Hypothetical Health States Research Articles

Surrogate inaccuracy in predicting older adults' desire for life-sustaining interventions in the event of decisional incapacity: is it due in part to erroneous quality-of-life assessments?

Family members are often called upon to make decisions for an incapacitated relative. Yet they have difficulty predicting a loved one's desire to receive treatments in hypothetical situations. We tested the hypothesis that this difficulty could in part be explained by discrepant quality-of-life assessments. The data come from 235 community-dwelling adults aged 70 years and over who rated their quality of life and desire for specified interventions in four health states (current state, mild to moderate stroke, incurable brain cancer, and severe dementia). All ratings were made on Likert-type scales. Using identical rating scales, a surrogate chosen by the older adult was asked to predict the latter's responses. Linear mixed models were fitted to determine whether differences in quality-of-life ratings between the older adult and surrogate were associated with surrogates' inaccuracy in predicting desire for treatment. The difference in quality-of-life ratings was a significant predictor of prediction inaccuracy for the three hypothetical health states (p < 0.01) and nearly significant for the current health state (p = 0.077). All regression coefficients were negative, implying that the more the surrogate overestimated quality of life compared to the older adult, the more he or she overestimated the older adult's desire to be treated. Discrepant quality-of-life ratings are associated with surrogates' difficulty in predicting desire for life-sustaining interventions in hypothetical situations. This finding underscores the importance of discussing anticipated quality of life in states of cognitive decline, to better prepare family members for making difficult decisions for their loved ones. ISRCTN89993391.

Estimation of health state utilities in breast cancer.

PurposeThe aim of this study is to determine the utility of breast cancer health states using the standard gamble (SG) and visual analog scale (VAS) methods in the Korean general population.Materials and methodsEight hypothetical breast cancer health states were developed based on patient education material and previous publications. Data from 509 individuals from the Korean general population were used to evaluate breast cancer health states using the VAS and the SG methods, which were obtained via computer-assisted personal interviews. Mean utility values were calculated for each human papillomavirus (HPV)-related health state.ResultsThe rank of health states was identical between two valuation methods. SG values were higher than VAS values in all health states. The utility values derived from SG were 0.801 (noninvasive breast cancer with mastectomy and followed by reconstruction), 0.790 (noninvasive breast cancer with mastectomy only), 0.779 (noninvasive breast cancer with breast-conserving surgery and radiation therapy), 0.731 (invasive breast cancer with surgery, radiation therapy, and/or chemotherapy), 0.610 (locally advanced breast cancer with radical mastectomy with radiation therapy), 0.587 (inoperable locally advanced breast cancer), 0.496 (loco-regional recurrent breast cancer), and 0.352 (metastatic breast cancer).ConclusionOur findings might be useful for economic evaluation of breast cancer screening and interventions in general populations.

Health literacy and logical inconsistencies in valuations of hypothetical health states: results from the Canadian EQ-5D-5L valuation study.

To examine the association of health literacy with logical inconsistencies in time trade-off valuations of hypothetical health states described by the EQ-5D-5L classification system. Data from the EQ-5D-5L Canadian Valuation study were used. Health literacy was assessed using the Brief Health Literacy Screen. A health state valuation was considered logically inconsistent if a respondent gave the same or lower value for a very mild health state compared to the value given to 55555, or gave the same or lower value for a very mild health state compared to value assigned to the majority of the health states that are dominated by the very mild health state. Average age of respondents (N = 1209) was 48 (SD = 17) years, 45% were male, 7% reported inadequate health literacy, and 11% had a logical inconsistency. In adjusted analysis, participants with inadequate health literacy were 2.2 (95%CI: 1.2, 4.0; p = 0.014) times more likely to provide an inconsistent valuation compared to those with adequate health literacy. More specifically, those who had problems in "understanding written information" and "reading health information" were more likely to have a logical inconsistency compared to those who did not. However, lacking "confidence in completing medical forms" was not associated with logical inconsistencies. Health literacy was associated with logical inconsistencies in valuations of hypothetical health states described by the EQ-5D-5L classification system. Valuations studies should consider assessing health literacy, and explore better ways to introduce the valuation tasks or use simpler approaches of health preferences elicitation for individuals with inadequate health literacy.

