Health Utility Scores Research Articles

The association between legal Japanese visual impairment grades and vision-related quality of life.

This study examines the relationship between quality of life (QOL) and the legal Japanese grade of visual impairment as defined by the Physically Disabled Persons Welfare Act. Participants of this cross-sectional study were 98 Japanese patients legally classified as visually impaired, from six ophthalmology departments. Vision-related QOL was evaluated using the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25). The short Japanese version of this questionnaire (VFQ-J11) score was calculated from the VFQ-25 results for each participant. Health utility was measured using the EuroQoL Index (EQ-5D). Data were collected for age, gender, vision-disability level, the corrected visual acuity of each eye, and disease type. The mean age was 66.8years (SD=17.8). Visual impairment grade was significantly associated with VFQ-J11 score and the composite score developed from the VFQ-25 (p<0.001), but not with the health utility score obtained from the EQ-5D. In general, the Japanese legally designated grading system for visual impairment reflects the degree of vision-related QOL, but does not reflect general health utility as determined by the EQ-5D.

Agreement between health utility instruments in cochlear implantation.

The objectives of our study were threefold: to compare health utility scores measured with different health utility instruments in adult patients with bilateral deafness, to compare the change in health utility scores after unilateral or bilateral cochlear implantation using the different health utility instruments and to assess which health utility instrument would be the most appropriate for future studies on cochlear implantation. A prospective study. The data for this article were collected as part of a multicentre randomised controlled trial in the Netherlands on the benefits of simultaneous bilateral cochlear implantation compared to unilateral cochlear implantation. The study included 38 adult patients with severe to profound bilateral post-lingual sensorineural hearing loss. Participants completed various quality of life questionnaires (the EuroQol five-dimensional questionnaire (EQ-5D), the Health Utilities Index mark 3 (HUI3), a visual analogue scale (VAS) for general quality of life and a VAS for hearing) preoperatively, and one and two years postoperatively. The general health utility instruments (EQ-5D, HUI3 and VAS general) were compared. The EQ-5D, HUI3 and VAS general utility scores differed significantly. The intraclass correlation coefficients showed poor to no agreement between these instruments. A gain in health utility after cochlear implantation was found with the HUI3 and VAS general. The highest gain in health utility was found with the HUI3. A health utility score depends on the health utility instrument that is used in a specific patient population. We recommend using the HUI3 in future studies on cochlear implantation.

Can the general public use vignettes to discriminate between Alzheimer's disease health states?

BackgroundValid estimates of health-related quality-of-life (HRQoL) are often difficult to obtain from persons with Alzheimer’s disease (AD) and family caregiver proxies. To help assess whether the general public can serve as an alternate source of proxy HRQoL estimates in AD, we examined whether the general public can use vignettes to discriminate between AD health states.MethodsWe administered a telephone survey to randomly recruited participants from the general public who were aged 18 years or older. Interviewers read vignettes describing the mild, moderate, and severe AD health states to the participants, who answered the EQ-5D-5L and Quality of Life-Alzheimer’s Disease (QoL-AD) scales as if they had AD based on the vignette descriptions. Participants also answered the EQ-5D-5L for their current health states. We converted EQ-5D-5L responses into health utility scores using Canadian preference weights. We employed the Wilcoxon signed rank test to examine whether mean health utility scores and mean QoL-AD scores differed between health states. We used Pearson’s r to assess correlations between health utility and QoL-AD scores.ResultsForty-eight participants (median age = 53 years; 25 female) completed the telephone interview; health utility and QoL-AD scores decreased as AD severity increased (p <0.0001). Mean health utility scores were 0.65 (mild), 0.51 (moderate), and 0.25 (severe). Mean QoL-AD scores were 26.7 (mild), 23.0 (moderate), and 17.4 (severe). The correlations between health utility and QoL-AD scores were moderate to strong (r ≥ 0.62).ConclusionsUsing the vignettes, the general public provided HRQoL estimates that discriminated between the three AD health states. This finding suggests the general public may be a promising source of proxy HRQoL estimates in place of persons with AD.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0207-4) contains supplementary material, which is available to authorized users.

