Quality of Life and General Health After Elective Surgery for Cervical Spine Pathologies: Determining a Valid and Responsive Metric of Health State Utility. Assessing the empirical validity of alternative multi-attribute utility measures in the maternity context Mapping between the Roland Morris Questionnaire and generic preference-based measures. An empirical evaluation of the SF-12, SF-6D, EQ-5D and Michigan Hand Outcome Questionnaire in patients with rheumatoid arthritis of the hand An empirical comparison of EQ-5D and SF-6D in liver transplant patients. How do the EQ-5D, SF-6D and the well-being rating scale compare in patients with ankylosing spondylitis? EQ-5D in a general population survey – A description of the most commonly reported EQ-5D health states using the SF-36 Comparison of EQ-5D and SF-6D utilities in mental health patients. Putting the ‘Q’ in depression QALYs: a comparison of utility measurement using EQ-5D and SF-6D health related quality of life measures Cost-utility estimates in depression: does the valuation method matter? Mapping utility scores from a disease-specific quality-of-life measure in bariatric surgery patients. SF-6D and EQ-5D result in widely divergent incremental cost-effectiveness ratios in a clinical trial of older women: implications for health policy decisions Assessing health-related quality of life pre- and post-liver transplantation: a prospective multicenter study. Quality of life and cost-effectiveness of a 3-year trial of lifestyle intervention in primary health care. Does Selecting Covariates Using Factor Analysis in Mapping Algorithms Improve Predictive Accuracy? A Case of Predicting EQ-5D-5L and SF-6D Utilities from the Women's Health Questionnaire. Mapping the FACT-G cancer-specific quality of life instrument to the EQ-5D and SF-6D Rapid and sustained improvement in health-related quality of life and utility for 72 weeks in patients with ankylosing spondylitis receiving etanercept. Mapping the clinical chronic obstructive pulmonary disease questionnaire onto generic preference-based EQ-5D values. Comparison of the EQ-5D and SF-12 health surveys in a general population survey in Alberta, Canada. Accurately measuring outcomes after surgery for adult Chiari I malformation: determining the most valid and responsive instruments. Comparison of the SF-6D and the EQ-5D in patients with coronary heart disease Mapping the cancer-specific EORTC QLQ-C30 to the preference-based EQ-5D, SF-6D, and 15D instruments. The bone-anchored hearing aid: quality-of-life assessment.
BACKGROUND As part of the Affordable Care Act , health utility metrics are being investigated to define a cost-effective , value-based health care model . EuroQOL-5D ( EQ-5D ) and Short Form-6D ( SF-6D ) are commonly used quality -of-life instruments . Domains in the EQ-5D question naire are thought to be less responsive in measuring quality of life after cervical surgery . OBJECTIVE To evaluate the validity and responsiveness of SF-6D and EQ-5D in determining health and quality of life after elective cervical spine surgery . METHODS A total of 420 patients undergoing elective cervical spine surgery over a period of 2 years were enrolled in a prospect i ve longitudinal registry . Patient-reported outcomes Neck Disability Index ( NDI ) , EQ-5D , and SF-12 were recorded . Based on previously published equations , SF-6D was calculated using NDI and SF-12 scores . Patients were asked whether " surgery met their expectations " ( meaningful improvement ) . The validity and relative responsiveness of SF-6D ( NDI ) , SF-6D ( SF-12 ) , and EQ-5D to discriminate between meaningful and nonmeaningful improvement were calculated . RESULTS Sixty-six percent of patients ( 277 ) reported a level of improvement after surgery that met their expectations ( meaningful improvement ) . SF-6D ( NDI ) ( area under the curve [ AUC ] = 0.69 ) was a more valid discriminator of meaningful improvement compared with the SF-6D ( SF-12 ) ( AUC = 0.65 ) and EQ-5D ( AUC = 0.62 ) . SF-6D ( NDI ) was also a more responsive measure compared with SF-6D ( SF-12 ) and EQ-5D ( st and ardized response mean difference : 0.66 , 0.48 , and 0.44 , respectively ) . CONCLUSION SF-6D is a more valid and responsive measure of general health and quality of life compared with EQ-5D . SF-6D derived from disease-specific disability scores was more valid and responsive than that derived from the generic preference-based SF-12 . Cost-effective studies should use SF-6D as a measure of QALY after cervical spine surgery Background Multi-attribute utility measures are preference-based health-related quality of life measures that have been developed to inform economic evaluations of health care interventions . The objective of this study was to compare the empirical validity of two multi-attribute utility measures ( EQ-5D and SF-6D ) based on hypothetical preferences in a large maternity population in Engl and . Methods Women who participated in a r and omised controlled trial of additional postnatal support provided by trained community support workers represented the study population for this investigation . The women were asked to complete the EQ-5D descriptive system ( which defines health-related quality of life in terms of five dimensions : mobility , self care , usual activities , pain/discomfort and anxiety/depression ) and the SF-36 ( which defines health-related quality of life , using 36 items , across eight dimensions : physical functioning , role limitations ( physical ) , social functioning , bodily pain , general health , mental health , vitality and role limitations ( emotional ) ) at six months postpartum . Their responses were converted into utility scores using the York A1 tariff set and the SF-6D utility algorithm , respectively . One-way analysis