Relative Efficiency of the EQ-5D, HUI2, and HUI3 Index Scores in Measuring Health Burden of Chronic Medical Conditions in a Population Health Survey in the United States

Department of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Medical care (Impact Factor: 3.23). 02/2009; 47(1):53-60. DOI: 10.1097/MLR.0b013e31817d92f8
Source: PubMed


We sought to compare the ability of the EQ-5D, Health Utilities Index Mark 2 (HUI2), and HUI Mark 3 (HUI3) index scores to discriminate between respondents based on the presence or absence of chronic medical conditions in a population health survey.
Secondary analyses were conducted with data from a probability sample (n = 3480, mean age: 42.5 years, male: 42.4%, Hispanic: 28.6%) of the 2001 noninstitutionalized US general adult population. F-statistic ratios were used to evaluate the relative efficiency of the EQ-5D, HUI2, and HUI3 in differentiating respondents with or without each of 18 chronic medical conditions, and differentiating respondents with low- or high-burden conditions.
In comparing respondents with and without chronic medical conditions, the F-statistic values of these 3 indices were not significantly different, except for EQ-5D versus HUI2 [mean F-statistic ratio: 0.79, 95% confidence interval (CI): 0.59-0.98]. In comparing respondents with a low-burden condition with those with a high-burden condition, the F-statistic values of EQ-5D and HUI2 index scores were similar, while those for EQ-5D versus HUI3 (mean: 0.79; 95% CI: 0.66-0.92) and for HUI2 versus HUI3 (mean: 0.83; 95% CI: 0.71-0.95) were significantly less than 1.0. The overall ceiling effects of the EQ-5D, HUI2, and HUI3 index scores were 48.9%, 15.4%, and 15.3%, respectively.
Although the EQ-5D seems to be marginally less informative, the EQ-5D, HUI2, and HUI3 index scores were generally comparable in determining health burden of chronic medical conditions in this population health survey data.

