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1.
Gerontologist ; 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31688902

RESUMO

BACKGROUND AND OBJECTIVES: A 2008 European consensus on research outcome measures in dementia care concluded that measurement of carer quality of life (QoL) was limited. Three systematic reviews (2012, 2017, and 2018) of dementia carer outcome measures found existing instruments wanting. In 2017, recommendations were published for developing reliable measurement tools of carers' needs for research and clinical application. The aim of this study was to develop a new instrument to measure the QoL of dementia carers (family/friends). METHODS: Items were generated directly from carers following an inductive needs-led approach. Carers (n = 566) from 22 English and Welsh locations then completed the items and comparator measures at three time points. Rasch, factor, and psychometric (reliability, validity, responsiveness, and minimally important differences [MIDs]) analyses were undertaken. RESULTS: Following factor analysis, the pool of 70 items was refined to three independent scales: primary SIDECAR-D (direct impact of caring upon carer QOL, 18 items), secondary SIDECAR-I (indirect impact, 10 items), and SIDECAR-S (support and information, 11 items). All three scales satisfy Rasch model assumptions. SIDECAR-D, I, S psychometrics: reliability (internal ≥ .70; test-retest ≥ .85); convergent validity (as hypothesized); responsiveness (effect sizes: D: moderate; I and S: small); MIDs (D = 9/100, I = 10/100, S = 11/100). DISCUSSION AND IMPLICATIONS: SIDECAR scales demonstrate robust measurement properties, meeting COSMIN quality standards for study design and psychometrics. SIDECAR provides a theoretically based needs-led QoL profile specifically for dementia carers. SIDECAR is free for use in public health, social care, and voluntary sector services, and not-for-profit organizations.

2.
Int J Health Policy Manag ; 8(7): 424-443, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31441279

RESUMO

BACKGROUND: The accountability for reasonableness (A4R) framework defines 4 conditions for legitimate healthcare coverage decision processes: Relevance, Publicity, Appeals, and Enforcement. The aim of this study was to reflect on how the diverse features of decision-making processes can be aligned with A4R conditions to guide decision-making towards legitimacy. Rare disease and regenerative therapies (RDRTs) pose special decision-making challenges and offer therefore a useful case study. METHODS: Features operationalizing each A4R condition as well as three different approaches to address these features (cost-per-QALY-focused and multicriteria-based) were defined and organized into a matrix. Seven experts explored these features during a panel run under the Chatham House Rule and provided general and RDRT-specific recommendations. Responses were analyzed to identify converging and diverging recommendations. RESULTS: Regarding Relevance, recommendations included supporting deliberation, stakeholder participation and grounding coverage decision criteria in normative and societal objectives. Thirteen of 17 proposed decision criteria were recommended by a majority of panelists. The usefulness of universal cost-effectiveness thresholds to inform allocative efficiency was challenged, particularly in the RDRT context. RDRTs raise specific issues that need to be considered; however, rarity should be viewed in relation to other aspects, such as disease severity and budget impact. Regarding Publicity, panelists recommended transparency about the values underlying a decision and value judgements used in selecting evidence. For Appeals, recommendations included a life-cycle approach with clear provisions for re-evaluations. For Enforcement, external quality reviews of decisions were recommended. CONCLUSION: Moving coverage decision-making processes towards enhanced legitimacy in general and in the RDRT context involves designing and refining approaches to support participation and deliberation, enhancing transparency, and allowing explicit consideration of multiple decision criteria that reflect normative and societal objectives.

