Abstract
BackgroundIn health economic analyses, health states are typically valued using instruments with few items per dimension. Due to the generic (and often reductionist) nature of such instruments, certain groups of respondents may experience challenges in describing their health state. This study is concerned with generic, preference-based health state instruments that provide information for decisions about the allocation of resources in health care. Unlike physical measurement instruments, preference-based health state instruments provide health state values that are dependent on how respondents interpret the items. This study investigates how individuals with spinal cord injury (SCI) interpret mobility-related items contained within six preference-based health state instruments.MethodsSecondary analysis of focus group transcripts originally collected in Vancouver, Canada, explored individuals’ perceptions and interpretations of mobility-related items contained within the 15D, Assessment of Quality of Life 8-dimension (AQoL-8D), EQ-5D-5L, Health Utilities Index (HUI), Quality of Well-Being Scale Self-Administered (QWB-SA), and the 36-item Short Form health survey version 2 (SF-36v2). Ritchie and Spencer’s ‘Framework Approach’ was used to perform thematic analysis that focused on participants’ comments concerning the mobility-related items only.ResultsFifteen individuals participated in three focus groups (five per focus group). Four themes emerged: wording of mobility (e.g., ‘getting around’ vs ‘walking’), reference to aids and appliances, lack of suitable response options, and reframing of items (e.g., replacing ‘walking’ with ‘wheeling’). These themes reflected item features that respondents perceived as relevant in enabling them to describe their mobility, and response strategies that respondents could use when faced with inaccessible items.ConclusionInvestigating perceptions to mobility-related items within the context of SCI highlights substantial variation in item interpretation across six preference-based health state instruments. Studying respondents’ interpretations of items can help to understand discrepancies in the health state descriptions and values obtained from different instruments. This line of research warrants closer attention in the health economics and quality of life literature.
Highlights
In health economic analyses, health states are typically valued using instruments with few items per dimension
Diseasespecific instruments are more sensitive to small changes in health-related quality of life (HRQoL) for the target group because they focus on aspects that are known to be relevant to that group
The aim of this study is to further explore and describe difficulties faced by respondents living with spinal cord injury (SCI) when answering mobility-related items included in health state instruments
Summary
Health states are typically valued using instruments with few items per dimension. This study is concerned with generic, preference-based health state instruments that provide information for decisions about the allocation of resources in health care. Preference-based health state instruments provide health state values that are dependent on how respondents interpret the items. This study investigates how individuals with spinal cord injury (SCI) interpret mobility-related items contained within six preference-based health state instruments. Instruments used to measure health-related quality of life (HRQoL) can be classified as either generic or specific to a particular disease, condition, or population otherwise defined (e.g., older adults). Information gained by using generic and disease-specific instruments is valuable when conducting economic evaluation to inform decision processes concerning competing demands for scarce health care resources [1, 3,4,5,6]. Only generic instruments allow for comparisons of interventions across different diseases and patient groups
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