Preference-based Quality Of Life Research Articles

Impact of secondary health conditions on the quality of life and wellbeing of Canadians living with spinal cord injury: A comparison of preference-weighted index scores derived from generic standardized instruments

Context/objectives To compare the assessment of the impact of secondary health conditions (SHCs) on the quality of life and wellbeing of Canadians living with spinal cord injury (SCI) using four preference-based outcome measures. Design Secondary analysis of data from a cross-sectional, online survey. Setting Community. Participants Community-dwelling adults (n = 364) living with traumatic or non-traumatic spinal cord injury at least one year post-injury (70% at least 10 years post-injury). Outcome measures A modified version of the Spinal Cord Injury Secondary Conditions Scale (SCI-SCS); three health-related instruments (EQ-5D-5L, Health Utilities Index Mark 3 (HUI3), and the Assessment of Quality of Life 8-dimension questionnaire (AQoL-8D)) and a capability wellbeing instrument (ICEpop CAPability measure for Adults (ICECAP-A)). Results Across unadjusted and controlled analyses (i.e. controlling for associations between index scores and sociodemographic and impairment characteristics), trends were observed that identified lower levels of quality of life/wellbeing with higher problem ratings for each of the SHCs. Despite the trends, there was considerable variation in mean index scores across instruments, with HUI3 scores the lowest of the health-related instruments and ICECAP-A scores the highest overall. Respiratory problems, depression/mood problems, pressure sores, and autonomic dysreflexia were associated with the lowest levels of quality of life and wellbeing. Conclusions Higher problem ratings for SHCs are negatively associated with scores derived from preference-based quality of life and wellbeing instruments. Variation in index scores across instruments – including across the health-related instruments alone – highlights the critical importance of assessing the relative merits of preference-based instruments when using (or considering using) these instruments/estimates in comparative effectiveness research and economic evaluation.

Utility for Uncorrected Refractive Errors in Adolescent Schoolchildren in Kakamega County, Kenya.

Uncorrected refractive errors (UREs) present an enormous lifetime burden in children. Despite this, there is a dearth of knowledge on URE-related preference-based quality of life (QoL) in East Africa. This study demonstrates the positive impact of interventions on UREs; hence, it provides an empirical justification for advocacy to improve the QoL of children with URE. This study investigated the preference-based QoL (utility) for URE in school-going adolescents of Kakamega County, in Kenya. An observational cross-sectional study with multistage sampling was conducted on randomly selected secondary school adolescents. School-going adolescents in Forms 1 to 4 were clinically examined for the presence of URE and classified according to their URE types. Pre-screened students who met the selection criteria were classified into two groups: URE and normal sight. Participants in the normal-sight group were randomly selected from among screened students without URE. Selected participants were administered a previously validated adolescent-specific utility weighting instrument-Assessment of Quality of Life-Six Dimensions. A total of 330 participants aged 17.32 ± 1.60 years (URE, 17.50 ± 1.58 years; normal-sight, 17.15 ± 1.61 years) were included in the study. The mean utility score, as elicited by the Assessment of Quality of Life-Six Dimensions scoring algorithm, was better in the normal-sight group (URE, 0.496 ± 0.22; normal sight, 0.567 ± 0.25) at baseline, whereas the reverse was true at follow-up (URE, 0.655 ± 0.20; normal sight, 0.603 ± 0.25). In all cases, the differences were significant ( P < .05); however, there was no significantly better ( P > .05) utility elicited by any URE subtype at any given time point. Nonetheless, the URE group showed significantly better utility ( P < .05) after spectacle correction. Uncorrected refractive errors are associated with reduced utility in school-going adolescents, regardless of URE subtype. Spectacle correction resulted in a significantly improved utility for those with URE. Thus, this study recommends early public health strategies and spectacle interventions in schools for adolescents with URE.

