Short Form-6D Utility Research Articles

Early surgery compared to nonoperative management for mild degenerative cervical myelopathy: a cost-utility analysis

BACKGROUND CONTEXTDegenerative cervical myelopathy (DCM) is a form of acquired spinal cord compression and contributes to reduced quality of life secondary to neurological dysfunction and pain. There remains uncertainty regarding optimal management for individuals with mild myelopathy. Specifically, owing to lacking long-term natural history studies in this population, we do not know whether these individuals should be treated with initial surgery or observation. PURPOSEWe sought to perform a cost-utility analysis to examine early surgery for mild degenerative cervical myelopathy from the healthcare payer perspective. STUDY DESIGN/SETTINGWe utilized data from the prospective observational cohorts included in the Cervical Spondylotic Myelopathy AO Spine International and North America studies to determine health related quality of life estimates and clinical myelopathy outcomes. PATIENT SAMPLEWe recruited all patients that underwent surgery for DCM enrolled in the Cervical Spondylotic Myelopathy AO Spine International and North America studies between December 2005 and January 2011. OUTCOME MEASURESClinical assessment measures were obtained using the Modified Japanese Orthopedic Association scale and health-related quality of life measures were obtained using the Short Form-6D utility score at baseline (preoperative), 6 months, 12 months and 24 months postsurgery. Cost measures inflated to January 2015 values were obtained using pooled estimates from the hospital payer perspective for surgical patients. METHODSWe employed a Markov state transition model with Monte Carlo microsimulation using a lifetime horizon to obtain an incremental cost utility ratio associated with early surgery for mild myelopathy. Parameter uncertainty was assessed through deterministic means using one-way and two-way sensitivity analyses and probabilistically using parameter estimate distributions with microsimulation (10,000 trials). Costs and utilities were discounted at 3% per annum. RESULTSInitial surgery for mild degenerative cervical myelopathy was associated with an incremental lifetime increase of 1.26 quality-adjusted life years (QALY) compared to observation. The associated cost incurred to the healthcare payer over a lifetime horizon was $12,894.56, resulting in a lifetime incremental cost-utility ratio of $10,250.71/QALY. Utilizing a willingness to pay threshold in keeping with the World Health Organization definition of "very cost-effective" ($54,000 CDN), the probabilistic sensitivity analysis demonstrated that 100% of cases were cost-effective. CONCLUSIONSSurgery compared to initial observation for mild degenerative cervical myelopathy was cost-effective from the Canadian healthcare payer perspective and was associated with lifetime gains in health-related quality of life.

Comparison of EuroQol-5D-3L and Short Form-6D Utility Scores in Family Caregivers of Colorectal Cancer Patients: A Cross-Sectional Survey in China.

Objective: To compare the EuroQol-5D-3L (EQ-5D-3L) and the Short Form-6D (SF-6D) utility scores in family caregivers (FCs) of colorectal cancer (CRC) patients.Method: This study was performed on FCs of CRC patients from three primary cancer centers in the capital city of the Heilongjiang province. The participants (FCs) who were enrolled, filled the EQ-5D-3L, along with the SF-6D questionnaire. Two tools were compared for their distribution, discriminant validity, agreement, and convergent validity along with known-groups validity.Result: Two hundred ninety-two FCs of CRC patients were enrolled. The score distribution of the SF-6D along with the EQ-5D-3L were not normal. A ceiling impact was seen in 31.8% of the FCs for EQ-5D-3L; however, none for the SF-6D. Good associations (Spearman’s rho = 0.622, p < 0.01) and intraclass correlation coefficient (ICC 0.637 and average ICC 0.778) between the two scores were observed. The EQ-5D-3L yielded higher utility scores in contrast with the SF-6D in the better health subclass. The SF-6D distinguished better between excellent and good health statuses, with better effect size and relative efficiency statistics. Both tools showed good known-groups validity.Conclusion: The utility scores of SF-6D were remarkably lower relative to that of the EQ-5D-3L, but the difference may be clinically insignificant. However, the SF-6D may be superior because of the lack of ceiling impact. SF-6D exhibited a better convergent validity along with discrimination validity of excellent health condition and improved known-groups validity efficiency.