3.
Eur Urol ; 76(2): 228-237, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31060822

RESUMO

BACKGROUND: Prostate cancer incidence, treatment, and survival rates vary throughout the UK, but little is known about regional differences in quality of survival. OBJECTIVE: To investigate variations in patient-reported outcomes between UK countries and English Cancer Alliances. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional postal survey of prostate cancer survivors diagnosed 18-42mo previously. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Urinary, bowel, and sexual problems and vitality were patient reported using the Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire. General health was also self-assessed. Regional variations were identified using multivariable log-linear regression. RESULTS AND LIMITATIONS: A total of 35823 men responded, 60.8% of those invited. Self-assessed health was significantly lower than the UK average in Wales and Scotland. Respondents reported more urinary incontinence in Scotland, more urinary irritation/obstruction in Scotland and Northern Ireland (NI), poorer bowel function in Scotland and NI, worse sexual function in Scotland, and reduced vitality/hormonal function in Scotland, Wales, and NI. Self-assessed health was poorer than the English average in South Yorkshire and North-East and Cumbria, with more urinary incontinence in North-East and Cumbria and Peninsula, greater sexual problems in West Midlands, and poorer vitality in North-East and Cumbria and West Midlands. Limitations include difficulty identifying clinically significant differences and limited information on pretreatment conditions. CONCLUSIONS: Despite adjustment for treatment, and clinical and sociodemographic factors, quality of survival among prostate cancer survivors varied by area of residence. Adoption of best practice from areas performing well could support enhanced survival quality in poorer performing areas, particularly with regard to bowel problems and vitality, where clinically relevant differences were reported. PATIENT SUMMARY: We conducted a UK-wide survey of patient's quality of life after treatment for prostate cancer. Outcomes were found to vary depending upon where patients live. Different service providers need to ensure that all prostate cancer patients receive the same follow-up care.

4.
PLoS One ; 14(4): e0214283, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31034491

RESUMO

The EQ-5D instrument is now used in many health systems as a health outcomes measure. Recently an EQ-5D valuation study was conducted for Trinidad and Tobago, but thus far there have been no population norms published for Trinidad and Tobago or for any Caribbean country. The objective of this study is to provide a set of population norms, and to investigate inequalities in health in Trinidad and Tobago. The EQ-5D-5L questionnaire was included in the 2012/2013 Adult Population Survey of the Global Entrepreneurship Monitor for Trinidad and Tobago. This survey covered a representative sample of 2,036 adults aged 18 and over. Demographic data and self-reported health using EQ-5D-5L were collected. The Trinidad and Tobago value set was used to obtain EQ-5D index values. The Kakwani index and logistic regression models were used to evaluate inequalities in health. Mean EQ-5D index values and EQ-VAS values were calculated by age group, ethnicity, gender, income, educational attainment, employment status and place of residence. The 10 most commonly observed EQ-5D-5L states accounted for 90% of the respondents. The mean VAS value for the sample was 83.6 and the mean EQ-5D-5L index value was 0.95. Pain/discomfort was found to be the EQ-5D dimension with the highest prevalence of reported problems with 22% of the population reporting pain at any level. Self-care was the dimension with the lowest prevalence of problems reported at any level (3%). Health declines with increasing age, and men reported fewer problems and higher levels of self-reported health than women. Age, gender and education level were found to be important drivers of health status as measured by the EQ-5D instrument. Being in a very low income group was also observed to affect EQ-VAS values among younger respondents. The population norms provided in this study can be used by clinicians, academics and policy makers in several ways. They can be used in comparing different demographic groups or patient groups, or as a basis for tracking the progress of patients through a treatment regimen. They can also provide a baseline for cost utility analysis of health interventions for Trinidad and Tobago.


Assuntos
Disparidades nos Níveis de Saúde , Inquéritos e Questionários , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Trinidad e Tobago , Escala Visual Analógica
5.
Qual Life Res ; 28(7): 1951-1961, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30739287

RESUMO

PURPOSE: EQ-5D-Y is a generic measure of health status for children and adolescents aged 8-15 years. Originally, it has three levels of severity in each dimension (3L). This study aimed to develop a descriptive system of EQ-5D-Y with an increased number of severity levels and to test comprehensibility and feasibility. METHODS: The study was conducted in Germany, Spain, Sweden and the UK. In Phase 1, a review of existing instruments and focus group interviews were carried out to create a pool of possible labels for a modified severity classification. Participants aged 8-15 rated the severity of the identified labels in individual sorting and response scaling interviews. In Phase 2, preliminary 4L and 5L versions were constructed for further testing in cognitive interviews with healthy participants aged 8-15 years and children receiving treatment for a health condition. RESULTS: In Phase 1, a total of 233 labels was generated, ranging from 37 (UK) to 79 labels (Germany). Out of these, 7 to 16 possible labels for each dimension in the different languages were rated in 255 sorting and response scaling interviews. Labels covered an appropriate range of severity on the health continuum in all countries. In Phase 2, the 5L version was generally preferred (by 68-88% of the participants per country) over the 4L version. CONCLUSIONS: This multinational study has provided a version of the EQ-5D-Y with 5 severity levels in each dimension. This extended version (EQ-5D-Y-5L) requires testing its psychometric properties and its performance compared to that of the original EQ-5D-Y-3L.