Understanding the burden of idiopathic generalized epilepsy in the United States, Europe, and Brazil: An analysis from the National Health and Wellness Survey

The aim of this study was to understand the current burden of primary generalized tonic-clonic seizures (PGTCS) associated with idiopathic generalized epilepsy (IGE) as a function of seizure frequency. We analyzed data for (IGE) as a proxy measure of PGTCS. Little is known about the quality of life (QoL), health utility, productivity, healthcare resource utilization (HRU), and cost burden of PGTCS or IGE. Patients were identified from the US (2011, 2012, & 2013), 5EU (2011 & 2013), and Brazil (2011 & 2012) National Health and Wellness Survey, a nationally representative, internet-based survey of adults (18+ years). Patients that self-reported a diagnosis of IGE were categorized into seizure frequencies of: ≥1 seizure per week, 1-3 seizures per month, 1-4 seizures per year, or <1 seizure per year. QoL was measured using the SF-36v2 Mental (MCS) and Physical Component Summary (PCS) scores, health utilities with the SF-6D, productivity with the Work Productivity and Activity Impairment (WPAI) questionnaire, and HRU as reported in the past six months. Unit costs were estimated from the literature and multiplied against HRU values to calculate direct costs and WPAI values to calculate indirect costs. Generalized linear regression was utilized to examine the relationship between seizure frequency and each measure of burden with adjustment for covariates. Out of the general population surveyed, IGE was self-reported in 782 of 176,093 (US), 172 of 30,000 (UK), 106 of 30,001 (Germany), 87 of 30,000 (France), 31 of 12,011 (Spain), 22 of 17,500 (Italy), and 34 of 24,000 (Brazil). Persistent seizures (≥1 per year) were reported in over 40% of patients with IGE (10-15% with ≥1 seizure per week, 10-15% with 1-3 seizures per month, 20-25% with 1-4 seizures per year). Over 75% were treated with antiepileptic drugs (AEDs). Compared with those having <1 seizure per year (reference group), patients in the two most frequent seizure categories reported worse MCS and PCS scores. Patients in the three highest seizure frequency groups consistently reported worse health utility scores, and greater presenteeism (attending work while not physically or mentally capable of working), overall work impairment, activity impairment, HRU, indirect costs, and direct costs than the reference group. Despite the availability of AEDs during the year surveyed, a substantial number of patients experienced persistent seizures. Increasing seizure frequency was clearly associated with worse outcomes. The burden of PGTCS and IGE may be proportionally reduced by newer AEDs which may increase the proportion of seizure-free patients or shift more patients into lower seizure frequency categories.

Overview of cost-effectiveness analysis and health state utilities in multiple myeloma and estimations of health state utilities from real-world macedonian data

Multiple myeloma (MM) is a hematological neoplastic plasma-cell disorder in the bone marrow. Nowadays, the survival of MM patients has improved by using novel therapies (e.g., bortezomib, thalidomide). Decision-analytic models (DAM) are known to be very useful in guiding clinical and health policy decisions by systematically evaluating expected outcomes of alternative treatments. When conducting DAM, it is recommended by National Institute for Clinical Excellence (NICE) as the preferred framework to use qualityadjusted life years as the main measure for health outcomes derived from generic preference-based instruments. The objective of our study was to identify and analyze the structural and methodological approaches of published studies that evaluated: (1) DAM for various treatment strategies in MM and (2) published health utility values (HUVs) after MM treatment. The searches were developed in the electronic literature database PubMed/MEDLINE. Additionally, we aimed to derive real-world data for HUVs from the current patients’ treatment landscape in the Hematology Clinical Center in Skopje. The survey collecting national HUVs was conducted during the period January-November 2016, using the generic preference-based instrument EQ-5D-5L, administered at one-time point in 20 MM patients. Only five studies reported on using a DAM. Seven studies were included in the extraction of already published HUVs. The calculated national health utility score of 0.723 was comparable to the published data in the previously identified studies reporting on similar MM treatment protocols. Several modeling approaches and HUVs, developed for different treatment strategies and target groups in MM were identified. Those data could be used to parameterize a DAM for MM treatment.