The Feasibility and Validity of Preference-Based Quality of Life Measures With Informal Carers: A Think-Aloud Study

ObjectivesA range of preference-based quality of life (QoL) measures have been proposed for use with informal carers. Qualitative evaluation of validity and feasibility of the measures is an important step in understanding whether measures will work as intended. At present, little is known about the performance of different types of preference-based QoL measures with informal carers. The objective of this study was to qualitatively assess the feasibility, content validity (including face validity), and acceptability of 5 QoL measures (the Carer Experience Scale, CarerQoL-7D, ASCOT-C, ICECAP-A, and EQ-5D-5L) with informal carers. MethodsA total of 24 “think-aloud” interviews were conducted with a cross-section of carers of adults in the United Kingdom. This think-aloud process was followed by semistructured discussion to probe issues of validity and feasibility in more detail. The interview data were transcribed, coded to identify the frequency of errors in completing the QoL measures and thematically analyzed to study the validity, feasibility, and acceptability of the measures. ResultsFew errors (3%-7% per item) were identified in completing each of the measures with little distinct pattern. Most participants found the measures to be concise, clear, and relevant. Challenges included relevance, context, time period, missing items, multiple questions, and response options. Informal carers generally expressed a preference for using a care-related QoL measure. ConclusionsExisting preference-based QoL measures have encouraging validity and feasibility within a mixed sample of informal carers, with minor challenges raised. These challenges ought to be considered, alongside the decision context, when administering QoL measures in this context.

P101 Estimating the quality of life and economic impact of arthritis in Tanzania

Abstract Background/Aims Musculoskeletal (MSK) disorders are one of the major causes of non-traumatic disability within the global burden of disease. A 2010 Global Burden of Disease study reported that MSK diseases account for 20% of all Years Lived with Disability (YLDs) in low/middle income countries. Significantly contributing to this MSK burden is arthritis. In Tanzania, a lack of data exists on the prevalence, quality of life, economic and societal impact of arthritis. We aim to estimate the health, economic and societal burden of arthritis in Tanzania. Methods A community-based cross-sectional survey was undertaken between January 2021 to Sept 2021 in the Kilimanjaro region of Tanzania working in partnership with the Kilimanjaro Christian Research Institute and Kilimanjaro Christian Medical Centre. Clinical screening tools, including the Gait Arms Legs Spine (GALS) and Regional Examination of the Musculoskeletal system (REMS) were used to screen people with MSK diseases and possible arthritis through a tiered system approach. Economic and quality of life questionnaires were used for a representative sample of all residents (aged over 5 years old) in selected households. Ethiopia and Zimbabwe tariffs were used for the EuroQol EQ-5D. Resource use captured out-of-pocket costs, healthcare costs, absenteeism, presenteeism &amp; work productivity loss. Regression based analysis were undertaken to estimate differences in utility scores and resources use / costs between those presenting as REMS+/- and GALS+/-. Other explanatory variables in the model included age, occupation, marital status, gender, religion, tribe, education. Results Preliminary results on data collected to-date show that for all QoL dimensions those with a positive diagnosis had lower utility scores. Whilst the population norms are in line with utility values for that age group from other countries (30-40 years, ∼0.9 utility), those presenting with a positive diagnosis had a significant reduction in utility of ∼0.12 to 0.15 depending on what country tariff was used. A higher proportion of participants in GALS/REMS +ve groups experienced work loss (6 x more likely) and had visited healthcare facilities/hospitalisation (2.5 x more likely) compared to GALS/REMS -ve. Health-related costs reported by household financial respondents did not show a significant statistical difference albeit a likely economically significant difference (Tanzanian Shillings 13,535 vs 6,683, p = 0.05), when adjusted for age and gender. Conclusion This is the first study to estimate burden and prevalence estimates of MSK in Tanzania using valid screening tools along with estimates of preference-based quality of life, disability impacts and quantification of the economic impacts of MSK. This study quantifies the significant burden of rheumatological conditions both in terms of health and poverty. The results will be used to guide clinical health practices, intervention design, service provision, and health promotion and awareness activities both at KCMC institutional level, Kilimanjaro region and national level. Disclosure E. Grieve: None. P. Hsieh: None. E. McIntosh: None. M. Deidda: None.

