How the EQ-5D utilities are derived matters in Chinese diabetes patients: a comparison based on different EQ-5D scoring functions for China

Quality of Life Research - In China, multiple approaches to calculating EQ-5D utilities are available, including the two EQ-5D-3L (3L2014 and 3L2018) scoring functions, the EQ-5D-5L (5L) scoring...     

Longitudinal predictive ability of mapping models: examining post-intervention EQ-5D utilities derived from baseline MHAQ data in rheumatoid arthritis patients

Objectives

The purpose of this methodological study was to to provide insight into the under-addressed issue of the longitudinal predictive ability of mapping models. Post-intervention predicted and reported utilities were compared, and the effect of disease severity on the observed differences was examined.

Methods

A cohort of 120 rheumatoid arthritis (RA) patients (60.0% female, mean age 59.0) embarking on therapy with biological agents completed the Modified Health Assessment Questionnaire (MHAQ) and the EQ-5D at baseline, and at 3, 6 and 12 months post-intervention. OLS regression produced a mapping equation to estimate post-intervention EQ-5D utilities from baseline MHAQ data. Predicted and reported utilities were compared with t test, and the prediction error was modeled, using fixed effects, in terms of covariates such as age, gender, time, disease duration, treatment, RF, DAS28 score, predicted and reported EQ-5D.

Results

The OLS model (RMSE = 0.207, R ² = 45.2%) consistently underestimated future utilities, with a mean prediction error of 6.5%. Mean absolute differences between reported and predicted EQ-5D utilities at 3, 6 and 12 months exceeded the typically reported MID of the EQ-5D (0.03). According to the fixed-effects model, time, lower predicted EQ-5D and higher DAS28 scores had a significant impact on prediction errors, which appeared increasingly negative for lower reported EQ-5D scores, i.e., predicted utilities tended to be lower than reported ones in more severe health states.

Conclusions

This study builds upon existing research having demonstrated the potential usefulness of mapping disease-specific instruments onto utility measures. The specific issue of longitudinal validity is addressed, as mapping models derived from baseline patients need to be validated on post-therapy samples. The underestimation of post-treatment utilities in the present study, at least in more severe patients, warrants further research before it is prudent to conduct cost-utility analyses in the context of RA by means of the MHAQ alone.     

Comparison of EQ-5D and SF-6D utilities in mental health patients

Various preference-based measures of health are available for use as an outcome measure in cost-utility analysis. The aim of this study is to compare two such measures EQ-5D and SF-6D in mental health patients. Baseline data from a Dutch multi-centre randomised trial of 616 patients with mood and/or anxiety disorders were used. Mean and median EQ-5D and SF-6D utilities were compared, both in the total sample and between severity subgroups based on quartiles of SCL-90 scores. Utilities were expected to decline with increased severity.Both EQ-5D and SF-6D utilities differed significantly between patients of adjacent severity groups. Mean utilities increased from 0.51 at baseline to 0.68 at 1.5 years follow-up for EQ-5D and from 0.58 to 0.70 for SF-6D. For all severity subgroups, the mean change in EQ-5D utilities as well as in SF-6D utilities was statistically significant. Standardised response means were higher for SF-6D utilities. We concluded that both EQ-5D and SF-6D discriminated between severity subgroups and captured improvements in health over time. However, the use of EQ-5D resulted in larger health gains and consequent lower cost-utility ratios, especially for the subgroup with the highest severity of mental health problems.     

Testing alternative regression models to predict utilities: mapping the QLQ-C30 onto the EQ-5D-5L and the SF-6D

Purpose

The purpose of the study was to compare alternative statistical techniques to find the best approach for converting QLQ-C30 scores onto EQ-5D-5L and SF-6D utilities, and to estimate the mapping algorithms that best predict these health state utilities.

Methods

772 cancer patients described their health along the cancer-specific instrument (QLQ-C30) and two generic preference-based instruments (EQ-5D-5L and SF-6D). Seven alternative regression models were applied: ordinary least squares, generalized linear model, extended estimating equations (EEE), fractional regression model, beta binomial (BB) regression, logistic quantile regression and censored least absolute deviation. Normalized mean absolute error (NMAE), normalized root mean square error (NRMSE), r-squared (r²) and concordance correlation coefficient (CCC) were used as model performance criteria. Cross-validation was conducted by randomly splitting internal dataset into two equally sized groups to test the generalizability of each model.

