Validity of the EQ-5D-5L and EQ-5D-3L in patients with Crohn’s disease

Quality of Life Research - The EuroQol five-dimension questionnaire (EQ-5D) is the most commonly used instrument to obtain utility values for cost-effectiveness analyses of treatments for...     

基于中国普通人群的EQ-5D-3L与EQ-5D-5L比较研究

目的:对EQ-5D-3L与EQ-5D-5L量表在中国普通人群中的差异进行比较分析。方法:样本来自北京、成都、南京、沈阳的城市和农村居民,对两种量表的天花板效应、再分布情况和信息区分能力进行分析,并探索这三个方面在城乡居民之间的差异。结果:天花板效应方面,EQ-5D-5L量表选择完全健康状态比例为60.50%,低于EQ-5D-3L的72.08%,并且,这种改善主要体现在"疼痛/不舒服"与"焦虑/抑郁"两个维度。城市和农村的天花板效应分别下降了12.94%和10.21%。再分布方面,两种量表总体不一致率为6.93%,不一致情况主要集中在"疼痛/不舒服"和"焦虑/抑郁"维度。不一致率在农村为8.96%,高于城市的4.93%。信息区分能力方面,EQ-5D-5L量表各个维度Shannon指数均大于3L,说明其信息区分能力更好,农村与城市样本中得到了一致的发现。结论:EQ-5D-5L量表能够降低天花板效应并提高健康状态的辨别能力,开展生命质量研究时应根据两种量表的优势和特点,进行合理选择。     

基于中国四类人群的EQ-5D-3L和EQ-5D-5L量表比较分析

  目的  分别在高血压、糖尿病、慢性肝炎患者和普通人群中,比较EQ-5D-3L和EQ-5D-5L量表的差异。  方法  用两量表对四类人群进行调查,比较两量表测量结果的一致性、再分布不一致性和信息区分能力。  结果  四类人群中,两量表效用值的组内相关系数均>0.7;EQ-5D-5L与EQ-5D-3L量表相比,天花板效应降幅分别为5.8%、8.3%、9.2%和17.3%;两量表五个维度的平均再分布不一致率分别为5.5%、7.6%、5.7%和2.2%,不一致情况主要集中在疼痛/不舒服和焦虑/抑郁两个维度;在四类人群中,除普通人群的自我照顾维度外,其余维度EQ-5D-5L量表的Shannon指数均优于EQ-5D-3L量表;Shannon均匀指数方面,在行动能力维度上四类人群均是EQ-5D-5L量表的值较大,两量表在其他四个维度对应的数值各有高低。  结论  在慢病人群中,EQ-5D-5L量表额外增加水平体现出其应有的优势,并能提高受访者对量表中健康状态的辨别能力,而在普通人群中EQ-5D-3L量表已能够满足研究需要。     

How different are composite and traditional TTO valuations of severe EQ-5D-5L states?

Quality of Life Research - Different variants of time trade-off (TTO) have been employed to elicit health state preferences and to create value sets for preference-based instruments. We compared...     

Validation and comparison of 15-D and EQ-5D-5L instruments in a Spanish Parkinson’s disease population sample

Purpose

To contribute to the ongoing discussion on the choice of a preference-based health-related quality of life (HRQoL) instrument to be used in cost-effectiveness analysis by studying and comparing the validity, sensitivity and relative efficiency of 15-D and EuroQol 5D 5L (EQ-5D-5L) in a Spanish Parkinson’s disease (PD) population sample.

Methods

One hundred and thirty-three volunteers were asked to complete an interview using 15-D and EQ-5D-5L. Spearman’s rank correlation coefficient (r) was used to test the convergent validity of these instruments with specific PD measures. Sensitivity and efficiency were compared using receiver operating characteristic (ROC) curves and relative efficiency statistic, respectively.

Results

A strong correlation (r > 0.65; p < 0.001) was found between both 15-D and EQ-5D-5L utilities with the summary score of the PDQ-8, and a strong correlation (r > 0.50; p < 0.001) was found between 15-D and EQ-5D-5L utilities with the EQ-VAS. The areas under the ROC of both instruments all exceeded 0.5 (p < 0.001). The 15-D instrument was 4.1–29.8 % less efficient at detecting differences between patients with optimal HRQoL, while this instrument was 11 % more efficient at detecting differences between patients at mild and moderate to strong severity of the PD symptoms.

Conclusions

15-D and EQ-5D-5L are showed to be valid and sensitivity generic HRQoL measures in Spanish PD patients with both instruments showing similar HRQoL dimension coverage and ceiling/floor effects. The 15-D has better efficiency and greater sensitivity to detect clinical changes in PD severity of the symptoms meanwhile the EQ-5D-5L is better to detect clinical HRQoL changes. Additionally, the EQ-5D-5L questionnaire requires less time than 15-D to be administered, and it might be more appropriate for studies conducted in Spain, since a country-specific “value set” is available for this instrument and not for the 15-D.     