of variance was used to test the hypothetically-constructed preference rule that each set of utility scores differs significantly by self-reported health status ( categorised as excellent , very good , good , fair or poor ) . The degree to which EQ-5D and SF-6D utility scores reflected alternative dichotomous configurations of self-reported health status and the Edinburgh Postnatal Depression Scale score was tested using the relative efficiency statistic and receiver operating characteristic ( ROC ) curves . Results The mean utility score for the EQ-5D was 0.861 ( 95 % CI : 0.844 , 0.877 ) , whilst the mean utility score for the SF-6D was 0.809 ( 95 % CI : 0.796 , 0.822 ) , representing a mean difference in utility score of 0.052 ( 95 % CI : 0.040 , 0.064 ; p < 0.001 ) . Both measures demonstrated statistically significant differences between subjects who described their health status as excellent , very good , good , fair or poor ( p < 0.001 ) , as well as monotonically decreasing utility scores ( test for linear trend : p < 0.001 ) . The SF-6D was between 29.1 % and 423.6 % more efficient than the EQ-5D at detecting differences in self-reported health status , and between 129.8 % and 161.7 % more efficient at detecting differences in the Edinburgh Postnatal Depression Scale score . In addition , the SF-6D generated higher area under the curve ( AUC ) scores generated by the ROC curves than the EQ-5D , indicating greater discriminatory power , although in all but one analysis the differences in AUC scores between the measures were not statistically significant . Conclusion This study provides evidence that the SF-6D is an empirically valid and efficient alternative multi-attribute utility measure to the EQ-5D , and is capable of discriminating between external indicators of maternal health OBJECTIVES The Rol and Morris Question naire ( RMQ ) is a widely used health status measure for low back pain ( LBP ) . It is not preference-based , and there are currently no established algorithms for mapping between the RMQ and preference-based health-related quality -of-life measures . Using data from r and omized controlled trials of treatment for LBP , we sought to develop algorithms for mapping between RMQ scores and health utilities derived using either the EuroQol five-dimensional question naire ( EQ-5D ) or the six-dimensional health state short form ( derived from Medical Outcomes Study 36-Item Short-Form Health Survey ) ( SF-6D ) . METHODS This study is based on data from the Back Skills Training Trial in which data were collected from 701 patients at baseline and subsequently at 3 , 6 , and 12 months postr and omization using a range of outcome measures , including the  RMQ , the EQ-5D , and the Short Form 12 item Health Survey ( SF-12 ) ( from which SF-6D utilities can be derived ) . We used baseline trial data to estimate models using both direct and response mapping approaches to predict EQ-5D and SF-6D health utilities and dimension responses . A multistage model selection process was used to assess the predictive accuracy of the models . We then explored different techniques and mapping models that made use of repeated follow-up observations in the data . The estimated mapping algorithms were vali date d using external data from the UK Back Pain Exercise and Manipulation trial . RESULTS A number of models were developed that accurately predict health utilities in this context . The best performing model for RMQ to EQ-5D mapping was a beta regression with Bayesian quasi-likelihood estimation that included 24 dummy variables for RMQ responses , age , and sex as covariates ( mean squared error 0.0380 ) based on repeated data . The model selected for RMQ to SF-6D mapping was a finite mixture model that included the overall RMQ score , age , sex , RMQ score squared , age squared , and an interaction term for age and RMQ score as covariates ( mean squared error 0.0114 ) based on repeated data . CONCLUSIONS It is possible to reasonably predict EQ-5D and SF-6D health utilities from RMQ scores and responses using regression methods . Our regression equations provide an empirical basis for estimating health utilities when EQ-5D or SF-6D data are not available . They can be used to inform future economic evaluations of interventions targeting LBP Background The aim of this study was to assess the psychometric properties , namely acceptability , validity , reliability , interpretability and responsiveness of the EuroQol EQ-5D ( EQ-5D visual analogue ( VAS ) and EQ-5D ( utility ) ) , Short Form 12 Dimensions ( SF-12 ) , SF-6D and Michigan H and Outcome Question naire ( MHQ ) in patients with rheumatoid arthritis ( RA ) of the h and . Methods The empirical investigation was based upon data from a r and omised controlled trial of 488 adults with rheumatoid arthritis who had pain and dysfunction of the h and s and /or wrists . Participants completed the EQ-5D , SF-12 and MHQ at baseline and at 4 and 12 months follow up . Acceptability was measured using completion rates over time ; construct validity using the “ known groups ” approach , based on pain troublesomeness ; convergent validity using spearman ’s rho correlation ( ρ ) ; reliability using internal consistency ( Cronbach ’s alpha ) ; interpretability using minimal important differences ( MID ) ; and responsiveness using effect sizes and st and ardised response means ( SRM ) stratified by level of self-rated improvement in h and and wrist function or level of self-rated benefit and satisfaction from trial treatments . Results At baseline , the study population had a mean age of 62.4 years , a mean MHQ score of 52.1 and included 76 % women . The EQ-5D ( utility ) had the highest completion rates across time points . All instruments discriminated between pre-specified