Hepatic Fat Reduction Due to Resmetirom in Patients With Nonalcoholic Steatohepatitis Is Associated With Improvement of Quality of Life

Nonalcoholic steatohepatitis (NASH) is a chronic liver disease associated with adverse clinical outcomes and impaired health-related quality of life (HRQL). Patients with biopsy-proven non-cirrhotic NASH with hepatic fat fraction of ≥10% by magnetic resonance imaging-proton density fat fraction were enrolled in a phase 2, multicenter, double-blind, randomized, placebo-controlled study of resmetirom. HRQL was assessed using Short Form-36 throughout 36 weeks of treatment. One hundred twenty-five NASH patients were enrolled (50 ± 11 years old, 50% male, 94% white, body mass index 35 ± 6 kg/m2, 39% with diabetes mellitus). Of these, 84 patients received 80 mg of resmetirom daily, and 41 received placebo. At baseline, HRQL scores were not different from general population norms (Physical Component Summary [PCS] 47.9 ± 9.3 vs 50, Mental Component Summary 50.4 ± 10.0 vs 50; all P > .05). By treatment week 12, patients who received resmetirom experienced improvement of Bodily Pain and Short Form-6D utility scores (P < .05); no HRQL improvement was noted in placebo (all P > .05). Improvement in PCS continued up to week 36 of treatment with resmetirom, again with no improvement in placebo group (all P > .05). Adjusted for the baseline score and clinicodemographic confounders, meeting the endpoint of a decrease in proton density fat fraction of ≥30% by week 12 (met by 54 of 116 treatment completers; 47 of 54 on resmetirom) was independently associated with greater improvements in Physical Functioning and PCS scores at week 36 (P < .05). Patients with improvement in NASH and fibrosis on liver biopsy also showed improvement in components of HRQL. Patients with NASH treated who improved their hepatic fat fraction and/or Nonalcoholic Fatty Liver Disease Activity Score on serial liver biopsy experienced improvement of HRQL. Further studies are needed to confirm long-term sustainability of that improvement. gov #NCT02912260.

Mapping the Memorial Anxiety Scale for Prostate Cancer to the SF-6D.

To create a crosswalk that predicts Short Form 6D (SF-6D) utilities from Memorial Anxiety Scale for Prostate Cancer (MAX-PC) scores. The data come from prostate cancer patients enrolled in the North Carolina Prostate Cancer Comparative Effectiveness & Survivorship Study (NC ProCESS, N = 1016). Cross-sectional data from 12- to 24-month follow-up were used as estimation and validation datasets, respectively. Participants' SF-12 scores were used to generate SF-6D utilities in both datasets. Beta regression mixture models were used to evaluate SF-6D utilities as a function of MAX-PC scores, race, education, marital status, income, employment status, having health insurance, year of cancer diagnosis and clinically significant prostate cancer-related anxiety (PCRA) status in the estimation dataset. Models' predictive accuracies (using mean absolute error [MAE], root mean squared error [RMSE], Akaike information criterion [AIC] and Bayesian information criterion [BIC]) were examined in both datasets. The model with the highest prediction accuracy and the lowest prediction errors was selected as the crosswalk. The crosswalk had modest prediction accuracy (MAE = 0.092, RMSE = 0.114, AIC = -2708 and BIC = -2595.6), which are comparable to prediction accuracies of other SF-6D crosswalks in the literature. About 24% and 52% of predictions fell within ± 5% and ± 10% of observed SF-6D, respectively. The observed mean disutility associated with acquiring clinically significant PCRA is 0.168 (standard deviation = 0.179). This study provides a crosswalk that converts MAX-PC scores to SF-6D utilities for economic evaluation of clinically significant PCRA treatment options for prostate cancer survivors.

Estimating Long-Term Health Utility Scores and Expenditures for Cardiovascular Disease From the Medical Expenditure Panel Survey.