PHP229 - Should Patients Estimate Health Related Quality Of Life? The Results Of Empirical Study

To contribute to the debate of using patients vs. general population preferences for valuing health states by obtaining patients based valuation of hypothetical health state and determine whether the preferences towards HRQoLdiffer between both groups. Values of hypothetical health states were acquired in face-to-face interviews of 611 metastatic breast cancer and rheumatoid arthritis patients in Spain, using EQ-5D-5L instrument. 20 health states were included in the EQ-VT design, which was developed specifically for use in ADVANCE HTA study. The ethical approval was obtained and training program was conducted for the interviewers. The interviews were carried out by GEPAC, the Spanish Group for Cancer Patients between June and November 2015. Patients were selected according to their willingness to participate and were selected from patient organizations and hospitals in Madrid. The data quality was performed. Data analysis was performed using R. The differences between each pair of health states were checked and causes of differences were determined using linear regression models. Patients, regardless of the disease, have similar preferences towards hypothetical health states, yet different to the general population. The average absolute difference between general and patient population is 0.232, while the average absolute difference between RA and BC patient group is 0.073. We found statistically significant differences between patients’ valuations and general public valuations on three health dimensions: mobility, pain or discomfort, and anxiety or depression. Patients consider problems related to mobility less problematic, while problems related to pain/anxiety are seen as more problematic The results suggest that not all health dimensions defined by EQ-5D are equally well understood by the general public. A possible explanation for the differences in the valuation that is suggested by the regression analysis is that problems with mobility, self-care, and usual activities are easier to imagine and understand by general population.

Advance Care Planning in Dementia: Do Family Carers Know the Treatment Preferences of People with Early Dementia?

Background and AimsWhen a person with dementia (PWD) has lost the ability to make treatment decisions, clinicians often rely on family carers to know and articulate these preferences with assumed accuracy. This study used the Life Support Preferences Questionnaire (LSPQ) to explore whether family carers’ choices show agreement with the end of life care preferences of the person with dementia for whom they care and what factors influence this.MethodsA cross-sectional study interviewing 60 dyads (a person with early dementia and preserved capacity and their family carer) each completing a modified LSPQ. We assessed how closely carers’ choices resembled the PWD’s preferences for treatment in three proposed health states: the here and now; severe stroke with coma; terminal cancer. Agreement between the PWD and their family carer responses was assessed using Kappa and Prevalence-Adjusted Bias-Adjusted Kappa (PABAK) statistics. We examined whether carer burden and distress, and relationship quality, influenced agreement.ResultsIn interviews PWD were able to indicate their treatment preferences across all three scenarios. In the here-and-now most wanted antibiotics (98%), fewer cardio-pulmonary resuscitation (CPR) (50%) and tube feeding (47%). In severe stroke and coma antibiotics remained the more preferred treatment (88%), followed by CPR (57%) and tube feeding (30%). In advanced cancer PWD expressed lower preferences for all treatments (antibiotics 68%; CPR 50%; tube feeding 37%). Carers’ choices were similar to the PWDs’ preferences in the here-and-now (71% (k = 0.03; PABAK = 0.4) with less agreement for future hypothetical health states. In severe stroke and coma carers tended wrongly to suggest that the PWD preferred more intervention (antibiotic, 67%; k = -0.022; PABAK = -0.60; CPR, 73%; k = 0.20; PABAK = -0.20, tube feeding, 66%; k = 0.25; PABAK = -0.12). In advanced cancer the agreement between PWD and carers was low (antibiotics; k = -0.03; PABAK = -0.52; CPR, k = -0.07; PABAK = -0.45; tube feeding; k = 0.20; PABAK = -0.22). However, both PWD and carers showed marked uncertainty about their preferences for end of life treatment choices. Relationship quality, carer distress and burden had no influence on agreement.ConclusionsThis study is the first to have used the LSPQ with PWD in the UK to consider treatment options in hypothetical illness scenarios. Key finding are that family carers had a low to moderate agreement with PWD on preferences for end of life treatment. This underscores how planning for care at the end of life is beset with uncertainty, even when the carer and PWD perceive the care-giving/receiving relationship is good. Families affected by dementia may benefit from early and ongoing practical and emotional support to prepare for potential changes and aid decision making in the context of the realities of care towards the end of life.

