Health State Descriptions Research Articles

Applying the WHO ICF Framework to the Outcome Measures Used in the Evaluation of Long-Term Clinical Outcomes in Coronavirus Outbreaks.

(1) Objective: The World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) classification is a unified framework for the description of health and health-related states. This study aimed to use the ICF framework to classify outcome measures used in follow-up studies of coronavirus outbreaks and make recommendations for future studies. (2) Methods: EMBASE, MEDLINE, CINAHL and PsycINFO were systematically searched for original studies assessing clinical outcomes in adult survivors of severe acute respiratory distress syndrome (SARS), middle east respiratory syndrome (MERS) and coronavirus disease-19 (COVID-19) after hospital discharge. Individual items of the identified outcome measures were linked to ICF second-level and third-level categories using ICF linking rules and categorized according to an ICF component. (3) Results: In total, 33 outcome measures were identified from 36 studies. Commonly used (a) ICF body function measures were Pulmonary Function Tests (PFT), Impact of event scale (IES-R) and Hospital Anxiety and Depression Scale (HADS); (b) ICF activity was 6-Minute Walking Distance (6MWD); (c) ICF participation measures included Short Form-36 (SF-36) and St George’s Respiratory Questionnaire (SGRQ). ICF environmental factors and personal factors were rarely measured. (4) Conclusions: We recommend future COVID-19 follow-up studies to use the ICF framework to select a combination of outcome measures that capture all the components for a better understanding of the impact on survivors and planning interventions to maximize functional return.

Clasificación de estados de salud y metodologías de valoración de preferencias para el cálculo de AVAC: una revisión de literatura

Este trabajo tiene por objetivo identificar los principales instrumentos de medición de estados de salud y las metodologías de valoración de preferencias que se utilizan para calcular los años de vida ajustados por calidad —AVAC—. A partir de una revisión de literatura con una estrategia de búsqueda equilibrada para la identificación de referencias bibliográficas relevantes, se presentan las características técnicas de los sistemas de clasificación en salud, como lo son los conceptos funcionales —sociales, mentales, físicos y sensoriales—, la combinación de atributos, el número de estados de salud diferentes, la duración de la encuesta y su administración. Asimismo, referente a las metodologías de valoración de preferencias, se resumen las particularidades sobre la consistencia con la teoría de los AVAC, la flexibilidad en la descripción de estados de salud, los estados peores que la muerte, entre otros aspectos. Se concluye que no existe un sistema de clasificación de estados de salud o método de valoración de preferencias mejor que otro, por lo que el investigador debe elegir la herramienta que mejor se adapte a la condición bajo análisis y al diseño de estudio en específico.

PNS18 IMPROVING THE APPLICATION OF PUBLISHED HEALTH UTILITIES IN COST-UTILITY ANALYSES: DEVELOPMENT OF THE HEALTH UTILITY APPLICATION TOOL (HAT)

Evaluating the relevance of published health utilities to the context of a cost-utility analysis (CUA) is an essential - yet often overlooked - task and is largely left to the discretion of the investigator. The objective of this study was to provide guidance on this process by developing the Health utility Application Tool (HAT). First, we conducted a scoping review of appraisal tools intended for use with economic evaluations or health utility studies to identify candidate items. Second, we conducted semi-structured telephone interviews with Canadian stakeholders from reimbursement bodies, academia, and the pharmaceutical industry. These interviews were designed to gather participants’ practices for selecting published health utilities for CUAs and their opinions about the relevance of the candidate items. Finally, we conducted an online survey with international members of the general health economics and outcomes research community to gather opinions on key concepts to consider when applying the health utility literature to CUAs. Based on the themes emerging from the review, interviews, and online questionnaire, the HAT includes questions to prompt investigators to consider the following constructs: similarity of the clinical condition in the health utility study and the CUA; similarity of health utility study participant demographics and the demographics of the CUA’s target population; similarity of the health state descriptions in the health utility study and the CUA; and use of health utility values in the CUA as reported in the health utility study. Consideration of good reporting standards identified additional important items: means by which the health utility study was identified; type of respondents; study design; and the measure used to collect health utility estimates. The HAT is intended to guide the evaluation of the applicability of published health utilities for a CUA, thus promoting transparency and accountability in the selection of model inputs.