Long-term health utility scores and costs used in cost-effectiveness analyses of cardiovascular disease prevention and management can be inconsistent, outdated, or invalid for the diverse population of the United States. Our aim was to develop a user friendly, standardized, publicly available code and catalog to derive more valid long-term values for health utility and expenditures following cardiovascular disease events. Individual-level Short Form-12 version 2 health-related quality of life and expenditure data were obtained from the pooled 2011 to 2016 Medical Expenditure Panel Surveys. We developed code using the R programming language to estimate preference-weighted Short Form-6D utility scores from the Short Form-12 for quality-adjusted life year calculations and predict annual health care expenditures. Result predictors included cardiovascular disease diagnosis (myocardial infarction, ischemic stroke, heart failure, cardiac dysrhythmias, angina pectoris, and peripheral artery disease), sociodemographic factors, and comorbidity variables. The cardiovascular disease diagnoses with the lowest utility scores were heart failure (0.635 [95% CI, 0.615-0.655]), angina pectoris (0.649 [95% CI, 0.630-0.667]), and ischemic stroke (0.649 [95% CI, 0.635-0.663]). The highest annual expenditures were for heart failure ($20 764 [95% CI, $17 500-$24 027]), angina pectoris ($18 428 [95% CI, $16 102-$20 754]), and ischemic stroke ($16 925 [95% CI, $15 672-$20 616]). The developed code and catalog may improve the quality and comparability of cost-effectiveness analyses by providing standardized methods for extracting long-term health utility scores and expenditures from Medical Expenditure Panel Survey data, which are more current and representative of the US population than previous sources.

Mapping the Chinese Version of the EORTC QLQ-BR53 Onto the EQ-5D-5L and SF-6D Utility Scores.

This study aimed to develop mapping algorithms from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-BR53, including EORTC QLQ-C30 and QLQ-BR23) onto the 5-level EQ-5D (EQ-5D-5L) and Short Form 6D (SF-6D) utility scores. The data were taken from 607 breast cancer patients in mainland China. The EQ-5D-5L and SF-6D instruments were scored using Chinese-specific tariffs. Three model specifications and seven statistical techniques were used to derive mapping algorithms, including ordinary least squares (OLS), Tobit, censored least absolute deviation (CLAD) model, generalized linear model (GLM), robust MM-estimator, finite mixtures of beta regression model for directly estimating health utility, and using ordered logit regression (OLOGIT) to predict response levels. A five-fold cross-validation approach was conducted to test the generalizability of each model. Two key goodness-of-fit statistics (mean absolute error and mean squared error) and three secondary statistics were employed to choose the optimal models. Participants had a mean ± standard deviation (SD) age of 49.0 ± 9.8years. The mean ± SD health state utility scores were 0.828 ± 0.184 (EQ-5D-5L) and 0.646 ± 0.125 (SF-6D). Mapping performance was better when both the QLQ-C30 and QLQ-BR23 dimensions were considered rather than when either of these dimensions were used alone. The mapping functions from the optimal direct mapping and indirect mapping approaches were reported. The algorithms reported in this paper enable EORTC QLQ-BR53 breast cancer data to be mapped into utilities predicted from the EQ-5D-5L and SF-6D. The algorithms allow for the calculation of quality-adjusted life years for use in breast cancer cost-effectiveness analyses studies.

Translation, Cultural Adaptation, and Validation of Short-Form 6D on the General Population in Indonesia

ObjectivesThis study aims to translate, culturally adapt, and validate the Short-Form 6D (SF-6D) instruments for measuring quality of life as outcome parameters in pharmacoeconomic studies. MethodsThe forward-backward methods were applied to translate the SF-6D questionnaire. A preliminary Indonesian version of SF-6D questionnaire was field tested in samples of 470 adult general population. Test–retest reliability was assessed by using Spearman rank correlation coefficient and internal consistency with Cronbach α. Face validity was assessed descriptively based on the response of the respondents to all items in SF-6D. The construct validity test included internal construct validity and convergent validity, which was assessed by examining the correlation between the questionnaire and Euro-Quality of life-5D based on the scale of each domain. The known group method was used to test discriminant validity. Mann-Whitney U test was employed for comparing the utility score on dichotomous variables and Kruskal-Wallis H test was used for polychromatic variables. ResultsThe SF-6D was a valid and reliable questionnaire, indicated by the reliability coefficient of 0.725 and the value of each item ranging from 0.698 to 0.750. Construct validity indicated a strong correlation between physical functioning, role limitation, social functioning, pain, and mental health with the SF-6D utility score. Convergent validity showed a weak and moderate correlation between dimensions on SF-6D and Euro-Quality of life-5D. ConclusionsThe SF-6D questionnaire has been translated into Indonesian version. The SF-6D questionnaire is valid and reliable. Known group validity shows that the SF-6D could differentiate utility scores by age group and history present illness.