Development, feasibility, and validity of a computer-based utility assessment tool for measuring asthma-specific health utilities in Malaysia using the standard gamble method

Objectives: To develop and test the feasibility and validity of a computer-based utility assessment tool that used standard gamble (SG) method for measuring asthma-specific health utilities. Methods: A computer-based SG (CBSG) tool was developed using Microsoft® PowerPoint 2007 to value asthma-specific health states in Malaysia. Eight hypothetical health states were considered, including two anchor states (healthy and dead), three chronic (C) states and three temporary (T) states (each numbered 1 through 3, with increasing severity) in addition to the subject's current health state. Twenty adult asthma patients completed the CBSG tool in addition to paper-based Asthma Control Test, three health status measures (EQ-5D, EQ-VAS, and Mini Asthma Quality of Life Questionnaire (MiniAQLQ)), and VAS utility assessment tool. Patients and interviewers rated the difficulty of the VAS and CBSG tools. Correlations between current health state values derived from the various measures were determined. Results: The SG and the VAS received similar difficulty ratings. 17 patients completed the CBSG tool within 30 minutes. The mean utilities determined by the CBSG tool for the T1-T3 asthma health states met the expected logical order of 1>2>3, but those for the C1-C3 states did not. Correlation between current health state values derived from the CBSG tool and other measurement tools was poor. Conclusion: The CBSG tool developed for measuring utilities of asthma health states showed acceptable feasibility and overall validity.

Determinants of time trade-off valuations for EQ-5D-5L health states: data from the Canadian EQ-5D-5L valuation study.

Previous studies suggest that population subgroups have different perceptions of health, as well as different preferences for hypothetical health states. To identify determinants of health states preferences elicited using time trade-off (TTO) for the 5-level EQ-5D questionnaire (EQ-5D-5L) in Canada. Data were from the Canadian EQ-5D-5L Valuation Study, which took place in Edmonton, Hamilton, Montreal, and Vancouver. Each respondent valued 10 of 86 hypothetical health states during an in-person interview using a computer-based TTO exercise. The TTO scores were the dependent variable and explanatory variables including age, sex, marital status, education, employment, annual household income, ethnicity, country of birth, dwelling, study site, health literacy, number of chronic conditions, previous experience with illness, and self-rated health. Average [standard deviation (SD)] age of respondents (N=1209) was 48 (17) years, and 45% were male. In multivariable linear regression models with random effects, adjusted for severity of health states and inconsistencies in valuations, older age [unstandardized regression coefficient (β)=-0.077], male sex (β=0.042), being married (β=0.069), and urban dwelling (β=-0.055) were significantly associated with health states scores. Additionally, participants from Edmonton (β=-0.124) and Vancouver (β=-0.156), but not those from Hamilton, had significantly lower TTO scores than those from Montreal. Socio-demographic characteristics were the main determinants of preferences for EQ-5D-5L health states in this study. Interestingly, preferences were significantly lower in western Canadian cities compared to eastern ones, bringing into question whether a single preference algorithm is suitable for use in all parts of Canada.

Disability weights for the Global Burden of Disease 2013 study.

The Global Burden of Disease (GBD) study assesses health losses from diseases, injuries, and risk factors using disability-adjusted life-years, which need a set of disability weights to quantify health levels associated with non-fatal outcomes. The objective of this study was to estimate disability weights for the GBD 2013 study. We analysed data from new web-based surveys of participants aged 18-65 years, completed in four European countries (Hungary, Italy, the Netherlands, and Sweden) between Sept 23, 2013, and Nov 11, 2013, combined with data previously collected in the GBD 2010 disability weights measurement study. Surveys used paired comparison questions for which respondents considered two hypothetical individuals with different health states and specified which person they deemed healthier than the other. These surveys covered 183 health states pertinent to GBD 2013; of these states, 30 were presented with descriptions revised from previous versions and 18 were new to GBD 2013. We analysed paired comparison data using probit regression analysis and rescaled results to disability weight units between 0 (no loss of health) and 1 (loss equivalent to death). We compared results with previous estimates, and an additional analysis examined sensitivity of paired comparison responses to duration of hypothetical health states. The total analysis sample consisted of 30 230 respondents from the GBD 2010 surveys and 30 660 from the new European surveys. For health states common to GBD 2010 and GBD 2013, results were highly correlated overall (Pearson's r 0·992 [95% uncertainty interval 0·989-0·994]). For health state descriptions that were revised for this study, resulting disability weights were substantially different for a subset of these weights, including those related to hearing loss (eg, complete hearing loss: GBD 2010 0·033 [0·020-0·052]; GBD 2013 0·215 [0·144-0·307]) and treated spinal cord lesions (below the neck: GBD 2010 0·047 [0·028-0·072]; GBD 2013 0·296 [0·198-0·414]; neck level: GBD 2010 0·369 [0·243-0·513]; GBD 2013 0·589 [0·415-0·748]). Survey responses to paired comparison questions were insensitive to whether the comparisons were framed in terms of temporary or chronic outcomes (Pearson's r 0·981 [0·973-0·987]). This study substantially expands the empirical basis for assessment of non-fatal outcomes in the GBD study. Findings from this study substantiate the notion that disability weights are sensitive to particular details in descriptions of health states, but robust to duration of outcomes. European Centre for Disease Prevention and Control, Bill and Melinda Gates Foundation.

