Health State Descriptions Research Articles

Utility scores for vesicoureteral reflux and anti-reflux surgery

Management of vesicoureteral reflux (VUR) continues to be controversial. In conditions of uncertainty, decision analytic techniques such as cost-utility analysis (CUA) can help to structure the decision-making process. However, CUA analyses require a "utility," a value between 0 (death) and 1 (perfect health) corresponding to the quality of life associated with a health state. Ideally, utility values are elicited directly from representative community samples, but utilities have not been rigorously measured for pediatric urology conditions. To elicit utility scores for VUR and open anti-reflux surgery (ARS) from a representative, well-characterized community sample of adults who have been parents. Cross-sectional survey of nationally representative adults who had ever been parents. Each respondent saw one of four descriptions of VUR, with or without continuous antibiotic prophylaxis (CAP) and occurrence of febrile urinary tract infection (UTI). A 6-week postoperative health state following ARS was also assessed. We used the time trade-off (TTO) method to elicit utility scores. Factors associated with utility score were assessed with a multivariate linear regression model. The survey was completed by 1200 individuals. Data were weighted to adjust for demographic differences between responders and non-responders. Mean age was 52 ± 15 years, 44% were male, and 68% were White. In terms of education, 29% had a college degree or higher. The mean utility score for VUR overall was 0.82 ± 0.28. VUR utility scores did not differ significantly based on inclusion of CAP or UTI in the health state description (p = 0.21). The 6-week postoperative period garnered a utility of 0.71 ± 0.43. Our results showed that VUR has a mean utility score of 0.82, which indicates that the community perceives this condition to be a substantial burden. For comparison, conditions with similar utility scores include compensated hepatitis B-related cirrhosis (0.80) and glaucoma (0.82); conditions with higher utilities include neonatal jaundice (0.99) and transient neonatal neurological symptoms (0.95); and conditions with lower utility scores include severe depression (0.43) and major stroke (0.30). Our results suggest that parents consider the burden associated with VUR to be significant, and that the impact of the condition on families and children is substantial. VUR is perceived as having a substantial impact on health-related quality of life, with a utility value of 0.82. However, use of CAP and occurrence of UTI do not seem to affect significantly the community perspective on HRQOL associated with living with VUR.

Health state descriptions to elicit stroke values: do they reflect patient experience of stroke?

BackgroundTo explore whether stroke health state descriptions used in preference elicitation studies reflect patients’ experiences by comparing published descriptions with qualitative studies exploring patients’ lived experience.MethodsTwo literature reviews were conducted: on stroke health state descriptions used in direct preference elicitation studies and the qualitative literature on patients’ stroke experience. Content and comparative thematic analysis was used to identify characteristics of stroke experience in both types of study which were further mapped onto health related quality of life (HRQOL) domains relevant to stroke. Two authors reviewed the coded text, categories and domains.ResultsWe included 35 studies: seven direct preference elicitation studies and 28 qualitative studies on patients’ experience. Fifteen coded categories were identified in the published health state descriptions and 29 in the qualitative studies. When mapped onto domains related to HRQOL, qualitative studies included a wider range of categories in every domain that were relevant to the patients’ experience than health state descriptions.ConclusionsVariation exists in the content of health state descriptions for all levels of stroke severity, most critically with a major disjuncture between the content of descriptions and how stroke is experienced by patients. There is no systematic method for constructing the content/scope of health state descriptions for stroke, and the patient perspective is not incorporated, producing descriptions with major deficits in reflecting the lived experience of stroke, and raising serious questions about the values derived from such descriptions and conclusions based on these values.

