The DEP-6D, a new preference-based measure to assess health states of dependency.

In medical literature there are numerous multidimensional scales to measure health states for dependence in activities of daily living. However, these scales are not preference-based and are not able to yield QALYs. On the contrary, the generic preference-based measures are not sensitive enough to measure changes in dependence states. The objective of this paper is to propose a new dependency health state classification system, called DEP-6D, and to estimate its value set in such a way that it can be used in QALY calculations. DEP-6D states are described as a combination of 6 attributes (eat, incontinence, personal care, mobility, housework and cognition problems), with 3-4 levels each. A sample of 312 Spanish citizens was surveyed in 2011 to estimate the DEP-6D preference-scoring algorithm. Each respondent valued six out of the 24 states using time trade-off questions. After excluding those respondents who made two or more inconsistencies (6% out of the sample), each state was valued between 66 and 77 times. The responses present a high internal and external consistency. A random effect model accounting for main effects was the preferred model to estimate the scoring algorithm. The DEP-6D describes, in general, more severe problems than those usually described by means of generic preference-based measures. The minimum score predicted by the DEP-6D algorithm is -0.84, which is considerably lower than the minimum value predicted by the EQ-5D and SF-6D algorithms. The DEP-6D value set is based on community preferences. Therefore it is consistent with the so-called 'societal perspective'. Moreover, DEP-6D preference weights can be used in QALY calculations and cost-utility analysis.

VALIDATION AND COMPARISON OF EQ-5D-3L AND SF-6D INSTRUMENTS IN A SPANISH PARKINSON´S DISEASE POPULATION SAMPLE.

INTRODUCTION: generic, preference-based Health- Related Quality of Life instruments are receiving growing attention in health-care decision-making process. In spite of this, to our knowledge, EQ-5D and SF-6D have never been compared in a Parkinson´s disease population sample. OBJECTIVE: the aim of this paper was to assess the psychometric properties of both instruments in a Spanish PD population sample. METHODS: a total sample of 133 patients were interviewed using EQ-5D-3L and SF-6D. The validity, level of agreement and sensitivity of both instruments were computed and then compared. The Spanish tariff has been used in both instruments. RESULTS: utilities of EQ-5D-3L and SF-6D have shown a strong correlation (r >0.50 and p<0.001) with the summary score of the PDQ-8 and the EQ-VAS score. Significant differences were observed in the stages III-IV of the Hoehn & Yahr stage. SF-6D had 51% higher efficiency than EQ-5D at detecting differences in symptoms severity. DISCUSSION: both EQ-5D-3L and SF-6D seem to be adequate generic Health-Related Quality of Life measures in terms of validity and sensitivity. CONCLUSION: EQ-5D-3L presents greater ceiling and floor effects than the SF-6D instrument in this sample. Besides, the instrument SF-6D was better at detecting changes in symptoms severity compared with EQ-5D-3L.

Introducción: el uso de cuestionarios de calidad de vida basados en preferencias poblacionales están recibiendo cada vez más atención en el proceso de toma de decisiones en el ámbito sanitario. Sin embargo, a nuestro entender, EQ-5D y SF-6D nunca han sido comparados en una muestra de población con la enfermedad de Parkinson. Objetivo: el objetivo de este trabajo fue evaluar las propiedades psicométricas de ambos instrumentos en una muestra de población española con enfermos de Parkinson. Métodos: un total de 133 pacientes fueron entrevistados utilizando EQ-5D y SF-6D. La validez, el grado de acuerdo y la sensibilidad de ambos instrumentos fueron calculados para su posterior comparación. Las preferencias de la población española fueron utilizadas en ambos instrumentos. Resultados: las utilidades de EQ-5D y SF-6D han mostrado una fuerte correlación (r> 0,50 y p.

Equity considerations in health care: the relevance of claims.

The general issues of equity and efficiency are central to the analysis of resource allocation problems in health care. We examine them using axiomatic bargaining theory. We study different solutions that have been proposed and relate them to previous literature on health care allocation. In particular, we focus on the solutions based on axiomatic bargaining with claims, and show that they are appealing as distributive criteria in health policy. Finally, we present the results of a survey that tries to elicit moral intuitions of people about resource allocation problems and their different solutions.

Health state after treatment: a reason for discrimination?

In this paper the issue of discrimination between patients based on the health improvement that each can achieve is addressed. Previous research in this area by Nord has shown that, in this context, society's preferences may be quite opposite to the principle of health maximization present in cost utility analysis. Using a different experimental design from that used by Nord, some results are achieved which suggest that social preferences may be somewhere in between two opposite extremes, which are that discrimination based on the degree of health improvement is never acceptable and that discrimination based on the degree of health improvement is always acceptable.