Abstract
BackgroundAssessments of health-related quality of life and particularly utility values are important components of health economic analyses. Several instruments have been developed to measure utilities. However no consensus has emerged regarding the most appropriate instrument within a therapeutic area such as chronic pain. The study compared two instruments – EQ-5D and SF-6D – for their performance and validity in patients with chronic pain.MethodsPooled data from three randomised, controlled clinical trials with two active treatment groups were used. The included patients suffered from osteoarthritis knee pain or low back pain. Differences between the utility measures were compared in terms of mean values at baseline and endpoint, Bland–Altman analysis, correlation between the dimensions, construct validity, and responsiveness.ResultsThe analysis included 1977 patients, most with severe pain on the Numeric Rating Scale. The EQ-5D showed a greater mean change from baseline to endpoint compared with the SF-6D (0.43 to 0.58 versus 0.59 to 0.64). Bland–Altman analysis suggested the difference between two measures depended on the health status of a patient. Spearmans rank correlation showed moderate correlation between EQ-5D and SF-6D dimensions. Construct validity showed both instruments could differentiate between patient subgroups with different severities of adverse events and analgesic efficacies but larger differences were detected with the EQ-5D. Similarly, when anchoring the measures to a disease-specific questionnaire – Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) – both questionnaires could differentiate between WOMAC severity levels but the EQ-5D showed greater differences. Responsiveness was also higher with the EQ-5D and for the subgroups in which improvements in health status were expected or when WOMAC severity level was reduced the improvements with EQ-5D were higher than with SF-6D.ConclusionsThis analysis showed that the mean EQ-5D scores were lower than mean SF-6D scores in patients with chronic pain. EQ-5D seemed to have higher construct validity and responsiveness in these patients.
Highlights
Assessments of health-related quality of life and utility values are important components of health economic analyses
A utility is a metric used in health economic evaluations to capture quality of life and is used as a basis of cost-utility analysis, the most common type of health economic evaluation used in health technology assessment
Mean values for baseline EQ‐5D and SF‐6D utilities compared with mean values for endpoint showed a greater change from baseline to endpoint with EuroQol-5 dimension (EQ-5D) compared with Short Form-6 dimension (SF-6D) (0.43 to 0.58 [mean change of 0.15; 95% CI: 0.143 0.169] versus 0.59 to 0.64 [mean change of 0.05; 95% CI: 0.045-0.055])
Summary
Assessments of health-related quality of life and utility values are important components of health economic analyses. Chronic pain represents a major health burden in Europe affecting as many as one in five adults [1,2,3] Pain can be directly related to absenteeism and unemployment, and severe daily pain has been shown to increase healthcare resource utilization with increased visits to healthcare providers, including hospitalisations [4,5,6] It has a major impact on an individual’s quality of life [6] which can substantially decrease with increasing pain severity [7]. Indirect measurement of utilities is more commonly undertaken by using pre-scored, multi-attribute health status classification systems [9] These generic instruments include the EuroQol-5 dimension (EQ-5D), Short Form-6 dimension (SF-6D), and Health Utilities Index 3 (HUI3) and generate utilities that can be used to compare QALYs across different patient groups and diseases
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