Automated Tool for Health Utility Assessments: The Gambler II.

Background. The Gambler II is a web-based utility assessment tool supporting visual analogue scale (VAS), standard gamble (SG), and time trade-off (TTO) utility assessments. It contains novel features, including an easy to use project development authoring tool and use of multimedia clips for health state descriptions. Objectives. Evaluate the usability and understandability of the patient-facing side of The Gambler. Investigate the feasibility of using The Gambler and evaluate its impact on patient knowledge regarding the relevant health states. Materials and Methods. We used The Gambler to assess utilities on a convenience sample of 55 users for common long-term complications of type 2 diabetes mellitus: diabetic neuropathy, diabetic retinopathy, and diabetic foot infection requiring transmetatarsal amputation. Using VAS, SG, and TTO, we collected metadata, such as time spent on each assessment and the entire assessment process. We evaluated usability with an adaptation of the System Usability Scale survey and understandability. We evaluated impact on knowledge gained through knowledge assessments about these complications before and after use of The Gambler. Results. Overall satisfaction with The Gambler was high, 4.02 on a 5-point scale. Usability rated highly at 84.93 on a normalized scale between 0 and 100. Knowledge scores increased significantly following use of The Gambler from pretest mean of 68% to posttest mean of 76% (P < 0.01). Average time using the software: ∼7½ minutes. Conclusions. The Gambler is an easy to use and understand computer-based tool for utility assessment. It is feasible to use within clinical encounters to support shared decision making, and it has unique features that make it a powerful tool for investigators interested in research on health utilities.

The attempt of graphodiagnostics of health state of the last hetman of Ukraine Kyrylo Rozumovskyi using samples of his handwriting

Background: The article makes an attempt to define health state and probable illnesses of the last hetman of Ukraine Kyrylo Rozumovskyi in the last years of his life.&#x0D; Methods: The study is based on using and analyzing of the memoirs and biography books, containing records and detailed description of health state of K. Rozumovskyi, and documentary archive materials with the samples of his handwriting. To analyze the handwriting of K. Rozumovskyi, the special graphological test developed by Polish physicians of National Health Institute in cooperation with psychologists and graphologists was used.&#x0D; Results: According to the authors’ conclusions, K. Rozumovskyi suffered from diabetes mellitus, gout, and ischemic heart disease. He was vulnerable to common cold also. It is assumed that these diseases contributed to the myocardial infarction which caused his death in 1803.&#x0D; Conclusion: Considering the lack of the system of professional medicine in XVII, XVIII, early XIX century, using graphological method for determining the health of well-known people of these times, is effective.&#x0D; Bangladesh Journal of Medical Science Vol.19(1) 2020 p.90-93

SP2 DISCREPANCY IN HEALTH STATE UTILITY VALUES BETWEEN COST-UTILITY ANALYSIS AND REFERENCED ORIGINAL HEALTH UTILITY STUDIES IN CARDIOVASCULAR DISEASE: A REGISTRY-BASED ANALYSIS

