Differences In Utility Values Research Articles

Effects of diabetes-related foot ulcer depth on healing days, cost, and quality of life: A prospective observational study.

The relationship between the depth of the diabetes-related foot ulcers, and the healing days, cost, and QOL was examined.Depth 4 and 5 ulcers, namely beyond the tendons, exhibited significantly longer healing days and higher costs than Depth 2 and 3 ulcers. As for QOL, there were no significant differences in utility values between the depth categories.Results on healing time and cost reiterate the importance of early consultation, especially before the depth becomes deeper than the tendon.

Comparison of the measurement properties of the EQ-5D-5L and SF-6Dv2 among overweight and obesity populations in China

ObjectiveTo evaluate and compare the measurement properties of the EQ-5D-5L and SF-6Dv2 among Chinese overweight and obesity populations.MethodsA representative sample of Chinese overweight and obesity populations was recruited stratified by age, gender, body mass index (BMI), and area of residence. Social-demographic characteristics and self-reported EQ-5D-5L and SF-6Dv2 responses were collected through the online survey. The agreement was assessed using intraclass correlation coefficients (ICC). Convergent validity and known-group validity were examined using Spearman’s rank correlation and effect sizes, respectively. The test-retest reliability was assessed using among a subgroup of the total sample. Sensitivity was compared using relative efficiency and receiver operating characteristic.ResultsA total of 1000 respondents (52.0% male, mean age 51.7 years, 67.7% overweight, 32.3% obesity) were included in this study. A higher ceiling effect was observed in EQ-5D-5L than in SF-6Dv2 (30.6% vs. 2.1%). The mean (SD) utility was 0.851 (0.195) for EQ-5D-5L and 0.734 (0.164) for SF-6Dv2, with the ICC of the total sample was 0.639 (p < 0.001). The Spearman’s rank correlation (range: 0.186–0.739) indicated an acceptable convergent validity between the dimensions of EQ-5D-5L and SF-6Dv2. The EQ-5D-5L showed basically equivalent discriminative capacities with the SF-6Dv2 (ES: 0.517–1.885 vs. 0.383–2.329). The ICC between the two tests were 0.939 for EQ-5D-5L and 0.972 for SF-6Dv2 among the subgroup (N = 150). The SF-6Dv2 had 3.7–170.1% higher efficiency than the EQ-5D-5L at detecting differences in self-reported health status, while the EQ-5D-5L was found to be 16.4% more efficient at distinguishing between respondents with diabetes and non-diabetes.ConclusionsBoth the EQ-5D-5L and SF-6Dv2 showed comparable reliability, validity, and sensitivity when used in Chinese overweight and obesity populations. The two measures may not be interchangeable given the systematic difference in utility values between the EQ-5D-5L and SF-6Dv2. More research is needed to compare the responsiveness.

Second Version of the Short Form 6-Dimension Value Set Elicited From Patients With Breast and Colorectal Cancer: A Hybrid Approach.

Quality-adjusted life-year instruments help comparison among programs by capturing their effects in terms of utility. Generic instruments are applicable to everyone, and for this reason, they are known to lack sensitivity when measuring gains in some domains. Specific instruments tend to fill this gap but, in domains like cancer, existing instruments are either nonpreferences-based or based on the general population's preferences. This study describes the development of a new value set for a well-known and highly used generic instrument, the Second Version of the Short Form 6-Dimension, to better consider the preferences of patients with cancer. In this aim, a hybrid approach combining the time trade-off and the discrete choice experiment was used. The population of interest was the Quebec population, Canada, with breast or colorectal cancer. Their preferences were elicited in 2 periods: before (T1) and 8 days after the beginning of a chemotherapy procedure (T2). A total of 2808 observations for the time trade-off and 2520 observations for the discrete choice experiment were used. The parsimonious model encompassing the 2 periods was the preferred model. The new value set allows a greater utility range than the EQ-5D-5L and the Second Version of the Short Form 6-Dimension reference value sets and helps in better considering patients experiencing severe health situations. A good correlation between these 2 instruments and other specific cancer instruments (ie, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, QLU-C10D, and Functional Assessment of Cancer Therapy-General) was observed. Significative differences in utility values were also noted within periods and types of cancer.

