Abstract
BackgroundEmpirical identification of the direct impact of hospitalisation in the change in utility could provide an interpretation for some of the unexplained variance in quality of life responses in clinical practice and clinical trials and provide assistance to researchers in assessing the impact of a hospitalisation in the context of economic evaluations. This study had the goal of determining the impact of nonfatal hospitalisations on the quality of life of a cohort of patients previously diagnosed with heart failure by using their quality of life measurements before and after hospitalisation.MethodsThe impact of hospitalisation on health-related quality of life was estimated by calculating the difference in utility measured using the EQ-5D-3L in patients that were hospitalised and had records of utility before and after hospitalisation. The variation in differences between the utilities pre and post hospitalisation was explained through two multiple linear regression models using (1) the individual patient characteristics and (2) the hospitalisation characteristics as explanatory variables.ResultsThe mean difference between health-related quality of life measurement pre and post hospitalisation was found to be 0.020 [95% CI: − 0.020, 0.059] when measured with the EQ-5D index, while there was a mean decrease of − 0.012 [95% CI: − 0.043, 0.020] in the utility measured with the visual analogue scale. Differences in utility variation according to the primary cause for hospitalisation were found. Regression models showed a statistically significant impact of body mass index and serum creatinine in the index utility differences and of serum creatinine for utilities measured with the visual analogue scale.ConclusionsKnowing the impact of hospitalisation on health-related quality of life is particularly relevant for informing cost-effectiveness studies designed to assess health technologies aimed at reducing hospital admissions. Through using patient-level data it was possible to estimate the variation in utilities before and after the average hospitalisation and for hospitalisations due to the most common causes for hospital admission. These estimates for (dis) utility could be used in the calculations of effectiveness on economic evaluations, especially when discrete event simulations are the employed modelling technique.
Highlights
Empirical identification of the direct impact of hospitalisation in the change in utility could provide an interpretation for some of the unexplained variance in quality of life responses in clinical practice and clinical trials and provide assistance to researchers in assessing the impact of a hospitalisation in the context of economic evaluations
Since New York Heart Association (NYHA) functional class is only assessed during clinical visits and provides a relatively simplistic way of classifying the extent of heart failure based on patients’ limitations during physical activity, the underlying determinants of reduced quality of life in patients with Heart failure (HF) remain hardly distinguishable [6], HF-related events that are expected to have an impact on patient utility [7]
In view of readmission being a common event for these patients [19, 20] – with the first few weeks after discharge from hospital being the highest risk period; between 20 and 30% of patients are readmitted within 30 days, rising to 50% at 6 months [21], it seemed relevant to have an estimate of the impact of this event on the Health-related quality of life (HRQoL) of HF patients, thereby overcoming the use of utility decrement estimates based on the assumption that patients progress to the immediately worse NYHA class after hospitalisation [8]
Summary
Empirical identification of the direct impact of hospitalisation in the change in utility could provide an interpretation for some of the unexplained variance in quality of life responses in clinical practice and clinical trials and provide assistance to researchers in assessing the impact of a hospitalisation in the context of economic evaluations. This study had the goal of determining the impact of nonfatal hospitalisations on the quality of life of a cohort of patients previously diagnosed with heart failure by using their quality of life measurements before and after hospitalisation. The New York Heart Association (NYHA) functional classification – a system for classifying patients according to the severity of their symptoms – has been shown to be a strong independent predictor of QoL for patients with HF [3]. Since NYHA functional class is only assessed during clinical visits and provides a relatively simplistic way of classifying the extent of heart failure based on patients’ limitations during physical activity, the underlying determinants of reduced quality of life in patients with HF remain hardly distinguishable [6], HF-related events that are expected to have an impact on patient utility (e.g. hospitalisation) [7]
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