groups based on pain troublesomeness . Convergent validity analysis indicated that the MHQ score correlated strongly with the EQ-5D ( ρ = 0.65 ) and SF-6D ( ρ = 0.63 ) utility scores . The MHQ was most responsive at detecting change in indicators of RA pain severity between baseline and 4 months , whilst minimal important differences varied considerably across PROMs . Conclusions The instruments evaluated in this study displayed varying psychometric properties in the context of RA of the h and . The selection of a preferred instrument in evaluative studies should ultimately depend on the relative importance placed on individual psychometric properties and the importance placed on generation of health utilities for economic evaluation purpose There remains disagreement about the preferred utility-based measure of health-related quality of life for use in constructing quality -adjusted life years ( QALYs ) . The recent development of a new measure , the SF-6D , has highlighted this issue . The SF-6D and EuroQol EQ-5D measure health-related utilities on a scale where 0 represents death and 1 represents full health , and both have utility scores generated from r and om sample s of the general UK population . This study explored whether , in a large sample of liver transplant patients , the two instruments provide similar results . The empirical data highlight important variation in the results generated from the use of the two instruments . The data are consistent with a view that the SF-6D does not describe health states at the lower end of the utility scale but is more sensitive than EQ-5D in detecting small changes towards the top of the scale Purpose : To compare aspects of validity of EuroQol—5 Dimensions ( EQ-5D ) and Short-Form—6 Dimensions ( SF-6D ) , two indirect utility instruments , and the well-being rating scale ( RS ) in ankylosing spondylitis ( AS ) . Methods : EQ-5D , SF-6D and RS were available for 254 patients fulfilling modified New York criteria . 134 patients were part of an observational cohort and 120 were part of a r and omised controlled trial ( RCT ) . Aspects of validity assessed were truth ( agreement and correlation with external health measures ) and discrimination ( differentiation between health states , repeatability and detection of treatment effect ) . Results : Median ( range ) values were 0.69 ( −0.08–1.00 ) for the EQ-5D , 0.65 ( 0.35–0.95 ) for the SF-6D and 0.65 ( 0.14–1.00 ) for the RS . Agreement ( intraclass correlation coefficient ) was moderate ( 0.46–0.55 ) . Instruments correlated equally with disease activity , functioning and quality of life . The SF-6D showed smaller average differences in utility between patients with better and worse disease compared with the EQ-5D and the RS . The smallest detectable difference ( SDD ) ( in the control group of RCT ) was 0.36 , 0.17 and 0.33 for EQ-5D , SF-6D and RS , respectively . The ability to detect treatment effect ( in the intervention trial ) showed st and ardised effect sizes that were moderate for EQ-5D and SF-6D ( 0.63 and 0.64 ) and low for the RS ( 0.23 ) . Conclusion : In patients with AS , EQ-5D , SF-6D and the RS correlate equally well with external measures of health , but have different psychometric properties . The SDD is most favourable for the SF-6D , but it discriminates less well between patients with different disease severities . The RS has a poorer ability to detect treatment effects . It is difficult to recommend one of the instruments The importance of study ing health-related quality of life in the general population has increasingly been emphasized . From a public health perspective , this benefits the identification of population inequalities in health status . One of the currently most popular instruments is the EQ-5D . Evaluations of the EQ-5D generally focus on the overall preference-based index . As this index has a built-in value , exploration of the information from the underlying health states is also important . In this study , the ten most commonly reported EQ-5D health states are described using the SF-36 . Data collected in 1999 by question naires mailed to a r and om sample aged 20–74 in south-eastern Sweden were used ( n = 9489 ) . Almost 43 % reported the best possible EQ-5D health state and 78 % were accounted for by three EQ-5D health states . The EQ-5D health state classification was largely reflected by the SF-36 , with the EQ-5D items mobility , usual activities , pain/discomfort and anxiety/depression tapping most clearly on the SF-36 scales physical functioning , role limitations due to physical health problems , bodily pain , and mental health , respectively . However , within the same level of EQ-5D ( i.e. , moderate problems ) there was a rather large variation of SF-36 scale scores , particularly regarding the EQ-5D item pain/discomfort and the SF-36 scale BP Various  preference-based measures of health are available for use as an outcome measure in cost-utility analysis . The aim of this study is to compare two such measures EQ-5D and SF-6D in mental health patients . Baseline data from a Dutch multi-centre r and omised trial of 616 patients with mood and /or anxiety disorders were used . Mean and median  EQ-5D  and  SF-6D utilities were compared , both in the total sample and between severity subgroups based on quartiles of SCL-90 scores . Utilities were expected to decline with increased severity . Both EQ-5D and SF-6D utilities differed significantly between patients of adjacent severity groups . Mean utilities increased from 0.51 at baseline to 0.68 at 1.5 years follow-up for EQ-5D and from 0.58 to 0.70 for SF-6D . For all severity subgroups , the mean change in EQ-5D utilities as well as in SF-6D utilities was statistically significant . St and ardised response means were higher for SF-6D utilities . We concluded that both EQ-5D and SF-6D discriminated between severity subgroups and captured improvements in health over time . However , the use of EQ-5D result ed in larger health gains and consequent lower cost-utility ratios , especially for the subgroup with the highest severity of mental health problems Background Generic health preference measures that capture quality of life improvements in depression are important for economic analysis of new technologies . Aim To compare two widely used preference measures , the EQ-5D and SF-6D , in terms of their dimensions and health utility values . Method EQ-5D and SF-6D data collected from 114 patients with depression , who participated in a cluster , r and omised controlled trial to evaluate a collaborative care intervention in UK , primary care practice s.  