1987). In addition, it avoids CBA problem of measuring health in monetary terms (Johannesson and Jonsson, 1991). CEA has received the favour of extra-welfarists because, differently from CBA, it focuses entirely on the maximization of health (benefits are measured as changes in health), excluding other components of utility from the analysis. However, the technique does not allow comparing treatment/programs/interventions across disease areas and disease groups (being focused on the natural unit of measurement only interventions with the same outcome can be compared) (Drummond et al, 2005), nor to compare interventions that differ in more than one treatment outcome (e.g. Brazier et al, 2007). For these reasons, CEA can be used only if the objective is to increase the level of effectiveness while maintaining a given budget, or maintaining the same level of effectiveness while reducing the budget (Morris et al, 2007). Cost-utility analysis CUA is a form of CEA that instead of comparing costs with the natural unit of the program compares them using a synthetic index of the length and HRQoL of individuals, with the later being based on utility. This is usually expressed in terms of QALYs and is easily obtained by multiplying the length of time passed in the condition by a value calculated on a scale from 0 to 1 (Drummond et al, 2005). This value is meant to reflect the strength of preference of individuals over different health states (utility). CUA shares with CEA the idea that there is no additional objective to health care than health maximization (Mooney, 2003) and in that it is favourably looked at by extra-welfarists. In addition, this seems the most reasonable approach in a number of health systems, such as the UK one, where the majority of individuals support public institutions expecting them to maximize health under the national budget (Garrison Jr., 2009). In fact, CUA employs a perspective where social welfare is externally assessed by the community, and uses values of an intervention derived from a representative sample of the general population (Brazier et al, 2017). Measurement and valuation of health for incorporation in QALYs are discussed in the next section.
A highly sensitive searching filter for reviews and meta-analysis developed by the information services team of the Canadian Agency for Drugs and Technologies in Health was used to refine the search (CADTH, 2014), which was not limited by date or language restrictions. Medline, Embase, Cochrane Library and Scharr HUD electronic databases were investigated. In addition, references of the included reviews were screened and a complementary search on Google Scholar was performed. Identified citations (both published and grey literature) were assessed against the following set of pre-defined eligibility criteria. Reports were eligible for inclusion if they were reviews, they examined the construct validity or responsiveness of at least one GPBMs, their main focus was on adult population (defined as ≥18 years old) and they summarized results reporting information at the study level (either in the text, tables or appendix of the reviews). Reviews were excluded if they reported results only in aggregate form, if they only examined reliability or face validity (i.e. not construct validity or responsiveness), if they tested translations of the GPBMs, if they were not in English or if they were only poster presentations. Quality Assessment of the reviews Quality has been assessed using a modified eight question version of the AMSTAR checklist for systematic reviews (Shea et al, 2007) with items weighted for their importance for GPBM research (See Appendixes Chapter 3 - Table II). Weighting was agreed after discussion between the PhD student and the supervisors John Brazier and Clara Mukuria. Questions on the “comprehensiveness of the literature search”, the “presence of a quality assessment tool” and the “use of quality scores to formulate conclusions” were assigned two points as they were considered essential for the correct identification and assessment of quality of studies included in reviews. “Characteristics of the included studies” was assigned 1.5 points, as these might significantly impact on the results. The “presence of duplicate data selection and extraction” and “double blinding” (although rarely used in systematic reviews of psychometric evidence) were assigned a score of one since they strengthen the reliability of the selection process. Questions on providing an a priori design, which minimizes the chance of results being changed once searches have being completed,