Comparison of the measurement properties of SF-6Dv2 and EQ-5D-5L in a Chinese population health survey

BackgroundSF-6Dv2, the latest version of SF-6D, has been developed recently, and its measurement properties remain to be evaluated and compared with the EQ-5D-5L. The aim of this study was to assess and compare the measurement properties of the SF-6Dv2 and the EQ-5D-5L in a large-sample health survey among the Chinese population.MethodsData were obtained from the 2020 Health Service Survey in Tianjin, China. Respondents were randomly selected and invited to complete both the EQ-5D-5L and SF-6Dv2 through face-to-face interviews or self-administration. Health utility values were calculated by the Chinese value sets for the two measures. Ceiling and floor effects were firstly evaluated. Convergent validity and discriminate validity were examined using Spearman’s rank correlation and effect sizes, respectively. The agreement was assessed using intraclass correlation coefficients (ICC). Sensitivity was compared using relative efficiency and receiver operating characteristic.ResultsAmong 19,177 respondents (49.3% male, mean age 55.2 years, ranged 18–102 years) included in this study, the mean utility was 0.939 (0.168) for EQ-5D-5L and 0.872 (0.184) for SF-6Dv2. A higher ceiling effect was observed in EQ-5D-5L than in SF-6Dv2 (72.8% vs. 36.1%). The Spearman’s rank correlation (range: 0.30–0.69) indicated an acceptable convergent validity between the dimensions of EQ-5D-5L and SF-6Dv2. The SF-6Dv2 showed slightly better discriminative capacities than the EQ-5D-5L (ES: 0.126–2.675 vs. 0.061–2.256). The ICC between the EQ-5D-5L and SF-6Dv2 utility values of the total sample was 0.780 (p < 0.05). The SF-6Dv2 had 29.0–179.2% higher efficiency than the EQ-5D-5L at distinguishing between respondents with different external health indicators, while the EQ-5D-5L was found to be 8.2% more efficient at detecting differences in self-reported health status than the SF-6Dv2.ConclusionsBoth the SF-6Dv2 and EQ-5D-5L have been demonstrated to be comparably valid and sensitive when used in Chinese population health surveys. The two measures may not be interchangeable given the moderate ICC and the systematic difference in utility values between the SF-6Dv2 and EQ-5D-5L. Further research is warranted to compare the test–retest reliability and responsiveness.

HEALTH RELATED QUALITY OF LIFE: CHRONIC KIDNEY DISEASE DENGAN HEMODIALISA MENGGUNAKAN INSTRUMEN EQ-5D-5L DI PEKANBARU

Chronic Kidney Disease (CKD) is a kidney disorder that continues to increase the globally and its also irreversible. Hemodialysis (HD) performed by CKD patients with severe conditions. Quality of life is one indicator of the success therapy patients CKD with HD. In addition to clinical conditions, the characteristics of patients can be affected to the quality of life. The aims of this study is to see the effect of the characteristics of CKD with HD of the Score Index utility. Its were measured using the EuroQuality of 5-dimensional 5 levels (EQ-5D-5L). The study was performed with the observational conversion using a cross sectional design in the CKD population in Pekanbaru hospital. The EQ-5D-5L questionnaire is given to 122 patients to measure the score utility. Different index score utility based on the characteristics of the tested patients using Mann Whitney and Kruskal Wallis. Based on the study, the average value of Pasa Pasa patients with HD patients was 0.24 ± 0.27. Dimensions of anxiety / depression and pain / discomfort of 6.56% with very severe problems and 2.46% could not move. Based on the anysis results, there are differences in utility values based on age characteristics, education levels, and commorbids (p &lt;0.05).