Assuntos
Nível de Saúde , Psicometria/métodos , Qualidade de Vida/psicologia , Inquéritos e Questionários , Adolescente , Criança , Feminino , Grupos Focais , Alemanha , Humanos , Linguagem , Masculino , Reprodutibilidade dos Testes , Espanha , Suécia , Reino Unido
6.
Lancet Oncol ; 20(3): 436-447, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30713036

RESUMO

BACKGROUND: Little is known about the health-related quality of life (HRQOL) of men living with advanced prostate cancer. We report population-wide functional outcomes and HRQOL in men with all stages of prostate cancer and identify implications for health-care delivery. METHODS: For this population-based study, men in the UK living 18-42 months after diagnosis of prostate cancer were identified through cancer registration data. A postal survey was administered, which contained validated measures to assess functional outcomes (urinary incontinence, urinary irritation and obstruction, bowel, sexual, and vitality and hormonal function), measured with the Expanded Prostate Cancer Index Composite short form (EPIC-26), plus questions about use of interventions for sexual dysfunction) and generic HRQOL (assessed with the 5-level EuroQol five dimensions questionnaire [EQ-5D-5L] measuring mobility, self-care, usual activities, pain or discomfort, and anxiety or depression, plus a rating of self-assessed health). Log-linear and binary logistic regression models were used to compare functional outcomes and HRQOL across diagnostic stages and self-reported treatment groups. Each model included adjustment for age, socioeconomic deprivation, and number of other long-term conditions. FINDINGS: 35 823 (60·8%) of 58 930 men responded to the survey. Disease stage was known for 30 733 (85·8%) of 35 823 men; 19 599 (63·8%) had stage I or II, 7209 (23·4%) stage III, and 3925 (12·8%) stage IV disease. Mean adjusted EPIC-26 domain scores were high, indicating good function, except for sexual function, for which scores were much lower. Compared with men who did not receive androgen deprivation therapy, more men who received the therapy reported moderate to big problems with hot flushes (30·7% [95% CI 29·8-31·6] vs 5·4% [5·0-5·8]), low energy (29·4% [95% CI 28·6-30·3] vs 14·7% [14·2-15·3]), and weight gain (22·5%, 21·7-23·3) vs 6·9% [6·5-7·3]). Poor sexual function was common (81·0%; 95% CI 80·6-81·5), regardless of stage, and more than half of men (n=18 782 [55·8%]) were not offered any intervention to help with this condition. Overall, self-assessed health was similar in men with stage I-III disease, and although slightly reduced in those with stage IV cancer, 23·5% of men with metastatic disease reported no problems on any EQ-5D dimension. INTERPRETATION: Men diagnosed with advanced disease do not report substantially different HRQOL outcomes to those diagnosed with localised disease, although considerable problems with hormonal function and fatigue are reported in men treated with androgen deprivation therapy. Sexual dysfunction is common and most men are not offered helpful intervention or support. Service improvements around sexual rehabilitation and measures to reduce the effects of androgen deprivation therapy are required. FUNDING: The Movember Foundation, in partnership with Prostate Cancer UK.

7.
BJU Int ; 122(5): 845-857, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29489050

RESUMO

OBJECTIVES: To provide data on the prevalence of urinary, bowel and sexual dysfunction in Northern Ireland (NI), to act as a baseline for studies of prostate cancer outcomes and to aid service provision within the general population. SUBJECTS AND METHODS: A cross-sectional postal survey of 10 000 men aged ≥40 years in NI was conducted and age-matched to the distribution of men living with prostate cancer. The EuroQoL five Dimensions five Levels (EQ-5D-5L) and 26-item Expanded Prostate Cancer Composite (EPIC-26) instruments were used to enable comparisons with prostate cancer outcome studies. Whilst representative of the prostate cancer survivor population, the age-distribution of the sample differs from the general population, thus data were generalised to the NI population by excluding those aged 40-59 years and applying survey weights. Results are presented as proportions reporting problems along with mean composite scores, with differences by respondent characteristics assessed using chi-squared tests, analysis of variance, and multivariable log-linear regression. RESULTS: Amongst men aged ≥60 years, 32.8% reported sexual dysfunction, 9.3% urinary dysfunction, and 6.5% bowel dysfunction. In all, 38.1% reported at least one problem and 2.1% all three. Worse outcome was associated with increasing number of long-term conditions, low physical activity, and higher body mass index (BMI). Urinary incontinence, urinary irritation/obstruction, and sexual dysfunction increased with age; whilst urinary incontinence, bowel, and sexual dysfunction were more common among the unemployed. CONCLUSION: These data provide an insight into sensitive issues seldom reported by elderly men, which result in poor general health, but could be addressed given adequate service provision. The relationship between these problems, raised BMI and low physical activity offers the prospect of additional health gain by addressing public health issues such as obesity. The results provide essential contemporary population data against which outcomes for those living with prostate cancer can be compared. They will facilitate greater understanding of the true impact of specific treatments such as surgical interventions, pelvic radiation or androgen-deprivation therapy.