构建EQ-5D-5L量表效用积分体系的国际研究现状分析

为降低天花板效应,增强对较轻健康状态的区分能力,欧洲生命质量小组在EQ-5D-3L量表的基础上开发出新的EQ-5D-5L量表。EQ-5D量表的测量结果需通过效用积分体系转化成健康效用值,目前,加拿大、西班牙、英国、乌拉圭、韩国及荷兰已构建起基于本国人群健康偏好的EQ-5D-5L效用积分体系。通过对上述国家构建的研究方案、测量方法、健康状态选取、样本估计、数据处理及模型结果等进行介绍和比较,以此为中国EQ-5D-5L积分体系的构建提供参考。     

A ‘new and improved’ EQ-5D valuation questionnaire?

Notwithstanding its widespread use, the standard questionnaire used to elicit visual analogue scale valuations for EQ-5D states is well known to suffer from problems with missing values (particularly for the state "dead") and logical inconsistencies. This contribution reports on efforts to redesign the questionnaire to overcome these problems and the results from its use in a pilot study. The redesigned questionnaire asks respondents to provide a numerical score for each state (instead of drawing lines to a visual analogue scale) and employs a new method for valuing "dead". A pilot study was undertaken to gauge the effects of these innovations, over and above other cosmetic changes to the questionnaire. The redesigned questionnaire was found to result in fewer missing values, fewer exclusions and fewer logical inconsistencies. Mean re-scaled values for the health states remained virtually identical. The results suggest that scoring is a better way of eliciting self-completed valuations than scaling.     

EQ-5D in Central and Eastern Europe: 2000–2015

Objective

Cost per quality-adjusted life year data are required for reimbursement decisions in many Central and Eastern European (CEE) countries. EQ-5D is by far the most commonly used instrument to generate utility values in CEE. This study aims to systematically review the literature on EQ-5D from eight CEE countries.

Methods

An electronic database search was performed up to 1 July 2015 to identify original EQ-5D studies from the countries of interest. We analysed the use of EQ-5D with respect to clinical areas, methodological rigor, population norms and value sets.

Results

We identified 143 studies providing 152 country-specific results with a total sample size of 81,619: Austria (n = 11), Bulgaria (n = 6), Czech Republic (n = 18), Hungary (n = 47), Poland (n = 51), Romania (n = 2), Slovakia (n = 3) and Slovenia (n = 14). Cardiovascular (21 %), neurologic (17 %), musculoskeletal (15 %) and endocrine, nutritional and metabolic diseases (13 %) were the most frequently studied clinical areas. Overall, 112 (78 %) of the studies reported EQ VAS results and 86 (60 %) EQ-5D index scores, of which 27 (31 %) did not specify the applied tariff. Hungary, Poland and Slovenia have population norms. Poland and Slovenia also have a national value set.

Conclusions

Increasing use of EQ-5D is observed throughout CEE. The spread of health technology assessment activities in countries seems to be reflected in the number of EQ-5D studies. However, improvement in informed use and methodological quality of reporting is needed. In jurisdictions where no national value set is available, in order to ensure comparability we recommend to apply the most frequently used UK tariff. Regional collaboration between CEE countries should be strengthened.

     

‘Like holding the axe on who should live or not’: adolescents’ and adults’ perceptions of valuing children’s health states using a standardised valuation protocol for the EQ-5D-Y-3L

Quality of Life Research - There is an increasing interest for using qualitative methods to investigate peoples’ cognitive process when asked to value health states. A standardised valuation...     

EQ-5D VAS映射模型比较

目的比较EQ-5D-3L量表与EQ-5D VAS映射模型及值域表,提出不同人群EQ-5D VAS映射模型的选择策略。方法通过对某功能社区的现场调查,获取EQ-5D-3L量表和EQ-5D VAS的实测值,对比国内外12个映射模型和本研究建立的预测模型的相关性和绝对误差。所有模型均为一般线性模型,数据处理采用R语言。结果 (1)欧洲及英国、芬兰等7个国家及新西兰之间EQ-5D VAS映射模型的相关系数均大于0.9。以芬兰作为国外VAS映射模型的代表,芬兰模型与中国2次调查和本研究的相关系数分别为0.969、0.939和0.976;(2)本研究和芬兰模型的VAS预测值与实测值的拟合曲线相似,平均绝对误差分别为17.11和16.96;(3)VAS预测值比TTO预测值平均少20分,更接近实测值。结论 2008年和2013年在第四次和第五次国家卫生服务调查建立的EQ-5D VAS映射模型,对于相对健康人群,2008年建立的N3模型误差较小。国外模型中,芬兰模型误差较小。根据特定人群建立的映射模型不能外推到其他人群。     