Utilities for treatment-related adverse events in type 2 diabetes

Objectives:The impact of Type 2 diabetes mellitus (T2DM) on health-related quality-of-life (HRQoL) is complex due to the burden of disease, lifelong treatment requirements, and comorbidities. This study aimed to capture UK societal utility values for health states associated with T2DM and treatment-related adverse events (AEs) to assess the burden of the disease and common AEs.Methods:Nine health state descriptions were developed (from a literature review and patient and clinician qualitative input) depicting the burden associated with T2DM and treatment-related AEs. These were mild/moderate urinary tract infection (UTI); severe UTI; mycotic infection; moderate hypoglycemic events; severe hypoglycemic events; fear of hypoglycemia; gastrointestinal symptoms; and hypovolemic events. Members of the UK general public (n = 100) valued these states using the time trade-off (TTO) methodology to elicit utility values (between 0 = dead, 1 = full health). Regression analysis was conducted to understand the influence of age and gender.Results:All treatment-related AEs were found to have a significant effect on utility. From the T2DM baseline state (0.92), the experience of AEs was associated with the following disutility: T2DM with hypovolemic events (0.08); T2DM with mild/moderate UTIs (0.09); T2DM with moderate hypoglycemic events (0.11); T2DM with severe hypoglycemic events (0.15); T2DM with fear of hypoglycemia (0.15); T2DM with severe UTIs (0.19); T2DM with GI symptoms (0.24); and T2DM with mycotic infection (0.25); Males consistently scored the states with significantly lower utility values, but no significant age effects emerged.Conclusions:Findings suggest that adverse events in T2DM can be a burden for some individuals. The study indicates the potential importance of including information regarding AEs in economic evaluations. Although some states were rated severely in terms of utility; in reality, many of these only last a few days, therefore having a minimal quality-adjusted life year (QALY) impact.

Utility values for pre-menopausal women suffering from symptomatic uterine fibroids

Background: Uterine fibroids (UF) represent the most common benign uterine tumor in women of reproductive age. Symptoms including heavy, prolonged menstrual bleeding, pelvic pain/pressure, and/or urinary frequency have a substantial impact on women's quality of life and utility values for UF have not been published. Methods: Health state descriptions associated with UF symptoms and treatment side effects were developed based on patient focus groups; validated using expert clinical input; and pilot tested for understandability. Using a web-based questionnaire, 909 community-dwelling, Canadian women were surveyed to assess their perceived value associated with these states. Results: Utility for uncontrolled bleeding was 0.55 (95% CI: 0.54, 0.57) and the decrement associated with hot flashes was 0.06 (95% CI: −0.07, −0.04). Utility improvement associated with bleeding control was 0.18 (95% CI: 0.17, 0.19) and with smaller fibroid size was 0.03 (95% CI: 0.02, 0.04). Conclusion: These values illustrate the high utility associated with control of excessive menstrual bleeding.

Review of disability weight studies: comparison of methodological choices and values.

IntroductionThe disability-adjusted life year (DALY) is widely used to assess the burden of different health problems and risk factors. The disability weight, a value anchored between 0 (perfect health) and 1 (equivalent to death), is necessary to estimate the disability component (years lived with disability, YLDs) of the DALY. After publication of the ground-breaking Global Burden of Disease (GBD) 1996, alternative sets of disability weights have been developed over the past 16 years, each using different approaches with regards to the panel, health state description, and valuation methods. The objective of this study was to review all studies that developed disability weights and to critically assess the methodological design choices (health state and time description, panel composition, and valuation method). Furthermore, disability weights of eight specific conditions were compared.MethodsDisability weights studies (1990¿2012) in international peer-reviewed journals and grey literature were identified with main inclusion criteria being that the study assessed DALY disability weights for several conditions or a specific group of illnesses. Studies were collated by design and methods and evaluation of results.ResultsTwenty-two studies met the inclusion criteria of our review. There is considerable variation in methods used to derive disability weights, although most studies used a disease-specific description of the health state, a panel that consisted of medical experts, and nonpreference-based valuation method to assess the values for the majority of the disability weights. Comparisons of disability weights across 15 specific disease and injury groups showed that the subdivision of a disease into separate health states (stages) differed markedly across studies. Additionally, weights for similar health states differed, particularly in the case of mild diseases, for which the disability weight differed by a factor of two or more.ConclusionsIn terms of comparability of the resulting YLDs, the global use of the same set of disability weights has advantages, though practical constraints and intercultural differences should be taken into account into such a set.

Developing a utility index for the Aberrant Behavior Checklist (ABC-C) for fragile X syndrome.