Can adult weights be used to value child health states? Testing the influence of perspective in valuing EQ-5D-Y

PurposeTo test whether or not adults assign the same values to hypothetical health states that describe health in adults as when those same descriptions refer to the health of a child.MethodsA two-part self-completion questionnaire was designed in which respondents were asked firstly to rate a fixed set of EQ-5D-Y health states on a 0–100 visual analogue scale as if they themselves were in these states. Two versions of the questionnaire were produced each with a different second part. One version instructed respondents to value the same states but to imagine them describing another adult. The second version required respondents to value these states as if they applied to a 10-year-old child. Questionnaires were distributed to adults recruited in three countries (Germany, Spain and England) using convenience sampling methods.ResultsA total of 1085 questionnaires were completed. Despite some significant differences in the characteristics of the achieved samples in the three countries involved, the rank order of health states was largely consistent across each adult/child reference perspective. In all countries, the mean values were lower when health states described children rather than adults. Significant differences were found for 16/24 states when values for those states applied to adult respondent themselves were compared with the values for those states applied to a 10-year-old child. A near-uniform pattern was found across all three countries in which health state values for children were found to be lower than for adults.ConclusionsValues for health states when ascribed to adults are higher than when those same states are associated with children. Were EQ-5D-3L values for adults applied to EQ-5D-Y health states, then this would effectively lead to an misrepresentation of the value assigned to a health status in children.

Multiattribute health utility scoring for the computerized adaptive measure CAT-5D-QOL was developed and validated

ObjectivesThe CAT-5D-QOL is a previously reported item response theory (IRT)–based computerized adaptive tool to measure five domains (attributes) of health-related quality of life. The objective of this study was to develop and validate a multiattribute health utility (MAHU) scoring method for this instrument. Study Design and SettingThe MAHU scoring system was developed in two stages. In phase I, we obtained standard gamble (SG) utilities for 75 hypothetical health states in which only one domain varied (15 states per domain). In phase II, we obtained SG utilities for 256 multiattribute states. We fit a multiplicative regression model to predict SG utilities from the five IRT domain scores. The prediction model was constrained using data from phase I. We validated MAHU scores by comparing them with the Health Utilities Index Mark 3 (HUI3) and directly measured utilities and by assessing between-group discrimination. ResultsMAHU scores have a theoretical range from −0.842 to 1. In the validation study, the scores were, on average, higher than HUI3 utilities and lower than directly measured SG utilities. MAHU scores correlated strongly with the HUI3 (Spearman ρ = 0.78) and discriminated well between groups expected to differ in health status. ConclusionResults reported here provide initial evidence supporting the validity of the MAHU scoring system for the CAT-5D-QOL.

Utility estimation of hypothetical chronic obstructive pulmonary disease health states by the general population and health professionals.

PurposeThis study attempted to estimate the utility weights for hypothetical chronic obstructive pulmonary disease (COPD) health states, including the effect of exacerbation, and based on utilities elicited from a representative sample using the time trade-off (TTO).MethodsA total of 200 study subjects were recruited using a quota sampling method in Seoul, Korea. Ten COPD health profiles were described reflecting the severity of COPD and the extent of exacerbation. Respondents evaluated each health state using a visual analogue scale and TTO during a personal interview. TTO values were estimated using a linear mixed model, and the model performance was evaluated in terms of its predictive ability and goodness of fit.ResultsThe estimated TTO values were 0.824 in moderate, 0.646 in severe, and 0.305 in very severe COPD health states. The estimated utility decrements in TTO varied from 0.082 for a non-serious exacerbation to 0.228 for one non-serious plus one serious exacerbation per year. The mean absolute error of the TTO model was 0.008, and the generalized R2 was 0.86.ConclusionThe social preference of various COPD health states and the utility decrement due to exacerbation can be useful for the economic evaluation of COPD intervention in Korea.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-015-0228-2) contains supplementary material, which is available to authorized users.