Utilities were examined across the whole sample and by level of depression severity using the PHQ-9 . Results Depression was associated with disutility at baseline . At 3 month follow-up mean utility increased 0.147 for EQ-5D and 0.082 for SF-6D . Health gains were observed in patients in remission from depression and those with the mildest level of depression severity . Conclusions Both generic preference measures were sensitive to health gains in depression within a relatively short follow-up period ; larger health gain was observed for the EQ-5D BACKGROUND Depression imposes a substantial burden on society . In view of the economic burden of depression , studies evaluating depression treatment increasingly incorporate a cost-utility analysis . Outcomes of these analyses are used by decision makers to prioritize healthcare . Although generic preference-based instruments have been recommended for measuring utility , depression research often uses a disease-specific method , based on depression-free days ( DFD ) , to measure utilities . AIMS OF THE STUDY The objective of this study was to compare utility measurement techniques in the context of a r and omized controlled trial . In particular , we studied the agreement between QALYs measured with the  EuroQol ( EQ-5D ) , the Short Form 6D ( SF-6D ) , and the DFD method , using the EQ-5D as the reference method . We also studied whether the use of different techniques leads to different conclusions for decision makers . METHODS Data were derived from the Depression in Elderly with Long-Term Afflictions ( DELTA ) study . This r and omized controlled trial was design ed to study the effectiveness and cost-effectiveness of a minimal psychological intervention for chronically ill patients with co-occurring minor or mild to moderate major depression . The  EQ-5D , SF-6D and Beck Depression Inventory  ( to estimate DFDs ) were assessed at baseline , and at three , six and twelve months after baseline . RESULTS Poor agreement was found between the EQ-5D and DFD ( Kendall 's Tau : 0.33 ; ICC : 0.21 ( 95 % CI:-0.07 - 0.45 ) ) and moderate agreement between the EQ-5D and SF-6D ( Kendall 's Tau : 0.60 ; ICC : 0.47 ( 95 % CI : 0.36 - 0.57 ) ) . The incremental cost-utility ratio led to similar conclusions for decision makers across techniques . DISCUSSION In conclusion , utilities from the disease-specific DFD method should not be compared directly with utilities derived from the EQ-5D . Although a disease-specific method might yield similar cost-utility ratios as generic instruments , generic instruments remain the preferred option for prioritizing healthcare . Limitations of this study include the presence of minor depression and chronic illnesses in our study population . IMPLICATION S Generic instruments remain preferred for cost-utility analyses , especially when results are used to prioritize healthcare . If the DFD method is a way forward , further research is required to vali date utility weights assigned to the DFDs OBJECTIVES To develop algorithms for a conversion of disease-specific quality -of-life into health state values for morbidly obese patients before or after bariatric surgery . METHODS A total of 893 patients were enrolled in a prospect i ve cross-sectional multicenter study . In addition to demographic and clinical data , health-related quality -of-life ( HRQoL ) data were collected using the disease-specific Moorehead-Ardelt II question naire ( MA-II ) and two generic question naires , the EuroQoL-5D ( EQ-5D ) and the Short Form-6D ( SF-6D ) . Multiple regression models were constructed to predict EQ-5D- and SF-6D-based utility values from MA-II scores and additional demographic variables . RESULTS The mean body mass index was 39.4 , and 591 patients ( 66 % ) had already undergone surgery . The average EQ-5D and SF-6D scores were 0.830 and 0.699 . The MA-IIwas correlated to both utility measures ( Spearman 's r = 0.677 and 0.741 ) . Goodness-of-fit was highest ( R(2 ) = 0.55 in the validation sample ) for the following item-based transformation algorithm : utility ( MA-II-based ) = 0.4293 + ( 0.0336 x MA1 ) + ( 0.0071 x MA2 ) + ( 0.0053 x MA3 ) + ( 0.0107 x MA4 ) + ( 0.0001 x MA5 ) . This EQ-5D-based mapping algorithm outperformed a similar SF-6D-based algorithm in terms of mean absolute percentage error ( P = 0.045 ) . CONCLUSIONS Because the mapping algorithm estimated utilities with only minor errors , it appears to be a valid method for calculating health state values in cost-utility analyses . The algorithm will help to define the role of bariatric surgery in morbid obesity Summary Using two instruments ( SF-6D and EQ-5D ) to estimate quality adjusted life years ( QALYs ) , we conducted an economic evaluation of a 12-month r and omized controlled trial with a 12-month follow-up study in older women to evaluate the value for money of two doses of resistance training compared with balance and tone classes . We found that the incremental QALYs estimated from the SF-6D were two- to threefold greater than those estimated from the EQ-5D . Introduction Decision makers must continually choose between existing and new interventions . Hence , economic evaluations are increasingly prevalent . The impact of quality -adjusted life year ( QALY ) estimates using different instruments on the incremental cost-effectiveness ratios ( ICERs ) is not well understood in older adults . Thus , we compared ICERs , in older women , estimated by the EuroQol-5D ( EQ-5D ) and the Short Form-6D ( SF-6D ) to discuss implication s on decision making . Methods Using both the EQ-5D and the SF-6D , we compared the incremental cost per QALY gained in a r and omized controlled trial of  resistance training in 155 community-dwelling women aged 65 to 75 years . The 12-month r and omized controlled trial included a subsequent 12-month follow-up . Our focus , the follow-up study , included 123 of the 155 participants from the Brain Power study ; 98 took part in the economic evaluation ( twice-weekly balance and tone exercises , n = 28 ; once-weekly resistance training , n = 35 ; twice-weekly resistance training , n = 35 ) . Our primary outcome measure was the incremental cost per QALY gained of once- or twice-weekly resistance training compared with balance and tone exercises . Results At cessation of the follow-up study , the incremental QALY was −0.051 ( EQ-5D ) and −0.144 ( SF-6D ) for the once-weekly resistance training group and −0.081 ( EQ-5D ) and −0.127 ( SF-6D ) for the twice-weekly resistance training group compared with balance and tone classes . Conclusion The incremental QALYs estimated from the SF-6D were two- to threefold greater than those estimated from the EQ-5D . Given the large magnitude of difference , the choice of preference-based utility instrument may substantially impact health care decisions We report on a prospect i ve multicenter study to assess pretransplantation and posttransplantation health-related quality of life ( HRQL ) of liver transplant recipients .  HRQL was assessed at several timepoints using a self-completion question naire consisting of the EuroQol instrument ( EQ-5D ) and the 36-Item Short-Form Health Survey ( SF-36 ) health status profile measure . All individuals selected to receive treatment as part of the UK NHS liver transplantation program at each of six liver transplantation centers in Engl and and Wales during a 2-year period ( n = 542 ) were eligible to be included on the study . An overall response rate of 84 % ( 455 responses ) was achieved . A paired comparison of HRQL at listing and 3 months posttransplantation showed statistically significant improvements ( P < .05 ) in all dimensions of the SF-36 ( with the exception of Bodily Pain [ P = .686 ] ) and the EQ-5D tariff and visual analogue scale ( VAS ) scores . An analysis of posttransplantation HRQL over time for patients who survived until the end of the study ( 24 months posttransplantation ) showed a statistically significant improvement ( P < .05 ) for all dimensions of the SF-36 ( apart from Mental Health [ P = .245 ] and Role-Emotional dimensions [ P = .265 ] ) and the EQ-5D VAS and tariff scores . Adjusting for patients who died posttransplantation reduced mean EQ-5D tariff scores substantially , and the change over time in EQ-5D tariff scores was no longer statistically significant ( P = .55 ) . Results of regression analysis conducted to assess the importance of patient characteristics and center size on EQ-5D tariff and VAS scores generated posttransplantation indicated there was variation in scores according to patient age and center size BACKGROUND Lifestyle interventions reduce cardiovascular risk and risk of diabetes mellitus , but reports on long-term effects on quality of life ( QOL ) and health care utilization are rare . We investigated the impact of a primary health care-based lifestyle intervention program on QOL and cost-effectiveness over 3 years . METHODS A total of 151 men and women , aged 18 to 65 years , at moderate to high risk for cardiovascular disease , were r and omly assigned to either lifestyle intervention with st and ard care or st and ard care alone . Intervention consisted of supervised exercise sessions and diet counseling for 3 months , followed by regular group meetings over a 3-year period . Change in QOL was measured with EuroQol ( 5-dimensional EuroQol-5D [ EQ-5D ] and EuroQol-VAS [ EQ-VAS ] ) , the 36-Item Short-Form Health Survey ( SF-36 ) , and the 6-dimensional Short-Form 6D ( SF-6D ) . The health economic evaluation was performed from a societal view and a treatment perspective . In a cost-utility analysis , the costs , gained quality -adjusted life-years ( QALYs ) , and savings in health care were considered . Cost-effectiveness was also described using the net monetary benefit method . RESULTS Significant differences between the groups over the 3-year period were shown in the EQ-VAS ( P = .002 ) , SF-6D ( P = .01 ) , and SF-36 ( P = .04 ) physical component summary but not in the EQ-5D ( P = .24 ) or SF-36 ( P = .37 ) mental component summary . The net savings were $ 47 per participant . Costs per gained QALY , savings not counted , were $ 1668 to $ 4813 . Probabilities of cost-effectiveness were 89 % to 100 % when the amount of $ 50,000 was used as stakeholder 's threshold of willingness to pay for a gained QALY . CONCLUSION Lifestyle intervention in primary care improves QOL and is highly cost-effective in relation to st and ard care . Trial Registration clinical trials.gov Identifier : NCT00486941 BACKGROUND In addition to theoretical justifications , many statistical methods have been used for selecting covariates to include in algorithms mapping nonutility measures onto utilities . However , it is not clear whether using exploratory factor analysis ( EFA ) as one such method improves the predictive ability of these algorithms . OBJECTIVE This question is addressed within the context of mapping a non-utility-based outcome , the core 23-item Women 's Health Question naire ( WHQ-23 ) , onto two utility instruments : five-level EuroQol five-dimensional question naire ( EQ-5D-5L ) and the six-dimensional health state short form ( derived from short form 36 health survey ) ( SF-6D ) . METHODS Data on all three outcomes were collected from 455 women from the Australian general population participating in a study assessing attitudes toward in vitro fertilization . Statistical methods for selecting covariates included stepwise regression ( SW ) , including all covariates ( Include all ) , multivariable fractional polynomial ( MFP ) , and EFA . The predictive accuracy of 108 regression models was assessed using five criteria : mean absolute error , root mean squared error , correlation , distribution of predicted utilities , and proportion of predictions with absolute errors of less than 0.0.5 . Validation of " primary " models was carried out on r and om sample s of the in vitro fertilization study . RESULTS The best results for EQ-5D-5L and SF-6D predictions were obtained from models using SW , " Include all , " and MFP covariate- selection approaches . Root mean squared error ( 0.0762 - 0.1434 ) and mean absolute error ( 0.0590 - 0.0924 ) estimates for these models were within the range of published estimates . EFA was outperformed by other covariate- selection methods . CONCLUSIONS It is possible to predict valid utilities from the WHQ-23 using regression methods based on SW , " Include all , " and MFP covariate- selection techniques Objective To help facilitate economic evaluations of oncology treatments , we mapped responses on cancer-specific instrument to generic preference-based measures . Methods Cancer patients ( n = 367 ) completed one cancer-specific instrument , the FACT-G , and two preference-based measures , the  EQ-5D and SF-6D . Responses were r and omly divided to form development ( n = 184 ) and cross-validation ( n = 183 ) sample s. Relationships between the instruments were estimated using ordinary least squares ( OLS ) , generalized linear models ( GLM ) , and censored least absolute deviations ( CLAD ) regression approaches . The performance of each model was assessed in terms of how well the responses to the cancer-specific instrument predicted EQ-5D and SF-6D utilities using mean absolute error ( MAE ) and root mean squared error ( RMSE ) . Results Physical , functional , and emotional well-being domain scores of the FACT-G best explained the EQ-5D and SF-6D . In terms of accuracy of prediction as measured in RMSE , the CLAD model performed best for the EQ-5D ( RMSE = 0.095 ) whereas the GLM model performed best for the SF-6D ( RMSE = 0.061 ) . The GLM predicted SF-6D scores matched the observed values more closely than the CLAD and OLS . Conclusion Our results demonstrate that the estimation of both EQ-5D and SF-6D utility indices using the FACT-G responses can be achieved . The CLAD model for the EQ-5D and the GLM model for the SF-6D are recommended . Thus , it is possible to estimate quality -adjusted life years for economic evaluation from studies where only cancer-specific instrument have been administered OBJECTIVE To examine the longterm effect of etanercept ( ETN ) therapy on health-related quality of life ( HRQOL ) and utility in patients with ankylosing spondylitis . METHODS Patients completing a 24-week placebo-controlled trial were continued on ETN in a 72-week open-label extension study . Short Form-36 ( SF-36 ) , EuroQOL-5D ( EQ-5D ) , and EuroQOL visual analog scale ( EQ-VAS ) scores were collected at open-label baseline and every 12 weeks thereafter . Mental and physical component scores ( MCS and PCS ) of the SF-36 , EQ-5D and SF-6D utility scores , and quality -adjusted life-years ( QALY ) were calculated . RESULTS 257 patients [ 129 previous placebo ( PLA ) and 128 ETN recipients ] enrolled in this open-label extension study , and 85 % completed the 72-week followup . PCS , EQ-5D and SF-6D utilities , and EQ-VAS were significantly lower at open-label baseline in the previous PLA group ( PLA/ETN group ) than in the previous ETN group ( ETN/ETN group ; all p < 0.001 ) . At week 12 , PCS and MCS , EQ-5D and SF-6D utility scores , and EQ-VAS were similar in the PLA/ETN and ETN/ETN groups . As expected , mean change in EQ-5D in the PLA/ETN group was significantly greater than that for SF-6D ( 0.18 vs 0.06 ; p < 0.0001 ) . HRQOL and utility improvements were maintained in both groups for up to 72 weeks . The average 72-week QALY gain per person in the PLA/ETN group was 0.24 and 0.10 for EQ-5D and SF-6D , respectively . CONCLUSION Patients continuing ETN therapy sustained HRQOL and utility improvements attained during the original PLA-controlled trial . Patients previously taking PLA  showed rapid and sustained improvements in HRQOL and utility and substantial QALY gain with ETN therapy OBJECTIVES To develop a model to predict  EuroQol five-dimensional question naire ( EQ-5D ) values from clinical chronic obstructive pulmonary disease ( COPD ) question naire ( CCQ ) scores . METHODS We used data from three clinical trials ( the R and omized Clinical Trial on Effectiveness of Integrated COPD Management in Primary Care [ RECODE ] , the Assessment Of Going Home Under Early Assisted Discharge [ GO-AHEAD ] , and the Health Status Guided COPD Care [ MARCH ] ) . Data were r and omly split into an estimation sample and a validation sample . The conceptual similarity between patient-reported CCQ and preference-based EQ-5D scores was assessed using correlation and