Comparison of the Minimally Important Difference for Two Health State Utility Measures: EQ-5D and SF-6D

Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, UK.
Quality of Life Research (Impact Factor: 2.49). 09/2005; 14(6):1523-32. DOI: 10.1007/s11136-004-7713-0
Source: PubMed


The SF-6D and EQ-5D are both preference-based measures of health. Empirical work is required to determine what the smallest change is in utility scores that can be regarded as important and whether this change in utility value is constant across measures and conditions.
To use distribution and anchor-based methods to determine and compare the minimally important difference (MID) for the SF-6D and EQ-5D for various datasets.
The SF-6D is scored on a 0.29-1.00 scale and the EQ-5D on a -0.59-1.00 scale, with a score of 1.00 on both, indicating 'full health'. Patients were followed for a period of time, then asked, using question 2 of the SF-36 as our anchor, if their general health is much better (5), somewhat better (4), stayed the same (3), somewhat worse (2) or much worse (1) compared to the last time they were assessed. We considered patients whose global rating score was 4 or 2 as having experienced some change equivalent to the MID. This paper describes and compares the MID and standardised response mean (SRM) for the SF-6D and EQ-5D from eight longitudinal studies in 11 patient groups that used both instruments.
From the 11 reviewed studies, the MID for the SF-6D ranged from 0.011 to 0.097, mean 0.041. The corresponding SRMs ranged from 0.12 to 0.87, mean 0.39 and were mainly in the 'small to moderate' range using Cohen's criteria, supporting the MID results. The mean MID for the EQ-5D was 0.074 (range -0.011-0.140) and the SRMs ranged from -0.05 to 0.43, mean 0.24. The mean MID for the EQ-SD was almost double that of the mean MID for the SF-6D.
There is evidence that the MID for these two utility measures are not equal and differ in absolute values. The EQ-5D scale has approximately twice the range of the SF-6D scale. Therefore, the estimates of the MID for each scale appear to be proportionally equivalent in the context of the range of utility scores for each scale. Further empirical work is required to see whether or not this holds true for other utility measures, patient groups and populations.