PurposeThis study aimed to develop a utility index (the ABC-UI) from the Aberrant Behavior Checklist-Community (ABC-C), for use in quantifying the benefit of emerging treatments for fragile X syndrome (FXS).MethodsThe ABC-C is a proxy-completed assessment of behaviour and is a widely used measure in FXS. A subset of ABC-C items across seven dimensions was identified to include in health state descriptions. This item reduction process was based on item performance, factor analysis and Rasch analysis performed on an observational study dataset, and consultation with five clinical experts and a methodological expert. Dimensions were combined into health states using an orthogonal design and valued using time trade-off (TTO), with lead-time TTO methods used where TTO indicated a state valued as worse than dead. Preference weights were estimated using mean, individual level, ordinary least squares and random-effects maximum likelihood estimation [RE (MLE)] regression models.ResultsA representative sample of the UK general public (n = 349; mean age 35.8 years, 58.2 % female) each valued 12 health states. Mean observed values ranged from 0.92 to 0.16 for best to worst health states. The RE (MLE) model performed best based on number of significant coefficients and mean absolute error of 0.018. Mean utilities predicted by the model covered a similar range to that observed.ConclusionsThe ABC-UI estimates a wide range of utilities from patient-level FXS ABC-C data, allowing estimation of FXS health-related quality of life impact for economic evaluation from an established FXS clinical trial instrument.

The impact on utilities of differences in body weight among Canadian patients with type 2 diabetes

Objective:The objective of this study was to estimate utility values for hypothetical health states that describe differences in weight and quality of life associated with type 2 diabetes mellitus (DM) from Canadians with type 2 DM. The impact on utility values was examined separately for participants with a body mass index (BMI) of 18 to less than 25 kg/m2 (‘healthy’), 25 to less than 30 (‘overweight’), and 30 or more (‘obese’).Methods:The health state descriptions were modified from a published diabetes utility study. Health states included a base-case type 2 DM health state (at participants’ current weight), and six health states where the weight and attendant quality of life impact varied (base case ±3%, ±5%, and ±7% weight). Utilities were elicited using the time trade-off technique. Linear regression modeling was used to estimate the utility increment or decrement associated with a one unit difference in BMI.Results:Among 96 participants, the mean age was 55 years and 51% were men. The mean BMI was 32 kg/m2 and 84% wanted to lose weight. The mean (SD) utility for the base-case state was 0.911 (0.013). Mean utilities (utility decrements) were 0.907 (−0.004), 0.865 (−0.046) and 0.806 (−0.105) for the health states describing an increased weight of 3%, 5% and 7%, respectively; and 0.923 (+0.012), 0.940 (+0.029) and 0.949 (+0.038) for the health states describing a decreased weight of 3%, 5% and 7%, respectively. For every increase of 1 kg/m2 BMI there was an associated decrease in utility of 0.0472 (95% CI: 0.0375, 0.0569) and for every decrease of 1 kg/m2 BMI there was an associated increase in utility of 0.0171 (95% CI: 0.0103, 0.0238).Conclusions:The preferences of Canadian patients with type 2 DM for diabetes-related health states varied according to the weight, and quality of life impact, associated with that health state. Increased weight had a greater effect on utilities than decreased weight.

Impact of caregiver and parenting status on time trade-off and standard gamble utility scores for health state descriptions

BackgroundThe purpose of this study was to examine the effect of caregiver status on time trade-off (TTO) and standard gamble (SG) health state utility scores. Respondents were categorized as caregivers if they reported that either children or adults depended on them for care.MethodsThis study was a secondary analysis of data from three studies in which general population samples rated health state descriptions. Study 1: UK; four osteoarthritis health states. Study 2: UK; three adult ADHD health states. Study 3: US; 16 schizophrenia health states. All three studies included time trade-off assessment. Study 1 also included standard gamble. Descriptive statistics were calculated to examine willingness to trade in TTO or gamble in SG. Utilities for caregivers and non-caregivers were compared using t-tests and ANCOVA models.ResultsThere were 364 respondents including 106 caregivers (n = 30, 47, and 29 in Studies 1, 2, and 3) and 258 non-caregivers. Most caregivers were parents of dependent children (78.3%). Compared to non-caregivers, caregivers had more responses at the ceiling (i.e., utility = 0.95), indicating less willingness to trade time or gamble. All utilities were higher for caregivers than non-caregivers (mean utility difference between groups: 0.07 to 0.16 in Study 1 TTO; 0.03 to 0.17 in Study 1 SG; 0.06 to 0.10 in Study 2 TTO; 0.11 to 0.22 in Study 3 TTO). These differences were statistically significant for at least two health states in each study (p < 0.05). Results of sensitivity analyses with two caregiver subgroups (parents of dependent children and parents of any child regardless of whether the child was still dependent) followed the same pattern as results of the primary analysis. The parent subgroups were generally less willing to trade time or gamble (i.e., resulting in higher utility scores) than comparison groups of non-parents.ConclusionsResults indicate that caregiver status, including being a parent, influences responses in time trade-off health state valuation. Caregivers (i.e., predominantly parents) were less willing than non-caregivers to trade time, resulting in higher utility scores. This pattern was consistent across multiple health states in three studies. Standard gamble results followed similar patterns, but with less consistent differences between groups. It may be useful to consider parenting/caregiving status when collecting, interpreting, or using utility data because this demographic variable could influence results.