The Significant Contribution of Pain in Determining the Health Status of Patients with Multiple Myeloma (MM)

BACKGROUND: Most cancer patients with bone metastases report significant pain and substantial impairment in their ability to function. In particular, patients with MM are susceptible to bone pain because of bone damage. Patient-reported outcomes such as a general health outcome measure and a legacy pain instrument may provide valuable information in determining the impact of this condition. The goal of this study was to provide a descriptive profile of health status for cancer patients using the EQ-5D-3L (EQ-5D), a commonly used tool to measure health utility scores. Another goal is to evaluate the predictive information provided by the Brief Pain Inventory (BPI), a self-report pain assessment tool designed to capture pain severity and interference in patients. These information may be useful in estimating the health status of patients where the EQ-5D was not administered.METHODS: Data was pooled across three denosumab registrational trials '20050136', '20050103', and '20050244'. Patients completed the EQ-5D and the BPI at baseline. Eligible patients had histologically confirmed advanced cancers, radiographic evidence of at least one bone metastasis (or lytic bone lesion from multiple myeloma), ECOG of 2 or better and adequate organ function. Using data from patients with MM (N=168), descriptive statistics were used to present summary information on health-related quality of life states and utility scores. Linear regressions were used to examine how BPI severity and interference subscale scores relate with EQ-5D utility scores. Ordinal regressions were used to evaluate how well BPI items predict EQ-5D individual items. Bonferroni adjustments were made when evaluating the relationships of BPI items to individual EQ-5D items. These analyses were repeated using data across several groups of cancer patients to determine if similar results can be obtained (breast cancer, N=2,044, prostate cancer, N=1,819 and others, N=1,509).RESULTS: About 9% of MM patients reported perfect health compared with 11% of all cancer patients. Of the 5 dimensions measured by the EQ-5D, the MM cohort rated pain (80%) the highest with moderate to extreme problems. This was followed by usual activities (68%), mobility (63%), anxiety/depression (49%), and self-care (36%). Similar order was observed across all cancer groups, but with slightly lower percentages for most items: pain (78%), usual activities (58%), mobility (55%), anxiety/depression (57%), and self-care (26%). Although pain interference subscale score explained more of the variability in the EQ-5D utility scores compared with pain severity items in the MM cohort (39% vs 31%) and for all patients (41% vs 34%), model fit was less than ideal (mean squared error=0.23 - 0.25). Hence, BPI items were fitted into individual EQ-5D items. Ordinal regression models fitting BPI items into individual EQ-5D items for the MM cohort showed good predictive power as measured by the concordance index c for mobility (86%), self-care (80%), usual activities (83%), pain (90%) and anxiety/depression (78%). For all patients, similar model fit were obtained for mobility (83%), self-care (78%), usual activities (81%), pain (90%) and anxiety/depression (72%). Further examination of the ordinal regression models across all groups showed that three BPI pain severity items, 'pain at its worst', 'average pain' and 'pain now' in addition to interference with activity and interference with work significantly predicted the EQ-5D pain item. Five interference items, activity, walking ability, work, sleep and enjoyment of life significantly predicted the EQ-5D usual activities item. Finally, 'pain now' and four interference items, relationship with others, enjoyment of life, mood, and activity significantly predicted the EQ-5D anxiety/depression item.CONCLUSIONS: Patients with MM reported several functional limitations on the EQ-5D. Majority of the patients reported moderate to extreme problems in all EQ-5D dimensions except self-care. Model fit of ordinal regression models relating BPI items with EQ-5D items are reasonable underscoring the benefit of using the BPI for planning patient care and health status evaluation. This consistency was also found across cancer groups that primarily include breast and prostate. The resultant model demonstrates the significant contribution of pain severity and interference in determining health status in this patient population. DisclosuresMendoza:Amgen Inc.: Consultancy. Shi:Amgen Inc.: Consultancy. Ma:Amgen Inc.: Employment. Zhang:Amgen Inc.: Employment. Qian:Amgen Inc.: Employment. Cleeland:Amgen Inc.: Consultancy.