impairment SF-6D HUI 3 the EQ-5D, HUI 3 and SF-6D in patients with visual disorders due to the different ways particular conditions affect HRQoL Genitourinary system Davis and Wailoo (2013) Urinary Incontinence Good EQ-5D SF-6D 15 D AQoL 8D To assess the appropriateness of the EQ-5D in people with urinary incontinence 17 (17) Wu (2013) HIV Good EQ-5D To examine the responsiveness of two health related quality of life measures used in clinical trials involving HIV infected adults 17 (17) Gynaecological problems Sanghera (2013) Menorrhagia Poor EQ-5D To review which economic measures have been used or assessed in menorrhagia and present criteria for deciding which measure is the most appropriate 56 (56)
Haematological problems Szende(2003) Haemophilia Good EQ-5D HUI 3 To review and evaluate the performance of health related quality of life and other health status measures used in studies of haemophilia in adult patients and provide recommendations for future research 19 (19) Musculoskeletal system Bansback (2008) Rheumatoid arthritis Poor EQ-5D SF-6D HUI 3 To review the clinical measures used in rheumatoid arthritis economic evaluations with respect to their relevance and sensitivity to changes in survival, health related quality of life and costs 22(22) DeVine (2011) Chronic low back pain Poor EQ-5D To determine the correlation of patient reported pain with physical function and health related quality of life after spine surgery and the responsiveness of pain, physical function and health related quality of life measures after spine surgery (for chronic low back pain) 5 (5)
Hill (2010) Spinal cord injury Poor SF-6D To critically review quality of life instruments used in spinal cord injury 14 (14) Whitehurst (2012) Spinal cord injury Good SF-6D To review the use of based instruments of health related quality of life within the context of spinal cord injury 22 (22) Mental health Brazier (2014) Bipolar disorder Good EQ-5D To examine the validity and responsiveness of two generic preference based measures of health (the EQ-5D and SF-6D) and two generic non preference based measures (the SF 36 and SF 12) in populations with bipolar disorder 22 (22) Papaioannou (2013) Personality disorder Good EQ-5D To assess the construct validity and responsiveness of four generic health status measures in personality disorder 10 (10) Papaioannou (2011) Schizophrenia Good EQ-5D To assess the construct validity and responsiveness of four generic health status measures in 33 (33)
SF-6D schizophrenia Peasgood (2012) Depression/ Anxiety Good EQ-5D SF-6D HUI 3 To assess the construct validity and responsiveness of EQ-5D and SF-6D measures in depression and anxiety 26 (26) Hounsome (2011) Dementia Poor EQ-5D HUI 3 To review evidence relating the application of EQ-5D in dementia research and issues concerning its use 21 (18) Neoplasm Longworth (2014) Cancer Good EQ-5D SF-6D HUI 3 To assess the reliability, validity and responsiveness of the HUI 3 and SF-6D for measuring health related quality of life in cancer 98 (98) Pickard (2008) Cancer Poor EQ-5D To summarize evidence on the validity and reliability of EQ-5D in cancer 34 (34) Nervous system Kuspinar and Mayo (2014) Multiple Sclerosis EQ-5D SF-6D HUI 3 To summarize the evidence from published literature on the psychometric properties of a generic utility measures in 15 (15)
AQoL 8D multiple sclerosis Nose Linder (2003) Acute sinusitis EQ-5D To identify and compare the performance of HRQoL instruments or symptom scores for adults with acute sinusitis. 29 (29) Others Ching (2003) Aesthetic surgery Poor EQ-5D To critically review the present literature to identify the appropriate instruments to assess outcomes in aesthetic surgery. 43 (not clear) Derrett (2009) Injuries Poor EQ-5D To describe EQ-5D administration, summarize its reliability and validity and report its outcomes in injuries 44 (41) Haywood (2005) Older patients Poor EQ-5D AQoL 8D To review the evidence relating to the measurement properties of multi-item generic patient or self assessed measures of health in older people 122 (122) Respiratory system Petrillo (2011) Asthma/COPD Poor EQ-5D To present and discuss the empirical evidence on the validity of generic multi attribute utility instruments within the 22 (22)