WILLINGNESS TO PAY FOR LUNG CANCER TREATMENT: PATIENT VERSUS GENERAL PUBLIC VALUES.

Lung cancer has been the most common cancer since 1985, accounting for 12-13 percent of cancer cases worldwide. Newer targeted therapies with potential increased survival benefits may not be affordable to patients. Many countries use arbitrary thresholds to determine whether a medical intervention is cost-effective. As such, many effective, albeit expensive, therapies are not being reimbursed. To understand the value placed on effective therapies, this study evaluates the patient and public willingness to pay (WTP) for a quality-adjusted life-year (QALY) for lung cancer treatments using Thailand as an example. A total of 300 subjects responded to hypothetical lung cancer health states, described by three levels of severity and two levels of side effects, and provided their valuation of the level of quality of life and their WTP to improve from one state to another. The patients with the lowest income and general public were willing to pay more than twice the threshold for acceptability in Thailand (US Dollar 5,123/QALY [Thai Baht 160,000/QALY]). This increased significantly by wealth category. Patients' WTP was associated with quality of life, financial difficulties, health insurance, diarrhea, and wealth. The current study highlights the value patients and general public place on effective lung cancer therapies.

A survey of population-based utility scores for cervical cancer prevention.

BackgroundWith human papillomavirus (HPV) vaccination introduced in a number of countries, there is considerable interest in evaluating the cost-effectiveness of HPV testing as the primary cervical screening test in these settings. However, the availability of utility scores for these newer interventions is limited. Our aim in this paper is to present utility scores for HPV vaccination, HPV testing and cytology based screening states among women targeted for cervical screening.MethodsWe invited a random sample of women targeted for cervical screening (aged 20-69 years) living in Sydney, Australia, to participate in a face-to-face interview. Participants were asked to indicate preferences (rank and utility scores) for 10 hypothetical health states relating to HPV vaccination, cytology and primary HPV screening, cervical precursor disease and early stage cervical cancer. Preferences for hypothetical health states were measured through ranking then a two-stage standard gamble. Each participant’s own health state was measured as a utility score using the EQ5D. Potential differences by age were assessed using the Wilcox Rank Sum test.ResultsA maximum of 276 women were contacted, of which 43 (mean age 49 years) agreed to be interviewed (15.6%). The overall health state of women as measured by the EQ5D was 0.86 (95% CI: 0.83-0.89). Of the 10 health states, the highest ranked were ‘normal cytology’ and ‘HPV vaccination’ (equal 1st). States involving an HPV positive result with a subsequent normal cytology or colposcopy were ranked below those for low grade cytological abnormalities with or without a subsequent colposcopic normal result (ranks 3-4 vs. 4-5). However, mean utility scores were broadly similar for all health states, except cervical cancer. No significant differences in scores were identified between age groups.ConclusionOur survey suggests health states relating to HPV testing are ranked below ‘low grade cytology’ disease abnormalities. However, this difference was minimal on the utility scale, as most values for health states were largely clustered. These results provide a preliminary set of non-clinic population-based utilities that may be used with other values to explore the economic implications of introducing HPV testing as a primary screening tool in the context of HPV vaccination.Electronic supplementary materialThe online version of this article (doi:10.1186/1756-0500-7-899) contains supplementary material, which is available to authorized users.

Cross-cultural measurement equivalence of the EQ-5D-5L items for English-speaking Asians in Singapore.

To investigate how the response labels of the 5-level EQ-5D (EQ-5D-5L) items are interpreted and used by English-speaking Chinese and non-Chinese Singaporeans, as a means to assessing whether those items are cross-culturally equivalent health-status measures in this Asian population. In face-to-face interviews, Chinese, Malay and Indian visitors to a primary care institution in Singapore were asked to rate the relative severity conveyed by EQ-5D-5L response labels, each containing the keyword of 'no(t),' 'slight(ly),' 'moderate(ly),' 'severe(ly),' or 'unable'/'extreme(ly),' using a 0-100 numerical rating scale. Participants were also asked to describe 25 hypothetical health states using the EQ-5D-5L response labels. Differences between Chinese and Malay/Indian participants in label interpretation and selection were examined using multivariate regression analysis to adjust for participant characteristics. The differences in adjusted mean severity scores for individual EQ-5D-5L labels between Chinese (n = 148) and non-Chinese (Malay: n = 53; Indian: n = 56) participants ranged from 0.0 to 9.0. The relative severity of the labels to the participants supported the ordinality of the EQ-5D-5L response labels and was similar across ethnic groups. Chinese and non-Chinese participants selected similar response labels to describe each hypothetical health state, with the adjusted odds ratios of selecting any type of the five response labels for non-Chinese versus Chinese participants ranging from 0.92 to 1.15 (p > 0.05 for all). The EQ-5D-5L items are likely to generate equivalent health outcomes between English-speaking Chinese and non-Chinese Singaporeans.