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Learning Objectives: In the UK the National Institute for Health and Care Excellence requires a new treatment to reach a cost effectiveness threshold of between $31200 and $46900 per Quality Adjusted Life Year (QALY) to be considered for implementation in the NHS. A 2007 UK study suggested that the incremental cost per QALY gain of treatment in ICU was ($10918) and therefore cost effective. This analysis was based on a health utility score of 0.66 and no increase in health care utilization after ICU. This current study modelled the cost-effectiveness of ICU using 4 different scenarios. Methods: Previous work in our hospital has shown that QoL and health utility scores, after ICU are affected by work status (employed (0.77) vs retired (0.62) vs unemployed (0.08) vs long term sick (0.05)). Using the standardized UK costs, we ran 4 models. Assuming the status quo with updated UK healthcare costs, QoL is poorer after ICU but no increase in healthcare utilization, increased health care utilization after ICU (2,3 or 5 times the population norm) but QoL is 0.66, both QoL is poorer and health care utilization is increased. Results: With the updated status quo the cost per QALY is $15049. When the population is divided into the employed, retired, unemployed and the chronically sick the costs per QALY are $12917, $16019, $121124 and $187400. If the health utility is assumed to be 0.66 but we assume increased healthcare utilization of 2, 3 and 5 times the population norm the costs per QALY are $20036, $25021, $34995. If there is both a poorer QoL and increased healthcare utilization the costs per QALY range from $17195 to $435783. Conclusions: Whilst many patients return to an acceptable level of health, many struggle physically, financially, socially and psychologically. Although potentially the minority of patients, these groups are of working age and pose a significant economic burden to society. Small, targeted changes are required to improve QoL and the cost per QALY for ICU services. A holistic approach with generic and vocational rehabilitation is required if we are to prevent recurrent ill health and dependency.

QOL-25EVALUATION OF THE UTILITY OF THE EQ-5D AND MDASI-BT IN PRIMARY BRAIN TUMOR PATIENTS

BACKGROUND: Patients with malignant glioma are highly symptomatic and often have functional limitations beginning from the time of diagnosis. The utility of measuring general health status may have value in determining impact of disease. This study provided a description of health status and utility scores in glioma patients throughout the illness trajectory using the EQ-5D. Furthermore, it evaluated the additive information provided by MD Anderson Symptom Inventory-Brain Tumor (MDASI-BT) in describing health-related quality of life as assessed by the EQ-5D. METHODS: Malignant glioma patients completed the EQ-5D and MDASI-BT self-reports. The MDASI-BT is a measure of symptom burden and interference whereas the EQ-5D is a functional measure of general health status. Linear regression evaluated whether MDASI-BT scores adequately predict patient health outcomes measured by the EQ-5D. RESULTS: The sample included 100 patients [65% male, 75% with a GBM, median age 52 (range 20-75), 56% in active treatment]. Thirty percent of patients reported no problems on any of the 5 areas measured by the EQ-5D. The remaining 70% reported some/moderate problems in at least 1 area. The most extreme cases reported inability to perform usual activities (8%) and significant anxiety/depression (5%). The MDASI-BT neurologic factor score and the WAW (Walking/Activity/Work) interference score explained 52% of the variability in the EQ-5D in this patient population while adjusting for the effect of tumor grade, recurrence status, and Karnofsky Performance Status (KPS). Residual diagnostics confirmed the adequacy of model fit. CONCLUSIONS: The majority of brain tumor patients reported at least one functional limitation on the EQ-5D. Over half of the variance in the EQ-5D was explained by the MDASI-BT, KPS, tumor grade, and recurrence status underscoring the benefit of using this information for planning patient care. The resultant model demonstrates the significant contribution symptom burden has on determining health status in this patient population.

Impact of Illicit Drug Use on Health-Related Quality of Life in Opioid-Dependent Patients Undergoing HIV Treatment.

To assess the impact of illicit drug use on health-related quality of life (health utility) among opioid-dependent HIV-infected patients. Secondary analyses of data from the Buprenorphine-HIV Evaluation and Support cohort of HIV-infected patients with opioid dependence in 9 US HIV clinics between 2004 and 2009. Health status [short form-12 (SF-12)], combination antiretroviral treatment (ART) status, CD4 cell count, hepatitis C virus antibody status, current drug use, and demographics were assessed at the initial visit and quarterly follow-up visits until 1 year. The SF-6D health utility scores were derived from the SF-12. Multivariate mixed-effects regression models were used to assess the impact of illicit drug use on health utility controlling for demographic, clinical, and social characteristics. Health utility was assessed among 307 participants, 67% male, with a median age of 46 years at 1089 quarterly assessments. In multivariate analyses, illicit opioid use, nonopioid illicit drug use, not being on ART, and being on ART with poor adherence were associated with lower health utility. The observed decrement in health utility associated with illicit opioid use was larger for those on ART with good adherence (beta = -0.067; P < 0.01) or poor adherence (-0.049; P < 0.01) than for those not on ART. Illicit opioid and nonopioid drug use are negatively associated with health utility in patients with HIV; however, the relative effect of illicit opioid use is smaller than that of not being on ART. Postponing ART until initiation of opioid substitution therapy or abstinence may have limited benefits from the perspective of maximizing health utility.