Associations Between Headache-Free Days and Patient-Reported Outcomes Among Migraine Patients: A Cross-Sectional Analysis of Survey Data in Europe.

IntroductionMigraine imposes a substantial burden on patients, society, and healthcare systems. This study aimed to assess the associations between the number of headache-free days (HFDs) and health-related quality of life (HRQoL), work productivity and activity impairment (WPAI), and healthcare resource utilization (HRU) in patients with migraine in the EU5 (France, Germany, Italy, Spain, and the United Kingdom).MethodsThis retrospective cross-sectional study collected survey responses from adults aged ≥ 18 years from the 2017 National Health and Wellness Survey (N = 62,000). Migraine patients with a physician’s diagnosis of migraine and who had experienced at least 4 monthly headache days in the prior month were included (N = 1569). Number of HFDs was compared with Short-Form 12-Item Survey Instrument, version 2 (SF-12v2) physical and mental component summary scores (PCS and MCS), Short-Form-6D (SF-6D) and EuroQoL-5D (EQ-5D) scores, WPAI, and HRU in migraine patients. Correlation analyses were conducted to test the bivariate associations, whereas generalized linear models were used for multivariable analyses.ResultsAn increase of 1 HFD was associated with average increases of 0.171, 0.306, 0.003, and 0.008 points for MCS, PCS, SF-6D utility score, and EQ-5D index score, respectively (p < 0.001 for all). Extrapolating the results to a tenfold increase in monthly HFDs corresponded to clinically meaningful increases in PCS and EQ-5D scores. An increase of 1 HFD was associated with expected average decreases in absenteeism of 3.9% and presenteeism of 2.1%. Further, an increase of 1 HFD was associated with expected decreases in HCP visits and neurologist visits of 1.0% and 4.7%, respectively.ConclusionAn increase in the number of HFDs was associated with better health-related outcomes in patients suffering from migraine. Further, the results demonstrate a need for more effective treatments that can reduce migraine frequency and thus improve HRQoL, increase work productivity, and reduce both activity impairment and HRU.FundingNovartis Pharma AG, Switzerland.

Responsiveness and minimally important difference of SF-6D and EQ-5D utility scores for the treatment of pelvic organ prolapse

Utility preference scores are standardized, generic, health-related quality of life (HRQOL) measures that quantify disease severity and burden and summarize morbidity on a scale from 0 (death) to 1 (optimal health). Utility scores are widely used to measure HRQOL and in cost-effectiveness research. To determine the responsiveness, validity properties, and minimal important difference (MID) of utility scores, as measured by the Short Form 6D (SF-6D) and EuroQol (EQ-5D), in women undergoing surgery for pelvic organ prolapse (POP). This study combined data from 4 large, U.S., multicenter surgical trials enrolling 1321 women with pelvic organ prolapse. We collected condition-specific quality of life data using the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ). A subset of women completed the SF6D; women in 2 trials also completed the EQ5D. Mean utility scores were compared from baseline to 12 months after surgery. Responsiveness was assessed using effect size (ES) and standardized response mean (SRM). Validity properties were assessed by (1) comparing changes in utility scores at 12 months between surgical successes and failures as defined in each study, and (2) correlating changes in utility scores with changes in the PFDI and PFIQ. MID was estimated using both anchor-based (SF-36 general health global rating scale "somewhat better" vs "no change") and distribution-based methods. The mean SF-6D score improved 0.050, from 0.705 ± 0.126 at baseline to 0.761 ± 0.131 at 12 months (P < .01). The mean EQ-5D score improved 0.060, from 0.810 ± 0.15 at baseline to 0.868 ± 0.15 at 12 months (P < .01). The ES (0.13-0.61) and SRM (0.13-0.57) were in the small-to-moderate range, demonstrating the responsiveness of the SF-6D and EQ-5D similar to other conditions. SF-6D and EQ-5D scores improved more for prolapse reconstructive surgical successes than for failures. The SF-6D and EQ-5D scores correlated with each other (r= 0.41; n= 645) and with condition-specific instruments. Correlations with the PFDI and PFIQ and their prolapse subscales were in the low to moderate range (r= 0.09-0.38), similar to other studies. Using the anchor-based method, the MID was 0.026 for SF-6D and 0.025 for EQ-5D, within the range of MIDs reported in other populations and for other conditions. These findings were supported by distribution-based estimates. The SF-6D and EQ-5D have good validity properties and are responsive, preference-based, utility and general HRQOL measures for women undergoing surgical treatment for prolapse. The MIDs for SF-6D and EQ-5D are similar and within the range found for other medical conditions.