Results

In predicting EQ-5D-5L utilities, the BB regression performed best. It gave better predictive accuracy in terms of all criteria in the full sample, as well as in the validation sample. In predicting SF-6D, the EEE performed best. It outperformed in all criteria: NRMSE?=?0.1004, NMAE?=?0.0798, CCC?=?0.842 and r²?=?72.7% in the full sample, and NRMSE?=?0.1037, NMAE?=?0.0821, CCC?=?0.8345 and r²?=?71.4% in cross-validation.

Conclusions

When only QLQ-C30 data are available, mapping provides an alternative approach to obtain health state utility data for use in cost-effectiveness analyses. Among seven alternative regression models, the BB and the EEE gave the most accurate predictions for EQ-5D-5L and SF-6D, respectively.

     

A cross-sectional validation study of EQ-5D among the Malaysian adult population

Purpose  

The objective of this study was to assess the construct validity of the EQ-5D instrument among the Malaysian population.     

Comparing SF-6D and EQ-5D utilities across groups differing in health status

Objectives  To compare the EQ-5D and SF-6D within socio-demographic and clinical groups in a representative sample (n = 1,005) of the Greek general population and to examine mean utility differences across groups differing in health in this population and in a highly morbid disease sample (diabetes, n = 215). Methods  Association and level of agreement between instruments were estimated with Pearson’s r and the intraclass correlation coefficient (ICC), respectively. Paired-samples t-test was used to identify significant score differences, which were regarded as minimally important differences (MID) when they exceeded 0.03. The EQ-VAS was used to classify individuals into health status groups, covering the range from very poor to very good health, and the same classification was used in the diabetes sample. Results  EQ-5D and SF-6D were in agreement and strongly correlated over the entire sample (ICC = 0.536, P < 0.001 and r = 0.662, P < 0.001), but correlation varied according to socio-demographic factors and clinical conditions. In healthier responders, EQ-5D scores were significantly higher than SF-6D scores (P < 0.001) and differences constituted MIDs. Contrarily, in individuals with clinical conditions, SF-6D scores were predominantly higher than EQ-5D. The pattern of results was replicated in the disease sample as well. Conclusions  The hypotheses that EQ-5D generates higher scores in healthier populations and the SF-6D in less healthier groups were confirmed. Based on the evidence provided here, EQ-5D and SF-6D measuring discrepancies generate utility differences across VAS-based health groups, which warrant further within-sample investigation.     

Falls and EQ-5D rated quality of life in community-dwelling seniors with concurrent chronic diseases: a cross-sectional study

Background

Although recommended for use in studies investigating falls in the elderly, the European Quality of Life Group instrument, EQ-5D, has not been widely used to assess the impact of falls on quality of life. The aim of this study was to investigate the association of single and frequent falls with EQ-5D rated quality of life in a sample of German community-dwelling seniors in primary care suffering a variety of concurrent chronic diseases and conditions.

Methods

In a cross-sectional study, a sample of community-dwelling seniors aged?≥?72 years was interviewed by means of a standardised telephone interview. According to the number of self-reported falls within twelve months prior to interview, participants were categorised into one of three fall categories: no fall vs. one fall vs. two or more falls within twelve months. EQ-5D values as well as other characteristics were compared across the fall categories. Adjustments for a variety of concurrent chronic diseases and conditions and further variables were made by using multiple linear regression analysis, with EQ-5D being the target variable.

Results

In total, 1,792 participants (median age 77 years; 53% female) were analysed. The EQ-5D differed between fall categories. Participants reporting no fall had a mean EQ-5D score of 81.1 (standard deviation [s.d.]: 15.4, median: 78.3), while participants reporting one fall (n?=?265; 14.8%) and participants with two or more falls (n?=?117; 6.5%) had mean total scores of 77.0 (s.d.: 15.8, median: 78.3; mean difference to participants without a fall: -4.1, p?<?0.05) and 72.1 (s.d.: 17.6, median: 72.5; mean difference: -9.0, p?<?0.05), respectively. The mean difference between participants with one fall and participants with two or more falls was -4.9 (p?<?0.05). Under adjustment for a variety of chronic diseases and conditions, the mean decrease in the total EQ-5D score was about -1.0 score point for one fall and about -2.5 points for two or more falls within twelve months. In quantity, this decrease is comparable to other chronic diseases adjusted for. Among the variables with the greatest negative association with EQ-5D ratings in multivariate analysis were depression and fear of falling.

Conclusions

The findings suggest that falls are negatively associated with EQ-5D rated quality of life independent of a variety of chronic diseases and conditions.     