The Impact of Chronic Urticaria from the Patient's Perspective: A Survey in Five European Countries.

BackgroundChronic spontaneous urticaria (CSU) is associated with considerable burden, but data from European patients are limited.MethodsThis study is a retrospective, cross-sectional analysis of National Health and Wellness Survey data from the five largest EU countries (5EU: France, Germany, Italy, Spain, and the UK) collected between 2010 and 2013. Burden of disease for patients with CSU was estimated by comparing individuals currently treated for chronic urticaria (proxy CSU cases) with controls selected from respondents without chronic urticaria. Matching and regression models were used to quantify the impact of chronic urticaria on health-related quality of life, self-reported psychological complaints, work and activity impairment, and healthcare use.ResultsThe sample included 175,923 respondents. Prevalence of diagnosed chronic urticaria was 0.5 and 0.2 % were treating the condition with a prescription. Cases (N = 369) had substantially lower (worse) regression-adjusted mean Mental Component Summary (40.2 vs. 45.4), Physical Component Summary (44.6 vs. 49.9), and SF-6D health utility scores (0.63 vs. 0.71; all p < 0.001) relative to controls (N = 1476), differences that exceed accepted minimally important differences for these measures. Depression, anxiety, and sleep difficulties were approximately twice as prevalent among those currently receiving treatment for chronic urticaria (all p < 0.001). Cases also had elevated presenteeism (31 vs. 17 %), overall work impairment (37 vs. 20 %), and impairment in non-work activities (42 vs. 26 %; all p < 0.01) relative to controls. Physician visits (9.1 vs. 4.9), emergency room visits (0.8 vs. 0.3), and hospitalizations (0.3 vs. 0.2) were more frequent than in controls (all p < 0.01).ConclusionsThis research adds to the existing evidence showing significant burden of CSU.Electronic supplementary materialThe online version of this article (doi:10.1007/s40271-015-0145-9) contains supplementary material, which is available to authorized users.

Comparing Utility Scores in Common Spinal Radiculopathies: Results of a Prospective Valuation Study.

Study Design Prospective observational study. Objective To determine whether preference-based health utility scores for common spinal radiculopathies vary by specific spinal level. Methods We employed a standard gamble study using the general public to calculate individual preference-based quality of life for four common radiculopathies: C6, C7, L5, and S1. We compared utility scores obtained for each level of radiculopathy with analysis of variance and t test. Multivariable regression was used to test the effects of the covariates age, sex, and years of education. We also reviewed the literature for publications reporting EuroQol-5 Dimensions (EQ-5D) scores for patients with radiculopathy. Results Two hundred participants were included in the study. Average utility for the four spinal levels fell within a narrow range (0.748 to 0.796). There were no statistically significant differences between lumbar and cervical radiculopathies, nor were there significant differences among the different spinal levels (F = 0.0850, p = 0.086). Age and sex had no significant effect on utility scores. There was a significant correlation between years of education and utility values for S1 radiculopathy (p = 0.037). On review of the literature, no study separated utility values by specific spinal level. EQ-5D utilities for both cervical and lumbar radiculopathy were considerably lower than the results of our study. Conclusions Utility values associated with the most common levels of cervical and lumbar radiculopathy do not significantly differ from each other, validating the current practice of grouping utility by spinal segment rather than by specific root levels. The discrepancy in average utility values between our study and the EQ-5D highlights the need to be mindful of the underlying instruments used when assessing outcomes studies from different sources.

Impact of depression on health utility value in cancer patients.