PSY107 - COST-EFFECTIVENESS OF BUDESONIDE IN MICROSCOPIC COLITIS PATIENTS IN THE CZECH REPUBLIC

Budesonide is an anti-inflammatory drug (corticosteroid hormone) and is an effective treatment of microscopic colitis. It increases probability of achieving short-term clinical remission as well as maintaining long-term remission, according to recent clinical evidence. There is no reimbursed treatment for patients in the Czech Republic. The aim of the analysis was to compare costs and effectiveness of budesonide in comparison with placebo in adult patients with microscopic colitis. To assess on cost-utility of budesonide, a Markov model was developed in Microsoft Excel. Budesonide was compared to placebo over a 1.5-year time horizon. The effectiveness and quality of life was derived from randomized clinical trials. Short-form 6D utilities were mapped from Gastrointestinal Quality of Life Index (GIQLI) according to Lee et al. (2013) findings. Cost analysis reflected current situation in the Czech Republic. Drug costs, adverse event costs, and management costs were included. The analysis was conducted from the perspective of the public healthcare payer. In the base case scenario, the incremental cost-effectiveness ratio (ICER) of budesonide compared to placebo reached 7 591 EUR/QALY. QALYs gained on budesonide treatment reached 0.98 whereas patients on placebo gained only 0,92 over a 1.5-year time horizon. Sensitivity and scenario analyses verified model robustness and stability of results. Probabilistic sensitivity analysis resulted in ICER below willingness to pay (WTP) threshold in 88% iterations. Based on the results budesonide improves quality of life of microscopic colitis patients. Moreover, budesonide is also highly cost-effective intervention as the ICER is well below WTP threshold which is 47 244 EUR.

Changes in Health Utility of Patients after Cardiac Surgery

Background: Health utility, which can be assessed by several preference-based utility measures, is an important measure in the analysis of cost effectiveness in health care. We aimed to examine differences in health utility by age following recovery phase II cardiac rehabilitation (CR). Methods: This longitudinal observational study assessed 62 consecutive cardiac surgery patients who were divided into a middle-aged group (<65 years, n=33) and older-age group (≥ 65 years, n=29). Health utility assessed by mean Short Form-6D (SF-6D) utility score was measured at 1 and 3 months after cardiac surgery and compared. Results: The mean SF-6D utility scores increased significantly from 1 to 3 months in both the middle-aged group (0.57 ± 0.07 to 0.64 ± 0.09, P<0.001) and the older-aged group (0.59 ± 0.08 to 0.67 ± 0.12, P<0.001). However, no significant period (from 1 to 3 months) by group interactions (middle-aged and older-aged groups) (mean SF-6D utility scores: F [1/60] 0.10, P=0.75) was detected. Conclusion: Following phase II CR, health utility showed an increase in both middle-aged and older-aged cardiac surgery Japanese patients.