Utility values for specific hepatic encephalopathy health states elicited from the general public in the United Kingdom.

Background and aimsTo elicit utility values for five health states corresponding to increasing severity of hepatic encephalopathy, from members of the general public in the UK. The health states studied were Conn grades 0, 1, 2, 3 and 4.MethodsInterviewer-administered time trade-off (TTO) and standard gamble (SG) utilities were elicited for the five health states from a random sample of 200 members of the general public in the UK, using health state descriptions validated by clinicians and members of the general public.ResultsRespondents’ mean age was 49.5 years and 49% were female. Mean utilities were 0.962 (TTO) and 0.915 (SG) for Conn grade 0; 0.912 (TTO) and 0.837 (SG) for Conn grade 1; 0.828 (TTO) and 0.683 (SG) for Conn grade 2; 0.691 (TTO) and 0.489 (SG) for Conn grade 3; and 0.429 (TTO) and 0.215 (SG) for Conn grade 4. The TTO and SG values between the five Conn grades were significantly different (p < 0.001). Additionally, the TTO value was significantly higher than the SG value for the corresponding state (p <0.0001).ConclusionThese findings quantify how different Conn grades and level of response to treatment may impact on the health-related quality of life of patients with hepatic encephalopathy. There were greater preference values for lower levels of disease, with the highest value associated with Conn grade 0. These health state preference values can be used to estimate the outcomes of different interventions for hepatic encephalopathy in terms of quality-adjusted life years.

Descriptions of health states associated with increasing severity and frequency of hypoglycemia: a patient-level perspective

AimsWe sought to develop descriptions of health states associated with daytime and nocturnal hypoglycemia in a structured fashion from the patient’s perspective under different combinations of severity and frequency of hypoglycemic events.MethodsAn expert meeting followed by two patient focus groups was used to develop comprehensive descriptions of acute consequences of severe and non-severe, daytime and nocturnal hypoglycemia. Patients with diabetes (type 1 = 85, type 2 = 162) from a survey panel then validated these descriptions and assessed how often they worried and took different actions to prevent hypoglycemia. Severity and frequency of hypoglycemia were compared with respect to how often people worried and took actions to prevent an event. The effect of hypoglycemia on 35 different life activities was quantitatively compared for patients who had and had not experienced a severe hypoglycemic event.ResultsAt least 95% of respondents agreed that the detailed patient-level descriptions of health states accurately reflected their experience of severe and non-severe, daytime and nocturnal hypoglycemia, thereby validating these descriptions. Respondents who had experienced a severe hypoglycemic event were generally more adversely affected in their worries and actions and life events than those who experienced only non-severe events; those who experienced nocturnal events were more affected than those who experienced only daytime events.ConclusionThe negative psychosocial consequences and undesirable compensatory behaviors arising from hypoglycemia underscore the importance of preventing severe episodes, particularly severe nocturnal episodes. These validated descriptions for hypoglycemia from the patient’s perspective may also help inform future qualitative and quantitative research.

Establishing disability weights from pairwise comparisons for a US burden of disease study.

To determine valid and reliable disability weights for a U.S. burden of disease study, a convenience sample of 68 clinical experts was recruited, including representatives from over 20 NIH institutes and Centers for Disease Control and Prevention. Experts were given various health state valuation tasks including pairwise comparison, ranking, and Person Trade Off. Materials consisted of standardized descriptions of 11 attributes per health state (Classification and Measurement System of Functional Health, CLAMES). Attributes comprised up to 5 ordinal levels of disability. All states were displayed either with or without health state labels. Health state descriptions were taken from an existing comprehensive Canadian system. Conditional Logistic (CLR) and Probit Regression (PR) were used to derive disability weights. CLR and PR converged in yielding stable regression weights to construct disability weights, with a correlation of 0.816. The overall test-retest reliability amounted to 92.5% identical decisions. No significant difference was found for the presentation of health states with or without labels. A comparison of the expert valuations from our study with a standard gamble based valuation in the general population resulted in agreement of r = 0.61. The chosen methodology yielded valid and reliable and disability weights. As it is based on a modularized set of attributes, this methodology will allow derivation of disability weights on the basis of existing descriptions using the CLAMES.

