The Responsiveness of Quality of Life Utilities to Change in Depression: A Comparison of Instruments (SF-6D, EQ-5D, and DFD)

Department of Clinical Psychological Science, Faculty of Psychology, Maastricht University, The Netherlands.
Value in Health (Impact Factor: 3.28). 07/2011; 14(5):732-9. DOI: 10.1016/j.jval.2010.12.004
Source: PubMed


Utilities are often a main outcome parameter in economic evaluations. Because depression has a large influence on quality of life, it is expected that utilities are responsive to changes in depression.
To evaluate the change in utility derived from different instruments in depression, including the Short Form 6D (SF-6D), the Euroqol based on the UK (EQ-5D(UK)), the Euroqol based on the Dutch tariff (EQ-5D(NL)), and utilities derived from Beck Depression Inventory Second Edition (BDI-II) using the Depression-Free-Day method.
This study evaluated the responsiveness, the minimally important difference, and the agreement in utility change derived from the different instruments.
The SF-6D, EQ-5D(UK), and EQ-5D(NL) were responsive. The minimally important difference values are in line with previous studies, about 0.3. The Depression-Free-Day method nearly always resulted in positive utility changes, even for subgroups that had no change or deterioration in health status or depression. There was poor agreement between utility changes of the SF-6D, EQ-5D (either EQ-5D(UK) or EQ-5D(NL)), and DFDu.
The SF-6D, EQ-5D(UK), and EQ-5D(NL) seem responsive and thus adequate for estimating utility in depression treatment. We do not recommend the use of the Depression-Fee-Day method. The low agreement between utility changes indicates that outcomes of the different instruments are incomparable.

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Available from: Silvia M A A Evers, Jul 13, 2014
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    • "Both the SF-6D and EQ-5D will be used to determine quality-adjusted life years (QALYs) due to floor effects found when using the SF-6D and ceiling effects with the EQ-5D in different study populations [79]. In addition, although both the SF-36 and EQ-5D appear to respond to changes in depression, the agreement between utility changes is low [80]. These procedures will inform the economic evaluation plan for the design of a future phase III RCT. "
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    ABSTRACT: Background: Increased life expectancy has resulted in a greater provision of informal care within the community for patients with chronic physical health conditions. Informal carers are at greater risk of poor mental health, with one in three informal carers of stroke survivors experiencing depression. However, currently no psychological treatments tailored to the unique needs of depressed informal carers of stroke survivors exist. Furthermore, informal carers of stroke survivors experience a number of barriers to attending traditional face-to-face psychological services, such as lack of time and the demands of the caring role. The increased flexibility associated with supported cognitive behavioral therapy self-help (CBTsh), such as the ability for support to be provided by telephone, email, or face-to-face, alongside shorter support sessions, may help overcome such barriers to access. CBTsh, tailored to depressed informal carers of stroke survivors may represent an effective and acceptable solution. Methods/design: This study is a Phase II (feasibility) randomized controlled trial (RCT) following guidance in the MRC Complex Interventions Research Methods Framework. We will randomize a sample of depressed informal carers of stroke survivors to receive CBT self-help supported by mental health paraprofessionals, or treatment-as-usual. Consistent with the objectives of assessing the feasibility of trial design and procedures for a potential larger scale trial we will measure the following outcomes: a) feasibility of patient recruitment (recruitment and refusal rates); (b) feasibility and acceptability of data collection procedures; (c) levels of attrition; (d) likely intervention effect size; (e) variability in number, length and frequency of support sessions estimated to bring about recovery; and (f) acceptability of the intervention. Additionally, we will collect data on the diagnosis of depression, symptoms of depression and anxiety, functional impairment, carer burden, quality of life, and stroke survivor mobility skill, self-care and functional ability, measured at four and six months post-randomization. Discussion: This study will provide important information for the feasibility and design of a Phase III (effectiveness) trial in the future. If the intervention is identified to be feasible, effective, and acceptable, a written CBTsh intervention for informal carers of stroke survivors, supported by mental health paraprofessionals, could represent a cost-effective model of care. Trial registration: Current Controlled Trials ISRCTN63590486.
    Full-text · Article · May 2014 · Trials
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    • "However, the investigation of health utility in patients with depression has been very limited, despite depression being a leading cause of disability worldwide [9]. The vast majority of previous comparison studies have not included samples from this population, have focused on common mental health disorders grouped together (not just depression) or used a very small sample size, presented mainly summary statistics or only assessed one aspect of instrument suitability [10-12]. As such the comparability of values of HRQoL produced by different instruments in patients with depression is unclear. "
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