Determining Cost-Effectiveness of Total Hip and Knee Arthroplasty Using the Short Form-6D Utility Measure

BackgroundWith the implementation of the Patient Protection and Affordable Care Act, cost-effectiveness analyses are becoming increasingly important for resource allocation, and particularly for the justification of costly procedures, such as total knee and total hip arthroplasties (TKAs and THAs). Therefore, using the Short Form-6D (SF-6D) utility values, the purpose of this study was to determine (1) the quality-adjusted life years (QALYs) gained and (2) and the cost-effectiveness of undergoing THA and TKA. MethodsA total of 844 patients (357 men, 487 women) who had a mean age of 65 years (range, 39 to 80 years) underwent primary TKA, and 224 patients who had a mean age of 69 years (range, 44 to 88 years) underwent primary THAs at 7 institutions. The SF-6D values were derived for each patient preoperatively and at 1-year follow-up. QALYs were estimated at 1 year, and lifetime QALYs gained were determined using predicted life-expectancy values, at a discounted rate of 3% per year of life expectancy, to reflect a diminishing gain with time. National-level costs were determined using the 2011 Nationwide Inpatient Sample, and incremental cost-effectiveness ratios (ICER) were deduced for both groups. ResultsThe preoperative SF-6D values for the THA and TKA cohorts were 0.614 (range, 0.37 to 1) and 0.62 (range, 0.3 to 0.93). Postoperatively, SF-6D values improved significantly at 1 year in both groups. One-year QALYs for TKA and THA were 0.768 and 0.799. Lifetime QALYs gained for the groups were 2.07 and 1.85 (1.39 and 1.34 if discounted at a rate of 3% per year). The estimated ICER for TKA vs baseline presurgery was $43,107 per QALY, and $39,453 per QALY for THA vs baseline presurgery. ConclusionThe ICER showed that THA and TKA are cost-effective, compared to the $50,000 USD/QALY threshold for cost-effectiveness, and justify resources allocated to these surgeries. The SF-6D can utilize existing functional outcome data, which makes these cost calculations considerably easier and more feasible for practicing orthopedists.

Comparison of the Multiattribute Utility Instruments EQ-5D and SF-6D in a Europe-Wide Population-Based Cohort of Patients with Inflammatory Bowel Disease 10 Years after Diagnosis.

Background. The treatment of chronic inflammatory bowel disease (IBD) is costly, and limited resources call for analyses of the cost effectiveness of therapeutic interventions. The present study evaluated the equivalency of the Short Form 6D (SF-6D) and the Euro QoL (EQ-5D), two preference-based HRQoL instruments that are broadly used in cost-effectiveness analyses, in an unselected IBD patient population. Methods. IBD patients from seven European countries were invited to a follow-up visit ten years after their initial diagnosis. Clinical and demographic data were assessed, and the Short Form 36 (SF-36) was employed. Utility scores were obtained by calculating the SF-6D index values from the SF-36 data for comparison with the scores obtained with the EQ-5D questionnaire. Results. The SF-6D and EQ-5D provided good sensitivities for detecting disease activity-dependent utility differences. However, the single-measure intraclass correlation coefficient was 0.58, and the Bland-Altman plot indicated numerous values beyond the limits of agreement. Conclusions. There was poor agreement between the measures retrieved from the EQ-5D and the SF-6D utility instruments. Although both instruments may provide good sensitivity for the detection of disease activity-dependent utility differences, the instruments cannot be used interchangeably. Cost-utility analyses performed with only one utility instrument must be interpreted with caution.

Mapping chronic liver disease questionnaire scores onto SF-6D utility values in patients with primary sclerosing cholangitis.

The chronic liver disease questionnaire (CLDQ) is a frequently used liver-specific quality of life instrument, but it does not provide information on preference-adjusted health status, which is essential for cost-utility analysis. We aimed to develop a mapping function deriving utilities from the CLDQ in primary sclerosing cholangitis (PSC). Short form-6D (SF-6D) utilities were calculated from SF-36 data collected in a recent prospective study in which unselected patients with PSC also completed the CLDQ. Ordinary least squares (OLS), generalized linear, median, and kernel regression analyses were employed to devise a mapping function predicting utilities. This was validated in three random subsamples of the cohort and in a separate sample of PSC patients following liver transplantation. Adjusted R (2) and root-mean-square error (RMSE) as well as Pearson's r coefficients and mean absolute errors between predicted and observed values were used to determine model performance. Decompensated liver disease and fatigue, systemic symptoms, and emotional distress, assessed with the CLDQ, were related to worse SF-6D utilities. The final OLS prediction model explained 66.3 % of the variance in the derivation sample. Predicted and observed utilities were strongly correlated (r = 0.807, p < 0.001), but the mean absolute error (0.0604) and adjusted RMSE (10.6 %) were of intermediate size. Similar model characteristics were observed after employment of generalized linear and median regression models and at validation. A model has been constructed, showing good validity predicting SF-6D utilities from CLDQ scores at the group level in PSC. Further testing is required to externally validate the model.