Comparing the sensitivity of EQ-5D, SF-6D and 15D utilities to the specific effect of diabetic complications

Objectives  

Diabetes patients suffer from comorbid conditions and disease-related complications. Combined with demographic, clinical and treatment satisfaction variables, they have a confounding effect on health-related quality of life (HRQoL). This study compared the sensitivity of EQ-5D, SF-6D and 15D utilities to the specific effect of diabetes complications.     

Development of the EQ-5D-Y: a child-friendly version of the EQ-5D

Purpose

To develop a self-report version of the EQ-5D for younger respondents, named the EQ-5D-Y (Youth); to test its comprehensibility for children and adolescents and to compare results obtained using the standard adult EQ-5D and the EQ-5D-Y.

Methods

An international task force revised the content of EQ-5D and wording to ensure relevance and clarity for young respondents. Children’s and adolescents’ understanding of the EQ-5D-Y was tested in cognitive interviews after the instrument was translated into German, Italian, Spanish and Swedish. Differences between the EQ-5D and the EQ-5D-Y regarding frequencies of reported problems were investigated in Germany, Spain and South Africa.

Results

The content of the EQ-5D dimensions proved to be appropriate for the measurement of HRQOL in young respondents. The wording of the questionnaire had to be adapted which led to small changes in the meaning of some items and answer options. The adapted EQ-5D-Y was satisfactorily understood by children and adolescents in different countries. It was better accepted and proved more feasible than the EQ-5D. The administration of the EQ-5D and of the EQ-5D-Y causes differences in frequencies of reported problems.

Conclusions

The newly developed EQ-5D-Y is a useful tool to measure HRQOL in young people in an age-appropriate manner.     

A review of health utilities using the EQ-5D in studies of cardiovascular disease

Background  

The EQ-5D has been extensively used to assess patient utility in trials of new treatments within the cardiovascular field. The aims of this study were to review evidence of the validity and reliability of the EQ-5D, and to summarise utility scores based on the use of the EQ-5D in clinical trials and in studies of patients with cardiovascular disease.     

Comparison of EQ-5D-5L and EORTC QLU-C10D utilities in gastric cancer patients

The European Journal of Health Economics - To compare measurement properties of the utility scores derived from various country-specific value sets of EQ-5D-5L (5L) and EORTC QLU-C10D (10D) in...     

Estimating health utilities in patients with asthma and COPD: evidence on the performance of EQ-5D and SF-6D

Objective  The objective of this study was to understand systematic differences in utility values derived from the EQ-5D and the SF-6D in two respiratory populations with heterogeneous disease severity. Methods  This study involved secondary analysis of data from two cross-sectional surveys of patients with asthma (N = 228; Hungary) and COPD (N = 176; Sweden). Disease severity was defined according to GINA and GOLD guidelines for asthma and COPD, respectively. EQ-5D and SF-6D scores and their distributional characteristics were compared across the two samples by disease severity level. Results  Within each patient population, mean EQ-5D and SF-6D scores were similar for the overall group and for those with moderate disease. Mean scores varied for patients with mild and severe disease. EQ-5D versus SF-6D scores in the asthma group by severity levels were 0.89 versus 0.80, 0.70 versus 0.73, 0.63 versus 0.64, and 0.51 versus 0.63, respectively. EQ-5D versus SF-6D scores in the COPD group by severity levels were 0.85 versus 0.80, 0.73 versus 0.73, 0.74 versus 0.73, and 0.53 versus 0.62, respectively. Conclusions  Results suggest the EQ-5D and SF-6D do not yield consistent utility values in patients with asthma and COPD due to differences in underlying valuation techniques and the EQ-5D’s limited response options relative to mild disease.     

Comparing the psychometric properties of the EQ-5D-3L and EQ-5D-5L descriptive systems and utilities in atopic dermatitis

Background

Atopic dermatitis (AD) is a common chronic inflammatory skin disorder affecting up to 10% of adults. The EQ-5D is the most commonly used generic preference-accompanied measure to generate quality-adjusted life years (QALYs) for economic evaluations.

Objectives

We aimed to compare psychometric properties of the three-level and five-level EQ-5D (EQ-5D-3L and EQ-5D-5L) in adult patients with AD.

Methods

In a multicentre cross-sectional study, 218 AD patients with a broad range of severity completed the EQ-5D-3L, EQ-5D-5L, Dermatology Life Quality Index (DLQI) and Skindex-16. Disease severity outcomes included the Investigator Global Assessment, Eczema Area and Severity Index and the objective SCORing Atopic Dermatitis.