Association Between Levels of Functional Disability and Health-Related Quality of Life With Spinal Cord Stimulation for Chronic Pain

ObjectivesPain score, functional disability, and health-related quality of life (HRQoL) are core outcome domains for chronic pain clinical trials. Although greater levels of pain reduction have been shown to be linked to larger gains in HRQoL, little is known of the association between HRQoL and disability in the setting of chronic pain. The aims of this study were to 1) investigate the association between functional disability and HRQoL and 2) estimate the utility values associated with levels of functional disability in patients treated with evoked compound action potential (ECAP) spinal cord stimulation (SCS) for chronic pain. Materials and MethodsData on functional disability assessed using the Oswestry Disability Index (ODI) and HRQoL (EQ-5D-5L) were collected from 204 patients with an Evoke ECAP-SCS device and followed up to 12 months. SF-6D utility scores also were retrieved for 134 of these patients. Multivariable linear regression models adjusted for baseline utility values and patient demographics were used to compare differences in utility values across ODI categories. ResultsSignificant improvements in functional disability and HRQoL were observed at three- and 12-month follow-up after SCS. Patients reporting “minimum disability,” “moderate disability,” “severe disability,” and “crippled” had mean EQ-5D scores of 0.82, 0.73, 0.59, and 0.45, respectively. The mean change in EQ-5D score was 0.007 per unit change in total ODI score. The R2 statistic showed a moderate level association (49%–64% of variance in EQ-5D explained by ODI). ConclusionECAP-SCS results in significant improvements in functional disability and HRQoL. This study shows that improvement in function of people with chronic pain before and after ECAP-SCS is associated with improvement in HRQoL.

A Comparison of the SF-6Dv2 and SF-6D UK Utility Values in a Mixed Patient and Healthy Population.

BackgroundThis paper describes the first evaluation of the construct validity and performance of the newly developed preference-based measure of health, the SF-6D version 2 (SF-6Dv2).MethodUtilising data from the Multi-Instrument Comparison (MIC) project (n = 7932), we explored the descriptive differences in utility values between the SF-6Dv2 and the SF-6D and evaluated the known group validity of both measures by testing the statistical significance of differences in utility values and calculating the effect sizes across known groups. The convergent validity of the SF-6Dv2 was explored by examining whether the SF-6Dv2 is related to alternative validated measures, including the EQ-5D-5L and AQoL-8D.ResultsDifferences between the utility values of the SF-6Dv2 and SF-6D were evident; utilities were generally lower for the SF-6Dv2, with larger standard deviations resulting in larger absolute differences between groups. The SF-6Dv2 performed well in terms of known-group validity and successfully distinguished disease severity and between the disease and healthy groups, outperforming the SF-6D in some but not all groups. Convergent validity analyses indicated strong associations between the SF-6Dv2 and the SF-6D, EQ-5D-5L and AQoL-8D utilities.ConclusionsThe psychometric performance of the SF-6Dv2 is favourable with respect to known group validity and convergent validity, but does not seem to have improved, compared with the SF-6D. However, the new method of valuation has had a substantial impact on the size of absolute differences in utility values, which could impact quality-adjusted life-year results. The economic evaluation of health interventions may therefore be influenced by the choice of the SF-6Dv2 over the SF-6D.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40273-021-01033-6.

Health-Related Quality of Life Associated With Pain Health States in Spinal Cord Stimulation for Chronic Neuropathic Pain

ObjectivesA substantial proportion of patients have recently reported pain reduction levels of ≥80% following treatment with Evoked Compound Action Potential (ECAP) spinal cord stimulation (SCS). The additional health-related quality of life (HRQoL) utility gain that can be achieved in this patient group is unclear. The aim of this study is to quantify the HRQoL utility values seen in a remission health state (defined as ≥80% pain reduction) and contrast with more traditional health states of <50% and ≥50% pain relief. Materials and MethodsPain intensity assessed using a 100 mm visual analogue scale (VAS) and EQ-5D-5L questionnaires were collected from 204 patients treated with ECAP SCS for chronic back and leg pain and followed up to 12 months. Utility values were derived using EQ-5D-5L responses crosswalked to EQ-5D-3L. Linear regression models adjusted for baseline utility values and patient demographics were used to compare differences in utility values across health states. ResultsPatients in the remission health state (i.e., ≥80% pain reduction) consistently reported statistically significant greater utility values (+0.09 to +0.15, all p < 0.003) compared to patients reporting ≥50% pain relief at 3- and 12-month follow-up for overall, back, and leg VAS pain. The gain in utility values per percent unit of pain reduction was statistically significant at 3- and 12-month follow-up with a mean increase in HRQoL utility score between 0.003 and 0.005 observed for each percent of pain reduction. ConclusionOur analyses show that patients in a remission health state report statistically and clinically significant better HRQoL than patients experiencing lesser pain relief.