Correlation of preference- and profile-based quality of life of Japanese oral cancer patients during the perioperative period measured using EQ-5D-5L and FACT-H&N

The EuroQol 5-dimension 5-level (EQ-5D-5L) instrument is among the most used preference-based quality of life (QOL) measures for cost–utility analysis. Each dimension is evaluated on five levels. The aim of this study was to clarify whether the EQ-5D-5L, which consists of only five items, correlates with profile-based QOL measures in Japanese oral cancer patients during the perioperative period. One hundred participants with oral cancer undergoing radical therapy completed QOL assessments before treatment, at treatment completion, and 1 and 3 months after treatment using the EQ-5D-5L and Functional Assessment of Cancer Therapy – Head & Neck instrument (FACT-H&N, Japanese version). To clarify how the EQ-5D-5L reflects the FACT-H&N, multiple regression analyses were performed using FACT-H&N subscales. The ceiling effect of the EQ-5D-5L was investigated. The EQ-5D-5L moderately correlated with the FACT-H&N over the entire perioperative period (rs = 0.586, P < 0.01). In the multiple regression analysis, the EQ-5D-5L was strongly reflected in the physical wellbeing subscale of the FACT-H&N, excluding social wellbeing. The pre-treatment EQ-5D-5L score was decreased owing to the impacts of the dimensions of pain/discomfort and anxiety/depression. The EQ-5D-5L did not have a ceiling effect in oral cancer patients. The EQ-5D-5L appears to generally correlate with the FACT-H&N for oral cancer patients during the perioperative period.

Burden and preference-based quality of life associated with bullying in children.

The objectives of this study are to assess the association between childhood bullying and preference-based health-related quality of life (QoL) in Australian school children and their parents and estimate quality-adjusted life years (QALYs) associated with bullying chronicity. Children aged 8-10years completed the child health utilities (CHU-9D), while parents completed the Australian quality of life (AQoL-8D). Children were grouped into four categories of bullying involvement (no bullying, victim, perpetrator, or both perpetrator and victim) based on the Revised Olweus Bully/Victim Questionnaire. Parental data were compared across two bullying involvement groups (bullying vs. no bullying). QALYs were calculated for children over two years and comparisons made based on the number of assessments where bullying was reported(baseline, 1- and 2-year follow up). Children who were involved in bullying (victims and/or perpetrators) reported statistically significantly lower mean utility scores compared to children who were not involved in bullying. Parents whose child was involved in bullying had significantly lower mean utility scores compared to parents of children not involved with bullying. There appeared to be a dose-response relationship, with higher QALY losses associated with increasing frequency of reported bullying. Bullying among Australian school children was associated with significantly lower preference-based QoL for themselves and their parents. This study also confirmed the significant burden of disease for bullying among children measured by an incremental decrease in QALY with an increasing chronicity of bullying over time.

A randomized, open-label, pragmatic study to assess reliever-triggered inhaled corticosteroid in African American/Black and Hispanic/Latinx adults with asthma: Design and methods of the PREPARE trial

BackgroundAsthma prevalence, morbidity, and mortality disproportionately impact African American/Black (AA/B) and Hispanic/Latinx (H/L) communities. Adherence to daily inhaled corticosteroid (ICS), recommended by asthma guidelines in all but the mildest cases of asthma, is generally poor. As-needed ICS has shown promise as a patient-empowering asthma management strategy, but it has not been rigorously studied in AA/B or H/L patients or in a real-world setting.Design and AimThe PeRson EmPowered Asthma RElief (PREPARE) Study is a randomized, open-label, pragmatic study which aims to assess whether a patient-guided, reliever-triggered ICS strategy called PARTICS (Patient-Activated Reliever-Triggered Inhaled CorticoSteroid) can improve asthma outcomes in AA/B and H/L adult patient populations. In designing and implementing the study, the PREPARE research team has relied heavily on advice from AA/B and H/L Patient Partners and other stakeholders.MethodsPREPARE is enrolling 1200 adult participants (600 AA/Bs, 600H/Ls) with asthma. Participants are randomized to PARTICS + Usual Care (intervention) versus Usual Care (control). Following a single in-person enrollment visit, participants complete monthly questionnaires for 15 months. The primary endpoint is annualized asthma exacerbation rate. Secondary endpoints include asthma control; preference-based quality of life; and days lost from work, school, or usual activities.DiscussionThe PREPARE study features a pragmatic design allowing for the real-world assessment of a patient-centered, reliever-triggered ICS strategy in AA/B and H/L patients. Outcomes of this study have the potential to offer powerful evidence supporting PARTICS as an effective asthma management strategy in patient populations that suffer disproportionately from asthma morbidity and mortality.