Migraine: The Seventh Disabler

Migraine: The Seventh Disabler

Does the correspondence between EQ-5D health state description and VAS score vary by medical condition?

BackgroundThe EQ-5D health-related quality of life instrument comprises a health state classification (health problems by severity in five domains), followed by an evaluation using a visual analogue scale (VAS). Despite the EQ-5D’s use in health technology assessment and as a patient-reported outcome measure (PROM), the correspondence between the two parts of the instrument remains ill-understood. In this paper, we consider whether the association between health state classification and VAS score might vary by medical condition.MethodsEQ-5D data collected for studies of patients in four different clinical conditions or circumstances (stroke, low back pain, colposcopic investigation or cytological surveillance) were pooled to generate a sample of 3,851 patient records. VAS scores were regressed on reported problem severities, with the inclusion of intercept and slope dummy variables specific to condition.ResultsThe regression model achieved a goodness-of-fit of 0.54. Given its structure and the significance of the coefficients, the proportion of VAS scores which differed by condition for the same health state varied between 33.3 and 88.5 per cent of possible states.ConclusionsMany of the patients with different medical conditions or in receipt of different interventions recorded different VAS valuations, in spite of ostensibly being in the same EQ-5D-defined health states. By implication, it is probable that the same state-to-state change would by valued differently by patients experiencing different conditions.

The Influence of Time and Adaptation on Health State Valuations in Patients With Spinal Cord Injury

One of the explanations for the difference between health state utilities elicited from patients and the public--often provided but seldom studied--is adaptation. The influence of adaptation on utilities was investigated in patients with spinal cord injury. Interviews were held at 3 time points (T1, after admission to the rehabilitation center; T2, during active rehabilitation; T3, at least half a year after discharge). At T1, 60 patients were interviewed; 10 patients withdrew at T2 and T3. At all time points, patients were asked to value their own health and a health state description of rheumatoid arthritis on a time trade-off and a visual analogue scale. The Barthel Index, a measure of independence from help in activities of daily living, and the adjustment ladder were filled out. Main analyses were performed using mixed linear models taking the time-dependent covariates (Barthel Index and adjustment ladder) into account. Time trade-off valuations for patients' own health changed over time, even after correction for gain in independence from help in activities of daily living, F(2, 59) = 8.86, P < 0.001. This change was related to overall adaptation. Both a main effect for adaptation, F(87, 1) = 10.05; P = 0.002, and an interaction effect between adaptation and time, F(41, 1)= 4.10, P = 0.024, were seen for time trade-off valuations. Valuations given for one's own health on the visual analogue scale did not significantly change over time, nor did the valuations for the hypothetical health state. Patients' health state valuations change over time, over and above the change expected by the rehabilitation process, and this change is partly explained by adaptation. Experience with a chronic illness did not lead to change in valuations of hypothetical health states.

Health State Utility Assessment for Breast Cancer

Objectives1) To develop both English and Chinese versions of the descriptions of health states describing different stages of breast cancer and different adverse effects related to tamoxifen and aromatase inhibitors for breast cancer and 2) to elicit individuals' preferences for these health states from a group of oncology nurses. MethodsTwenty hypothetical health states and their descriptions were developed on the basis of literature review and oncology expert panel reviews. Health state utilities were obtained from 20 oncology nurses by using the visual analogue scale and standard gamble methods. After recalibration, the adjusted utility scores were on a scale of 0 (dead) and 1 (perfect health). ResultsThe health states developed represented different disease stages and the presence and type of treatment side effects in breast cancer. For each health state, various general health-related quality-of-life domains, such as pain/discomfort and ability to work, were included in the descriptions, along with a state-specific description. The mean utility score of respondents' “current health” was greater than 0.9, while mean adjusted visual analogue scale–derived utility scores ranged from 0.256 to 0.860 and median adjusted standard gamble–derived utility scores ranged from 0.284 to 0.673. Among the side effects evaluated in the “no recurrence” health state, ischemic cerebrovascular events, pulmonary embolism, and spine fracture had the greatest utility detriment. ConclusionsThe study results indicate the value that individuals place on the avoidance of disease progression and the side effects of hormonal therapies in breast cancer. The health state descriptions developed can be used in future research to obtain society's utilities for use in a cost-utility analysis.