Exploring the consistency of the SF-6Dv2 in a breast cancer population

ABSTRACT Background: Short-Form Six-Dimension version 2 (SF-6Dv2) is a multi-attribute utility instrument that can be used in combination with the SF-36v2 (SF-6Dv2SF-36) or as an independent instrument in two forms: six questions (SF-6Dv2ind-6) and 10 questions (SF-6Dv2ind-10). The purpose of this research was to assess the consistency between the results of the SF-6Dv2ind-6 and the SF-6Dv2SF-36 in patients with breast cancer. Research design and methods: This cross-sectional study was carried out on 418 patients with breast cancer. The degree of agreement between the descriptive systems of instruments was calculated using Spearman’s correlation coefficient, global consistency index (GCI), and identically classified index (ICI). Results: The average size of the Spearman’s correlation coefficients between the descriptive systems of instruments was higher than 0.5. The results of the GCI revealed that the level of agreement between dimensions of the two instruments had a mean of 64.9 (range 32.45–86.8). The SF-6Dv2SF-36 generates statistically higher values than does the SF-6Dv2ind-6, and mean difference between the two instruments was 0.087 for model 3 and 0.027 for model 10. Conclusions: This study provided evidence that the SF-6Dv2SF-36 and the SF-6Dv2ind-6 may produce different answers from patients with breast cancer and lead to a small difference in utility values.

Comparing the EQ-5D-5L crosswalks and value sets for England, the Netherlands and Spain: Exploring their impact on cost-utility results.

This study compares the five-level EuroQol five-dimension questionnaire (EQ-5D-5L) crosswalks and the 5L value sets for England, the Netherlands, and Spain and explores the implication of using one or the other for the results of cost-utility analyses. Data from two randomized controlled trials in depression and diabetes were used. Utility value distributions were compared, and mean differences in utility values between the EQ-5D-5L crosswalk and the 5L value set were described by country. Quality-adjusted life years (QALYs) were calculated using the area-under-the-curve method. Incremental cost-effectiveness ratios (ICERs) were calculated, and uncertainty around ICERs was estimated using bootstrapping and graphically shown in cost-effectiveness acceptability curves. For all countries investigated, utility value distributions differed between the EQ-5D-5L crosswalk and 5L value set. In both case studies, mean utility values were lower for the EQ-5D-5L crosswalk compared with the 5L value set in England and Spain, but higher in the Netherlands. However, these differences in utility values did not translate into relevant differences across utility estimation methods in incremental QALYs and the interventions' probability of cost-effectiveness. Thus, our results suggest that EQ-5D-5L crosswalks and 5L value sets can be used interchangeably in patients affected by mild or moderate conditions. Further research is needed to establish whether these findings are generalizable to economic evaluations among severely ill patients.

Estimation of population-based utility weights for health states of chronic kidney disease, dialysis and kidney transplantation.

