients with early-stage breast cancer: A prospective longitudinal study

Background The health utilities index (HUI3) is a health measurement instrument based on individuals’ preferences for different health states. Breast cancer (BC) is common, with a high proportion of long-term survivors, making evaluation of treatment effects important. Feasibility and responsiveness of HUI3 was compared to the short-form 36 (SF-36) in patients with BC. Methods HUI3 and SF-36 were administered eight times: at initial surgical consultation, 1 week before surgery; 1 week, 3, 6, 12, 18, and 24 months after surgery. Effect size, analysis of variance, and Pearson product moment correlations were calculated. BC data were compared to normative values. Results Eighty-five patients were enrolled. Ninety-one percent of planned assessments were completed. HUI3 showed significant responsiveness (P < 0.01) after surgery and during recovery. HUI3 scores correlated with SF-36 scores. Comparison to normative data demonstrated the significant detrimental effect of BC diagnosis. Results showed long-term effects of treatment on physical health and positive effects on mental/emotional health in BC survivors. Conclusion(s) HUI3 was found to be feasible and responsive in our cohort of BC patients. Changes in HUI3 values over time, and compared to normative data, paralleled SF-36 scores. HUI3 is a valuable tool in health-related quality of life and cost-utility studies in patients with BC.     

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.     

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.     

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.     

A comparison of the Nottingham Health Profile and Short Form 36 Health Survey in patients with chronic lower limb ischaemia in a longitudinal perspective

Background

Different generic quality of life instruments such as the Nottingham Health Profile (NHP) and the Short Form 36 Health Survey (SF-36) have revealed conflicting results in patients with chronic lower limb ischaemia in psychometric attributes in short-term evaluations. The aim of this study was to compare the NHP and the SF-36 regarding internal consistency reliability, validity, responsiveness and suitability as outcome measures in patients with lower limb ischaemia in a longitudinal perspective.

Methods

48 patients with intermittent claudication and 42 with critical ischaemia were included. Assessment was made before and one year after revascularization using comparable domains of the NHP and the SF-36 questionnaires.

Results

The SF-36 was less skewed and more homogeneous than the NHP. There was an average convergent validity in three of the five comparable domains one year postoperatively. The SF-36 showed a higher internal consistency except for social functioning one-year postoperatively and was more responsive in detecting changes over time in patients with intermittent claudication. The NHP was more sensitive in discriminating among levels of ischaemia regarding pain and more able to detect changes in the critical ischaemia group.

Conclusion

Both SF-36 and NHP have acceptable degrees of reliability for group-level comparisons, convergent and construct validity one year postoperatively. Nevertheless, the SF-36 has superior psychometric properties and was more suitable in patients with intermittent claudication. The NHP however, discriminated better among severity of ischaemia and was more responsive in patients with critical ischaemia.

     

Comparing utility scores before and after hearing-aid provision

Utility scores were estimated for 609 hearing-impaired adults who completed EQ-5D, Health Utilities Index Mark III (HUI3) and SF-6D survey instruments both before and after being provided with a hearing aid. Pre-intervention, the mean utility scores for EQ-5D (0.80) and SF-6D (0.78) were significantly higher than the mean HUI3 utility score (0.58). Post-intervention, the mean improvement in the HUI3 (0.06 change) was significantly higher than the mean improvement according to the EQ-5D (0.01 change) or SF-6D (0.01 change). The estimated cost effectiveness of hearing-aid provision is therefore likely to be dependent on which instrument is used to measure utility.     

Comparing short form and RAND physical and mental health summary scores: results from total hip arthroplasty and high-risk primary-care patients

OBJECTIVES: Summary physical health scores for the Short Form (SF) measures are computing using positive weights for physical items and negative weights for mental health items. Mental health summary scores use positive weights for mental items and negative weights for physical. The RAND Health Status Inventory (HSI) measures do not use negative weights. Do these different approaches to scoring matter? The objective was to compare summary scores using both the SF and RAND-HSI. METHODS: SF-36 and the Health Utilities Index Mark 3 (HUI3) were administered to a cohort of patients waiting for elective total hip arthroplasty (THA). SF-12 and HUI3 were administered to a cohort of high-risk primary-care patients. Summary scores were generated and compared. Single-attribute utility scores for emotion in HUI3 were also computed. Canadian and US norms for SF, RAND-HSI, and HUI3 were used to interpret results. RESULTS: For THA patients, mean physical health scores were 28 and 36 for SF and RAND-HSI. Mean mental health scores were 55 and 42. For the primary-care patients, the scores were 34 and 36 for physical and 46 and 40 for mental health. CONCLUSIONS: SF and RAND-HSI provided somewhat similar summary scores in the THA study. However, SF and RAND-HSI mental health scores differed in the primary-care patient cohort and results from HUI3 corroborate the mental health deficits identified by the RAND-HSI. It may be wise for investigators to use both SF and RAND-HSI scoring systems.     

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.     

Assessing Health-Related Quality of Life in Cataract Patients: The Relationship between utility and Health-Related Quality of Life Measurement

The relationship between health-related quality of life (HQL) measures and patient preference for their health status was studied. Study subjects consisted of 132 patients at four hospitals who were scheduled for cataract surgery. Generic and disease-specific health status measures were determined in study subjects. The Medical Outcomes Study Short-form 36 (SF-36) item health status instrument was used to measure generic health status and the Visual Function 14 (VF-14) item visual health status instrument was used as the disease-specific health measure. Preference for general health and visual health was measured by assessing utilities assigned by patients to certain health states. Utilities assigned for general health were correlated with all categories of the SF-36 and VF-14 scores. Utilities assigned for visual health were correlated with four categories of the SF-36 (role limitation due to emotional health, general health, physical functioning, and vitality) and VF-14 scores. Utilities assigned for visual health were more strongly correlated with VF-14 scores than generic measures of health. Verbal ratings for visual health were correlated with Snellen visual acuity (SVA) (r=0.20), utilities assigned for visual health (r=0.58), VF-14 scores (r=0.74), all categories of the SF-36 (r values ranging from 0.21 to 0.28), utilities assigned for general health (r=0.19), and verbal ratings for general health (r=0.29). Utility measures and verbal ratings for general and visual health were shown to be appropriate HQL measures. These measures were strongly correlated with other established generic and disease-specific health measures and should be included in the array of health status measures. This revised version was published online in June 2006 with corrections to the Cover Date.     

Mapping analyses to estimate health utilities based on responses to the OM8-30 otitis media questionnaire

Purpose  

To investigate the statistical relationship between the OM8-30 health-related quality of life measure for children with otitis media with effusion (OME) and measures of health utility (Health Utilities Index [HUI] Mark 3 and Mark 2) and to develop models to estimate HUI3 and HUI2 health utilities from OM8-30 scores.     

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.