Assuntos
Enteropatias/epidemiologia , Disfunções Sexuais Fisiológicas/epidemiologia , Transtornos Urinários/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Humanos , Masculino , Saúde do Homem , Pessoa de Meia-Idade , Irlanda do Norte/epidemiologia , Prevalência
8.
Int J Health Policy Manag ; 7(2): 120-136, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29524936

RESUMO

BACKGROUND: The measurement of health benefits is a key issue in health economic evaluations. There is very scarce empirical literature exploring the differences of using quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) as benefit metrics and their potential impact in decision-making. METHODS: Two previously published models delivering outputs in QALYs, were adapted to estimate DALYs: a Markov model for human papilloma virus (HPV) vaccination, and a pneumococcal vaccination deterministic model (PNEUMO). Argentina, Chile, and the United Kingdom studies were used, where local EQ-5D social value weights were available to provide local QALY weights. A primary study with descriptive vignettes was done (n = 73) to obtain EQ-5D data for all health states included in both models. Several scenario analyses were carried-out to evaluate the relative importance of using different metrics (DALYS or QALYs) to estimate health benefits on these economic evaluations. RESULTS: QALY gains were larger than DALYs avoided in all countries for HPV, leading to more favorable decisions using the former. With discounting and age-weighting - scenario with greatest differences in all countries - incremental DALYs avoided represented the 75%, 68%, and 43% of the QALYs gained in Argentina, Chile, and United Kingdom respectively. Differences using QALYs or DALYs were less consistent and sometimes in the opposite direction for PNEUMO. These differences, similar to other widely used assumptions, could directly influence decision-making using usual gross domestic products (GDPs) per capita per DALY or QALY thresholds. CONCLUSION: We did not find evidence that contradicts current practice of many researchers and decision-makers of using QALYs or DALYs interchangeably. Differences attributed to the choice of metric could influence final decisions, but similarly to other frequently used assumptions.


Assuntos
Avaliação da Deficiência , Medicina Preventiva , Avaliação de Programas e Projetos de Saúde/métodos , Anos de Vida Ajustados por Qualidade de Vida , Humanos , Modelos Teóricos , Reprodutibilidade dos Testes
9.
Rev. salud pública ; 19(3): 340-346, mayo-jun. 2017. tab
Artigo em Espanhol | LILACS-Express | ID: biblio-903113

RESUMO

RESUMEN Objetivo Determinar la percepción sobre la calidad de vida relacionada con salud (CVrS) que tiene la población adulta en Colombia. Métodos Encuesta poblacional en una muestra representativa de la población rural y urbana, de 18 y más años. Se midió la CVrS con el instrumento EQ5D-3L y la escala visual análoga, como parte de la cuarta Encuesta Nacional de Salud Mental. Las estimaciones fueron ajustadas por el diseño de muestreo y se acompañan de intervalos de confianza al 95 %. Resultados 1 0867 personas completaron la medición; 69,7 % (IC95 % 66,9 a 68,9) de la población reporto estar en "salud completa"; la mayor proporción de personas valoraron su salud por encima de 80 puntos. La presencia de "moderado dolor o malestar", seguida de estar "moderadamente angustiado o deprimido" fueron las alteraciones más frecuentes. Los adultos jóvenes tienden a valorar mejor su salud que los adultos mayores. No hay diferencias en la percepción de la salud entre regiones del país. Conclusiones La calidad de vida relacionada con salud en la población colombiana es mayor de 80 puntos en una escala de 1 a 100. Las alteraciones como angustia y depresión y la percepción del dolor, fueron las más comúnmente reportadas por los colombianos. La situación de pobreza y el bajo nivel educacional son determinantes de la valoración que hacen los colombianos de su CVrS.