This study aimed to determine the utility of chronic kidney disease (CKD)-related health states in the Korean general population by using the standard gamble (SG) method. Seven hypothetical CKD-related health states were developed and revised based on previous publications. Data from 242 individuals from the Korean general population were obtained via computer-assisted personal interviews and used to evaluate the CKD-related health states by using the visual analogue scale (VAS) and SG methods. Mean and median utility values were calculated for each health state. To assess the reliability of the valuation, some samples were retested and evaluated using intraclass correlation coefficients (ICC). In all health states, the utility weights from SG were higher than those from VAS. The difference in utility values between the two valuation methods ranged from 0.258 to 0.308. The utility value of CKD grade 3 was the highest and that of peritoneal dialysis (PD) was the lowest. The utility weights tended to decrease in accordance with the progression of CKD. CKD grade 3 was assigned a SG utility value of 0.878, whereas PD was assigned 0.507. The SG utility values of predialysis end-stage renal disease, haemodialysis, kidney transplantation (KT), and post-KT recovery states were 0.666, 0.547, 0.748 and 0.827, respectively. The mean ICC (SD) at the individual level was 0.746 (0.281) for the SG scores. Our results could be used to measure the burden of kidney disease or to evaluate the economic efficiency of CKD-related interventions.

HOUT-17. UTILITIES OF RARE CANCERS LIKE MALIGNANT PLEURAL MESOTHELIOMA AND GLIOBLASTOMA MULTIFORME - DO THEY COMPARE?

Abstract BACKGROUND Glioblastoma (GBM) is the most aggressive primary brain cancer in adults. Malignant pleural mesothelioma (MPM) is an invasive and generally fatal malignancy of the pleura mainly caused by exposure to asbestos fibers. TTFields treatment has been shown effective in both MPM and GBM with a comparable increase in median overall survival (OS). Differences in utility values however, could significantly influence assessment of cost-effectiveness for MPM and GBM, despite similar clinical efficacy. METHODS We reviewed the published literature adressing health state preference values or health utilities in both indications using a boolean search of the PubMed database. The results were compiled separately for both diseases and then compared to each other. RESULTS Estimates of health states preference values or utilities in GBM all refer to one single publication by the UK NICE. Healthy members of the NHS Value of Health Panel (VoHP) rated a total of nine descriptive health state scenarios using the standard gamble method for preference elicitation. Utilities for MPM were derived at individual patient level from the EQ-5 questionnaire collected during one trial. Other publications do not use specific mesothelioma heath state preference velues but assume applicability of utilities derived from a non small cell lung cancer (NSCLC) population. CONCLUSIONS GBM utilites use different health states for elicitation, while utilities used in MPM were elicited at patient level. GBM utilities can be used in a health state disease model but there are no similar published values for MPM. MPM utilities using the EQ-5 questionnaire however better describe individual utilities and their change during the course of disease. Despite similar costs and clinical efficacy of TTFields treatment for GBM and MPM, the difference in elicitation methods and sources of utilites may lead to significant disparities in cost effectiveness assessment and subsequent adoption of TTFields treatment in different indications.

Consistency Between Three Different Ways of Administering the Short Form 6 Dimension Version 2

BackgroundThe Short Form 6 Dimension (SF-6D) is a multi-attribute utility instrument derived from the Short-Form 36 Health Survey Version 2 (SF-36v2) quality of life questionnaire and is used to calculate quality-adjusted life years (QALYs) on a scale 0 to 1. The SF-6Dv2 is a new version of the SF-6D. ObjectiveThe aim of this study was to assess the consistency of respondents’ answers to 3 different methods to administer this new version. MethodsSF-6Dv2 utility values were generated from the SF-36v2 using the following: (1) full questionnaire with 36 items (SF-6Dv2SF-36); (2) subset questionnaire with 10 items (SF-6Dv2ind-10); (3) SF-6Dv2 administered as an independent instrument (rephrased questionnaire with only 6 items [SF-6Dv2ind-6]). The order of the 3 instruments was randomly allocated between respondents. ResultsA total of 782 respondents from Quebec, Canada, were interviewed, out of whom 697 fully completed the survey. Very few deviations in respondents’ answers were observed between the 3 instruments, with mean weighted kappa of 0.79 (range 0.61-0.91) and mean global consistency index of 70% (range 54-83). Maximal difference in utility values generated was found between SF-6Dv2ind-10 and SF-6Dv2ind-6 (mean difference 0.016, P < .01), whereas minimal difference was found between SF-6Dv2SF-36 and SF-6Dv2ind-10 (0.002, P = .38). No ceiling effect was observed. ConclusionsThe SF-6Dv2 was designed to derive utilities from the SF-36v2, and our results indicate that it is still preferable to use the full questionnaire, although the difference with other variants of the questionnaire is very small. To use the SF-6Dv2 as an independent instrument will thus introduce minimal bias in utility values generated.