Cardiovascular disease (CVD) is the leading cause of noncommunicable disease deaths worldwide. CVD is associated with significant financial and humanistic burden. Cost-utility analysis (CUA) uses quality-adjusted life (QALY) as the outcome measure and is commonly used in CVD. Health state utility values (HSUVs) used in calculating QALYs play an important role in determining cost effectiveness of CVD treatments. The objective was to compare HSUVs between CUAs and referenced original HSUV studies in CVD. Tufts Cost-Effectiveness Analysis Registry is a comprehensive database including more than 7,000 CUAs studies published since 1976. We used the primary disease filter to identify all CUA studies focusing on CVD included in the registry. We reviewed and extracted original HSUV studies cited in the CUAs whenever available. The descriptions and values of health states used in the CUA were compared with those reported in the original HSUV studies to evaluate the consistency in using published HSUVs. A total of 577 CVD CUAs published between 1982 and 2016 were included in the analysis. Out of 3358 health states extracted, 642 were collected as part of the CUA and 2278 obtained from external sources. The EQ-5D (50.8%) and time trade-off (TTO) (29.1%) were the most frequently used indirect and direct methods to measure HSUVs, respectively. For the 2278 health states, only 574 (25.2%) had the same health state description and value as those in the original sources. 990 health states (43.5%) differed in both description and value for which the majority did not provide any explanation for the discrepancies. Discrepancy in the description and value for the health states between the CUA and referenced health utility studies remain an important issue in CVD. Any such discrepancy, if not justified, could affect the validity of cost effectiveness results.

PIN14 HEALTH UTILITY ESTIMATES FOR CONGENITAL CYTOMEGALOVIRUS DISEASE: CONCEPTUAL DESIGN CONSIDERATIONS

Health utility estimation for sensory losses and pediatric populations is methodologically challenging, further compounded in congenital cytomegalovirus disease (cCMVd), where infants and children may sustain hearing, visual, and cognitive losses and a variety of other sequalae. These sequelae may occur alone or in combination, range in severity and age of onset, and persist into adulthood. We developed a conceptual study design to measure utility for cCMVd health states and spillover effects for parents and siblings to inform future economic evaluation of new prevention programmes. Systematic and targeted reviews were performed to identify sequelae associated with cCMVd and existing utility estimates. Economic model health states were defined for hearing impairment, other moderate sequelae, and severe sequelae (transient and long-term) by age group (neonate, infant, child, adolescent, and adult). The following preference-based measures were reviewed for age-range suitability, alignment of the descriptive system with key sequelae, and empirical responsiveness to key sequelae: EQ-5D, EQ-5D-Y, HUI, SF-6D, CHU-9D, 15/16/17D, AQoL, QWB, and mapping from the PedsQL. Alternative study designs for utility measurement in cCMVd were evaluated. The systematic review identified no utility estimates for cCMVd. The HUI was determined to be the most appropriate utility measure overall. An observational study with a sampling frame capturing the spectrum of age, sequela type, and severity was recommended, using proxy respondents for young children and patients with cognitive impairment. Estimation of spillover effects was recommended by valuation of health state descriptions (vignettes), as existing utility measures were not designed for and may not adequately capture spillover effects. In conclusion, an observational study using the HUI and a vignette valuation study is recommended to address the lack of utility data for cCMVd. Additional research is recommended to further evaluate the responsiveness of the HUI in cCMVd.

Describing the Development of a Health State Valuation Protocol to Obtain Community-Derived Disability Weights.

For the prioritization of the allocation of national resources, estimating the burden of disease studies play a critical role. Hence the first Global Burden of Disease study conducted in the 1990s was done for this particular estimation. By the means of introducing disability-adjusted life year (DALY) metric, the burden of various diseases was calculated using disability weights (DWs)—a component of DALY. DWs are values that capture individuals' perception regarding the severity of diseases that involve valuation tools and health state descriptions. Various studies have been conducted over the past few decades to evaluate health states and derive disease-specific disability weights using Person-Trade off, Time-trade off, etc. However, use of these complex and cognitively demanding methods has been carried out in developed countries where the bulk of the populace is more educated. Few attempts have been made in low- and middle-income countries such as India, where not only the majority is less educated but also the social construction of diseases and health conditions are diverse. Therefore, due to the absence of methodological protocols of health state valuations for application at the community-level in the developing world, we attempted to systematically describe the procedure that can be used universally and cross-culturally for various health states. We began with the tentative selection of health states and health states valuation methods by conducting a meticulous literature review, followed by community exploration and medical consultations. This led to developing vignettes (clinical description) and 6D5L pictorial narrations (functional status description). Two field tests for checking the usability and refinement of the tools was done. Final consultation by an expert panel comprising of medical and non-medical professionals was held/conducted to finalize the health state labels and functional status profiles of each health state. The methodical approach provides a robust and thorough procedure for guiding researchers to implement health state valuation studies at community level.