Estimating EQ-5D Values from the Neck Disability Index and Numeric Rating Scales for Neck and Arm Pain

Cost-utility analyses evaluate the value of interventional treatments. However, these analyses require a measure from which utility can be determined. The Neck Disability Index (NDI) and numeric rating scales for neck and arm pain are widely used disease-specific measures for health-related quality of life in patients with cervical degenerative disorders. Previous studies have shown that the relationship between the Short Form-6D (SF-6D) and NDI is robust such that an SF-6D utility value can be estimated from the NDI alone. Increasingly the EuroQOL-5D (EQ-5D) is being used as a measure of utility due to ease of administration and scoring.

Mapping the Gastrointestinal Quality of Life Index to Short-Form 6D utility scores

PurposeThe Gastrointestinal Quality of Life Index (GIQLI) is a disease-specific quality of life instrument that is commonly used in gastrointestinal disorders. However, no preference weights, which are used to calculate quality-adjusted life years for cost-effectiveness analyses, for this instrument have been assigned. Therefore, the objective of this study was to develop a mapping function to derive utility scores for the GIQLI. MethodsPatients undergoing elective laparoscopic cholecystectomy completed the short-form 6D (SF-6D), a preference-weighted utility measure, and the GIQLI at baseline and at 1 wk and 1 mo postoperatively. The responsiveness of the SF-6D to expected postoperative changes as well as the correlation between the SF-6D and the GIQLI was investigated. Ordinary least squares regression was performed to derive a mapping function using the baseline values, which was then validated using postoperative values. Adjusted r2, mean absolute error, and root mean square error was used to determine model performance. ResultsA total of 50 patients were included in the study (mean age 51.1 [standard deviation 16.8], 28% male). The SF-6D and GIQLI domains were responsive to expected postoperative changes, and there was high correlation between the SF-6D and four of the five GIQLI domains (excluding treatment effects). The final mapping function explained 63% of the variance in the derivation sample but had relatively high mean absolute error (0.075 and 0.067 in the 1-wk and 1-mo samples, respectively) and adjusted root mean square error (13.1% and 12.0% in the 1-wk and 1-mo samples, respectively). ConclusionsThe GIQLI can be accurately mapped to SF-6D preference weights at the group level but may be too inexact at the individual level.

SAT0315 Comparison of the euroqol and short form 6D in multiethnic asian patients with psoriatic arthritis

ObjectivesTo compare EuroQol (EQ-5D) and Short form 6D (SF-6D) utility scores among multiethnic Asian patients with psoriatic arthritis (PsA).MethodsConsecutive patients fulfilling the Classification Criteria for Psoriatic Arthritis (CASPAR) for PsA...

Comparison of the SF6D, the EQ5D, and the oswestry disability index in patients with chronic low back pain and degenerative disc disease

BackgroundThe need for cost effectiveness analyses in randomized controlled trials that compare treatment options is increasing. The selection of the optimal utility measure is important, and a central question is whether the two most commonly used indexes - the EuroQuol 5D (EQ5D) and the Short Form 6D (SF6D) – can be used interchangeably. The aim of the present study was to compare change scores of the EQ5D and SF6D utility indexes in terms of some important measurement properties. The psychometric properties of the two utility indexes were compared to a disease-specific instrument, the Oswestry Disability Index (ODI), in the setting of a randomized controlled trial for degenerative disc disease.MethodsIn a randomized controlled multicentre trial, 172 patients who had experienced low back pain for an average of 6 years were randomized to either treatment with an intensive back rehabilitation program or surgery to insert disc prostheses. Patients filled out the ODI, EQ5D, and SF-36 at baseline and two-year follow up. The utility indexes was compared with respect to measurement error, structural validity, criterion validity, responsiveness, and interpretability according to the COSMIN taxonomy.ResultsAt follow up, 113 patients had change score values for all three instruments. The SF6D had better similarity with the disease-specific instrument (ODI) regarding sensitivity, specificity, and responsiveness. Measurement error was lower for the SF6D (0.056) compared to the EQ5D (0.155). The minimal important change score value was 0.031 for SF6D and 0.173 for EQ5D. The minimal detectable change score value at a 95% confidence level were 0.157 for SF6D and 0.429 for EQ5D, and the difference in mean change score values (SD) between them was 0.23 (0.29) and so exceeded the clinical significant change score value for both instruments. Analysis of psychometric properties indicated that the indexes are unidimensional when considered separately, but that they do not exactly measure the same underlying construct.ConclusionsThis study indicates that the difference in important measurement properties between EQ5D and SF6D is too large to consider them interchangeable. Since the similarity with the “gold standard” (the disease-specific instrument) was quite different, this could indicate that the choice of index should be determined by the diagnosis.