Health state utility values of high prevalence mental disorders in Australia: results from the National Survey of Mental Health and Wellbeing.

High prevalence mental disorders including depression, anxiety and substance use disorders are associated with high economic and disease burden. However, there is little information regarding the health state utility values of such disorders according to their clinical severity using comparable instruments across all disorders. This study reports utility values for high prevalence mental disorders using data from the 2007 Australian National Survey of Mental Health and Wellbeing (NSMHWB). Utility values were derived from the AQoL-4D and analysed by disorder classification (affective only (AD), anxiety-related only (ANX), substance use only (SUB) plus four comorbidity groups), severity level (mild, moderate, severe), symptom recency (reported in the past 30days), and comorbidity (combination of disorders). The adjusted Wald test was applied to detect statistically significant differences of weighted means and the magnitude of difference between groups was presented as a modified Cohen's d. In total,1526 individuals met criteria for a 12-month mental disorder. The mean utility value was 0.67 (SD = 0.27), with lower utility values associated with higher severity levels and some comorbidities. Utility values for AD, ANX and SUB were 0.64 (SD = 0.25), 0.71 (SD = 0.25) and 0.81 (SD = 0.19), respectively. No differences in utility values were observed between disorders within disorder groups. Utility values were significantly lower among people with recent symptoms (within past 30days) than those without; when examined by diagnostic group, this pattern held for people with SUB, but not for people with ANX or AD. Health state utility values of people with high prevalence mental disorders differ significantly by severity level, number of mental health comorbidities and the recency of symptoms, which provide new insights on the burden associated with high prevalence mental disorders in Australia. The derived utility values can be used to populate future economic models.

Relationship between physician-based assessment of disease activity, quality of life, and costs of ulcerative colitis in Poland.

IntroductionUlcerative colitis (UC) is an idiopathic inflammatory bowel disorder, which requires lifelong treatment. It generates substantial direct and indirect costs, and significantly affects the quality of life, especially in the active state of the disease.AimTo evaluate the direct and indirect costs of UC as well as to assess disease activity and quality of life reported by patients with UC in Polish settings.Material and methodsA questionnaire, cross-sectional study among UC patients as well as physicians involved in the therapy of the patients was conducted. The Clinical Activity Index (CAI) was used to assess disease activity, and the WPAI questionnaire to assess productivity loss. The quality of life was presented as utility calculated using the EQ-5D-3L questionnaire. Indirect costs included absenteeism, presenteeism, and informal care were assessed with the Human Capital Approach and expressed in euros (€). The productivity loss among informal caregivers was valuated with the average wage in Poland. Correlations were presented using the Spearman’s coefficient, and the between-group difference was assessed with Mann-Whitney U-test.ResultsOne hundred and forty-seven patients participated in the study, including 95 working persons. Mean cost of absenteeism and presenteeism was €1615.2 (95% CI: 669.5–2561.0) and €3684.4 (95% CI: 2367.8–5001.1), respectively, per year per patient with a disease in remission. The mean yearly cost of productivity loss due to informal care was estimated to be €256.6 (range: 0.0–532.6). The corresponding values for patients with active disease were: €8,913.3 (95% CI: 6223.3–11,603.3), €4325.1 (95% CI: 2282.4–6367.8), and €2396.1 (95% CI: 402.0–4390.3). The between-group difference in total indirect costs, cost of absenteeism, and cost of informal care was statistically significant (p < 0.05). The average weighted monthly costs of therapy with particular drugs categories (e.g. mesalazine or biologic drugs) differed significantly between active disease or remission patients. The difference in utility values between patients with a disease in remission (0.898 ±0.126) and patients with an active disease (0.646 ±0.302) was statistically significant.ConclusionsOur study revealed the social burden of UC and high dependency of direct and indirect costs as well as quality of life on the severity of UC in Poland. The statistically significant differences were identified in total direct and indirect cost, cost of absenteeism, cost of informal care, and health-related quality of life among patients with an active disease compared to patients with a disease in remission.