失能老人EQ-5D-5L自评与代评生命质量及其影响因素分析*

目的：测评成都市60岁及以上失能老人自评与代评生命质量并分析其影响因素,评估两类结果的一致性及代评可行性。方法：使用EQ-5D-5L测量失能老人自评与代评的生命质量,应用加权Kappa和ICC进行一致性检验,使用Mann-Whitney/Wilcoxon和Kruskal-Wallis检验进行单因素与差异性分析,影响因素分析使用了广义线性模型回归。结果：失能老人自评健康效用均值为（0.106±0.308）,EQ-VAS均值为（62.06±21.91）;代评健康效用均值为（0.113±0.323）,EQ-VAS均值为（63.04±21.25）,代评结果均略高于自评结果。自评、代评健康效用值与EQ-VAS一致性较好（ICC均大于0.70）,各维度一致性为尚可或中等（加权Kappa值约为0.40～0.50）。失能老人失能程度、经济状况、户外活动与睡眠、照护者与老人的关系、照护者是否掌握照护相关知识等对失能老人生命质量及自评、代评结果差异影响具有统计显著性（P＜0.05）。结论：失能老人生命质量远低于常人,应综合考虑相关因素,提高失能老人生命质量;其主要照护者的EQ-5D-5L代评结果可考虑作为失能老人自评结果的补充,但个别维度需谨慎应用,需考虑被评价对象的人群特征与个人差异、代理人类型、测量工具等。     

基于EQ-5D-5L量表的住院肺癌患者健康相关生命质量及其影响因素分析

目的 以山东省肿瘤医院为例,测量住院肺癌患者的健康相关生命质量,并分析其影响因素。方法 采用EQ-5D-5L量表及自编问卷对2020年8—9月山东省肿瘤医院符合纳排标准的住院肺癌患者进行调查,使用Mann-Whitney检验或Kruskal-Wallis检验进行单因素分析,采用Tobit回归模型分析调查对象健康相关生命质量的影响因素。结果 最终收集到189份有效问卷,住院肺癌患者的健康效用值平均值为(0.81±0.16),EQ视觉模拟评分刻度尺(EQ-VAS)评分的平均值为(76.61±13.99)分。Tobit回归分析显示,居住地、癌症分期以及是否转移是肺癌患者健康效用值的影响因素。农村患者的健康效用值低于城市患者(β=-0.006,P=0.049);疾病分期为Ⅲ期(β=-0.114,P=0.013)、Ⅳ期(β=-0.180,P<0.01)的患者的健康效用值均低于疾病分期Ⅰ期组;癌症发生转移的患者的健康效用值低于未转移组(β=-0.038,P=0.033)。结论 本研究住院肺癌患者健康效用值较低,农村、癌症分期较晚以及发生转移的患者健康相关生命质量较差。     

EQ-5D-3L两种积分效用体系对成都市城镇居民的适用性评价

目的通过比较英国与中国EQ-5D-3L两种积分效用体系对成都市城镇居民生命质量健康效用值的评价,探讨两种体系对研究对象的适用性。方法用EQ-5D量表测量患者的生命质量,数据用SPSS 19.0进行统计分析。结果通过spearmen相关矩阵分析得出两种积分体系具有高度的相关性,所得健康指数的分布均为偏态分布,但是相较于英国的积分体系,中国积分体系模型拟合优度的R2、F值比英国高,且AIC值与BIC值低于英国。结论相比于英国的效用积分体系,我国的积分体系对研究人群健康效用评价有更好的适用性。     

基于EQ-5D-3L和ICECAP-A量表的我国普通人群生命质量研究

目的:分析EQ-5D-3L和ICECAP-A量表评价我国普通人群生命质量的差异以及对干预方案价值评价的影响,为研究者选择合适的生命质量测量工具提供参考。方法:采用配额抽样选取802名受访者进行生命质量评价,并分别采用因子分析、多分格相关性和Bland-Altman plot一致性分析等方法探讨两量表测量结果的差异。结果:Wilcoxon秩和检验表明EQ-5D-3L量表的健康效用均值高于ICECAP-A量表的测量结果;ICECAP-A量表五个维度均主要加载于反映社会心理健康的因子1,而EQ-5D-3L量表的大部分维度主要加载于反映生理健康的因子2。部分维度之间也存在显著的相关性,但均较弱。两量表效用值的ICC为0.32,一致性分析显示5.74%的受访者超出了95%的一致性界限。结论:前者的测量内涵是健康相关生命质量,而后者则反映的是幸福感、可行能力等更广义的生命质量,其对于旨在提升公众广义幸福感和社会福祉的干预措施效果评估方面具有较好的适用性。研究者可根据测量目的及量表属性选择合适的量表,鉴于两个量表在测量内涵中的互补性,也可以在研究中同时采用两种量表以便更全面地反映干预措施的效果或受访者的生命质量。     