Comparison of EuroQol-5D and Short Form-6D Utility Scores in Multiethnic Asian Patients with Psoriatic Arthritis: A Cross-sectional Study

To compare EuroQol-5D (EQ-5D) and Short Form-6D (SF-6D) utility scores in multiethnic Asian patients with psoriatic arthritis (PsA). Consecutive patients fulfilling the Classification Criteria for Psoriatic Arthritis attending a rheumatology outpatient clinic were recruited and completed the EQ-5D and SF-6D questionnaires. Comparisons were performed by score distribution, mean, median, and the Outcome Measures in Rheumatology filter: i.e., truth, discrimination, and feasibility. Eighty-six patients were enrolled (69 English-speaking and 17 Chinese-speaking; male:female ratio 0.91). The score distribution of SF-6D was normal, while that of EQ-5D was bimodal. A ceiling effect was observed in 20% of patients for EQ-5D and none for SF-6D. There were moderate correlations (Spearman's rho = 0.59, p < 0.0001) between the 2 scores, but poor agreements on scatterplot, intraclass correlation (ICC 0.43 and standardized ICC 0.21), and Bland-Altman plots. EQ-5D generated lower utility scores than SF-6D in the poorer health subgroup. SF-6D had stronger correlation with the general health status and other external measures of health; and it distinguished better between good and poor general health status, with better effect size and relative efficiency statistics. EQ-5D demonstrated higher patient acceptability. EQ-5D and SF-6D instruments generated different utility scores in PsA. SF-6D may be superior because of normal scaling distribution and the absence of ceiling and floor effects. SF-6D also had better construct validity and better discrimination of poor health status. More studies are required for cost-utility analysis in PsA.

Valuing postoperative recovery: validation of the SF-6D health-state utility

BackgroundMany surgical innovations are costly but may result in faster patient recovery. Economic analyses of these innovations require utility measures that reflect the construct of “postoperative recovery.” We investigated the validity of Short Form 6D (SF-6D) utility value as a measure of postoperative recovery in patients undergoing elective colorectal resection. Materials and methodsPatients undergoing elective colorectal resection completed the Short Form 36 and the 6-min walk test at baseline (before surgery) and at 4 and 8 wk postoperatively. SF-6D utilities were derived from the Short Form 36. Longitudinal validity (responsiveness) was assessed using standardized response means (SRM). Construct validity was assessed by comparing the difference in mean SF-6D between patients with and without complications (discriminant) and by correlating the SF-6D with other measures of recovery (convergent). ResultsA total of 191 patients were included (58% male; mean age 63.0 (SD 14.2) y, 81% malignancy, and 54% laparoscopic). SF-6D values dropped significantly from baseline to 4 wk after surgery (SRM −0.54, P < 0.001) and returned to baseline by 8 wk (SRM −0.12, P = 0.111). At 4 wk after surgery, the SF-6D was lower in patients with complications than in those without (mean difference −0.047, 95% CI −0.088, −0.006). At all time points, the SF-6D correlated significantly with the physical and mental component scales of the SF-36 (Pearson r 0.67–0.80, all P < 0.001) and the 6-min walk test (r 0.21–0.29, all P < 0.05). ConclusionsThe SF-6D is a valid measure of postoperative recovery following elective colorectal resection and may be used to measure quality-adjusted life years for cost-effectiveness analyses of surgical technologies and interventions hypothesized to impact recovery.