ABSTRACT Objective To determine the perception about quality of life related to health in the adult population of Colombia. Methods Population-based survey applied on a representative sample of the Colombian rural and urban population, aged 18 years or more. Quality of life related to health was measured using the generic EQ5D instrument and the analogue visual scale as part of the fourth National Mental Health Survey. Estimates were accompanied by 95 % confidence intervals and were adjusted by the sampling design. Results 10 867 people aged 18 years or older completed the measurement. 69.7 % (CI95 %; 66.9-68.9) of the population reported being "completely healthy". Most of the population rated their health condition above 80 points. The presence of "moderate pain or discomfort", followed by being "moderately distressed or depressed" were the most frequent alterations. Young adults tend to perceive their health better than older adults. There is no difference in the perception of health between regions of the country. Conclusions Quality of life related to health in the Colombian population is greater than 80 points on a scale of 1 to 100. Alterations such as angst and depression and the perception of pain were the most frequently reported by Colombians. Poverty and a low level of education are determinants of the perception of Colombians regarding their quality of life related to health.

10.
Rev Salud Publica (Bogota) ; 19(3): 340-346, 2017.
Artigo em Espanhol | MEDLINE | ID: mdl-30183938

RESUMO

OBJECTIVE : To determine the perception about quality of life related to health in the adult population of Colombia. METHODS: Population-based survey applied on a representative sample of the Colombian rural and urban population, aged 18 years or more. Quality of life related to health was measured using the generic EQ5D instrument and the analogue visual scale as part of the fourth National Mental Health Survey. Estimates were accompanied by 95 % confidence intervals and were adjusted by the sampling design. RESULTS : 10 867 people aged 18 years or older completed the measurement. 69.7 % (CI95 %; 66.9-68.9) of the population reported being "completely healthy". Most of the population rated their health condition above 80 points. The presence of "moderate pain or discomfort", followed by being "moderately distressed or depressed" were the most frequent alterations. Young adults tend to perceive their health better than older adults. There is no difference in the perception of health between regions of the country. CONCLUSIONS : Quality of life related to health in the Colombian population is greater than 80 points on a scale of 1 to 100. Alterations such as angst and depression and the perception of pain were the most frequently reported by Colombians. Poverty and a low level of education are determinants of the perception of Colombians regarding their quality of life related to health.


Assuntos
Nível de Saúde , Qualidade de Vida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colômbia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Percepção , Qualidade de Vida/psicologia , Fatores Socioeconômicos , Adulto Jovem
11.
Value Health Reg Issues ; 11: 60-67, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27986200

RESUMO

BACKGROUND: Resource allocation decision making in the Caribbean can be greatly enhanced by the introduction of cost per quality-adjusted life-year (QALY) analysis on the basis of local preferences. In the valuation literature there have been recommendations for the elicitation methods of the EuroQol five-dimensional questionnaire (EQ-5D) that combine discrete-choice experiment (DCE) for bulk valuation with a time trade-off component for rescaling. OBJECTIVES: To create a three-level EQ-5D value set for Trinidad and Tobago using an elicitation method that takes into account the local constraints, and that can be easily deployed in other Caribbean islands. METHODS: A D-efficient DCE was completed by a representative sample of 307 adults. A time trade-off procedure was used to obtain values for rescaling the DCE model on a scale anchored at 0 (dead) and 1 (full health). RESULTS: A mixed logit analysis of the DCE data produced an internally valid model that is similar to the results obtained in earlier pilot studies. CONCLUSIONS: This EQ-5D value set allows cost per QALY analyses to be carried out on the basis of preferences from Trinidad and Tobago, and the approach to the DCE design can be taken for similar value sets to be created in the small, resource-constrained health systems of the Caribbean. Some guidelines for the initial application and introduction of cost per QALY analysis into the Trinidad and Tobago health system are also presented.


Assuntos
Nível de Saúde , Qualidade de Vida , Alocação de Recursos , Região do Caribe , Humanos , Inquéritos e Questionários , Trinidad e Tobago
12.
BMJ Open ; 6(12): e013555, 2016 12 07.
Artigo em Inglês | MEDLINE | ID: mdl-27927667