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    • "The EQ-5D is a widely used health utility index that can be derived from SF-36 scales [26]. It provides a single general measure of health status that can be used in economic analyses and to track the impact of healthcare interventions, and has been shown to be useful in a number of conditions [27] [28] [29] [30] [31] [32]. "
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    ABSTRACT: Objective: Researchers have identified significant limitations in some currently used measures of health literacy. The purpose of this paper is to present data on the relation of health-related quality of life, health status, and health service utilization to performance on a new measure of health literacy in a nonpatient population. Methods: The new measure was administered to 475 English- and Spanish-speaking community-dwelling volunteers along with existing measures of health literacy and assessments of health-related quality of life, health status, and healthcare service utilization. Relations among measures were assessed via correlations and health status and utilization was tested across levels of health literacy using ANCOVA models. Results: The new health literacy measure is significantly related to existing measures of health literacy as well as to participants' health-related quality of life. Persons with lower levels of health literacy reported more health conditions, more frequent physical symptoms, and greater healthcare service utilization. Conclusion: The new measure of health literacy is valid and shows relations to measures of conceptually related constructs such as quality of life and health behaviors. Practice implications: FLIGHT/VIDAS may be useful to researchers and clinicians interested in a computer administered and scored measure of health literacy.
    Full-text · Article · May 2014 · Patient Education and Counseling
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    • "The magnitude of score changes reported in the literature were used to assess whether effect sizes reached or exceeded the minimal clinically important differences (MCID) for each measure: EQ-5D utility score—0.03 to 0.07 [20,21]; I-QOL subscales—4 to 11 [13]; OAB-q HRQoL score—5 [22,23]; OAB-q symptom severity score—10 [22,23]. MCIDs for WPAI have been validated only in patients with insomnia and Crohn’s disease [24,25], and thus were deemed insufficiently reliable to be used for comparisons. "
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    ABSTRACT: Neurogenic detrusor overactivity (NDO) leads to impaired health-related quality of life (HRQoL), productivity, and greater healthcare resource burden. The humanistic and economic burden may be more apparent in NDO patients with urinary incontinence (UI). The objective of this study was to compare the HRQoL, productivity, and health resource use (HRU) between continent and incontinent NDO patients. A retrospective database analysis was conducted using the Adelphi Overactive Bladder (OAB)/UI Disease Specific Programme, a multi-national, cross-sectional survey reported from both patients' and physicians' perspectives. The population for this analysis included NDO patients with or without UI. General and disease-specific HRQoL were assessed using the EuroQoL-5D (EQ-5D), Incontinence Quality of Life questionnaire (I-QOL), and the Overactive Bladder Questionnaire (OAB-q). Productivity and daily activity impairment were measured using the Work Productivity and Activity Impairment (WPAI) questionnaire. HRU indicators included OAB-related surgery, OAB-related hospitalizations, incontinence pad usage, switching anticholinergics used for OAB due to inadequate response or adverse effects, and OAB-related physician visits. Bivariate analyses, multivariate ordinary least squares (OLS) regression analyses and published minimal clinically important differences (MCID) were used to assess relationships between incontinent status and the aforementioned outcome measures. A total of 324 NDO patients with or without urinary incontinence were included, averaging 54 years of age (SD 16), of whom 43.8 percent were male. Bivariate analyses detected no significant relationship between incontinent status and HRU variables. Regression analyses revealed that incontinent patients had clinically and statistically lower disease-specific HRQoL and greater impairment in daily activities as compared to continent patients. On average, incontinent patients scored 10 points lower on the I-QOL total score, 9 points lower on the OAB-q HRQoL score, 15 points higher on OAB-q symptom severity, and experienced 8.2 percent higher activity impairment due to their bladder condition (all p < 0.001). Incontinent NDO patients experience significantly lower HRQoL and activity impairment as compared to continent NDO patients.
    Full-text · Article · Apr 2014 · BMC Neurology
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    • "The EQ-5D questionnaire was selected because it has been used in testing, albeit in a limited way in breast biopsy [22] [23]. The EQ-5D questionnaire has pronounced ceiling effects in prior literature [24] [25] [26]. The version used for many years has three levels in each of five attributes, allowing for 243 health states. "
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    ABSTRACT: The Testing Morbidities Index (TMI) was developed to measure the effects of any diagnostic or screening procedure on health-related quality of life (HRQOL); it includes seven domains incorporating mental and physical aspects before, during, and after testing. To add to prior work on the validity of the TMI classification, responsiveness of a summated scale version was evaluated in 71 colonoscopy patients. Further data on construct validity were also obtained. Patients enrolled in the study when scheduling colonoscopy days to weeks beforehand. The baseline survey included the EuroQol five-dimensional (EQ-5D) questionnaire with five levels in each attribute (EQ-5D-5L questionnaire) and its visual analogue scale (VAS) assessment (EQ-VAS), the Short Form 12 version 2 (SF-12v2) component summary scores and six-dimensional health state short-form (derived from the short-form 12v2 health survey [SF-6D] utilities), and an original construct-specific VAS (CS-VAS) for usual HRQOL using utility scale anchors. The TMI's highest possible summated score (all best levels) served as its baseline. Survey data were generally obtained by telephone interview. A postprocedure survey was given to patients after colonoscopy and interviews conducted as soon as possible after the day of the procedure. The postprocedure survey included the SF-12v2/SF-6D, EQ-5D questionnaire instruments, TMI items, and a CS-VAS incorporating the overall HRQOL effects of colonoscopy. Standardized response means showed greatest responsiveness by the TMI (-1.52) followed by the CS-VAS instruments (-0.42). The EQ-5D-5L questionnaire, the EQ-VAS, and the SF-12 component summaries were unresponsive, and the SF-6D was minimally responsive (-0.05). Correlation of the post-CS-VAS with the TMI was substantial (r = -0.52), suggesting TMI construct validity. Moderate to strong correlation of the baseline CS-VAS with standard indexes was observed (r = 0.54-0.81). The TMI appears responsive and exhibits further evidence of construct validity.
    Full-text · Article · Sep 2013 · Value in Health
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