principal-component analysis . Different types of models were estimated with increasing complexity . We selected the final models on the basis of mean absolute error and root mean square error when comparing predicted and observed values from the same population ( internal validity ) and from different trial population s ( external validity ) . We also developed models for different country-specific EQ-5D value sets . RESULTS The principal-component analysis showed that the CCQ domains functional state and mental state are associated with four dimensions of the EQ-5D . The EQ-5D dimension pain/discomfort formed a separate construct on which no CCQ item loaded . The mean observed EQ-5D values were not significantly different from the mean predicted EQ-5D values in internal validation sample s but did significantly differ in external validation sample s. The models underestimated EQ-5D values in milder health states and overestimated them in more severe health states . The predictive ability of the models was similar across different EQ-5D value sets . CONCLUSIONS The models can predict mean EQ-5D values that are similar to observed mean values in a similar population . The overestimating/underestimating of the low/high EQ-5D values , however , limits its use in Markov models . Therefore , mapping should be used cautiously OBJECTIVES The purpose s of this analysis were to evaluate the construct validity of the EQ-5D and compare responses on the EQ-5D with the Physical Component Summary ( PCS-12 ) and Mental Component Summary ( MCS-12 ) scores of the SF-12 Health Survey . METHODS Data were collected via a survey instrument mailed to 4,200 r and omly selected subjects in the province of Alberta , Canada . The instrument contained the EQ-5D and SF-12 health surveys , with additional questions eliciting clinical and demographic information from the respondents . RESULTS 1,555 respondents returned mailed question naires ; 606 question naires were returned undeliverable . The SF-12 summary scores were calculated for 1,380 respondents . Analysis of the EQ-5D responses by demographic variables found significant differences among categories of age , gender , and self-reported chronic medical conditions . Corresponding dimensions and summary scores were more strongly related ( eg , mobility and PCS-12 ; F ratio = 598.3 , P < 0.001 ) than dissimilar dimensions ( eg , mobility and MCS-12 ; F ratio = 18.8 , P < 0.001 ) . The EQ-5D index scores were moderately correlated with SF-12 summary scores ( r = 0.41 for MCS-12 and r = 0.68 for PCS-12 ) . For subjects reporting no problems on the EQ-5D , PCS-12 and MCS-12 scores were significantly lower for people reporting medical problems or feelings of depression . CONCLUSIONS The results of this investigation generally supported the validity of the EQ-5D . However , an important ceiling effect was observed for the EQ-5D in this sample . The combination of the EQ-5D and SF-12 provides relatively broad coverage of important health domains and scores for various purpose BACKGROUND There has been a transition to using patient-reported outcome instruments ( PROi ) to assess surgical effectiveness . However , none of these instruments have been vali date d for outcomes of adult Chiari I malformation ( CMI ) . OBJECTIVE The aim of this study was to determine the relative validity and responsiveness of various PROi in measuring outcomes after surgery for CMI . METHODS Fifty patients undergoing suboccipital craniotomy for adult CMI were prospect ively followed for 1 year . Baseline and 1-year patient-reported outcomes ( visual analog scale for head pain and visual analog scale for neck pain , Neck Disability Index [ NDI ] , Headache Disability Index , SF-12 , Zung Self-Rating Depression Scale , and EuroQol-5D [ EQ-5D ] ) were assessed . A level of improvement in general health after surgery was defined as meaningful improvement . Receiver-operating characteristic curves were generated to assess the validity of PROi to discriminate between meaningful improvement and not . The difference between st and ardized response means ( SRMs ) in patients reporting meaningful improvement vs not as calculated to determine the relative responsiveness of each outcome instrument . RESULTS For pain and disability , the NDI was the most accurate discriminator of meaningful effectiveness ( area under the curve : 0.90 ) and also most responsive to postoperative improvement ( st and ardized response means difference : 1.87 ) . For general health and quality of life , the SF-12 PCS , EQ-5D , and Zung Self-Rating Depression Scale were all accurate discriminators ; however , SF-12 Physical Component Scale ( SF-12 PCS ) and EQ-5D were most accurate . SF-12 PCS was also most responsive . CONCLUSION For pain and disability , NDI is the most valid and responsive measure of improvement after surgery for CMI . For health-related quality of life , SF-12 PCS and EQ-5D are the most valid and responsive measures . NDI with SF-12 or EQ-5D is the most valid in patients with CMI and should be considered in cost-effectiveness studies Background The SF-6D was derived from the SF-36 . A single summary score is obtained allegedly preserving the descriptive richness and sensitivity to change of the SF-36 into utility measurement . We compared the SF-6D and EQ-5D on domain content , scoring distribution , pre-treatment and change scores . Methods The SF-6D and the EQ-5D were completed prior to intervention and 1 , 3 , 6 and 12 months post-intervention in a study enrolling 561 patients with symptomatic coronary stenosis . Patients were r and omized to off-pump coronary artery bypass surgery ( CABG ) , st and ard on-pump CABG , or percutaneous transluminal coronary angioplasty ( PTCA ) .  