Table 3.2 Main EQ-5D, SF-6D and HUI 3 results Authors Condition examined or population examined Known groups Convergent validity Responsiveness EQ-5D SF-6D HUI III EQ-5D SF-6D HUI III EQ-5D SF-6D HUI III Disease Area/Population Autoimmune system Castelino (2013) Systemic Lupus Erythematosus N/R ✓ ± N/R ✓ ✓ N/R Holloway (2014) Systemic Lupus Erythematosus ✓ N/R N/R ✓ N/R N/R N/R N/R Cardiovascular system Dyer (2010) Cardiovascular diseases ✓✗ ✓✗ Ear Yang (2013) Hearing impairment ✗ ✓/ ✓ ✓✓// ✓✗✗✗ Endocrine, nutritional and metabolic system Janssen (2011) Type 2 Diabetes ✓✗ N/R N/R Speight Diabetes N/R N/R N/R N/R ✗ N/R N/R ✗✗ ✓✗/ ✓✓✓✓
(2009) Eye Tosh (2012) Visual disorders ✓ ✓✓ ✓ ✓ ✓±✗ ✓ Genito-urinary system Davis and Wailoo (2013) Urinary Incontinence ✓ N/R N/R N/R Wu (2013) HIV ✓ N/R N/R N/R N/R N/R N/R Gynaecological problems Sanghera (2013) Menorrhagia ✓ N/R N/R N/R N/R ✗ N/R N/R Haematological problems Szende(2003) Haemophilia ✓✓ N/R ✓ ✓ N/R N/R ±±✗✗
Musculoskeletal system Bansback (2008) Rheumatoid arthritis ✓ ✓ ✓ DeVine (2011) Chronic Low Back Pain N/R N/R / N/R N/R / N/R N/R Hill (2010) Spinal Cord Injury N/R N/R N/R N/R N/R ✓ N/R Whitehurst (2012) Spinal Cord Injury ✓ Mental Health Brazier (2014) Bipolar disorder ✓✓✗ N/R N/R N/R N/R N/R N/R Papaioannou (2013) Personality Disorder ✓✓✗ N/R N/R ±± N/R N/R ✓✓/ N/R N/R Papaioannou (2011) Schizophrenia ✓ N/R ✗ N/R N/R Peasgood (2012) Depression and Anxiety ✓✓✓ ✓✓± ✓ ✓± ✓ ✓✓✓ Hounsome (2011) Dementia N/R N/R ✓ N/R Neoplasm Longworth (2014) Cancer (various) ✗ ✓
Pickard (2008) Cancer (various) N/R N/R ✓ N/R N/R ✓✓ N/R N/R Nervous system Kuspinar and Mayo (2014) Multiple Sclerosis ± ✓ ✓✓ ✓ Nose Linder (2003) Rhino sinusitis N/R N/R N/R N/R ✗ N/R N/R Others Ching (2003) Aestetic surgery N/R N/R N/R N/R ± N/R N/R Derrett (2009) Injuries N/R N/R N/R N/R ✗ N/R N/R Haywood (2005) Older population N/R N/R / N/R N/R ✓ N/R N/R Respiratory system Petrillo (2011) COPD ✓± N/R N/R N/R N/R ✓✓✓ N/R N/R Pickard (2007) COPD and Asthma N/R ✓ N/R ✓✗✗✗ N/R
Study ID Main report Objective Methods used for identifying bolt-on dimensions Bolt-on tested Sample size Methods used for testing bolt-on dimensions Impact of bolt-on 1 Gudex (1991) To investigate the impact of including an energy/ tiredness dimension to the 3L version of the EQ-5D Previous large scale survey Energy 340 Comparison of health status based on VAS for EQ-5D with and EQ-5D without bolt-on No impact 2 Krabbe et al (1999) To investigate the impact of adding a cognitive dimension to the 3L version of the EQ-5D Expert opinion of a Dutch group of experts Cognition 87 Comparison of health state values for paired health states based on VAS with and without bolt-on using T tests Impact
5 Swinburn et al (2013) To test and value a disease specific version of the 5L version of the EQ-5D Literature review highlighting inconclusive psychometric evidence for the EQ-5D in dermatological conditions, a literature review to understand the aspects of health that impacted the condition of interest and qualitative interviews to assess whether expert in the field and patients agreed on the importance of these aspects Skin irritation and self confidence 300 Comparison of health state values for paired health states based on TTO with and without bolt-on Impact 6 Hogendoorn et al (2016) To test the impact of two respiratory bolt-ons on the 5L version of the EQ-5D Literature review highlighting poor responsiveness and face validity of the EQ-5D in patients affected by COPD Breathing 430 Comparisons of health state values for paired health states based on TTO and DCE with and without bolt-ons using T tests and Chi square tests Impact
Table 4.1 – Content analysis based on Wilson and Cleary model Symptom status Physical symptoms Measure Psychological symptoms Measure Pain EQ-5D pain/discomfort SF-6D pain HUI 3 pain 15 D discomfort / symptoms AQoL 8D frequency of pain AQoL 8D intensity of pain AQoL 8D pain inter usual act* Other items 15 D breathing GPBM GPBM GPBM GPBM GPBM GPBM GPBM GPBM Anxiety/depression EQ-5D anx/depression 15 D depression 15 D distress AQoL 8D calmness AQoL 8D depression AQoL 8D worry ONS anxiety yesterday Coping AQoL 8D worthlessness AQoL 8D self harm AQoL 8D feel control life AQoL 8D freq despair AQoL 8D coping Isolation and exclusion AQoL 8D social exc* AQoL 8D social isol* Other items SF-6D mental health AQoL 8D freq sadness AQoL 8D freq anger GPBM GPBM GPBM GPBM GPBM GPBM SWBM GPBM GPBM GPBM GPBM GPBM GPBM GPBM GPBM GPBM GPBM