RESUMO

BACKGROUND: Prostate cancer and its treatment may impact physically, psychologically and socially; affecting the health-related quality of life of men and their partners/spouses. The Life After Prostate Cancer Diagnosis (LAPCD) study is a UK-wide patient-reported outcomes study which will generate information to improve the health and well-being of men with prostate cancer. METHODS AND ANALYSIS: Postal surveys will be sent to prostate cancer survivors (18-42 months postdiagnosis) in all 4 UK countries (n=∼70 000). Eligible men will be identified and/or verified through cancer registration systems. Men will be surveyed twice, 12 months apart, to explore changes in outcomes over time. Second, separate cohorts will be surveyed once and the design will include evaluation of the acceptability of online survey tools. A comprehensive patient-reported outcome measure has been developed using generic and specific instruments with proven psychometric properties and relevance in national and international studies. The outcome data will be linked with administrative health data (eg, treatment information from hospital data). To ensure detailed understanding of issues of importance, qualitative interviews will be undertaken with a sample of men who complete the survey across the UK (n=∼150) along with a small number of partners/spouses (n=∼30). ETHICS AND DISSEMINATION: The study has received the following approvals: Newcastle and North Tyneside 1 Research Ethics Committee (15/NE/0036), Health Research Authority Confidentiality Advisory Group (15/CAG/0110), NHS Scotland Public Benefit and Privacy Panel (0516-0364), Office of Research Ethics Northern Ireland (16/NI/0073) and NHS R&D approval from Wales, Scotland and Northern Ireland. Using traditional and innovative methods, the results will be made available to men and their partners/spouses, the funders, the NHS, social care, voluntary sector organisations and other researchers.


Assuntos
Neoplasias da Próstata/psicologia , Cônjuges/psicologia , Sobreviventes/psicologia , Adaptação Psicológica , Protocolos Clínicos , Humanos , Acontecimentos que Mudam a Vida , Masculino , Medidas de Resultados Relatados pelo Paciente , Formulação de Políticas , Neoplasias da Próstata/terapia , Psicometria , Qualidade de Vida , Medicina Estatal , Reino Unido/epidemiologia
13.
Med Decis Making ; 36(2): 242-52, 2016 02.
Artigo em Inglês | MEDLINE | ID: mdl-26289747

RESUMO

BACKGROUND: . Logical inconsistency for health states preferences occurs when one logically worse health state, in terms of quality of life, is ranked higher than a logically better health state. OBJECTIVE: . This study explores the presence of inconsistent responses for the EQ-5D health states valuations in a Brazilian population survey. It compares the level of inconsistency in 3 preference-based methods: ranking, visual analog scale (VAS), and time tradeoff (TTO). The influence of EQ-5D health state descriptions is explored by examining the distance between states using a city-block metric as an indicator of proximity. Moreover, it examines the association between formal education and the presence of inconsistencies, as well as the effect of removing inconsistent respondents on the estimation of social value sets from TTO and VAS. METHODS: . Data came from a valuation study with 3362 literate individuals aged between 18 and 64 years living in urban areas of Minas Gerais state, Brazil. Logical inconsistency was assessed using the percentage of inconsistent respondents and inconsistency rate. A logistic model was estimated to assess the association between formal education and the logical inconsistency. Societal preferences were estimated excluding inconsistent respondents considering city-block metric. RESULTS: . The percentage of inconsistent respondents and inconsistency rate are similar for TTO and ranking and lower for VAS. The probability of being inconsistent is higher among less educated groups in ranking and TTO. Inconsistency decreases with distance for all 3 methods. The removal of inconsistent individuals by considering city-block distance improves TTO estimation of social value sets. CONCLUSION: . Findings suggest that removal of inconsistencies in TTO should consider city-block distance. For VAS, inconsistencies are not associated with formal education and do not affect social value set estimation.


Assuntos
Nível de Saúde , Qualidade de Vida , Inquéritos e Questionários/normas , Adolescente , Adulto , Fatores Etários , Brasil , Escolaridade , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Características de Residência , Fatores Sexuais , Fatores Socioeconômicos , Fatores de Tempo , Adulto Jovem
14.
Med Decis Making ; 36(2): 253-63, 2016 02.
Artigo em Inglês | MEDLINE | ID: mdl-26492896

RESUMO

BACKGROUND: Most EQ-5D-3L valuation studies include the same sample of health states that was used in the protocol of the original UK Measurement and Valuation of Health (MVH) study. Thus far, no studies using a time tradeoff utility elicitation method have been carried out using all 243 EQ-5D health states. Because the values and preferences regarding health outcomes differ among countries, it is essential to have country-specific data to enable local high-level decisions regarding resource allocation. This study developed a country-specific set of values for EQ-5D-3L health states. METHODS: A multicentric study was conducted in 4 Brazilian areas. A probabilistic sample of the general population, aged 18 to 64 y, stratified by age and gender, was surveyed. The interview followed a revised version of the MVH protocol, in which all 243 health states were valued. Each respondent ranked and valued 7 health states using the TTO in a home interview. RESULTS: Data were collected from 9148 subjects. The best-fitting regression model was an individual-level mixed-effects model without any interaction terms. The dimensions "Mobility" and "Usual Activities" were associated with higher losses in health state utility value. The "Anxiety/Depression" dimension was the domain that contributed to lower losses in health state utility value. CONCLUSIONS: This study generated significant insight into the Brazilian population's health preferences that can be applied to health technology assessment and economic analyses in Brazil. This information represents an important new tool that can be used in Brazilian health policy creation and evaluation.