Comparison of health state values derived from patients and individuals from the general population.

Utility values are critical for cost-utility analyses that guide healthcare decisions. We aimed to compare the utility values of the 5-level EuroQoL-5Dimension (EQ-5D-5L) health states elicited from members of the general public and patients with heart disease or cancer. In face-to-face interviews with 157 heart disease patients, 169 cancer patients, and 169 members from the general population, participants valued 10 EQ-5D-5L health states using a composite Time Trade-Off method. Pooling utility values for all health states, heart disease patients and cancer patients had mean utility values lower by 0.11 points (P value=0.014) and 0.06 points (P value=0.148), respectively, compared to the general population. Adjusting for sociodemographic characteristics, differences in health state utility values between the patient and the general populations were rendered non-significant, except that heart disease patients gave higher utility values (mean difference=0.08; P value=0.007) to mild health states than the general population. Difference in utility values, defined as utility value of a better health state minus that of a poorer health state, was higher among heart disease patients compared to the general population, before and after adjusting for sociodemographic characteristics. Patients may differ from members of the general population in the strength of their preferences for hypothetical health states. Using utility values derived from the general population may under-estimate the comparative effectiveness of healthcare interventions for certain diseases, such as heart diseases.

Preferences of Pregnant Women for Outcomes Related to Epilepsy and the Use of Antiepileptic Medications in Pregnancy [18N

INTRODUCTION: Women with epilepsy are at risk of higher seizure-frequency in pregnancy and fetal malformations from the use of antiepileptic drugs (AEDs). The trade-offs women are willing to make, to optimize pregnancy outcomes have not been determined. This study elicits preferences of pregnant women with and without epilepsy, for maternal and fetal health states related to epilepsy and the use of AEDs in pregnancy with a view to informing practice and research. METHODS: Cross-sectional study on pregnant women that had epilepsy or another chronic medical disorder requiring medications during pregnancy. Study participants were presented with seven vignettes related to epilepsy and the use of AEDs in pregnancy and asked to assign them values on a visual analogue scale, by the standard gamble and time trade-off methods. Utility values were presented on a scale of 0-100. RESULTS: 52 pregnant women completed the interviews. The median age was 33 (29.5-35) years and the median gestational age was 30 weeks. The epileptic and non-epileptic groups had identical demographic characteristics. Utility values for combined maternal-fetal health states related to epilepsy and the use of AEDs was obtained by three methods, from women with and without epilepsy. There were no differences in utility values obtained between groups regardless of the method used. CONCLUSION: This study provides utility values for combined maternal-fetal health states related to epilepsy and the use of AEDs for use in decision analysis studies and suggests that these preferences could be obtained from pregnant women with any chronic medical disorder taking medications during pregnancy.

Iron Deficiency Anemia in Pregnancy and Treatment Options: A Patient-Preference Study [1L

INTRODUCTION: As many as 17% of Canadian women suffer from iron deficiency anemia (IDA) in pregnancy. Treatment options include oral ferrous salts, haem iron, intravenous (IV) iron and blood transfusions. Trade-offs pregnant women are willing to make to alleviate symptoms of IDA have not been determined. This study elicits preferences of pregnant women for health-states arising from IDA and the use of various treatment options. METHODS: A cross-sectional study was conducted on pregnant women with and without IDA. Participants were presented with five vignettes representing maternal health-states arising from IDA in pregnancy. They were asked to rank these states and assign them values on a visual analogue scale, by the standard gamble, and by time trade-off methods. Utility values (preferences) of women with and without IDA, obtained from these methods were presented on a scale of 0-100 where 0 represented death and 100 represented perfect health. RESULTS: 60 pregnant women (30 with IDA and 30 without) completed the interviews. With all three methods, utility values were lowest for blood transfusion and highest for oral iron. Regardless of the evaluation method, there was no difference in utility values for treatment with oral ferrous salts vs. haem iron or between women with or without IDA. CONCLUSION: Women acknowledge that symptoms of IDA in pregnancy reduce quality of life. Despite side effects and frequency of administration, oral iron is preferred over IV iron and blood transfusion. Confirmation of these findings in larger studies would directly inform clinical practice and research.