AQoL 8D feeling burden * GPBM Functioning status Physical functioning Measure Psychological functioning Measure Independent living/self care EQ-5D self care 15 D eating AQoL 8D get help out house AQoL 8D need help house job AQoL 8D washing yourself ICECAP being independent Ambulation EQ-5D mobility SF-6D physical functioning HUI 3 ambulation 15 D mobility AQoL 8D mobility Senses HUI 3 vision HUI 3 hearing 15 D vision 15 D hearing AQoL 8D vision AQoL 8D hearing Usual activities GPBM GPBM GPBM GPBM GPBM SWBM GPBM GPBM GPBM GPBM GPBM GPBM GPBM GPBM GPBM GPBM GPBM Energy SF-6D vitality* 15 D vitality* AQoL 8D energy* Other items HUI 3 cognition* 15 D mental function GPBM GPBM GPBM GPBM GPBM
General health perception Measure Overall quality of life (happiness, satisfaction and subjective wellbeing) Measure PWI satisfaction health SWBM Contentment with life HUI 3 emot (happy life) AQoL 8D cont life PWI sat life as a whole PWI sat standard of living SWLS life close ideal SWLS cond life excelent SWLS satisfaction life SWLS changing life over ONS satisfied with life Purposefulness PWI sat achievement SWLS got import things ICECAP achievement ONS life worthwhile Happiness AQoL 8D happiness AQoL 8D pleasure ICECAP enjoy pleasure ONS happiness yesterday Safety GPBM GPBM SWBM SWBM SWBM SWBM SWBM SWBM SWBM SWBM SWBM SWBM SWBM GPBM GPBM SWBM SWBM
AQoL 8D frequency worthlessness .734 ONS Anxiety yesterday .712 -.300 AQoL 8D calmness or agitation .656 AQoL 8D anger .608 AQoL 8D self harm .591 AQoL 8D coping with life problems .578 AQoL 8D burden to others .393 .529 SF-6D social functioning .489 .528 AQoL 8D feeling in control of life .514 AQoL 8D confidence .508 HUI 3 emotion .500 AQoL 8D happiness ✓ .439 .350 ICECAP Feeling settled and secure ✓ .366
AQoL 8D contentment with life ✓ .339 PWI satisfaction standard of living ✓ .899 ONS satisfaction life ✓ .889 PWI satisfaction life as a whole ✓ .858 PWI satisfaction future security ✓ .829 PWI satisfaction achievement ✓ .826 SWLS satisfaction with life ✓ .825 SWLS conditions life excellent ✓ .823 SWLS life close to ideal ✓ .779 SWLS gotten important things in life ✓ .776 ONS things you do are worthwhile ✓ .747 PWI satisfaction with safety ✓ .736 ONS happiness yesterday ✓ .681
ICECAP love, friendship and support ✓ .831 AQoL 8D close relationships (family) ✓ .800 AQoL 8D enjoyment close relationship ✓ .680 AQoL 8D frequency pleasure ✓ .501 AQoL 8D social isolation ✓ .421 .453 AQoL 8D social exclusion ✓ .408 .448 ICECAP enjoyment and pleasure ✓ .445 15 D speech ✓ .763 15 D eating ✓ .693 HUI 3 speech ✓ .677 15D mental function ✓ .535 .514 HUI 3 cognition ✓ .474 .434 HUI 3 dexterity ✓ .304 .461
AQoL 8D communication ✓ .449 15 D hearing ✓ .869 AQoL 8D hearing ✓ .852 HUI 3 hearing ✓ .815 AQoL 8D energy ✓ .688 SF-6D vitality ✓ .302 .600 AQoL 8D sleeping ✓ .388 .524 15 D sleeping ✓ .398 .504 15 D vitality ✓ .477 AQoL 8D enthusiasm ✓ .440 15 D elimination ✓ .412 AQoL 8D vision ✓ .911 15D vision ✓ .863
SWLS gotten important things in life ✓ -.768 ONS things you do are worthwhile ✓ -.679 PWI satisfaction with safety ✓ -.638 PWI satisfaction personal relations ✓ -.605 -.470 ONS happiness yesterday ✓ -.367 -.579 PWI satisfaction community ✓ -.591 SWLS changing life over ✓ -.591 PWI satisfaction with health ✓ -.485 PWI satisfaction with spirituality ✓ -.400 EQ-5D pain/discomfort .370 .711 AQoL 8D intensity pain/discomfort .709 HUI 3 pain .411 .649 15 D discomfort and symptoms 376 .595
AQoL 8D frequency serious pain .385 .578 SF-6D Pain .433 .530 AQoL 8D pain interference with usual .476 .487 AQoL 8D enjoyment close relationship ✓ .745 AQoL 8D close relationships (family) ✓ .714 ICECAP love, friendship and support ✓ .699 AQoL 8D close relationships (including sexual) ✓ .559 AQoL 8D frequency pleasure ✓ .315 ICECAP enjoyment and pleasure ✓ .313 15 D speech ✓ .748 HUI 3 speech ✓ .705
15 D eating ✓ .512 15D mental function ✓ .493 .296 AQoL 8D communication ✓ .450 HUI 3 cognition ✓ .434 .328 15 D hearing ✓ .859 AQoL 8D hearing ✓ .711 HUI 3 hearing ✓ .681 AQoL 8D energy ✓ .723 SF-6D vitality ✓ .630 AQoL 8D enthusiasm ✓ .530 15 D vitality ✓ .313 .413 AQoL 8D sleeping ✓ .361 ICECAP achievement and progress ✓ .337
