Can Multi-Attribute Utility Instruments Adequately Capture Net Health Gains in Vision-Related Quality of Life (QoL)?

Abstract

Background: Health states/outcomes evaluation is an integral part of medical economics. Generic utility instruments compare quality of life (QoL) effects of healthcare interventions across a wide spectrum of diseases and patient populations. This study seeks to determine whether these generic instruments are sensitive to ocular diseases, where expected QoL effects of treatment are patient comfort and symptoms relief, rather than additional quality-adjusted life years (QALYs). Methods: Targeted search and systematic review of refereed studies on dry eye therapy with omega-3 fatty acids (omega-3s) were performed across four databases to identify clinical effectiveness parameters and outcomes. An alternative utility instrument for measuring comparative vision/opthalmic-related QoL effects of pharmaceutical-grade fish oils is used for illustration. Results: Most studies utilise common parametric indices of omega-3 therapy in dry eye. VisQoL appears sufficiently sensitive and customisable to a QoL impact assessment of omega-3s. Clinical outcomes and covariates can be matched to VisQoL in capturing aspects of vision functioning that are vital for patient daily performance and well-being, U = x / n. In contrast, generic measures tend to be content-insensitive to changes in vision/opthalmic-related QoL. Conclusions: Relevance, reliability and validity of multi-attribute utility measures in ocular conditions, like dry eye, can be assessed in terms of four key factors addressed by VisQoL: (a) sensitivity to ocular condition; (b) correlation with clinical parametric data; (c) customisability based on presenting symptoms; and (d) suitability to comparative investigations of intervention effectiveness relative to vision-related QoL.