Assuntos
Nível de Saúde , Qualidade de Vida , Inquéritos e Questionários/normas , Atividades Cotidianas , Adolescente , Adulto , Fatores Etários , Brasil/epidemiologia , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Limitação da Mobilidade , Dor/epidemiologia , Fatores Sexuais , Fatores Socioeconômicos , Fatores de Tempo , Adulto Jovem
15.
Value Health ; 18(6): 841-5, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26409612

RESUMO

BACKGROUND: The EuroQol five-dimensional questionnaire is a standardized instrument used in the economic evaluation of health care to measure health state preferences across disease groups. A time trade-off (TTO) approach is commonly used to elicit preferences from the public. However, there are issues regarding how best to measure worse-than-dead states; at present, extreme valuations are rounded up to more acceptable values. TTO elicitation is also cognitively demanding for respondents and is therefore expensive to investigate. OBJECTIVES: To describe how the analytic hierarchy process approach could be used to generate utilities from the ordinal relationships between the health states instead of the ordinal relationships between health states, allowing potentially useful preference data to be incorporated rather than excluded as they are at present. It was applied to the Measurement and Valuation of Health study data set, measuring health state preferences for the United Kingdom. METHODS: The analytic hierarchy process approach was explained. Five approaches to structure pairwise comparisons of health state preference were described (two concave, two convex, and one linear). RESULTS: All approaches described predicted the rankings of health states well. However, utilities derived followed an unconventional, bunched shape compared with the original Measurement and Valuation of Health TTO study. An approach was identified by optimizing the parameters, minimizing the sum of squared errors between the ordinal "health state ranking" approach and the original TTO-derived utilities. CONCLUSIONS: This approach outlined offers the potential to convert ordinal preference data into cardinal utilities. It is simpler than TTO studies to carry out and removes the need to directly alter results of the preference ranking exercise.


Assuntos
Pesquisa sobre Serviços de Saúde/métodos , Indicadores Básicos de Saúde , Nível de Saúde , Inquéritos e Questionários , Técnicas de Apoio para a Decisão , Humanos , Modelos Lineares , Modelos Logísticos , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Reino Unido
16.
Qual Life Res ; 24(11): 2761-76, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25896666

RESUMO

PURPOSE: This study explores the use of EQ-5D-3L as a measure of population health status in a Brazilian region with significant socioeconomic, demographic, and epidemiological heterogeneity. METHODS: Data came from a study of 3363 literate individuals aged between 18 and 64 years living in urban areas of the state of Minas Gerais. Descriptive analysis and logistic and OLS regression models were performed to analyze the relationship between EQ-5D-3L (descriptive system and EQ VAS) and other health (self-assessed health status and 8 self-reported diagnosed chronic diseases), socioeconomic (educational level and economic class), and demographic (gender and age) measures. Additionally, a grade of membership (GoM) analysis was performed to identify multidimensional health profiles. RESULTS: A total of 76 health statuses were identified in the Brazilian population. The most prevalent one is full health (44 % of the sample). Elderly people, women, and individuals with poor health and lower socioeconomic conditions generally report more health problems in the EQ-5D-3L dimensions. The GoM analysis demonstrated that health status of older individuals is associated with the socioeconomic condition. Arthritis exhibited the strongest association with the EQ-5D-3L instrument. CONCLUSIONS: The results indicate that EQ-5D-3L is a good measure of health status for the Brazilian population. The instrument has a good discriminatory capacity in terms of demographic, socioeconomic, and health measures. The high prevalence of individuals with full health may indicate the presence of ceiling effect. However, this prevalence is smaller than that in other countries.