Estimation of impact of RPE65-mediated inherited retinal disease on quality of life and the potential benefits of gene therapy

Background/aimsIn rare diseases, health-related quality of life (HRQL) data can be difficult to capture. Given the ultrarare nature of RPE65-mediated inherited retinal disease (IRD), it was not feasible to recruit...

Elicitation of Health-Related Utility in Perianal Fistula in Crohn's Disease.

Perianal fistulae are a common complication of Crohn's disease (CD) and pose a substantial burden on quality of life. Data capturing health-related utility associated with perianal fistulae in CD are scarce. The current study aims to value health states related to different stages of the disease to quantitatively evaluate the impact of complex perianal fistulae on CD patients' quality of life. Eight health state descriptions associated with complex perianal fistulae in CD were developed following qualitative research with patients and validation by clinicians. Following pre-testing, a survey was administered online in two samples of UK respondents: the general population and patients with CD. A choice-based valuation technique, the time trade-off (TTO), was used for direct utility measurement. CD patients also valued their current health state using the TTO. Exclusion criteria for respondents displaying logical inconsistencies were applied. Usable responses were received from 835 respondents, reflective of the UK population in age and sex, in the general population survey and 162 CD patients in the patient survey. Non-remission states were valued much lower than the remission state by both samples, ranging from 0.20 for proctectomy with a negative outcome to 0.66 for chronic symptomatic fistulae with mild symptoms. Patients currently experiencing fistulae reported lower values for current health than those without fistulae. Low utility values were assigned to the non-remission health states for perianal fistulae in CD by the general public and patients with CD. This demonstrates the high humanistic burden of inadequately managed perianal fistula in CD.

Utility valuation of health states for haemophilia and related complications in Europe and in the United States.

There is currently a paucity of health utility data describing the consequences of haemophilia and related complications. To quantify the impact of distinct stages of severity of haemophilia and disease-related complications on health-related quality of life, expressed as health utilities in Europe and the United States. Nine health state descriptions were developed based on literature review and interviews with haematologists and haemophilia patients. Three descriptions characterized the impact of mild, moderate and severe haemophilia without inhibitors. Six descriptions characterized disease-related complications added to the moderate haemophilia description (arthroscopic synovectomy, prosthetic joint replacement, chronic pain, spontaneous bleed, traumatic bleed and end-stage joint disease). Time trade-off (TTO) interviews were conducted with 100 adults from the general public in the UK, France, Germany, Italy, Sweden and the United States. Mean TTO-derived utility values were expressed on a scale from 0 (death) to 1 (full health). Utility values obtained for the health states corresponding to mild (0.73-0.86), moderate (0.68-0.76) and severe (0.64-0.71) haemophilia followed the increase in severity. The addition of a complication to the "moderate" state leads to a decrease in the associated utility value. The most severe disutility (0.23-0.36) across all countries was associated with the burden of end-stage joint disease. This study underlines the value that the French, Italian, German, Swedish, United States and UK populations ascribe to the avoidance of disease progression in haemophilia without inhibitors. Improved treatment options hold a potential for important benefits to haemophilia patients.

Disease severity-based evaluation of utility weights for lung cancer-related health states in Korea