The quality-adjusted life year, which is usually calculated from the health utility value, is now a standard measurement used in political decision-making in health. Although depression is the leading cause of decrement in health utility in general population, impact of comorbid depression among cancer patients has not been studied sufficiently. Therefore, this study aimed to measure the impact of depression on cancer patients' health utility score, according to the severity of depression. Impact of depression severity (measured by the Patient Health Questionnaire) on health utility score (measured by the EuroQoL-5 scale) was evaluated in a sample of 328 Japanese cancer patients, controlling for performance status, symptom burden, and demographic variables. The patients with depression had significantly lower health utility value than those without depression (mean decrement = 0.14). Decrements in health utility of 0.13, 0.18, and 0.19 were observed for mild, moderate, and moderately severe to severe level of depression, respectively. The difference was significant between groups. Depression severity was a significant predictor for health utility (standardized coefficient beta = -0.25), which was comparable with physical symptom burden and performance status. Participants' age, gender, cancer stage, and comorbid illness were not significant. The model explained 37.9% of the variance. Even mild level of depression caused clinically meaningful decrement in health utility value in cancer patients, which was comparable with decrements due to major physical complications of cancer. Influence of depression should be carefully investigated when interpreting the quality-adjusted life year among cancer patients. Copyright © 2015 John Wiley & Sons, Ltd.

The PROMIS of QALYs.

Measuring health and health-related quality of life (HRQoL) is important for tracking the health of individuals and populations over time. Generic HRQoL measures allow for comparison across health conditions. One form of generic HRQoL measures are profile measures, which provide a description of health across several different domains (such as physical functioning, depression, and pain). Recent advances in health profile measurement include the development of measures based on item response theory. The Patient-Reported Outcomes Measurement Information System (PROMIS®) has been constructed using this theory. Another form of generic HRQoL measures are utility measures, which assess the value of health states. Multi-attribute utility theory provides a framework for valuing disparate domains of health and aggregating them into a single preference-based score. Such a score provides an overall measure of health outcomes as well as a quality of life weight for use in decision analyses and cost-effectiveness analyses. Developing a utility score for PROMIS® would allow simultaneous estimation of both health profile and utility scores using a single measure. The purpose of this paper is to provide a roadmap of the methodological steps necessary to create such a scoring system.

Effect of chronic urticaria on US patients: analysis of the National Health and Wellness Survey

BackgroundChronic idiopathic (also called spontaneous) urticaria (CIU/CSU) is the most common form of chronic urticaria and has been associated with impairment to health outcomes, although the effect has never been assessed using a nationally representative sample in the United States. ObjectivesTo assess the burden of CIU/CSU from the patients' perspective in terms of health related quality of life, impairment to work and nonwork activities, and health care resource use. MethodsData were obtained from the US National Health and Wellness Survey. Current use of a prescription for the treatment of chronic hives was used as a proxy for CIU/CSU. Patients with CIU/CSU in the proxy group were matched 1:4 to respondents without chronic hives using survey year, sex, age, and race. Generalized linear models were adjusted for comorbidities, smoking, body mass index, and health insurance status. Outcome measures included the Medical Outcomes Study 12-Item and 36-Item Short Form Health Surveys; self-reported depression, anxiety, and sleep difficulties; the Work Productivity and Activity Impairment questionnaire, and health care resource use. ResultsAfter matching and adjustment for covariates, those currently using a prescription for chronic hives had mental component summary scores 5.7 points lower, physical component summary scores 6.5 points lower, and health utility scores 0.11 points lower than controls, as well as higher adjusted odds of reporting depression, anxiety, and sleep difficulties. Mean adjusted work impairment was approximately double in prescription-treated chronic hives relative to controls, as was frequency of health care visits. ConclusionChronic hives substantially affects quality of life, nonwork activities, capacity to work, and health care use, providing further evidence of a high burden of CIU/CSU across multiple health outcomes and unmet need for effective treatment.

Assessing health status in informal schizophrenia caregivers compared with health status in non-caregivers and caregivers of other conditions.

