Assessing Quality of Life in a Clinical Study on Heart Rehabilitation Patients: How Well Do Value Sets Based on Given or Experienced Health States Reflect Patients' Valuations?

Overview

Journal Health Qual Life Outcomes

Publisher Biomed Central

Specialty Public Health

Date 2016 Mar 24

PMID 27005466

Citations 6

Authors

Reiner Leidl

Bernd Schweikert

Harry Hahmann

Juergen M Steinacker

Peter Reitmeir

Affiliations

Soon will be listed here.

Abstract

Background: Quality of life as an endpoint in a clinical study may be sensitive to the value set used to derive a single score. Focusing on patients' actual valuations in a clinical study, we compare different value sets for the EQ-5D-3L and assess how well they reproduce patients' reported results.

Methods: A clinical study comparing inpatient (n = 98) and outpatient (n = 47) rehabilitation of patients after an acute coronary event is re-analyzed. Value sets include: 1. Given health states and time-trade-off valuation (GHS-TTO) rendering economic utilities; 2. Experienced health states and valuation by visual analog scale (EHS-VAS). Valuations are compared with patient-reported VAS rating. Accuracy is assessed by mean absolute error (MAE) and by Pearson's correlation ρ. External validity is tested by correlation with established MacNew global scores. Drivers of differences between value sets and VAS are analyzed using repeated measures regression.

Results: EHS-VAS had smaller MAEs and higher ρ in all patients and in the inpatient group, and correlated best with MacNew global score. Quality-adjusted survival was more accurately reflected by EHS-VAS. Younger, better educated patients reported lower VAS at admission than the EHS-based value set. EHS-based estimates were mostly able to reproduce patient-reported valuation. Economic utility measurement is conceptually different, produced results less strongly related to patients' reports, and resulted in about 20 % longer quality-adjusted survival.

Conclusion: Decision makers should take into account the impact of choosing value sets on effectiveness results. For transferring the results of heart rehabilitation patients from another country or from another valuation method, the EHS-based value set offers a promising estimation option for those decision makers who prioritize patient-reported valuation. Yet, EHS-based estimates may not fully reflect patient-reported VAS in all situations.

Citing Articles

Patient characteristics and valuation changes impact quality of life and satisfaction in total knee arthroplasty - results from a German prospective cohort study.

Felix J, Becker C, Vogl M, Buschner P, Plotz W, Leidl R Health Qual Life Outcomes. 2019; 17(1):180.

PMID: 31815627 PMC: 6902559. DOI: 10.1186/s12955-019-1237-3.

Comparison of health state utility estimates from instrument-based and vignette-based methods: a case study in kidney disease.

Briggs A, Belozeroff V, Feeny D BMC Res Notes. 2019; 12(1):385.

PMID: 31286995 PMC: 6615078. DOI: 10.1186/s13104-019-4413-y.

People in states worse than dead according to the EQ-5D UK value set: would they rather be dead?.

Bernfort L, Gerdle B, Husberg M, Levin L Qual Life Res. 2018; 27(7):1827-1833.

PMID: 29616427 PMC: 5997722. DOI: 10.1007/s11136-018-1848-x.

Experience-Based Values: A Framework for Classifying Different Types of Experience in Health Valuation Research.

Cubi-Molla P, Shah K, Burstrom K Patient. 2018; 11(3):253-270.

PMID: 29305706 DOI: 10.1007/s40271-017-0292-2.

International comparison of experience-based health state values at the population level.

Heijink R, Reitmeir P, Leidl R Health Qual Life Outcomes. 2017; 15(1):138.

PMID: 28683747 PMC: 5501450. DOI: 10.1186/s12955-017-0694-9.

References

Vogl M, Leidl R, Plotz W, Gutacker N . Comparison of pre- and post-operative health-related quality of life and length of stay after primary total hip replacement in matched English and German patient cohorts. Qual Life Res. 2014; 24(2):513-20. DOI: 10.1007/s11136-014-0782-9. View

Dixon T, Lim L, Oldridge N . The MacNew heart disease health-related quality of life instrument: reference data for users. Qual Life Res. 2002; 11(2):173-83. DOI: 10.1023/a:1015005109731. View

Muche R, Imhof A . [The Comprehensive Cohort Design as alternative to the randomized controlled trial in rehabilitation research: advantages, disadvantages, and implementation in the SARAH study]. Rehabilitation (Stuttg). 2003; 42(6):343-9. DOI: 10.1055/s-2003-45457. View