BackgroundUtility weight, a measure of health-related quality of life, is used in disease burden measurements and economic evaluations. In this study, we used the visual analogue scale (VAS) and standard gamble (SG) method to determine the utility weights of lung cancer health states in South Korea from a societal perspective.MethodsSix hypothetical health states for lung cancer or a related health state reflective of disease severity were developed: 1) Stage I, 2) Stage II, 3) Stage IIIa, 4) Stage IIIB, 5) Stage IV, and 6) Pulmonary nodule. The description of each health state description was divided into four parts: diagnosis, symptoms, treatment, and progression and prognosis. A total of 515 representative adult Korean participants used a VAS and SG to evaluate these six health states via face-to-face computer-assisted interviews. The means, standard deviations, and median utility weights of the six health states were estimated by valuation method.ResultsThe two valuation methods of the scenarios yielded the same mean utility rankings. Pulmonary nodule received the highest rank (VAS, 0.66 and SG, 0.83), whereas Stage 4 was assigned the lowest rank (VAS, 0.09 and SG, 0.31). For all health states, the mean utility weights calculated using the SG were greater than those calculated using the VAS. The differences between the utility weights obtained using the two valuation methods ranged from 0.14 (Stage I) to 0.22 (Stage IV). The two approaches tended to yield larger differences for more severe stages.ConclusionsThis study determined utilities for squamous cell lung cancer that will be useful for estimating the burden of lung cancer and for conducting economic evaluations of lung cancer interventions.

Applying the WHO International Classification of Functioning, Disability and Health in Nursing Assessment of Population Health.

Classification systems constitute an important contribution to nursing practice, as they provide standardized frameworks for communication between nurses and other healthcare professionals. International Classification of Functioning, Disability and Health (ICF) provides a unified and standardized language, as well as a working structure, for the description of health and health-related states. This paper aims to describe some of the available classifications used in nursing practice and to identify the potential value provided by the application of the World Health Organization (WHO) International Classification of Functioning, Disability and Health by all healthcare professionals. With this purpose, a concept analysis was conducted. The relevant nursing classifications were analyzed and related evidence on the use of ICF classification was reviewed to provide a discussion on the application of ICF in nursing practice. The use of ICF could be beneficial in different areas of nursing practice, as it provides a more comprehensive framework to classify nursing outcomes and interventions, improving areas such as interprofessional communication and optimization of care. Although there is published evidence on the use of ICF core sets, further research is needed on this area.

Poor Health Reporting? Using Anchoring Vignettes to Uncover Health Disparities by Wealth and Race

In spite of the wide disparities in wealth and in objective health measures like mortality, observed inequality by wealth in self-reported health appears to be nearly nonexistent in low- to middle-income settings. To determine the extent to which this is driven by reporting tendencies, we use anchoring vignettes to test and correct for reporting heterogeneity in health among elderly South Africans. Significant reporting differences across wealth groups are detected. Poorer individuals rate the same health state description more positively than richer individuals. Only after we correct for these differences does a significant and substantial health disadvantage of the poor emerge. We also find that health inequality and reporting heterogeneity are confounded by race. Within race groups—especially among black Africans and to a lesser degree among whites—heterogeneous reporting leads to an underestimation of health inequalities between richest and poorest. More surprisingly, we also show that the correction may go in the opposite direction: the apparent black African (vs. white) health disadvantage within the top wealth quintile almost disappears after we correct for reporting tendencies. Such large shifts and even reversals of health gradients have not been documented in previous studies on reporting bias in health inequalities. The evidence for South Africa, with its history of racial segregation and socioeconomic inequality, highlights that correction for reporting matters greatly when using self-reported health measures in countries with such wide disparities.

PSY20 - Health State Utilities and High Body Mass Index: Evidence from who Study of Global Ageing and Adult Health (SAGE)

To provide age- and sex-specific health state utilities (HSUs) and examine their associations with overweight/ obesity in the Ghanaian population. Data from the World Health Organization’s 2008 Study of Global Ageing and Adult Health (SAGE) was used. HSUs were derived, first by mapping EQ-5D-3L profiles to responses from the health state descriptions in SAGE. The UK population norms were applied in the baseline scenario to calculate HSUs. Multilevel linear regressions that utilize the identity link were used to evaluate associations between HSUs and overweight/ obesity. Responses from 3,946 adults aged 18-79 years were analysed. The mean (95 % confidence interval) HSU was 0.661 (95% CI: 0.652, 0.670) for the analytical sample, 0.690 (95% CI: 0.679, 0.702) for men and 0.626 (95% CI: 0.612, 0.640) for women. Mean HSU was significantly higher for overweight respondents compared to those with normal BMI. There was statistically significant negative association between HSUs and being a woman (-0.048; 95% CI: -0.066, -0.029) compared to being a man, women with class I obesity (-0.047; 95% CI: -0.091, -0.002) compared to women with normal BMI, ages 50-79 years compared to 18-29 years and all obesity-related medical conditions. The study provides HSUs by sex and age in the Ghanaian population. Mean HSU was significantly higher in overweight respondents in the population; and class I obesity (BMI= 30.00 to ≤ 35.00kg/m2) was negatively associated with HSUs in women.