Abstract P5-15-05: Long-term quality of life after four common surgical treatment pathways for breast cancer and the effect of complications

Abstract Background: Comparing the quality of life (QoL) for all common breast cancer surgery options could support decision-making. However, current evidence generally consists of non-preference-based outcomes for sub-comparisons of options which are unsuitable for the calculation of Quality Adjusted Life Years (QALYs), the preferred outcome in health economics. The preference-based EQ-5D-5L is specifically designed to provide the Q in QALY and could facilitate a (health-care) wide comparison of breast cancer surgery options. This study gives an overview of both non-preference and preference-based QoL after four common surgical breast cancer treatment pathways. Method: Breast cancer patients from a large multicenter observational cohort in the Netherlands were invited for participation in an online survey. QoL was obtained by the EQ-5D-5L, EORTC-QLQ-C30/-BR23 and Breast-Q questionnaires. Patient cohorts based on surgical procedure (breast-conserving surgery (BCS), mastectomy (MAS), autologous breast reconstruction (A-BR) and implant-based breast reconstruction (I-BR) were compared after propensity-weighted adjustment of pretreatment differences. Results: Of all invited patients, 1871 responded, respectively patients treated with BCS (n=615), MAS (n=507), A-BR (n=330), and I-BR (n=419). Table 1 shows QoL outcomes without overlapping 95% CI. Patients reported complications in 47% of the A-BR, 32% of the I-BR, 18% BCS and 22% of the MAS groups. QoL outcomes differed statistically significantly between patients with and without complications for all groups, except the I-BR group. Table 1:patient-reported quality of life per surgical treatment for propensity-weighted cohorts BCSMASA-BRI-BR Estimated sample sizen=434.0n=386.3n=178.6n=295.5EQ-5D-5L Utility Overall0.844a0.805b0.849a0.850a No complication0.859a0.878b0.847a0.818a,b Complication0.771a0.771a,c0.816b,c0.861bBreast-Q Satisfaction with breasts 65.52a60.65b71.29c59.39b Satisfaction with outcome 75.75a66.37b Psychosocial well-being 73.77a66.50b75.78a71.60a Sexual well-being 62.70a50.00b63.33a56.38c Physical well-being: chest 67.39a73.47b,c75.81c72.64bEORTC-QLQ-C30 Physical function 84.53a82.94a85.62a,b87.97b Role function 84.35a80.70b84.02a,b86.02a Pain 15.41a18.93b17.18a,b15.89a,b Financial problems 5.23a8.22b12.30b7.71a,bEORTC-QLQ-BR23 Body image 87.45a80.49b82.28b82.35b Sexual functioning 27.90a27.51a31.95a,b33.35b Sexual enjoyment 57.03a54.82a64.24b63.80b Breast symptoms 13.45a9.94b8.79b10.82a Arm symptoms 12.68a17.12b18.18b16.82dMean values of the respective outcome scale after propensity score weighting and are derived from an estimator of the average treatment effect on the population. Values in the same row not sharing the same subscript do not show overlapping 95% Confidence Intervals in a pairwise comparison. Discussion: Preference-based QoL outcomes are an essential input for cost-effectiveness analyses, used to justify the use of care in a society progressively confronted with increasing health care expenses. The results from this large multicenter cohort study contribute substantially to the current knowledge in the field of breast cancer reconstructive surgery. Citation Format: Kouwenberg CA, Ligt KM, Rakhorst HA, Leeuw D, Siesling S, Buschbach JJ, Kranenburg LW, Mureau MA. Long-term quality of life after four common surgical treatment pathways for breast cancer and the effect of complications [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-15-05.

To what extent does the EQ-5D-3L correlate with the FACT-H&N of patients with oral cancer during the perioperative period?