SF-6D role 0.485 (0.015) 0.351 (0.016) SF-6D social functioning 0.449 (0.014) 0.433 (0.014) AQoL 8D pain interference with usual 0.286 (0.018) 0.667 (0.017) 15 D depression 0.929 (0.004) AQoL 8D frequency depression 0.911 (0.004) AQoL 8D happiness 0.899 (0.005) EQ-5D anxiety/depression 0.896 (0.005) AQoL 8D sadness 0.893 (0.004)
AQoL 8D frequency worthlessness 0.873 (0.006) AQoL 8D feeling of despair 0.866 (0.007) AQoL 8D feeling in control of life 0.856 (0.006) AQoL 8D coping with life problems 0.848 (0.007) 15 D distress 0.844 (0.007) SF-6D mental health 0.797 (0.007) AQoL 8D frequency worry 0.793 (0.007) AQoL 8D confidence 0.760 (0.008)
SWLS gotten important things in life ✓ 0.777 (0.008) ONS things you do are worthwhile ✓ 0.824 (0.009) SWLS changing life over ✓ 0.700 (0.011) ONS happiness yesterday ✓ 0.830 (0.010) PWI satisfaction personal relations ✓ 0.652 (0.013) 0.025 (0.027) PWI satisfaction community ✓ 0.642 (0.013) PWI satisfaction with safety ✓ 0.634 (0.013) PWI satisfaction future security ✓ 0.725 (0.012)
HUI 3 cognition ✓ 0.440 (0.024) 0.392 (0.022) 15D vision ✓ 0.918 (0.020) AQoL 8D vision ✓ 0.815 (0.016) HUI 3 vision ✓ 0.540 (0.025) 15 D vitality ✓ 0.925 (0.005) AQoL 8D enthusiasm ✓ 0.297 (0.024) -0.071 (0.017) 0.298 (0.021) 0.222 (0.023) AQoL 8D energy ✓ 0.853 (0.006) SF-6D vitality ✓ 0.796 (0.009)
15 D sleeping ✓ 0.696 (0.011) AQoL 8D sleeping 0.676 (0.011) Note: * loadings not statistically significant at 0.01 level; ✓identified bolt-ons using CFA. Table 4.5 – CFA factor correlation matrix estimates (standard errors) Component Physical functioning Psychological symptoms Satisfaction Pain Relationships Speech /Cognition Hearing Energy / Sleep Vision Physical functioning 1.000 0.495 (0.014) -0.365 (0.016) 0.836 (0.008) 0.438 (0.016) 0.473 (0.023) 0.334 (0.020) 0.750 (0.009) 0.479 (0.018) Psychological symptoms 0.495 (0.014) 1.000 -0.724 (0.008) 0.428 (0.015) 0.827 (0.007) 0.522 (0.021) 0.161 (0.019) 0.796 (0.007) 0.298 (0.019) Satisfaction -0.365 (0.016) -0.724 (0.008) 1.000 -0.317 (0.016) -0.739 (0.009) -0.302 (0.023) -0.105 (0.020) -0.613 (0.012) -0.237 (0.019) Pain 0.836 (0.008) 0.428 (0.015) -0.317 (0.016) 1.000 0.353 (0.016) 0.342 (0.024) 0.268 0.695 0.393
(0.019) (0.010) (0.018) Relationships 0.438 (0.016) 0.827 (0.007) -0.739 (0.009) 0.353 (0.016) 1.000 0.460 (0.022) 0.207 (0.020) 0.697 (0.011) 0.307 (0.019) Speech / Cognition 0.473 (0.023) 0.522 (0.021) -0.302 (0.023) 0.342 (0.024) 0.460 (0.022) 1.000 0.586 (0.024) 0.421 (0.023) 0.458 (0.025) Hearing 0.334 (0.020) 0.161 (0.019) -0.105 (0.020) 0.268 (0.019) 0.207 (0.020) 0.586 (0.024) 1.000 0.245 (0.020) 0.465 (0.019) Energy / Sleep 0.750 (0.009) 0.796 (0.007) -0.613 (0.012) 0.695 (0.010) 0.697 (0.011) 0.421 (0.023) 0.245 (0.020) 1.000 0.406 (0.018) Vision 0.479 (0.018) 0.298 (0.019) -0.237 (0.019) 0.307 (0.019) 0.307 (0.019) 0.458 (0.025) 0.465 (0.019) 0.406 (0.018) 1.000
PWI satisfaction life as a whole PWI satisfaction personal relationships PWI satisfaction standard of living PWI satisfaction with health PWI satisfaction with safety PWI satisfaction with spirituality PWI satisfaction life as a whole PWI satisfaction personal relationships PWI satisfaction standard of living PWI satisfaction with health PWI satisfaction with safety PWI satisfaction with spirituality PWI satisfaction life as a whole PWI satisfaction personal relationships PWI satisfaction standard of living PWI satisfaction with health PWI satisfaction with safety PWI satisfaction with spirituality SWLS SWLS changing life over SWLS conditions life excellent SWLS gotten important things in life SWLS life close to ideal SWLS satisfaction with life SWLS changing life over SWLS conditions life excellent SWLS gotten important things in life SWLS life close to ideal SWLS satisfaction with life SWLS changing life over SWLS conditions life excellent SWLS gotten important things in life SWLS life close to ideal SWLS satisfaction with life ICECAP ICECAP achievement and progress ICECAP enjoyment and ICECAP achievement and progress ICECAP enjoyment and ICECAP achievement and progress ICECAP enjoyment and
