Measuring quality of life in opioid-induced constipation: mapping EQ-5D-3L and PAC-QOL.

Anthony James Hatswell,Stefan Vegter

doi:10.1186/s13561-016-0091-9

Abstract

BackgroundIn health economic evaluations, quality of life should be measured with preference-based utilities, such as the EuroQol 5 Dimension 3-level (EQ-5D-3 L). Non-preference-based instruments (often disease-specific questionnaires) are commonly mapped to utilities. We investigated if the relationship observed between the Patient Assessment of Constipation Quality of Life (PAC-QOL) and the EQ-5D-3 L in patients with chronic idiopathic constipation (CIC) also applies in opioid-induced constipation (OIC).MethodsEQ-5D-3 L patient-level data from a clinical study of lubiprostone in OIC (n = 439) were scored using the UK tariff. A published mapping between the PAC-QOL and the EQ-5D-3 L was tested using these data. New mapping formulas were analysed, including PAC-QOL total and subscale scores. The root mean square error (RMSE), the adjusted R2 and predicted/observed plots were used to test the fit.ResultsThe utility measured with the EQ-5D-3 L was 0.450 ± 0.329, with a distinctly bimodal distribution. This significantly improved if patients responded to treatment (defined as an increase of three spontaneous bowel movements per week, with no rescue medication taken). The published mapping in CIC performed poorly in this OIC population, and the PAC-QOL could not be reliably mapped on to the EQ-5D-3 L even when re-estimating coefficients. This was shown in our two mappings (using PAC-QOL total score, and subscale scores) by a high RMSE (0.317 and 0.314) and a low R2 (0.068 and 0.080), with high utilities underestimated and low utilities overestimated.ConclusionsPatients with OIC have a low quality of life which does improve with the resolution of symptoms. However the PAC-QOL cannot be used to estimate the EQ-5D-3 L utility – potentially as the PAC-QOL does not capture the all relevant aspects of the patients quality of life (for example the cause of the opioid use).

Highlights

In health economic evaluations, quality of life should be measured with preference-based utilities, such as the EuroQol 5 Dimension 3-level (EQ-5D-3 L)
As chronic idiopathic constipation (CIC) patients experience the same symptoms, our expectation was that a similar relationship would exist between the Patient Assessment of Constipation Quality of Life (PAC-QOL) and EQ-5D-3 L in opioid-induced constipation (OIC) and CIC
Patients were enrolled with a confirmed diagnosis of non-methadone OIC for chronic non-cancer-related pain, who were having fewer than three spontaneous bowel movements (SBMs) per week and experiencing symptoms of constipation

Summary

Introduction

Quality of life should be measured with preference-based utilities, such as the EuroQol 5 Dimension 3-level (EQ-5D-3 L). Non-preference-based instruments (often disease-specific questionnaires) are commonly mapped to utilities. We investigated if the relationship observed between the Patient Assessment of Constipation Quality of Life (PAC-QOL) and the EQ-5D-3 L in patients with chronic idiopathic constipation (CIC) applies in opioid-induced constipation (OIC). The condition is caused by opioids inhibiting the secretion of intestinal fluids and suppressing the peristaltic propulsion of the gastrointestinal tract, thereby slowing gastrointestinal motility [1]. The relationship between a non-preference-based instrument (often a disease-specific questionnaire containing aspects on quality of life) and a generic measure is estimated [8]. The Patient Assessment of Constipation Quality of Life (PAC-QOL) is a commonly used disease-specific questionnaire, which contains questions on worries and concerns, physical discomfort, psychosocial discomfort, and satisfaction [9]. As CIC patients experience the same symptoms (with the same endpoints and scales used in clinical trials), our expectation was that a similar relationship would exist between the PAC-QOL and EQ-5D-3 L in OIC and CIC

Methods

Results

Conclusion