Condition-specific or generic preference-based measures in oncology? A comparison of the EORTC-8D and the EQ-5D-3L

Purpose

It has been argued that generic health-related quality of life measures are not sensitive to certain disease-specific improvements; condition-specific preference-based measures may offer a better alternative. This paper assesses the validity, responsiveness and sensitivity of a cancer-specific preference-based measure, the EORTC-8D, relative to the EQ-5D-3L.

Methods

A longitudinal prospective population-based cancer genomic cohort, Cancer 2015, was utilised in the analysis. EQ-5D-3L and the EORTC QLQ-C30 (which gives EORTC-8D values) were asked at baseline (diagnosis) and at various follow-up points (3 months, 6 months, 12 months). Baseline values were assessed for convergent validity, ceiling effects, agreement and sensitivity. Quality-adjusted life-years (QALYs) were estimated and similarly assessed. Multivariate regression analyses were employed to understand the determinants of the difference in QALYs.

Results

Complete case analysis of 1678 patients found that the EQ-5D-3L values at baseline were significantly lower than the EORTC-8D values (0.748 vs 0.829, p < 0.001). While the correlation between the instruments was high, agreement between the instruments was poor. The baseline health state values using both instruments were found to be sensitive to a number of patient and disease characteristics, and discrimination between disease states was found to be similar. Mean generic QALYs (estimated using the EQ-5D-3L) were significantly lower than condition-specific QALYs (estimated using the EORTC-8D) (0.860 vs 0.909, p < 0.001). The discriminatory power of both QALYs was similar.

Conclusions

When comparing a generic and condition-specific preference-based instrument, divergences are apparent in both baseline health state values and in the estimated QALYs over time for cancer patients. The variability in sensitivity between the baseline values and the QALY estimations means researchers and decision makers are advised to be cautious if using the instruments interchangeably.

     

The “no problems”-problem: an empirical analysis of ceiling effects on the EQ-5D 5L

Aim

To analyze the association between ceiling effects on the EQ-5D 5L and morbidity in a general population sample.

Methods

We used a cross-sectional sample of the German general population (n?=?5007) to describe the frequency of health state “11111” and “no problems”-answers on the five single dimensions stratified by the number of diseases for which participants utilized health care during the last 6 months. For the five single dimensions we also used specific criteria to analyze their discriminative ability. A logit-model was applied for a multivariate analysis of ceiling effects.

Results

31% of participants reported the health state “11111.” This percentage strongly decreased with increasing morbidity, down to 4.9% if four or more diseases were present. The dimensions “mobility,” “usual activities,” and “pain/discomfort” showed good discriminative abilities. The dimensions “anxiety/depression” and “self -care” were able to discriminate between different levels of morbidity, but nevertheless showed strong ceiling effects, in particular “self-care.”

Conclusion

When analyzing ceiling effects of the EQ-5D 5L, one has to draw attention to morbidity since high proportions of participants indicating the best health state might result from being healthy regarding the dimensions assessed by the EQ-5D, in particular in general population datasets.

     

基于EQ-5D-5L量表的甲状腺结节/肿瘤患者生命质量及其影响因素分析*

目的：评价甲状腺结节/肿瘤患者生命质量现状并分析其影响因素，为改善甲状腺结节/肿瘤患者的生命质量提供参考建议。方法：使用欧洲五维健康 （EQ-5D-5L） 量表并采用线上调查的形式对符合纳入排除标准的甲状腺结节/肿瘤患者进行调查，采用单因素方差分析和多水平线性回归分析影响因素。结果：甲状腺结节/肿瘤患者健康效用值均值为 （0.708± 0.298），健康状况自评问卷与视觉模拟标尺评分 （EQ Visual analogue scale，EQ-VAS） 均值为 （65.45±27.82） 分，性别、年龄、户籍类型、婚姻状态、家庭平均年收入、颈部暴露史、甲状腺癌家族史、结节/肿瘤性质对甲状腺结节/肿瘤患者健康效用值和EQ-VAS量表的影响，差异具有统计学意义 （P＜0.05）。结论：甲状腺结节/肿瘤患者生命质量偏低，应综合考虑影响生命质量的各种因素，提升患者生理机能和心理弹性，改善甲状腺结节/肿瘤患者的生命质量。