The EuroQol 5-dimension scale (EQ-5D) is one of the most frequently used preference-based quality of life (QOL) measures for health technology assessment. The 3-level version of the EQ-5D comprises a descriptive system (the EQ-5D-3L) and a visual analog scale (EQ-VAS). It remains unclear whether this five-item scale correlates with the QOL of patients with oral cancer during the perioperative period. We sought to clarify this point in the present study. Participants were 84 patients with oral malignancies who underwent radical treatment and completed the EQ-5D-3L and Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) at regular intervals over 3 months after treatment. We analyzed the correlations between the EQ-5D-3L, EQ-VAS, and FACT-H&N, and conducted multiple regression analyses to examine how the FACT-H&N subscales relate to the EQ-5D-3L and EQ-VAS. We also investigated whether the EQ-5D-3L shows ceiling effects. The EQ-5D-3L and EQ-VAS were strongly correlated with the FACT-H&N (rs = 0.621 and 0.638, respectively; P < 0.01). Furthermore, the EQ-5D-3L was significantly related with all FACT-H&N subscales except for social/family well-being. Particularly, the physical well-being subscale had the strongest relationship with the EQ-5D-3L. The FACT H&N and EQ-5D-3L showed similar changes over time. The EQ-5D-3L did not have a ceiling effect statistically. Our results indicate that actual physical performance might be most important for cost-utility analysis, whereas the assessment of familial feelings or friendship seems less important. However, the EQ-5D-3L appears to generally correlate with the FACT-H&N of patients with oral cancer during the perioperative period. Therefore, it is reasonable to assess the cost performance of oral cancer treatment using the EQ-5D-3L in Japan.

Assessment of the construct validity and responsiveness of preference-based quality of life measures in people with Parkinson’s: a systematic review

Generic preference-based quality of life (PbQoL) measures are sometimes criticized for being insensitive or failing to capture important aspects of quality of life (QoL) in specific populations. The objective of this study was to systematically review and assess the construct validity and responsiveness of PbQoL measures in Parkinson's. Ten databases were systematically searched up to July 2015. Studies were included if a PbQoL instrument along with a common Parkinson's clinical or QoL measure was used, and the utility values were reported. The PbQoL instruments were assessed for construct validity (discriminant and convergent validity) and responsiveness. Twenty-three of 2758 studies were included, of which the majority evidence was for EQ-5D. Overall good evidence of discriminant validity was demonstrated in the Health Utility Index (HUI)-3, EQ-5D-5L, EQ-5D-3L, 15D, HUI-2, and Disability and Distress Index (DDI). Nevertheless, HUI-2 and EQ-5D-3L were shown to be less sensitive among patients with mild Parkinson's. Moderate to strong correlations were shown between the PbQoL measures (EQ-5D-3L, EQ-5D-5L, 15D, DDI, and HUI-II) and Parkinson's-specific measures. Twelve studies provided evidence for the assessment of responsiveness of EQ-5D-3L and one study for 15D, among which six studies reached inconsistent results between EQ-5D-3L and the Parkinson's-specific measures in measuring the change overtime. The construct validity of the PbQoL measures was generally good, but there are concerns regarding their responsiveness to change. In Parkinson's, the inclusion of a Parkinson's-specific QoL measure or a generic but broader scoped mental and well-being focused measure to incorporate aspects not included in the common PbQoL measures is recommended.

Measuring quality of life in children with speech and language difficulties: a systematic review of existing approaches.

Children's and adolescent's speech and language difficulties (SaLD) can affect various domains of quality of life (QoL), and speech and language therapy interventions are critical to improving QoL. Systematically measuring QoL outcomes in this population is highly complex due to factors such as heterogeneity in impairments and differing targets during intervention. However, measurements of QoL are increasingly required by healthcare commissioners and policy-makers to inform resource allocation. To review the use of QoL measures in research involving children (age ≤ 18 years) with SaLD. A systematic review was undertaken. A systematic search across various databases was performed. Information on the methodological details of each relevant study, along with descriptions of the QoL measures employed, were extracted into standardized data extraction forms. Findings were discussed in a narrative synthesis. Twenty-one relevant studies were identified that deal with a range of subpopulations of children with SaLD. For the most part, generic QoL measures were used, although there was little convergence on the type of QoL measures employed throughout the literature. Five studies utilized preference-based QoL measures, including the 16D/17D, HUI3, EQ-5D and QWB-SA. Of these measures, the HUI3 demonstrated the most promising discriminant validity, although the preference weights for this measure were generated with adults. QoL among children with SaLD is not yet being captured in a systematic way. The HUI3 measure appears to show some promise for generating relevant preference-based QoL estimates, although further testing of the measure is required.

Sex, race, and the adverse effects of social stigma vs. other quality of life factors among primary care patients with moderate to severe obesity.