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    • "To study the association between the independent variables (age, gender, country of origin, education, PROM and SOC at baseline) and the primary outcome EQ-5D-index, binary logistic regression analysis was performed. To dichotomize the EQ-5D index, the earlier described minimal clinically important change (MCIC) of 0.1 [34] was used to differentiate either increased or unchanged/decreased (1 = patients with EQ-5D index increased by ≥0.1 and 0 = patients with EQ-5D index decreased or unchanged). The independent variables were also dichotomized and coded as binary variables in age (≤40 years, ≥41), country of origin (Sweden, Table 1 Descriptive statistics for patients' demographics at baseline; n (%). "
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    ABSTRACT: j o u r n a l h o m e p a g e : w w w. S c a n d i n a v i a n J o u r n a l P a i n. c o m • Patients with chronic pain treated at a conventional pain clinic showed high complexity of pain and pain-related problems. • Patients' suffering included very low health-related quality of life, high pain-related disability and insomnia. • One year after a multimodal rehabilitation programme, patients' health-related quality of life, insomnia, pain-related disability and kinesiophobia had significantly improved. • Multimodal rehabilitation at a conventional pain clinic is a successful treatment option. a b s t r a c t Background and aims: Multimodal rehabilitation (MMR) programmes, including, physical training, educational and psychological interventions by an interdisciplinary team are found to be more successful for patients with disabling chronic pain compared with less comprehensive treatments. MMR programmes are based on the biopsychosocial model and the goal is usually to improve function, quality of life and facilitate and enable return to work. As pain clinics traditionally offer conventional medical pain treatment , there is limited knowledge about MMR given in this context. The aim of our study was to describe characteristics of patients with chronic pain, treated with a MMR programme at a conventional pain clinic, to evaluate patient-reported outcome measures (PROM) from start to one year after, and to study possibly associated factors for the improvement of health-related quality of life after one year. Methods: A prospective, observational study with a one-year follow-up was performed. Subjects: A total of 42 individuals (38 females, age 44.0 ± 12.3 years and 4 men age 40 ± 8.5 years) with different pain diagnoses were included. After a team assessment, the patients began a programme that lasted about three months. The MMR programme contained coordinated, individually adapted treatments administered individually or in groups, and was based on cognitive behavioural principles. Questionnaires regarding health-related quality of life (HRQoL) (EQ-5D), insomnia (ISI), mental health (HADS), pain-related disability (PDI), kinesiophobia (TSK), current pain intensity (VAS) and sense of coherence (SOC) were used at the start of the MMR and at follow-up. Demographic data were collected from the patient records. Results: The PROM at baseline showed substantial pain problems with low HRQoL (EQ-5D index of 0.1 ± 0.282, and EQ VAS of 32.67 ± 20.1), moderate insomnia (ISI 18.95 ± 6.7), doubtful cases of depression and anxiety (HADS-depression 9.35 ± 4.1 and HADS-anxiety 9.78 ± 3.95), presence of pain-related disability (PDI 39.48 ±12.64), kinesiophobia (TSK 40.8 ± 9.8), as well as moderate current pain (VAS 61.31 ± 20.4). The sense of coherence was weak (SOC of 51.37 ± 14). At one-year follow-up, significant (p ≤ 0.05) improvement occurred on the EQ-5D index, EQ VAS, ISI, PDI and TSK. In the logistic regression analysis, no significant associations could be identified. Conclusions: MMR for patients with complex pain problems can be a successful treatment alternative at conventional pain clinics. Implications: Since access to rehabilitation clinics in Sweden may be limited, the availability of MMR can increase by providing this type of intervention in pain clinics. Increased knowledge of MMR in different settings can also contribute to increased understanding and collaboration between pain clinics and rehabilitation units.
    Scandinavian Journal of Pain 01/2016; 10(10):36-42. DOI:10.1016/j.sjpain.2015.08.008
    • "Even before objective signs are visible, patients can experience complaints such as heaviness of the leg, itching and cramps and even venous claudication, and these complaints may have a significant impact on daily functioning of patients. Therefore disease specific scores such as the Veines-Qol score [14]and generic scores such as the EQ 5D scores [15] are important tools in the assessment of patients. Even though the Villalta score has its merits, there is room for improvement . "
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    ABSTRACT: Post thrombotic syndrome (PTS) is a very common chronic complication of deep venous thrombosis (DVT), as three out of ten patients with lower extremity DVT will develop PTS. The possibility to identify patients at risk is limited. Diagnosis is challenging, because there is no gold standard diagnostic method. Progress in diagnostic options may therefore change future diagnostic strategies. The better understanding of pathophysiologic processes that underlie PTS may stimulate the development of treatment modalities and improve and diversify management options. The quest for adequate preventive strategies and treatment is important because PTS has a detrimental effect on patients' quality of life and is associated with increased healthcare as well as societal costs. [1,2]The problem of PTS prevention is therefore clearly relevant to patients, doctors as well as policy makers.
    Blood reviews 10/2015; DOI:10.1016/j.blre.2015.09.002 · 5.57 Impact Factor
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    • "Higher scores indicate better health status. Differences in PCS and MCS scores exceeding 3 points are considered minimally important differences, as are SF-6D health utilities differences exceeding 0.03 points (Walters and Brazier, 2005; Maruish, 2011). "
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    ABSTRACT: Objectives Individuals with dementia due to Alzheimer's disease often receive care from family members who experience associated burden. This study provides the first broad, population-based account of caregiving-related health outcome burden in Brazil.Methods Data were analyzed from the 2012 National Health and Wellness Survey in Brazil (n = 12 000), an Internet-based survey of adults (aged 18+ years), using stratified sampling by sex and age to ensure demographic representation of Brazil's adult population. Caregivers of individuals with Alzheimer's disease or dementia were compared with non-caregivers on comorbidities, productivity impairment, health-related quality of life, resource utilization, sociodemographic/health characteristics and behaviors, and Charlson comorbidity index scores. Regression models assessed outcomes associated with caregiving, adjusting for potential confounds.ResultsAmong 10 853 respondents, caregivers' (n = 209) average age was 42.1 years, 53% were female, and 52% were married/living with a partner. Caregivers versus non-caregivers (n = 10 644) were more frequently obese, smokers, insured, employed, college-educated, and wealthier and had higher Charlson comorbidity index, all p < 0.05. Adjusting for covariates, caregiving was associated with significantly increased risk of depressive symptoms (odds ratio [OR] = 2.008), major depressive disorder (OR = 1.483), anxiety (OR = 1.714), insomnia (OR = 1.644), hypertension (OR = 1.584), pain (OR = 1.704), and diabetes (OR = 2.103), all p < 0.015. Caregiving was also associated with lower health utilities (−0.024 points) and mental health status (−1.70 points), higher rates of presenteeism-related impairment (32.7% greater) and overall work impairment (35.9% greater), and higher traditional provider visit rates (28.7% greater), all p < 0.035.Conclusions Caregiver status was found to be a factor associated with worse health outcomes and psychiatric and clinical disorders.
    International Journal of Geriatric Psychiatry 05/2015; DOI:10.1002/gps.4309 · 2.87 Impact Factor
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