AQoL close relationships (including sexual) [Your close and intimate relationships (including any sexual relationships) make you:] Very happy 15D 15D vision I see normally, i.e. I can read newspapers and TV text without difficulty (with or without glasses) 15 D hearing I can hear normally, i.e. normal speech (with or without a hearing aid) 15 D sleeping I am able to sleep normally, i.e. I have no problems with sleeping 15 D speaking I am able to speak normally, i.e. clearly, audibly and fluently 15 D mental function I am able to think clearly and logically, and my memory functions well 15 D vitality I feel healthy and energetic ICECAP ICECAP Love and support I can have a lot of love, friendship, and support ONS ONS satisfaction with life [Overall, how satisfied are you with your life nowadays?] Completely satisfied ONS life is worthwhile [Overall, to what extent do you feel that the things you do in your life are worthwhile?] Completely worthwhile ONS happiness yesterday [Overall, how happy did you feel yesterday?] Completely happy PWI PWI satisfaction with life as a whole [Thinking about your own life and personal circumstances, how satisfied are you with your life as a whole?] Completely satisfied PWI satisfaction [How satisfied are you with
(including sexual) 4 AQoL close relationships (including sexual) 5 -11.277** 1.365 ICECAP Love and support 1 (Omitted) (Omitted) ICECAP Love and support 2 -1.468** .420 ICECAP Love and support 3 -5.282** .604 ICECAP Love and support 4 -7.657** 1.561 Satisfaction SWLS satisfaction with life 1 (Omitted) (Omitted) SWLS satisfaction with life 2 -3.511** .680 SWLS satisfaction with life 3 -7.887** .721 SWLS satisfaction with life 4 -12.342** .819 SWLS satisfaction with life 5 -14.587** .828 SWLS satisfaction with life 6 -19.591** .891 SWLS satisfaction with life 7 -24.868** 1.145 PWI satisfaction standard of living 1 (Omitted) (Omitted) PWI satisfaction standard of living 2 -1.010 .811 PWI satisfaction standard of living 3 -2.830** .751 PWI satisfaction standard of living 4 -6.449** .776 PWI satisfaction standard of living 5 -8.040** .844 PWI satisfaction standard -10.477** .870
of living 6 PWI satisfaction standard of living 7 -9.834** .937 PWI satisfaction standard of living 8 -12.078** .993 PWI satisfaction standard of living 9 -14.152** 1.108 PWI satisfaction standard of living 10 -12.871** 1.402 PWI satisfaction standard of living 11 -11.483** 1.438 Vision AQoL vision 1 (Omitted) (Omitted) AQoL vision 2 -2.390** .494 AQoL vision 3 -4.070** .548 AQoL vision 4 -8.383** 1.513 AQoL vision 5 -33.079* 11.450 AQoL vision 6 14.274 8.131 15 D vision 1 (Omitted) (Omitted) 15 D vision 2 -2.286** .458 15 D vision 3 -3.653** 1.062 15 D vision 4 -1.448 1.595 15 D vision 5 -1.779 5.148 Speech / Cognition HUI 3 cognition 1 (Omitted) (Omitted) HUI 3 cognition 2 -3.022** .674 HUI 3 cognition 3 -3.674** .560 HUI 3 cognition 4 -4.940** 1.056 HUI 3 cognition 5 -7.719** 1.993 HUI 3 cognition 6 5.787 4.269 HUI 3 speech 1 (Omitted) (Omitted) HUI 3 speech 2 -1.445 .749
Table 5.5 – β coefficients, statistical significance and standard errors of a model with chronic conditions but without the EQ-5D dimensions (Health VAS dependent variable) Variables β coefficients Standard error Constant 82.670** 1.023 Age 18-24 (Omitted) (Omitted) Age 25-34 -.140 1.071 Age 35-44 -2.998* 1.041 Age 45-54 -3.945** 1.002 Age 55-64 -2.215 1.002 Age >65 2.740* 1.027 Highschool education (Omitted) (Omitted) Diploma education 1.541* .515 University education 4.566 .565 Male (Omitted) (Omitted) Female 1.266* .448 Cancer -24.177** .860 Asthma -16.431** .814
COPD -35.270** 2.415 Depression -28.860** .799 Diabetes -22.010** .808 Hearing problems -11.405** .830 Arthritis -20.002** .809 Heart diseases -22.847** .810 Stroke -37.283** 4.019 R2 0.483 Note: * P≤0.05; ** P≤0.01
Table 5.7 Changes in chronic condition β coefficients after factor were included individually (three items per factor) Factors – change in coefficients Chronic conditions Base model coefficients Satisfaction Relationships Hearing Vision Speech/ Cognition Energy/ Sleep Cancer -14.008 0.045 0.067 -0.069 -0.397 -0.070 0.005 Asthma -9.587 0.019 0.048 -0.040 -0.206 -0.042 -0.003 COPD -15.570 -0.617 0.294 -0.093 -0.436 -0.115 0.638 Depression -11.123 0.037 0.053 -0.055 -0.863 -0.055 -0.022 Diabetes -12.565 0.062 0.053 -0.074 -0.503 -0.071 -0.050 Hearing Problems -6.890 -0.014 0.031 -0.009 -0.274 -0.014 0.027 Arthritis -7.731 0.003 0.039 0.026 -0.060 -0.029 0.010 Heart diseases -13.323 0.047 0.063 -0.069 -0.322 -0.069 -0.030 Stroke -20.651 1.735 0.010 -0.589 -2.623 -0.580 -1.561 Note: Bold indicates reduction in b coefficients ≥0.5. All coefficients were statistically significant at p≤0.05.