Patients with obesity face widespread social bias, but the importance of this social stigma to patients relative to other quality of life (QOL) factors is unclear. Our aim was to examine the importance of obesity-related social stigma relative to other QOL factors on reducing patients' overall well-being. We used a cross-sectional telephone interview. The study was conducted at four diverse primary care practices in Greater Boston. Three hundred and thirty-seven primary care patients aged 18-65 years and with a body mass index (BMI) of 35 kg/m(2) or higher participated in the study. Patients' health utility (preference-based QOL measure) was determined via responses to a series of standard gamble scenarios assessing willingness to risk death to lose various amounts of weight or to achieve perfect health. We used the Impact of Weight on Quality of Life-lite instrument to assess QOL domains specific to obesity (physical function, self-esteem, sexual life, public distress or social stigma, and work), and we examined variation in utility explained by these domains. Depending on patients' race/ethnicity, mean health utilities ranged from 0.92 to 0.99 among men and from 0.89 to 0.93 among women. After adjustment for race, BMI, and education, none of the QOL domains explained much of the variation in utility among men, except for work function among Hispanic men. In contrast, social stigma was the leading QOL contributor to utility for Caucasian women (explaining 6 % of the marginal variation beyond demographics and BMI). In contrast, sexual function was the most important contributor among African American women (3 % marginal variation), and work life was most important among Hispanic women (> 20 % in variation). Lower scores in one domain did not always translate into lower well-being. Moreover, QOL summary scores often explained less of the variation than some individual domains. Obesity-related social stigma had disproportionate adverse effects on Caucasian women patients' well-being, whereas weight-related impairment in work function was particularly important among Hispanic patients and impaired sexual function was important to diminished well-being among African American women although its impact appeared modest.

Quality of life data from EQ-5D for evidence-based health service practice in dialysis care

Background Hemodialysis (HD) and peritoneal dialysis (PD) are therapeutic options for patients with end-stage-renal-disease (ESRD), if transplantation is not available. Mortality rates for HD and PD are similar, while PD is generally the less costly alternative. Percentage of HD and PD shows considerable variability between high income countries (for PD from 5-7% in Germany and Switzerland up to 19-24% in the UK and Scandinavia). Patient reported outcomes, such as quality of life (QOL), can provide complementary evidence for planning of patient oriented dialysis services. Profile instruments (e.g. SF36, KDQOL) show no consistent QOL differences between HD and PD. However, single index preference-based QOL measures (such as EQ-5D), may add new information and are useful for later health economic evaluations. We aimed to collect current evidence for QOL of ESRD patients as measured with EQ-5D.

Is It Feasible to Apply Preference-Based Quality-of-Life Measures on Patients with Chronic Myeloid Leukemia?

Chronic myeloid leukemia (CML) has become a chronic and costly disease, since the launch and long-term use of tyrosine kinase inhibitors, including imatinib. Evidence for imatinib’s cost-effectiveness impact were largely based on preference-based quality of life (QoL) measured from randomized controlled trials, however, little is known aboutthe feasibility of QoL measured as a follow-up indicator in real life. This commentary describes our experiences in exploring the QoL measures and attributes influencing QoL in Taiwanese CML patients who were receiving imatinibtreatment.

PRM143 - Meta-Analysis of Quality of Life in Coronary Heart Disease

Objectives: A large number of quality of life (QoL) values for patients with coronary heart disease (CHD) are available in the literature. From the abundance of QoL values in CHD, only preference-based values can be directly applied in cost-utility analysis (CUA). In this study we performed a multivariate meta-regression analysis of the preference-based QoL values in CHD. Our aim was to obtain a summarized QoL estimate while accounting for study-level covariates and for the correlation between multiple outcomes both within and between studies. Methods: Studies were considered eligible for this analysis if they reported mean QoL values, standard deviations and the instrument for measuring QoL (e.g. EQ-5D, SF-6D). Additionally studies reporting separate values of SF-36 and SF-12 QoL instruments were included. The scores of the SF-36 and SF-12 QoL were mapped onto EQ-5D and SF-6D values. Mapped preference-based values were added to the base-case data set that consisted only of published preference-based QoL values. Finally, a multivariate metaregression model was used in order to estimate pooled, instrument-specific QoL in CHD. Results: Our systematic search identified 35 eligible studies reporting 43 preference-based QoL values in CHD as well as 46 studies reporting QoL scores of SF-36 and SF-12. Following instrument-specific QoL estimates were obtained when conducting the analysis on the base-case data set: 0.77 (EQ-5D UK), 0.79 (EQ-5D US), 0.65 (SF-6D), 0.85 (15D), 0.44 (HUI3) and 0.63 (QWB). Age was the only studylevel covariate that showed an influence on instrument-specific QoL estimates. Significant heterogeneity was observed when the analysis was conducted on the expanded data set. Conclusions: This study represents the first meta-analysis of QoL in CHD. Given the abundance of QoL values in CHD on the one hand and the requirement for single, accurate QoL values in CUA on the other hand, pooled estimates of QoL could be highly applicable in CUA.