BackgroundResearch indicates schizophrenia is a cause of burden for patients and caregivers. This study examined health-related quality of life (HRQoL) and comorbidities experienced by informal schizophrenia caregivers compared with non-caregivers and caregivers of adults with other conditions (e.g., Alzheimer’s disease, cancer, and stroke).MethodsData were obtained from the 5EU (France, Germany, Italy, Spain, UK) National Health and Wellness Survey, an online questionnaire that is representative of the total 5EU adult (18+ years) population. Respondents provided information on HRQoL (SF-36v2: mental and physical component summary (MCS, PCS) and SF-6D (health utility) scores), items from the Caregiver Reaction Assessment (strongly disagree to strongly agree) and comorbidities (sleep difficulties, insomnia, pain, headaches, heartburn, anxiety, depression) experienced in the past 12 months. Schizophrenia caregivers (n = 398) were matched to non-caregivers (n = 158,989) and caregivers of other conditions (n = 14,341) on baseline characteristics via propensity scores. Chi-square tests and ANOVAs were used to determine significant differences across groups.ResultsThe average age of schizophrenia caregivers was 45.3 years (SD = 15.8), and 59.6 % were female. After matching, schizophrenia caregivers reported lower MCS (40.3 vs. 45.9), PCS (46.8 vs. 49.0), and health utilities (0.64 vs. 0.71) compared with non-caregivers (all p < 0.001). Schizophrenia caregivers were more likely to experience sleep difficulties (42.7 % vs. 28.5 %), insomnia (32.4 % vs. 18.5 %), pain (39.7 % vs. 30.4 %), headaches (48.0 % vs. 42.0 %), heartburn (31.7 % vs. 22.9 %), anxiety (37.9 % vs. 23.6 %), and depression (29.4 % vs. 19.4 %) than non-caregivers. Comparing schizophrenia caregivers and other caregivers, schizophrenia caregivers reported lower MCS (40.3 vs. 42.7, p < 0.001), and health utilities (0.64 vs. 0.67, p < 0.001). Schizophrenia caregivers were more likely to experience sleep difficulties, insomnia, pain, and anxiety than other caregivers. Almost 60 % of schizophrenia caregivers agree/strongly agree that caring for the patient is important to them, but only 31.9 % agree/strongly agree that they have the financial resources to provide adequate care.ConclusionsSchizophrenia caregivers reported worse HRQoL than non-caregivers and caregivers of other conditions. Providing care for an adult relative with schizophrenia is important to caregivers, but caregivers need more resources to provide adequate care. Providing informal schizophrenia caregivers with support services to help better manage patients may improve their health status.

Burden of benign prostatic hyperplasia among men in Japan: Patient-reported outcomes among those diagnosed and experiencing symptoms.

To quantify the burden of benign prostatic hyperplasia among Japanese men according to patient-reported outcomes. A secondary aim was to quantify the incremental burden of nocturia among these men. Survey data representative of the Japanese population by age and sex were analyzed (total n=59997). All measures were self-reported, including the revised Medical Outcomes Study 12-Item Short Form Health Survey or the revised Medical Outcomes Study 36-Item Short Form Health Survey, Work Productivity and Activity Impairment questionnaire, and 6-month healthcare use. Men aged ≥50years were organized into three analysis groups according to diagnosis of benign prostatic hyperplasia and International Prostate Symptom Score total: diagnosed benign prostatic hyperplasia (n=1183); undiagnosed benign prostatic hyperplasia with moderate to severe symptoms (International Prostate Symptom Score total≥8; n=3141); and controls (no benign prostatic hyperplasia diagnosis and International Prostate Symptom Score total <8; n=9468). Subgroup analyses were carried out according to frequency of nocturia. Generalized linear models adjusted for potential confounders. Relative to controls, diagnosed and undiagnosed benign prostatic hyperplasia respondents had reduced health-related quality of life, with mean decrements of ≥3.1points for mental component summary scores, ≥2.0 for physical component summary scores and ≥0.05 for health utility scores (all P<0.001). Mean absenteeism, impairment at work and non-work activity impairment among the diagnosed and undiagnosed groups were ≥1.4-fold those of the control group (P<0.01). Both diagnosed and undiagnosed groups used significantly more healthcare than controls. The outcomes of undiagnosed men were worse than diagnosed patients on many measures. Frequent nocturia (≥3 voids per night) was associated with worse health-related quality of life. Benign prostatic hyperplasia impacts health-related quality of life, work productivity and healthcare use of Japanese men, with more impact among undiagnosed men experiencing lower urinary tract symptoms and frequent nocturia.

A telephone-delivered multiple health behaviour change intervention for colorectal cancer survivors: making the case for cost-effective healthcare.