Effect of pH on potassium metabisulphite biocidic activity against yeast and human cell cultures.

Potassium metabisulphite (PMB) is a common antimicrobial additive in the food industry. In aqueous solutions, PMB leads to complex equilibria according to its concentration, pH and temperature, and different chemical species can be present. In winemaking, PMB is used at low pH, suggesting that the biocidic activity is exerted by sulphur dioxide while, in other applications, it is employed at higher pH values with little if any dissociation. This observation leads to the question of which chemical form is biologically active. For this reason, Saccharomyces cerevisiae cells were subjected to PMB solutions at different pH values and analysed with a Fourier transform infrared spectroscopy (FTIR)-based bioassay, to assess the entity and the type of stress. Cell viability was determined and compared to the metabolomics (FTIR) stress indices, which revealed that the metabolomics fingerprint was an effective description of the cell health state. GC-MS metabolite profiles were obtained to describe (in detail) the changes caused by PMB in the fatty acids region. Human dermal fibroblasts (HDF) were also subjected to PMB stress at pH 7.0 and analysed with the FTIR protocol, in order to compare the response spectra of yeast and human cell cultures.

Measuring Health-Related Quality of Life

Preference-based community valuation of healthrelated quality of life is a bedrock of medical decision and cost-effectiveness analysis. We want to live longer and we want to live better, and we need to know how changes in our health will affect us in order to make informed medical decisions. As a society, we need measures of preference that can help us allocate resources most beneficially. Studies advancing our understanding of preferences for life/ health states and of the valuation process itself are thus a regular feature of Medical Decision Making. Five articles in this issue of the journal focus on measurement of health-related quality of life. Two of these studies 1,2 investigate properties of existing instruments for health state description (PORPUS) or quality of life measurement (WHOQOL-BREF) and provide evidence for the validity of their measurements. For PORPUS, this takes the form of a multi-attribute utility function that can map PORPUS health states into utilities that show good correspondence with standard gamble utilities, the gold standard in utility measurement. For WHOQOL-BREF, Rasch models offer new evidence that 3 of the 4 quality of life domains measured by that instrument produce scores that can be treated as interval scales, facilitating statistical comparisons between scales. Joyce and others 3 demonstrate the application of quality of life measures to better understand the impacts of interrupted and intensified antiretroviral therapy in patients with HIV. Basu and Manca 4 develop robust regression methods based on beta distributions that appear well-suited for modeling quality-of-life outcomes, overcoming their statistically difficult score distributions, which are characterized by considerable skew and spikes at “perfect” quality of life. These articles are important because they answer significant questions and, in many cases, provide new tools that will help answer many additional questions. The fifth of these papers follows suit in asking and answering an important question about health state measurement, but its most powerful contribution may be the new questions it raises. Rowen and others 5 find that whether a health state is named (e.g., “irritable bowel syndrome” or “cancer”) when it is described can—sometimes—affect time–tradeoff utilities elicited from community respondents. Although their respondents valued unlabeled health states similarly to the same states with an “irritable bowel syndrome” label, they behaved differently when states were labeled “cancer.” Specifically, more severe states received lower utility values as “cancer” than when they were unlabeled, and utilities were sensitive to whether respondents had experience with cancer (either themselves or as carers for others) when the health state was labeled “cancer.” Utility assessment tasks in the general population require people to imagine a health state and indicate their preferences among life profiles that may include the state. Shifts in preference that result from apparently irrelevant descriptive variations should lead us to be cautious in how we conduct and report valuation studies. Rowen and others report that their respondents were affected by a cancer label but not by an irritable bowel syndrome label; the finding suggests that cancer qua cancer has a special salience, which might arise from social messaging, personal experiences, or the disease descriptions presented to the respondents. Future research using different condition labels may help to disentangle these effects.