Baseline and change over time scores were compared using parametric and non-parametric tests . Results The relative contribution of similar domains measuring daily functioning to the utility scores differed substantially . SF-6D focused more on social functioning , while EQ-5D gave more weight to physical functioning . Pain and mental health had similar contributions . The scoring range of the EQ-5D was twice the range of the SF-6D . Before treatment , EQ-5D and SF-6D mean scores appeared similar ( 0.64 versus 0.63 , p = 0.09 ) . Median scores , however , differed substantially ( 0.69 versus 0.60 ) , a difference exceeding the minimal important difference of both instruments . Agreement was low , with an intra-class correlation of 0.45.Finally , we found large differences in measuring change over time . The SF-6D recorded greater intra-subject change in the PTCA-group . Only the EQ-5D recorded significant change in the CABG-groups . In the latter groups changes in SF-6D domains cancelled each other out . Conclusion Although both instruments appear to measure similar constructs , the EQ-5D and SF-6D are quite different . The low agreement and the differences in median values , scoring range and sensitivity to change after intervention show that the EQ-5D and SF-6D yield incomparable scores in patients with coronary heart disease OBJECTIVES To estimate models , via ordinary least squares regression , for predicting Euro Qol 5D ( EQ-5D ) , Short Form 6D ( SF-6D ) , and 15D utilities from scale scores of the European Organization for Research and Treatment of Cancer Quality of Life Question naire ( EORTC QLQ-C30 ) . METHODS Forty-eight gastric cancer patients , split up into equal subgroups by age , sex , and chemotherapy scheme , were interviewed , and the survey included the QLQ-C30 , SF-36 , EQ-5D , and 15D instruments , along with sociodemographic and clinical data . Model predictive ability and explanatory power were assessed by root mean square error ( RMSE ) and adjusted R(2 ) values , respectively . Pearson 's r between predicted and reported utility indices was compared . Three r and om sub sample s , half in size the initial sample , were created and used for " external " validation of the modeling equations . RESULTS Explanatory power was high , with adjusted R(2 ) reaching 0.909 , 0.833 , and 0.611 for 15D , SF-6D , and EQ-5D , respectively . After normalization of RMSE to the range of possible values , the prediction errors were 12.0 , 5.4 , and 5.6 % for EQ-5D , SF-6D , and 15D , respectively . The estimation equations produced a range of utility scores similar to those achievable by the st and ard scoring algorithms . Predicted and reported indices from the validation sample s were comparable thus confirming the previous results . CONCLUSIONS Evidence on the ability of QLQ-C30 scale scores to validly predict 15D and SF-6D utilities , and to a lesser extent , EQ-5D , has been provided . The modeling equations must be tried in future studies with larger and more diverse sample s to confirm their appropriateness for estimating quality -adjusted life-year in cancer-patient trials including only the QLQ-C30 OBJECTIVES To assess the impact of a bone-anchored hearing aid ( BAHA )  on the  quality of life ( QOL ) of adults and to test the hypothesis that a BAHA improves QOL because otorrhea and /or skin irritations decrease . DESIGN Prospect i ve postal-based question naire study using vali date d health-related QOL instruments , combined with hearing-aid-related questions . PATIENTS AND METHODS The study included 56 consecutive adult patients with acquired conductive or mixed hearing loss who were scheduled for BAHA implantation at the University Medical Centre Nijmegen , Nijmegen , the Netherl and s. All 56 patients completed the 36-Item Short-Form  Health  Survey  ( SF-36 ) , the EuroQol-5D ( EQ-5D ) , and the Hearing H and icap and Disability Inventory ( HHDI ) ; 36 patients had been using an air-conduction hearing aid ( ACHA ) and 20 patients a conventional bone-conduction hearing aid ( CBHA ) .  Question naires were filled out before surgery and after 6 months of experience with the BAHA . RESULTS In the SF-36 group , there was significant improvement in the scores of the mental health domain ( P = .02 ) . When the SF-36 patients were classified according to previous hearing aid , there was no statistically significant change in the scores in any of the domains . In the EQ-5D group and in its ACHA and CBHA subgroups , there were no important differences in the results before and after the patients received their BAHAs . In the HHDI group , the h and icap and disability scales showed significant improvement ( P<.01 ) irrespective of the type of previously worn hearing aid . CONCLUSIONS Overall , generic health-related QOL was not influenced significantly by the use of a BAHA according to the SF-36 and the EQ-5D . The more disease-specific scales ( HHDI ) did show improved QOL with a BAHA
Most of the evidence concerns the SF-36 and EQ-5D , and for these instruments there was evidence for known group validity .
Although the evidence base is limited in a number of important respects , including problems with the measures used to develop constructs in the validation studies , it is sufficient to raise doubts about the use of generic measures of health like the EQ-5D and SF-36 in patients with schizophrenia
OBJECTIVES Generic health status measures such as the short form health survey ( SF-36 ) and EuroQol-5D ( EQ-5D ) are increasingly being used to inform health policy .
They are cl aim ed to be applicable across disease areas and have started to be used within mental health research .
This review aims to assess the construct validity and responsiveness of four generic health status measures in schizophrenia , including the preference-based SF-6D and EQ-5D .