Validation of the underlying assumptions of the quality-adjusted life-years outcome: results from the ECHOUTCOME European project.

Quality-adjusted life-years (QALYs) have been used since the 1980s as a standard health outcome measure for conducting cost-utility analyses, which are often inadequately labeled as 'cost-effectiveness analyses'. This synthetic outcome, which combines the quantity of life lived with its quality expressed as a preference score, is currently recommended as reference case by some health technology assessment (HTA) agencies. While critics of the QALY approach have expressed concerns about equity and ethical issues, surprisingly, very few have tested the basic methodological assumptions supporting the QALY equation so as to establish its scientific validity. The main objective of the ECHOUTCOME European project was to test the validity of the underlying assumptions of the QALY outcome and its relevance in health decision making. An experiment has been conducted with 1,361 subjects from Belgium, France, Italy, and the UK. The subjects were asked to express their preferences regarding various hypothetical health states derived from combining different health states with time durations in order to compare observed utility values of the couples (health state, time) and calculated utility values using the QALY formula. Observed and calculated utility values of the couples (health state, time) were significantly different, confirming that preferences expressed by the respondents were not consistent with the QALY theoretical assumptions. This European study contributes to establishing that the QALY multiplicative model is an invalid measure. This explains why costs/QALY estimates may vary greatly, leading to inconsistent recommendations relevant to providing access to innovative medicines and health technologies. HTA agencies should consider other more robust methodological approaches to guide reimbursement decisions.

Health state utilities for migraine based on attack frequency: a time trade-off study.

This study aims to evaluate health state utilities for migraine based on attack frequency from a mixed population sample consisting of migraineurs and non-migraineurs. A cross-sectional questionnaire survey was designed to measure health-related quality of life (HRQOL) in migraine without aura by time trade-off method (TTO). A convenience sample of university students and staff was recruited regardless of having ever experienced migraine or not. Subjects were asked to elicit two hypothetical health states characterised by different migraine frequencies ('m': two migraines lasting 4 h each month and 'w': each week) within two hypothetical lifetime frames (20 years left to live/lives until the age of 80 years). Utilities were calculated for the four tasks (U20m, U80m, U20w, U20w) and compared amongst subgroups. Overall 180 respondents were included in the analysis. Mean age was 25.6 years (SD 6.4), 128 (71%) were female and 110 (61%) were self-reported migraineurs. Mean utilities for two migraines each month were U20m = 0.84 (SD 0.26) and U80m = 0.89 (SD 0.14), and for each week were U20w = 0.79 (SD 0.27) and U80w = 0.83 (SD 0.17), respectively. Self-reported migraineurs and females attached higher mean utilities for U80m and older respondents for U20m, respectively (p < 0.05). To our knowledge, this is the first study that provides HRQOL results measured by TTO methodology for migraine. Utility loss ranged from 0.1 to 0.2 depending on attack frequency. HRQOL impairment of having two migraine attacks per week was found similar to living with low back pain (0.77-0.79).

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.

The utility score of epilepsy with partial seizure measured by TTO, VAS, and EQ-5D in the general Korean population