The impact of using different tariffs to value EQ-5D health state descriptions: an example from a study of acute cough/lower respiratory tract infections in seven countries

When using the EQ-5D in European cross-national studies, there is no consensus over whether the European value set (EVS), country specific value sets (CVS) or UK value set (UKVS) should be used. Data on health outcomes were collected in 7 countries. EQ-5D index scores were generated for each country using all three value sets. QALYs gained over 4 weeks based on EQ-5D scores were also generated in order to investigate the implications for cost-utility analysis. EQ-5D scores obtained using the EVS were similar to values obtained using the CVS and UKVS in all countries. CVS-based EQ-5D scores were on average associated with a smaller baseline-to-week 4 change/improvement in all countries (except in Wales and Belgium) while UKVS-based EQ-5D scores showed the largest improvement over the same period for every country. With regards to cost-utility analysis, the results suggest that in most countries (with the exception of Belgium and Finland), using different tariffs to value EQ-5D would not have made a difference to the decisions based on the results of cost-utility analysis.

PND39 Hereditary Angioedema Health State Utility Valuation Study from the Perspective of A Representative Sample of the Australian General Public

The impact of hereditary angioedema (HAE) on patients' health related quality of life (QoL) extends beyond the acute attack period. This study was to value the disutility of living with HAE outside of the acute attack period, according to different emergency treatments available to the patient. The study used a vignette/health state scenario based approach and standard gamble methodology. The health states described three different circumstances faced by patients with HAE in terms of availability of emergency medications should they suffer a swelling attack: Scenario A: HAE without any effective emergency medication; Scenario B: HAE with effective emergency medication available in hospital; Scenario C: HAE with effective emergency medication available for self-administration. The health state descriptions were based evidence from on relevant clinical trials, burden of disease and QoL studies and HAE treatment guidelines, supported by clinical expert opinion. The standard gamble survey was web based/administered online. Respondents were recruited from an existing consumer research panel. A total of 201 respondents completed the survey; 91% were prepared to gamble with death to achieve perfect health in at least one of the three health states. The mean utility weighting elicited for health state C was significantly higher than either weightings elicited for health state B (0.75 [95%CI. 0.71, 0.79] versus 0.64 [95% CI 0.60, 0.69]; p<0.001), or for health state A (0.75 [95%CI. 0.71, 0.79] versus 0.62 [95% CI 0.58, 0.67]; p<0.001). There was no statistical difference between the utilities elicited for health states B and A. The results demonstrate the recognition of and value placed on the QoL benefits provided by the availability of and immediate access to a self-administered emergency medication for HAE over that provided by treatment available only in the hospital accident and emergency treatment setting.

Assessment of Health State in Patients With Tinnitus: A Comparison of the EQ-5D and HUI Mark III

Expressing the outcomes of treatment in quality-adjusted life years is increasingly important as a tool to aid decision makers concerning the allocation of scarce resources within the health care sector. A quality-adjusted life year is a measure of life expectancy that is weighted by health-related quality of life. These weights are referred to as utility scores and are usually measured by multiattribute utility measures. Several studies found that different utility measures provide different estimates of the same person's level of utility. The aim of this study was to investigate which of two widely used utility measures, the EQ-5D and the HUI mark III, is preferred in a tinnitus population. Baseline and follow-up data on EQ-5D and HUI mark III of 429 patients of a randomized controlled clinical trial, investigating cost-effectiveness of usual care versus specialized care of tinnitus, were included. Agreement, discriminative power, and responsiveness of the health state description and the utility scores were examined. Corresponding dimensions of the EQ-5D and HUI mark III showed large correlations; although ceiling effects were more frequently observed in the EQ-5D. Mean utility scores for EQ-5D (0.77; SD 0.22) and HUI mark III (0.64; SD 0.28) were significantly different (Wilcoxon signed ranks test, p < 0.001), and agreement was low to moderate (intraclass correlation coefficient = 0.53). Both health state description and utility scores of both measures discriminated between different severity groups. These groups were based on baseline scores of the Tinnitus Questionnaire. The HUI mark III had a higher ability than the EQ-5D to detect improved patients from randomly selected pairs of improved and unimproved patients. This study shows that different utility measures lead to different health state descriptions and utility scores among tinnitus patients. However, both measures are capable of discriminating between clinically different groups. The HUI mark III is more responsive than the EQ-5D, and therefore preferred in a tinnitus population.