Utility and Uncorrected Refractive Error

To investigate utility (a preference-based quality of life [QoL] measure) associated with uncorrected refractive error (URE). Cross-sectional study. A cohort of 341 consecutive patients 40 to 65 years of age with refractive error and no ocular disease impairing vision worse than 20/25 (0.1 logarithm of the minimum angle of resolution [logMAR] units) in the better eye. Without vision correction, 30 had no vision impairment, 65 had only distance vision impairment (DVI), 97 had only near vision impairment (NVI), 112 had moderate amounts of both distance and near vision impairment (DNVI), and 37 had severe impairment (distance or near worse than 20/200 [>1.0 logMAR]) in the better eye. All participants underwent a comprehensive eye examination with refraction, aided and unaided visual acuity (VA) at 6 m and 40 cm, and ocular health assessment. Utilities were elicited for a number of scenarios using a standardized, face-to-face time trade-off (TTO) interview method. The main outcome measure was TTO utility for the participant's own uncorrected vision state. Utilities ranged from 0 to 1, where 0 = death and 1 = perfect vision, and were scaled to account for comorbidities so that 1 = perfect health (adjusted utility). Unaided VA was 0.50 ± 0.24 logMAR at distance in the DVI group, 0.43 ± 0.17 logMAR at near in the NVI group, and 0.72 ± 0.36 and 0.56 ± 0.29 at distance and near, respectively, in the DNVI group. Adjusted utilities for the 3 groups were 0.82 ± 0.16 in the DVI group, 0.81±0.17 in the NVI group, and 0.68 ± 0.25 in the DNVI group. The DVI and NVI group utilities (adjusted and unadjusted) did not differ significantly (P = 0.73 and P = 0.77, respectively). The DNVI utility was significantly worse than that of the DVI and NVI groups (adjusted and unadjusted, P<0.01). The URE is associated with measurable reductions in utility (and therefore QoL). Reductions are similar regardless of whether near or distance vision is impaired, but worse when both are impaired. The results underscore the significance of the effect of URE on QoL, particularly with respect to uncorrected presbyopia, which has been a relatively neglected area in research and policy. The utility figures in this study can be used as inputs for cost-effectiveness studies relating to URE to assist resource allocation decisions. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Functional outcome instruments used for cervical spondylotic myelopathy: interscale correlation and prediction of preference-based quality of life

Background contextThere is limited literature comparing different functional outcome measures used for cervical spondylotic myelopathy (CSM). PurposeTo determine the correlation among five functional outcome measures used in CSM patient assessment and their ability to predict preference-based quality of life (QOL). Study design/settingProspective observational study. Patient samplePatients, aged 40 to 85 years, with CSM and cervical spinal cord compression at two or more levels from degenerative spondylosis were enrolled from seven sites over a 2-year period. Outcome measuresThe modified Japanese Orthopedic Association scale, Oswestry neck disability index (Oswestry NDI or Oswestry), Nurick scale, norm-based short-form 36 physical component summary, and EuroQol-5D (EQ-5D) were collected. MethodsThe Jean and David Wallace foundation provided funding for this study. Cervical spondylotic myelopathy patients undergoing either anterior or posterior surgery were prospectively followed with five different functional outcome measures over 1 year. Correlations among scales were tested using the Spearman rank correlation test. The sensitivity and specificity of each scale for predicting the global index of the EQ-5D were determined, and receiver-operating characteristic analysis was used to compare each scale's ability to discriminate QOL. ResultsA total of 106 patients were initially enrolled; 103 were operated on for CSM and followed for 1 year. Their ages ranged from 40 to 82 years (mean 61.9), and 61.3% were men. Correlations among the various functional outcome instruments were all highly significant (p<.001), but the degree of correlation varied greatly. Correlation between the EQ-5D scale and the Nurick scale was the least (Spearman rho 0.5539); correlation was the highest with the Oswestry NDI (Spearman rho 0.8306). The Oswestry NDI also had the greatest ability to discriminate favorable from adverse QOL compared with the other outcome instruments (p=.023). ConclusionsPreference-based quality-of-life instruments, such as the EQ-5D, are important measures for studying spinal disorders. Among the various commonly used outcome instruments for CSM, the Oswestry NDI is the most predictive of preference-based QOL.