In patients with colorectal cancer, a trial of a telephone-delivered multiple health behaviour change intervention, using acceptance commitment therapy strategies, found benefits for health and psychosocial outcomes including increased physical activity, improved dietary habits and lower body mass index. Our aim was to address the health economic outcomes by assessing the health system cost and health utility impacts of the intervention. A cost-consequences analysis was performed using data from a two-group randomised controlled intervention trial (n=410). Outcomes included health-related quality of life (HRQoL), health utility and health system costs. At 12months, clinically meaningful improvements were found for SF-6D over time but no significant differences were found between groups (P=0.95). The cost of delivering the 6-month intervention was on average €280 per person and made up 21% of overall healthcare costs for participants during the intervention period. Excluding intervention costs, costs were similar for health professional visits and medications across groups. Despite significant positive intervention effects on health behaviours, health utility and HRQoL scores were similar across groups. On the basis that intervention costs were small and physical activity, diet and weight management improved, on balance the intervention is potentially a worthwhile investment in healthcare funds. ACTRN12608000399392.

Health-Related Quality of Life in Australasian Survivors of H1N1 Influenza Undergoing Mechanical Ventilation. A Multicenter Cohort Study.

Patients surviving acute respiratory distress syndrome suffer decrements in physical function and health-related quality of life (HR-QoL); however, it is unclear whether HR-QoL is disproportionately affected in those with H1N1 influenza. The objective was to compare the HR-QoL of patients with a diagnosis of H1N1 influenza who were mechanically ventilated, 12 months after intensive care unit (ICU) discharge with healthy population data and ICU survivor data. A prospective, observational, binational, multicenter cohort study was conducted in 11 ICUs in Australia and New Zealand during June-September 2009. Eligible participants were mechanically ventilated in the ICU with a confirmed diagnosis of H1N1 influenza. People were excluded if they were less than 18 years of age or could not speak English. Two validated HR-QoL questionnaires (Short Form-36 version 2 [SF-36], and Assessment of Quality of Life [AQoL]) were administered 1 year after ICU discharge. Sixty-two patients (48% male) had a median (interquartile range) age of 42 (29-53) years and an APACHE II score of 18.0 (14-20); ventilation days, 10.0 (4-23); and ICU and hospital length of stay, 12.5 (7-27) and 20.0 (15-38) days, respectively. Hospital mortality was 7%, and 31% of the cohort received a tracheostomy. The mean (SD) health utility score at 1 year was 0.68 (0.30) compared with the healthy age-matched population (0.81 [0.23]). The mean (SD) SF-36 physical and mental component summary scores were within population normal ranges at 44.4 (12.3) and 45.5 (12.5), respectively. Health-related quality of life of Australasian survivors of severe H1N1 influenza was comparable to the healthy population 1 year after ICU discharge. Consensus should be sought on standardization of follow-up time points and outcome measurement. Clinical trial registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12609001037291).

Patient-reported symptoms and Canadian Health Utility scores in esophageal cancer patients.

6607 Background: Health utility scores (HUS) are an increasingly important tool to help determine the cost-effectiveness of therapies worldwide. The EQ-5D-3L is a validated tool for deriving HUS, with reference data in numerous populations, but there is limited information on the role that individual symptom complexes (SC) play in determining HUS in Esophageal cancer (EC) patients. Methods: A cross-sectional survey of EC patients at Princess Margaret Cancer Centre (2012-2014) assessed EQ-5D-3L and FACT-E. EQ-5D scores were converted to HUS using Canadian references. SC were developed: domains from FACT-E were identified and grouped to represent symptoms such as pain, dysphagia, fatigue, dyspnea, nausea and loss of appetite. Multivariable regression analysis was performed to assess associations between SC and HUS, adjusting for age, sex, and stage of disease. Results: Of 197 patients, median age was 67 (range 32-93) years, 76% were male, with stage I/II-IVA/IVB (6%/66%/28%) disease. Mean (SE) HUS were 0.90...

PCV88 - Comparing The Eq-5d-3l And Sf-6d Utility Scores Of Acute Coronary Syndrome Patients From An Asian Population

Objectives: EQ-5D and SF-6D can both be used to derive health utility scores. Variations in utility scores can have a major impact on the results of cost-utility studies. This study aimed to compare the health utility of acute coronary syndrome (ACS) patients from Malaysia measured by the two descriptive systems Methods: Data was obtained from an earlier study. The study collected data from ACS patients admitted to the Sarawak General Hospital who consented to the study. Validated language versions of the EQ-5D-3L and SF-36v1 were administered during admission and 12-months post-admission. Health utility scores were calculated using the Malaysian EQ-5D-3L utility tariff and Brazier SF-6D algorithm. Patient demographic and clinical data were extracted from medical records.