Health State Utilities for Acute Myeloid Leukaemia: A Time Trade-off Study.

Acute myeloid leukaemia (AML) is an aggressive haematological cancer associated with significant humanistic impact. The current study assessed how the general public in the United Kingdom (UK) values AML health states. The composite time trade-off (cTTO) methodology was employed to elicit health state utilities in AML. Pertinent AML literature related to symptom and quality-of-life impact including physical, functional and emotional well-being, as well as the safety profile of AML treatments, were taken into consideration for drafting health state descriptions. Ten health states included in the study were newly diagnosed AML, induction, consolidation, maintenance, long-term follow-up, relapsed/refractory, stem-cell transplant (SCT) procedure, SCT recovery, SCT long-term follow-up with complications and SCT long-term follow-up without complications. The descriptions were validated by haematologists and nurse specialists for clinical accuracy and completeness. A total of 210 individuals from the general UK population participated in the cTTO interviews. Descriptive statistics were computed for health state utility values. The mean age of the participants was 44.0years (standard deviation [SD] 14.9, range 18-81) and comprised 129 (61.4%) female participants. The utility values ranged from 0.94 (SD 0.13) for SCT long-term follow-up without complications to - 0.21 (SD 0.62) for the SCT procedure. The study provides health utilities for a range of AML health states, with the SCT procedurehealth state being valued worse than death. The utilities obtained in this study can be employed as inputs in cost-effectiveness analyses of AML therapies.

Modeling health information for measurement of health state descriptions coded by ICF: Requirements for software development

The International Classification of Functioning, Disability and Health (ICF) proposes an organization that is based on coded and qualified information distinguishing functioning and disability codes. The aim of this study was to develop a tool able to use information converted into qualified codes proposed by the ICF to establish a measure of the health-related states for individuals and populations, and that represents reliable and valid indices for investment in health information systems. We outlined a cross-sectional study with descriptive and exploratory aims for technological development, including quantitative and qualitative approaches to collective speech content analysis, and modelling of data of in a single case report. We perform three stages: (1) modelling of data coming from the information reported in the case to identify codes and qualify them; (2) survey of the requirements and face validation through focus group, which was heard the demands of future users of the software, beyond to establish a list of useful requirements for (3) development of the computer program. The sequence of events followed the simulation model, producing theoretical results, conceptual, graphics and numeric components. The simulation revealed that the measure may be better represented by a three-dimensional model which considers the events over time, the ratio between functioning and disability codes and discrete events representing health condition hallmarks. The model was validated by the focus group (face validation), resulting in a list of requirements that contributed to development of the preliminary version of the desired product: the DataCIF.

A preference-based item response theory model to measure health: concept and mathematics of the multi-attribute preference response model

BackgroundA new patient-reported health measurement model has been developed to quantify descriptions of health states. Known as the multi-attribute preference response (MAPR) model, it is based on item response theory. The response task in the MAPR is for a patient to judge whether hypothetical health-state descriptions are better or worse than his/her own health status.MethodsIn its most simple form MAPR is a Rasch model where for each respondent on the same unidimensional health scale values are estimated of their own health status and values of the hypothetical comparator health states. These values reflect the quality or severity of the health states. Alternatively, the respondents are offered health-state descriptions that are based on a classification system (e.g., multi-attribute) with a fixed number of health attributes, each with a limited number of levels. In the latter variant, the weights of the levels of the attributes in the descriptive system, which represents the range of the health states, are estimated. The results of a small empirical study are presented to illustrate the procedures of the MAPR model and possible extensions of the model are discussed.ResultsThe small study that we conducted to illustrate the procedure and results of our proposed method to measure the quality of health states and patients’ own health status showed confirming results.ConclusionsThis paper introduces the typical MAPR model and shows how it extends the basic Rasch model with a regression function for the attributes of the health-state classification system.