Table 5.8 Changes in chronic condition coefficients after items were included individually (three items per factor presented) Factors on which items loaded Satisfaction Relationships Items (change in coefficients) Chronic condition Base model coefficients ONS Life SWLS Condition life SWLS Live life over ICECAP Love, friendship support AQoL close rel (family friends) AQoL close rel (sexual) Cancer -14.008 -0.841 -0.943 0.138 0.107 0.174 -0.066 Asthma -9.587 -0.259 -0.513 0.065 0.008 -0.089 0.073 COPD -15.570 -0.537 0.036 0.176 0.179 0.213 0.062 Depression -11.123 -0.598 -0.883 -0.591 -0.138 -0.677 -0.537 Diabetes -12.565 -0.888 -0.832 -0.170 0.070 -0.118 -0.139 Hearing Problems -6.890 -0.284 0.045 0.155 -0.074 -0.231 -0.106 Arthritis -7.731 -0.223 -0.177 -0.165 0.097 -0.02 0.248 Heart -13.323 -0.537 -0.512 0.085 0.020 0.027 0.111 Stroke -20.651 -2.582 -3.519 -1.648 -1.010 0.009 -0.473 Note: Bold indicates reduction in b coefficients ≥0.5. All coefficients remained statistically significant at p≤0.05.
Table 5.8 (continued) Factors on which items loaded Energy / Sleep Vision Items (change in coefficients) Chronic conditions Base model coefficients AQoL energy SF6D vitality AQoL sleeping AQoL Vision HUI3 Vision 15D Vision Cancer -14.008 -1.802 -1.048 -0.434 -0.194 -0.023 -0.052 Asthma -9.587 -1.618 -1.02 -0.439 -0.218 -0.043 -0.038 COPD -15.570 -3.059 -2.187 -0.451 -0.284 -0.043 0.058 Depression -11.123 -2.836 -1.975 -0.807 -0.098 -0.101 0.052 Diabetes -12.565 -1.914 -1.16 -0.459 -0.323 -0.139 -0.149 Hearing Problems -6.890 -1.194 -0.561 -0.296 -0.364 -0.184 -0.208 Arthritis -7.731 -0.907 -0.427 -0.477 -0.187 -0.055 -0.004 Heart -13.323 -2.284 -1.363 -0.444 -0.208 -0.063 -0.057 Stroke -20.651 -2.401 -0.265 -0.484 -0.832 -0.751 -0.477 Note: Bold indicates reduction in b coefficients ≥0.5. All coefficients remained statistically significant at p≤0.05.
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Appendices Chapter 3 Table I – Searching strategy for Medline Search Searching terms #1 validity OR responsiveness OR “psychometric characteristic$” OR “psychometric aspect$” OR “psychometric propert$” #2 “Preference based instrument$” OR “preference based measure$” OR “multi-attribute utility instrument$” OR “generic adj instrument$” OR “multi adj instrument$” OR “patient reported outcome$” OR “PROMS” OR “PROM” #3 euroqol OR “euro qol” OR “eq5d” OR “eq 5d” OR “eq-5d” OR “euro adj qol” OR “eur adj qual” OR “eq adj 5d[tw]” #4 sf6D OR “sf 6D” OR “short form 6D” OR “shortform 6D” OR “sf six D” OR “sfsixD” OR “shortform six D” OR “short form sixD” OR OR 6d OR 6-d OR “6 dimension[tw]” #5 “hui3” OR “hui 3” OR “health utilities index mark 3” OR “health utilities mark three” OR “hui III” OR “hui mk III” OR huiIII[tw] #6 “15D instrument” OR “fifteen D instrument” OR “fifteen dimension instrument” OR “15 dimension instrument” OR “15dimension instrument” #7 “Assessment of Quality of Life” OR AQOL OR
Peasgood Depression/ Anxiety Good EQ5D 3 Severity In one study EQ5D presented significant differences in values according to the severity levels measured by the severity of illness scale (p N/R). Similar results were found in another study, but differences were not statistically significant between moderate and severe cases. In a third study EQ5D scores decreased as anxiety symptom severity increased (measured by Hospital Anxiety and Depression Scale), with statistically significant results for all levels but normal versus mild. 3 Different types of In one study EQ5D distinguished between single and recurrent depression but differences were not statistically significant while results were statistically significant for the physical component of SF36. In one study EQ5D values were different depending on the type of depressive disorder (p N/R). In another EQ5D values differed according to whether patients had major depressive disorder, anxiety, both or none (p N/R).