Results

A good agreement was established between the two EQ-5D versions with an intraclass correlation coefficient of 0.815 (95% CI 0.758–0.859, p < 0.001). Overall, 33 different health state profiles occurred in the EQ-5D-3L and 84 in the EQ-5D-5L. Compared to the EQ-5D-3L, ceiling effect was reduced for the mobility, self-care, usual activities and pain/discomfort dimensions by 4.6–11.5%. EQ-5D-5L showed higher average relative informativity (Shannon’s evenness index: 0.64 vs. 0.59). EQ-5D-5L demonstrated better convergent validity with EQ VAS, DLQI and Skindex-16. The two measures were similar in distinguishing between groups of patients based on disease severity and skin-specific quality of life with a moderate or large effect size (η² = 0.083–0.489).

Conclusion

Both instruments exhibited good psychometric properties in AD; however, the EQ-5D-5L was superior in terms of ceiling effects, informativity and convergent validity. We recommend the use of the EQ-5D-5L to measure health outcomes in clinical settings and for QALY calculations in AD.

     

Feasibility, reliability, and validity of the EQ-5D-Y: results from a multinational study

Purpose

To examine the feasibility, reliability, and validity of the newly developed EQ-5D-Y.

Methods

The EQ-5D-Y was administered in population samples of children and adolescents in Germany, Italy, South Africa, Spain, and Sweden. Percentages of missing values and reported problems were calculated. Test–retest reliability was determined. Spearman’s rank correlation coefficients with other generic measures of HRQOL were calculated. Known groups’ validity was examined by comparing groups with a priori expected differences in HRQOL.

Results

Between 91 and 100% of the respondents provided valid scorings. Sweden had the lowest proportion of reported problems (1–24.9% across EQ-5D-Y dimensions), with the highest proportions in South Africa (2.8–47.3%) and Italy (4.3–39.0%). Percentages of agreement in test–retest reliability ranged between 69.8 and 99.7% in the EQ-5D-Y dimensions; Kappa coefficients were up to 0.67. Correlation coefficients with other measures of self-rated health indicated convergent validity (up to r = ?0.56). Differences between groups classified according to presence of chronic conditions, self-rated overall health and psychological problems provided preliminary evidence of known groups’ validity.

Conclusions

Results provide preliminary evidence of the instrument’s feasibility, reliability and validity. Further study is required in clinical samples and for possible future applications in economic analyses.     

Exploring the relationship between development and road traffic injuries: a case study from India

BACKGROUND: Road traffic injuries (RTI) are a major cause of mortality and disability in the world. Only after significant losses have communities in developed nations taken necessary steps to prevent crashes and their consequences. Increase in road safety is related to increasing socio-economic development. We aim to study the trends in injury and death rates in a developing country, India, define sub-national variations, and analyse these trends in relation to economic and population growth. METHODS: Public sector data from India were used to develop a standardized database on traffic injuries and indicator of economic development. The data were analysed using linear regression models to test the a priori hypothesis of a positive relationship between net domestic product (NDP), and injury and death rates from road crashes across states. RESULTS: The absolute burden of RTI in India has been consistently rising over the past three decades. The reported rates are lower than those estimated by global health agencies and may reflect under-reporting. Population-based rates provide a better assessment of the public health burden of RTI than vehicle-based rates. There is an inverted U-shaped relationship between NDP and injury and death rates. Even with the limited data, Kuznets phenomenon is evident for within-country level comparisons. CONCLUSIONS: India and other developing countries could learn from the experience of highly motorized nations to avoid the expected rise in RTI and deaths with economic development, by currently investing in road safety and prevention measures.     

Exploring the relationship between convenience and fish consumption: a cross-cultural study

The purpose of the present study is to explore cultural differences in the meaning of convenience and the relationships between convenience, attitudes and fish consumption in five European countries. The results suggest that the meaning of meal convenience is not culture specific, whilst the absolute levels of convenience orientation and the perceived inconvenience of fish differ between cultures. Convenience orientation was highest in Poland, followed by Spain, and was lowest in the Netherlands. The relationships between convenience orientation and attitudes towards fish, and convenience orientation and fish consumption, were insignificant in most countries. However, convenience orientation was positively related to the perceived inconvenience of fish. Perceived inconvenience of fish was negatively related to both attitudes towards fish and to fish consumption. Together, these results confirm some earlier findings that fish is generally perceived as a relatively inconvenient type of food. This study suggests that convenience orientation can be crucial to understanding food choice or behaviour only when critical mediating constructs are explored.