Torrance G . Measurement of health state utilities for economic appraisal. J Health Econ. 1986; 5(1):1-30. DOI: 10.1016/0167-6296(86)90020-2. View

Schweikert B, Hahmann H, Leidl R . Validation of the EuroQol questionnaire in cardiac rehabilitation. Heart. 2005; 92(1):62-7. PMC: 1860985. DOI: 10.1136/hrt.2004.052787. View

Parkin D, Devlin N . Is there a case for using visual analogue scale valuations in cost-utility analysis?. Health Econ. 2006; 15(7):653-64. DOI: 10.1002/hec.1086. View

Konig H, Bernert S, Angermeyer M, Matschinger H, Martinez M, Vilagut G . Comparison of population health status in six european countries: results of a representative survey using the EQ-5D questionnaire. Med Care. 2009; 47(2):255-61. DOI: 10.1097/MLR.0b013e318184759e. View

Weinstein M, Torrance G, McGuire A . QALYs: the basics. Value Health. 2009; 12 Suppl 1:S5-9. DOI: 10.1111/j.1524-4733.2009.00515.x. View

Knies S, Evers S, Candel M, Severens J, Ament A . Utilities of the EQ-5D: transferable or not?. Pharmacoeconomics. 2009; 27(9):767-79. DOI: 10.2165/11314120-000000000-00000. View

10.

Greiner W, Claes C, Busschbach J, von der Schulenburg J . Validating the EQ-5D with time trade off for the German population. Eur J Health Econ. 2009; 6(2):124-30. DOI: 10.1007/s10198-004-0264-z. View

11.

Schweikert B, Hahmann H, Steinacker J, Imhof A, Muche R, Koenig W . Intervention study shows outpatient cardiac rehabilitation to be economically at least as attractive as inpatient rehabilitation. Clin Res Cardiol. 2009; 98(12):787-95. DOI: 10.1007/s00392-009-0081-6. View

12.

Dyer M, Goldsmith K, Sharples L, Buxton M . A review of health utilities using the EQ-5D in studies of cardiovascular disease. Health Qual Life Outcomes. 2010; 8:13. PMC: 2824714. DOI: 10.1186/1477-7525-8-13. View

13.

Gandjour A . Theoretical foundation of patient v. population preferences in calculating QALYs. Med Decis Making. 2010; 30(4):E57-63. DOI: 10.1177/0272989X10370488. View

14.

Steinacker J, Liu Y, Muche R, Koenig W, Hahmann H, Imhof A . Long term effects of comprehensive cardiac rehabilitation in an inpatient and outpatient setting. Swiss Med Wkly. 2011; 141:w13141. DOI: 10.57187/smw.2011.13141. View

15.

Devlin N, Tsuchiya A, Buckingham K, Tilling C . A uniform time trade off method for states better and worse than dead: feasibility study of the 'lead time' approach. Health Econ. 2011; 20(3):348-61. DOI: 10.1002/hec.1596. View

16.

Bernert S, Fernandez A, Haro J, Konig H, Alonso J, Vilagut G . Comparison of different valuation methods for population health status measured by the EQ-5D in three European countries. Value Health. 2009; 12(5):750-8. DOI: 10.1111/j.1524-4733.2009.00509.x. View

17.

Leidl R, Reitmeir P . A value set for the EQ-5D based on experienced health states: development and testing for the German population. Pharmacoeconomics. 2011; 29(6):521-34. DOI: 10.2165/11538380-000000000-00000. View

18.

Leidl R, Reitmeir P, Konig H, Stark R . The performance of a value set for the EQ-5D based on experienced health states in patients with inflammatory bowel disease. Value Health. 2012; 15(1):151-7. DOI: 10.1016/j.jval.2011.08.004. View

19.

Hunger M, Sabariego C, Stollenwerk B, Cieza A, Leidl R . Validity, reliability and responsiveness of the EQ-5D in German stroke patients undergoing rehabilitation. Qual Life Res. 2011; 21(7):1205-16. DOI: 10.1007/s11136-011-0024-3. View

20.

Burstrom K, Sun S, Gerdtham U, Henriksson M, Johannesson M, Levin L . Swedish experience-based value sets for EQ-5D health states. Qual Life Res. 2013; 23(2):431-42. PMC: 3967073. DOI: 10.1007/s11136-013-0496-4. View