The impact of social and psychological consequences of disease on judgments of disease severity: An experimental study

BackgroundThe Global Burden of Disease (GBD) project systematically assesses mortality, healthy life expectancy, and disability across 195 countries and territories, using the disability-adjusted life year (DALY). Disability weights in the DALY are based upon surveys that ask users to rate health states based on lay descriptions. We conducted an experimental study to examine whether the inclusion or removal of psychological, social, or familial implications from a health state description might affect individual judgments about disease severity, and thus relative disability weights.MethodsWe designed a survey consisting of 36 paired descriptions in which information about plausible psychological, social, or familial implications of a health condition was either present or absent. Using a Web-based platform, we recruited 1,592 participants, who were assigned to one of two experimental groups, each of which were asked to assign a value to the health state description from 0 to 100 using a slider, with 0 as the “worst possible health” and 100 as the “best possible health.” We tested five hypotheses: (1) the inclusion of psychological, social, or familial consequences in health state descriptions will reduce the average rating of a health state; (2) the effect will be stronger for diseases with lower disability weights (i.e., less severe diseases); (3) the effect will vary across the type of additional information added to the health state description; (4) the impact of adding information on familial consequences will be stronger for female than male; (5) the effect of additional consequences on ratings of health state descriptions will not differ by levels of completed education and age.ResultsOn average, adding social, psychological, or familial consequences to the health state description lowered individual ratings of that description by 0.78 points. The impact of adding information had a stronger impact on ratings of the least severe conditions, reducing average ratings in this category by 1.67 points. Addition of information about child-rearing had the strongest impact, reducing average ratings by 2.09 points. We found little evidence that the effect of adding information on ratings of health descriptions varied by gender, education, or age.ConclusionsIncluding information about health states not directly related to major functional consequences or symptoms, particularly with respect to child-rearing and specifically for descriptions of less severe conditions, can lead to lower ratings of health. However, this impact was not consistent across all conditions or types of information, and was most pronounced for inclusion of information about child-rearing, and among the least severe conditions.

A utility valuation study assessing the impact of postprandial glucose control on quality of life of individuals with type 1 or type 2 diabetes

BackgroundConsideration of health-related quality of life (HRQOL) in diabetes has been associated with long-term and short-term complications such as hypoglycaemia, but not with short-term glucose control. This study aimed to collect health utilities related to different degrees of poorly controlled postprandial glucose (PPG) and its impact on HRQOL in the UK and in Sweden.MethodsThree health state descriptions were developed based on literature reviews and interviews with people with diabetes and healthcare professionals, characterising mild, moderate and severe impact of postprandial hyperglycaemic symptoms on HRQOL. Time Trade-Off (TTO) interviews with a 10-year trade-off period were conducted with samples of the UK general public and of Swedish people with diabetes. Mean TTO-derived health state values were expressed on a scale from 0 (death) to 1 (full health).ResultsOne hundred fifty participants from the general population were interviewed in the UK (57% female, mean age 35 years) and 150 participants with diabetes in Sweden (64% female, mean age 51 years, 42% type 1 and 58% type 2 diabetes). The mean TTO-derived health state values were for the UK and Swedish participants: mild impact of poorly PPG control (0.89/0.76); moderate (0.75/0.71); severe (0.56/0.58).ConclusionsGlucose lowering treatments associated with improved control over PPG levels could have important benefits to people with type 1 and type 2 diabetes since findings suggest that increasing severity in postprandial hyperglycaemic symptoms is perceived as having significant negative impact on HRQOL of individuals with type 1 or type 2 diabetes.