Health State Utilities for Patients with Brain Metastases.

Purpose: Estimating the cost-effectiveness of whole-brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS), including Gamma Knife radiosurgery (GKRS), requires the quantitative measurement of patients’ health states after treatment. We sought to quantify individuals’ preferences for the relevant health states after WBRT or GKRS for brain metastases on a 0 to 1 scale, where 1 is perfect health and 0 is death.Methods: We prospectively measured utilities in patients with brain metastases evaluated at Yale for consideration of WBRT and/or GKRS, as well as oncology nurses who had cared for patients with brain metastases before and after WBRT or GKRS, using the Standard Gamble (SG) technique. Demographic information was also collected. Nonparametric tests were used to compare potential differences in utility values and for subgroups based on demographic characteristics.Results: There were 24 patients and 31 nurses who completed the study between December 2013 and May 2015. Median utilities ranged from 0.85 for the status-post (S/P) GKRS state to 0.25 (for neurologic dying). The median utility of being S/P WBRT was 0.70 compared to 0.85 S/P GKRS (p < 0.001). The cognitive decline from WBRT was associated with a notably low utility score of 0.30. There were no statistically significant differences between patients’ and nurses’ median utility scores.Conclusions: These SG utilities provide unique insights into brain metastases-related health states from the patient and provider perspective. As perceived by individuals with direct knowledge of the health states in question, WBRT has a significantly lower utility compared to GKRS. Cognitive decline following WBRT is associated with significant perceived reduction in quality of life. Differences in the relative importance of overall survival and quality of life with treatment existed between patients with different stages of disease. These utilities can be used to calculate quality-adjusted life expectancy in cost-effectiveness evaluations of SRS and WBRT.

Paving the way for the use of the SDQ in economic evaluations of school-based population health interventions: an empirical analysis of the external validity of SDQ mapping algorithms to the CHU9D in an educational setting.

PurposeThe Strengths and Difficulties Questionnaire (SDQ) is a behavioural screening tool for children. The SDQ is increasingly used as the primary outcome measure in population health interventions involving children, but it is not preference based; therefore, its role in allocative economic evaluation is limited. The Child Health Utility 9D (CHU9D) is a generic preference-based health-related quality of-life measure. This study investigates the applicability of the SDQ outcome measure for use in economic evaluations and examines its relationship with the CHU9D by testing previously published mapping algorithms. The aim of the paper is to explore the feasibility of using the SDQ within economic evaluations of school-based population health interventions. MethodsData were available from children participating in a cluster randomised controlled trial of the school-based roots of empathy programme in Northern Ireland. Utility was calculated using the original and alternative CHU9D tariffs along with two SDQ mapping algorithms. t tests were performed for pairwise differences in utility values from the preference-based tariffs and mapping algorithms.ResultsMean (standard deviation) SDQ total difficulties and prosocial scores were 12 (3.2) and 8.3 (2.1). Utility values obtained from the original tariff, alternative tariff, and mapping algorithms using five and three SDQ subscales were 0.84 (0.11), 0.80 (0.13), 0.84 (0.05), and 0.83 (0.04), respectively. Each method for calculating utility produced statistically significantly different values except the original tariff and five SDQ subscale algorithm.ConclusionInitial evidence suggests the SDQ and CHU9D are related in some of their measurement properties. The mapping algorithm using five SDQ subscales was found to be optimal in predicting mean child health utility. Future research valuing changes in the SDQ scores would contribute to this research.