Health-related quality of life of people attending screening for diabetic retinopathy within a trial setting CJ Sampson,1† M James,1 D Van Eker,2 D Szmyt,2 SP Harding3 †chris.sampson@nottingham.ac.uk 1University of Nottingham | 2Royal Liverpool University Hospital | 3University of Liverpool Introduction Background • DR associated with lower health-related quality of life (HRQoL) • Economic evaluations tend to base outcomes on visual acuity. Aims • Estimate generic HRQoL for a cross-section of attenders within the UK screening programme • Inform calculation of quality-adjusted life years (QALYs) for model-based economic evaluation. Methods: the sample ▶874 people from 7 screening centres in Liverpool, UK ▶Baseline trial data from the ISDR study ▶Matched screening outcome data R0 No retinopathy R1 Background retinopathy (in at least one eye) Methods: outcome measures ▶Two widely-used generic descriptors of HRQoL. ▶Both can be used to calculate QALYs. ▶Together provide 5 ways to measure HRQoL. EQ-5D-5L Dimensions 5 dimensions reported from 1 (no problems) to 5 (extreme problems) Index score Weighted score based on health state preferences elicited from the UK general public, used to calculate QALYs EQ-VAS A visual analogue scale from 0 (“The worst health you can imagine”) to 100 (“The best health you can imagine”) HUI3 Dimensions 8 dimensions (including ‘vision’) scored from 1 (no problems) to 5 or 6 (severe functional limitations) Index score Multi-attribute utility function, to calculate QALYs Results: full sample ▶840 (96%) fully completed EQ-5D-5L ▶738 (84%) fully completed HUI3 ▶Mean EQ-5D-5L index score was 0.777 ▶Mean HUI3 index score was 0.707 Table: EQ-5D-5L: distribution of responses 1 2 3 4 5 Mobility 52% 15% 17% 15% 0% Self-care 76% 10% 10% 4% 1% Usual activities 57% 15% 15% 10% 3% Pain/discomfort 43% 20% 20% 14% 4% Anxiety/depression 67% 14% 12% 5% 1% Table: HUI3: distribution of responses 1 2 3 4 5 6 Vision 31% 63% 3% 2% 2% 1% Hearing 78% 11% 7% 3% 1% 0% Speech 93% 4% 2% 0% 0% — Ambulation 63% 18% 11% 5% 2% 0% Dexterity 81% 14% 2% 2% 1% 0% Emotion 66% 21% 9% 3% 1% — Cognition 68% 8% 18% 4% 2% 0% Pain 40% 26% 15% 12% 7% — ▶Dimensions with ≥20% of responses are highlighted Results: R1 vs R0 ▶R1 screening outcome associated with lower HRQoL on average than R0 EQ-5D-5L 0.762 vs 0.776 HUI3 0.660 vs 0.713 (p=0.03) EQ-VAS: How do EASDec delegates compare? ▶The left side of the scale shows the distribution in our sample. ▶Place a sticker on the right according to how good or bad your health is TODAY. The best health you can imagine 100 0 The worst health you can imagine Discussion ▶HUI3 recognised as being more sensitive to visual impairment, but may require trade-off with data quality • Lower mean HUI3 index score may reflect inclusion of sensory domains ▶Economic modelling studies that treat R1 and R0 as homogeneous may give biased results ▶We cannot determine whether the difference in HRQoL between R1 and R0 is because of retinopathy level Conclusions ▶DR screening attendees have an impaired HRQoL compared with the general population ▶People with background retinopathy have lower health-related quality of life than people with no retinopathy • Statistically significant difference of 0.053 in mean HUI3 index score ▶HUI3 is associated with poorer completion rates • Greatest missingness on ‘vision’ domain ▶www.isdrproject.co.uk ▶Twitter @ISDRstudy Download this poster DOI: 10.6084/m9.figshare.3443705 This poster presents independent research funded by the NIHR under the Programme Grants for Applied Research programme (RP-PG-1210-12016). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Heath.