This study aimed to measure utilities, which are quantitative terms incorporating preferences, for various health states of epilepsy with partial seizure in the general population in South Korea. It also aimed to find socio-demographic characteristics associated with the utility scores. Utility scores using Time Trade-Off (TTO), Visual Analog Scale (VAS), and EuroQol five Dimension (EQ-5D) were obtained from 300 people aged 16 and over by face-to-face interviews. We measured utilities for three hypothetical health states of epilepsy for which scenarios were defined based on the frequency of partial seizure: seizure-free, seizure reduction, and withdrawal. We compared utilities with varying seizure frequency using a repeated-measures ANOVA, and analyzed the association between utilities and socio-demographic characteristics using a generalized estimating equation (GEE). The mean utility scores for withdrawal state, seizure reduction state, and seizure-free state were 0.303, 0.493, and 0.899, respectively, when measured by TTO. VAS yielded the mean utility scores of 0.211, 0.424, and 0.752 for respective health states, and corresponding scores with EQ-5D were 0.261, 0.645, and 0.959. The utility scores for the three health states were statistically different in TTO, VAS, and EQ-5D. The withdrawal state had the lowest utility scores. There were differences in mean utilities for the three health states across the three methods. Utilities by EQ-5D tended to have higher values than those by TTO and VAS. Utilities by VAS had the lowest values. In GEE analysis, the severity of epilepsy and household income were significantly related to utility scores. The withdrawal state of epilepsy had the lowest utility value and the seizure-free state had the highest by all three techniques of utility measurement used. There were significant differences in utilities between one severity level of epilepsy and another. Utility was associated with household income and the severity of disease. Utility scores for distinct epilepsy states obtained in this study could facilitate health economic analyses of epilepsy treatments and thus help decision making in resource allocation.

Patient-centered health care delivery systems: does expected utility change depending on different information regarding the disease?

Objectives: Patient-centered care is seen as a critical factor in a high-performance healthcare system. We considered a randomized decision-situation in which the available information is given by three hypothetical health states. Methods: Within a discrete-choice experiment 21 characteristics of a healthcare delivery system are being used to construct 4 DCEs based on thematic mapping (patient-involvement; point of care; personnel; organization). Each DCE included six attributes with three specific levels. Respondents were randomly assigned and asked to make their decisions based on different information sets. Results: For N=3900 respondents the feature “out-of-pocket costs” was the important attribute across all 4 DCEs (DCE-1coefficient: 0,6550; DCE-2coefficient: 0,8624; DCE-3coefficient, 0,6991; DCE-4coefficient, 0,7926). The relevance of the “out-of-pocket cost” changed when respondents were asked to consider their responses in the context of diabetes or lung cancer diagnosis (statusquo: 0.6749; diabetes: 0.81145; lung-cancer: 0.50431). Furthermore, the feature “trust and respect” (status-quo: 0.70338; diabetes: 0.65555; lung-cancer: 0.6369) was also less valuable when participants assumed a worse health state. Conclusions: The study aimed to close the gap between simplistic representations of patient preferences in today’s healthcare systems and the complexity of actual patient decision-making processes by using the explanatory power of DCEs. Understanding how patients perceive and value different aspects of coordinated-care is vital to the optimal design and evaluation of programs.

Flexible insulin dosing improves health-related quality-of-life (HRQoL): a time trade-off survey

Purpose:People with insulin-treated diabetes often face strict regimens with inflexible dose timing, frequent injections, and frequent self-measured blood glucose (SMBG) testing. The objective of this study was to estimate the health-related quality-of-life (HRQoL) impact of these aspects using time trade-off (TTO) methods.Methods:HRQoL was examined via a TTO survey in the UK, Canada, and Sweden with separate analyses of 2465 respondents from the general population, 274 people with type 1 diabetes, and 417 people with type 2 diabetes. Respondents evaluated health states with diabetes, SMBG testing, and basal injections that were once-daily time flexible, once-daily at a fixed time, and twice-daily at a fixed time in a basal or basal–bolus regimen.Results:Time-flexible basal injections were associated with 0.016 and 0.013 higher utility vs a fixed time of injection for basal-only and basal–bolus regimens, respectively, as evaluated by the general population. The diabetes respondents confirmed the basal-only results with 0.015 higher utility, but the difference in utility was non-significant for basal–bolus. Once-daily injections had higher utility compared with twice-daily injections for basal (0.039 and 0.042) and basal–bolus (0.022 and 0.021) regimens, as evaluated by the general population and people with diabetes, respectively. Increased frequency of SMBG negatively affected health utility.Limitations:This study has the limitation that it measures hypothetical health states rather than the HRQoL of people with these health states; furthermore, it could be suggested that the web-based nature of this survey is biased towards literate respondents with internet access and IT competence.Conclusions:Flexible dosing and fewer injections have a positive HRQoL impact, which potentially may enhance therapy adherence and could contribute to improved long-term outcomes. The impact of flexibility is greater in people treated with basal-only insulin regimens, and diminishes if bolus injections are part of the treatment regimen.