Assuntos
Nível de Saúde , Qualidade de Vida/psicologia , Adolescente , Adulto , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
17.
Qual Life Res ; 24(10): 2519-39, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25894060

RESUMO

PURPOSE: To test whether or not adults assign the same values to hypothetical health states that describe health in adults as when those same descriptions refer to the health of a child. METHODS: A two-part self-completion questionnaire was designed in which respondents were asked firstly to rate a fixed set of EQ-5D-Y health states on a 0-100 visual analogue scale as if they themselves were in these states. Two versions of the questionnaire were produced each with a different second part. One version instructed respondents to value the same states but to imagine them describing another adult. The second version required respondents to value these states as if they applied to a 10-year-old child. Questionnaires were distributed to adults recruited in three countries (Germany, Spain and England) using convenience sampling methods. RESULTS: A total of 1085 questionnaires were completed. Despite some significant differences in the characteristics of the achieved samples in the three countries involved, the rank order of health states was largely consistent across each adult/child reference perspective. In all countries, the mean values were lower when health states described children rather than adults. Significant differences were found for 16/24 states when values for those states applied to adult respondent themselves were compared with the values for those states applied to a 10-year-old child. A near-uniform pattern was found across all three countries in which health state values for children were found to be lower than for adults. CONCLUSIONS: Values for health states when ascribed to adults are higher than when those same states are associated with children. Were EQ-5D-3L values for adults applied to EQ-5D-Y health states, then this would effectively lead to an misrepresentation of the value assigned to a health status in children.


Assuntos
Saúde da Criança/tendências , Comportamentos Relacionados com a Saúde , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Inquéritos e Questionários
18.
J Clin Oncol ; 33(6): 616-24, 2015 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-25559806

RESUMO

PURPOSE: This population-level study was conducted to define the health-related quality of life (HRQL) of individuals living with and beyond colorectal cancer (CRC) and to identify factors associated with poor health outcomes. PATIENTS AND METHODS: All individuals diagnosed with CRC in England in 2010 and 2011 who were alive 12 to 36 months after diagnosis were sent a questionnaire. This included questions related to treatment, disease status, other long-term conditions (LTCs), generic HRQL (EuroQol-5D), and cancer-specific outcomes (Functional Assessment of Cancer Therapy and Social Difficulties Inventory items). RESULTS: The response rate was 63.3% (21,802 of 34,467 patients). One or more generic health problems were reported by 65% of respondents, with 10% of patients reporting problems in all five domains. The reporting of problems was higher than in the general population and was most marked in those age less than 55 years. Certain subgroups reported a higher number of problems, notably those with one or more other LTCs, those with active or recurrent disease, those with a stoma, and those at the extremes of the age range (< 55 and > 85 years). Of respondents without a stoma, 16.3% reported no bowel control. Reversal of a stoma resulted in fewer severe bowel problems but more moderate problems than those who had never had a stoma. A quarter of rectal cancer respondents (25.1%) reported difficulties with sexual matters (compared with 11.2% of colon cancer respondents). CONCLUSION: This study demonstrates the success of a national patient-reported outcomes survey. The results have the potential to support system-wide improvement in health outcomes through the identification of particular challenges faced by individuals after treatment for CRC.


Assuntos
Neoplasias Colorretais/fisiopatologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/psicologia , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Autorrelato , Inquéritos e Questionários
20.
Qual Life Res ; 24(3): 693-703, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25246184

RESUMO

PURPOSE: To investigate the feasibility of deriving experience-based visual analogue scale (VAS) values for EQ-5D-3L health states using national general population health survey data in China. METHODS: The EQ-5D-3L was included in the National Health Services Survey (n = 120,709, aged 15-103 years) to measure health-related quality of life. The respondents reported their current health status on a VAS and completed the EQ-5D-3L questionnaire, enabling modelling of the association between the experience-based VAS values and self-reported problems on EQ-5D dimensions and severity levels. RESULTS: VAS values were generally negatively associated with problems reported on the EQ-5D dimensions, and the anxiety/depression dimension had the greatest impact on VAS values. A previously obtained value for dead allowed the values for all 243 EQ-5D-3L health states to be transformed to the 0-1 scale (0 = dead, 1 = full health). CONCLUSIONS: This study presents the feasibility of deriving an experience-based VAS values for EQ-5D-3L health states in China. The analysis of these VAS data raises more fundamental issues concerning the universal nature of the classification system and the extent to which Chinese respondents utilise the same concepts of health as defined by this classification system.


Assuntos
Nível de Saúde , Inquéritos Epidemiológicos/métodos , Medição da Dor , Qualidade de Vida , Autorrelato , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , China , Depressão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
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