Economic and Humanistic Burden of External Genital Warts

External genital warts (EGW) are a sexually transmitted infection caused by various strains of human papillomavirus (HPV). Several studies have described the direct and indirect costs of EGW, while others have reported on the burden of EGW in terms of the impact on the quality of life (QOL) of patients. The arrival of a quadrivalent HPV vaccine that protects against both cervical cancer and EGW requires a proper understanding of the impact of vaccines on costs and QOL. Using pre-defined search terms and inclusion/exclusion criteria, we performed a systematic review of the economic and humanistic burden of EGW. The focus of our review was on literature describing the direct and indirect costs of EGW per episode of care (EoC) or per year, as well as the impact of EGW on disease-specific, generic, or preference-based QOL measures. We also reviewed the literature on the national economic burden of EGW from the perspectives of different countries. Other aspects of EGW management that can inform economic modelling studies, such as length of EoC, number of physician visits and indirect costs, were also explored. Our review sheds light on the high economic and humanistic burden of EGW and important differences in the costs between men and women, as well as the differences in health resource utilization and costs across countries. Our study also highlights the dearth of information on the impact of EGW on the QOL and productivity of patients.

Future Directions in Dermatology Quality of Life Measures

Within the last few decades, outcomes research, and in particular quality of life (QoL) outcomes research, has become integrated into clinical and research practices. QoL outcomes are important to dermatology, because many diseases carry significant psychosocial burdens and morbidity from appearance and symptoms with few cases of mortality. In this article, the authors discuss the future directions in QoL. Important areas are the determination, clinical significance and interpretation of measured QoL values. Additionally, the development of proxies for preference-based QoL measures and modules for health status QoL measures are discussed.

Quality of Life Implications of Bisphosphonate-Associated Osteonecrosis of the Jaw

Potentially debilitating, osteonecrosis of the jaw (ONJ) is an emerging complication of bisphosphonates. However, its effect on quality of life (QoL) is unknown. We determined the ONJ-related QoL decline in a cancer patient cohort. Thirty-four cancer patients with bisphosphonate-associated ONJ completed a telephone survey (October 2007 through May 2008). The Oral Health Impact Profile 14 (OHIP) retrospectively assessed participant oral health-related QoL before and after ONJ. Standardized ONJ descriptions were developed in a multidisciplinary, iterative process and were evaluated with three frequently used preference-based QoL measurement methods on a 0 (death) to 1 (perfect health) scale: Visual Analogue Scale (VAS), Time Trade-Off (TTO), and EQ-5D. ONJ significantly (p < .001) increased OHIP scores (worse QoL) for additive (3.56-16.53) and weighted (7.0-17.5) methods. Seven individual OHIP items significantly increased (Bonferroni correction p < .0035): pain, eating discomfort, self-consciousness, unsatisfactory diet, interrupted meals, irritability, and decreased life satisfaction. Mean preference-based QoL values significantly decreased (p < .001) with worsening ONJ stage (VAS, TTO, and EQ-5D): no ONJ (0.76, 0.86, 0.82), ONJ stage 1 (0.69, 0.82, 0.78), ONJ stage 2 (0.51, 0.67, 0.55), and ONJ stage 3 (0.37, 0.61, 0.32). As ONJ worsened, EQ-5D domain scores significantly increased (p < .001). Pain/discomfort and anxiety/depression contributed most to declining QoL. ONJ significantly affects QoL, a detriment that increases with worsening ONJ. QoL impairments for ONJ stages 2 and 3 are similar to other treatment side effects that influence decision-making. Bisphosphonate-associated ONJ QoL is an important consideration for patients, clinicians, and policy makers.