measures. In a third study comparing laser versus resection therapy, only one outcome (maximum flow) presented significant differences in favour of resection. Also EQ5D reported greater gains for resection than laser therapy (p value N/A). In a fourth study, while the number of leaks avoided did not show any significant reduction for the three comparisons between active treatment arms, EQ5D showed statistically significant gains for 2 of three comparisons (p<0.05) Devine Chronic Low Back Pain Poor EQ5D Effect size The pooled mean effect size for the EQ5D was 0.78 +- 0.12. Haywood Older population Poor EQ5D 1 Difference between treatment arms One study reported that EQ5D had the ability to discriminate over treatment groups (p N/R) Hill Spinal Cord Injury Poor SF6D 1 Difference between treatment arms In one study it was reported that SF6D could discriminate between the two groups (p values N/R). Janssen Diabetes type 2 Good EQ5D 4 Change over time In one study a significant decline in health over a 2 years period was found for the EQ5D index (f=5.97, p=0.003) and the
3 PWI satisfaction with life as a whole 4 -8.823** .829 PWI satisfaction with life as a whole 5 -12.252** .911 PWI satisfaction with life as a whole 6 -12.376** .916 PWI satisfaction with life as a whole 7 -15.976** 1.043 PWI satisfaction with life as a whole 8 -19.238** 1.060 PWI satisfaction with life as a whole 9 -21.300** 1.149 PWI satisfaction with life as a whole 10 -19.737** 1.558 PWI satisfaction with life as a whole 11 -22.271** 1.604 Satisfaction SWLS satisfaction with life 1 (omitted) (omitted) SWLS satisfaction with life 2 -3.511** .680 SWLS satisfaction with life 3 -7.887** .721 SWLS satisfaction with life 4 -12.342** .819 SWLS satisfaction with life 5 -14.587** .828 SWLS satisfaction with life 6 -19.591** .891 SWLS satisfaction with life 7 -24.868** 1.145 Satisfaction SWLS condition of life are excellent 1 (omitted) (omitted) SWLS condition of life are excellent 2 -3.293** .821 SWLS condition of life are excellent 3 -6.843** .828
SWLS condition of life are excellent 4 -11.123** .884 SWLS condition of life are excellent 5 -14.229** .902 SWLS condition of life are excellent 6 -19.105** .951 SWLS condition of life are excellent 7 -23.262** 1.130 Satisfaction SWLS life close ideal 1 (omitted) (omitted) SWLS life close ideal 2 -2.136 .951 SWLS life close ideal 3 -6.733** .952 SWLS life close ideal 4 -9.657** 1.014 SWLS life close ideal 5 -11.826** 1.031 SWLS life close ideal 6 -17.383** 1.049 SWLS life close ideal 7 -20.917** 1.192 Satisfaction SWLS gotten important things in life 1 (omitted) (omitted) SWLS gotten important things in life 2 -1.909* .623 SWLS gotten important things in life 3 -6.409** .658 SWLS gotten important things in life 4 -8.394** .750 SWLS gotten important things in life 5 -10.542** .781 SWLS gotten important things in life 6 -14.878** .859 SWLS gotten important things in life 7 -17.962** 1.064 Satisfaction ONS life is worthwhile 1 (omitted) (omitted)
ONS happiness yesterday 10 -18.303** 1.203 ONS happiness yesterday 11 -19.570** 1.139 Satisfaction PWI satisfaction personal relationships 1 (omitted) (omitted) PWI satisfaction personal relationships 2 -1.220 .611 PWI satisfaction personal relationships 3 -2.475** .627 PWI satisfaction personal relationships 4 -4.891** .683 PWI satisfaction personal relationships 5 -5.323** .793 PWI satisfaction personal relationships 6 -7.147** .729 PWI satisfaction personal relationships 7 -8.671** .963 PWI satisfaction personal relationships 8 -10.254** 1.004 PWI satisfaction personal relationships 9 -10.511** 1.059 PWI satisfaction personal relationships 10 -11.847** 1.210 PWI satisfaction personal relationships 11 -13.028** 1.248 Satisfaction PWI satisfaction part of the community 1 (omitted) (omitted) PWI satisfaction part of the community 2 -1.042** .801 PWI satisfaction part of the community 3 -3.284** .753 PWI satisfaction part of the community 4 -5.634** .783