Mapping functions for the PHQ-9 and GAD-7 to generate EQ-5D-3L for economic evaluation.

PURPOSE: Generic preferenced-based measures, such as EQ-5D-3L, that are used to estimate quality adjusted life years (QALYs) for economic evaluation are not always available in clinical trials. Predicting EQ-5D-3L values from the commonly used Patient Health Questionnaire 9 (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7) would allow estimation of QALYs from such trials. The aim was to provide mapping functions to estimate EQ-5D-3L from PHQ-9 and GAD-7 to facilitate economic evaluation. METHODS: Data was drawn from four trials of patients with symptoms of depression testing collaborative care or computerised cognitive behavioural therapy. Patients completed PHQ-9, GAD-7, and EQ-5D-3L at different timepoints. Mapping was undertaken using adjusted limited dependent variable mixture models (ALDVMM), ordinary least squares (OLS), and Tobit models based on PHQ-9, GAD-7 scores or questions, and age to predict EQ-5D-3L utilities. Models were selected based on mean error (ME), mean absolute error (MAE), root mean squared error (RMSE), model goodness of fit, and visual inspection of the predictions. RESULTS: There were 5583 and 3942 observations for EQ-5D-3L combined with PHQ-9 and GAD-7 respectively. ALDVMM models had low ME ( ≤|0.0018|) and MAE ranging from 0.189 to 0.192, while RMSE was from 0.251 to 0.254 and had better predictions than OLS and Tobit models. ALDVMM models with four components based on PHQ-9 and GAD-7 scores are recommended for estimating EQ-5D-3L utilities. CONCLUSIONS: Recommended mapping functions provide users with an approach to estimate EQ-5D-3L utilities for economic evaluation using PHQ-9, GAD-7, or both scores where they have been used together.

Validation of the arabic version of the EuroQol-5-dimension 5-level (EQ-5D-5 L) in patients with spinal degenerative diseases.

OBJECTIVE: This study aims to test the reliability and validity of the translated Arabic version of EQ-5D-5 L. METHODS: The study was conducted on 100 patients operated upon for degenerative spine diseases coming for follow up in the outpatient clinic of a Tertiary care hospital. Test-retest reliability was assessed by completing the self-administered tool in two follow up visits, one week apart, by 50 patients. Internal consistency was evaluated by Cronbach's alpha. Intra-class correlation coefficients and kappa statistics were performed to test for the agreement between the two ratings. Criterion validity was assessed by comparing the responses of 100 patients to the EQ-5D-5 L with scores of two validated questionnaires; the Arabic version of the Oswestry disability index and the Arabic version of short-form health survey-36. The construct validity was assessed using known-groups comparison to test for hypothesized differences concerning demographic and clinical variables. RESULTS: The Arabic version of EQ-5D-5 L questionnaire had a high reliability with high observed internal consistency (Cronbach's alpha = 0.816, CI: 0.719-0.886). It showed strong temporal stability, with ICCs of the EQ-5D-5 L score, index and EQ-visual analog scale (EQ-VAS) of 0.852, 0.801, and 0.839 respectively. Agreement by kappa was moderate; above 0.4, for all domains, except for the "Usual activities" domain. EQ-5D-5 L domains, VAS and index had moderate to strong significant correlations with SF-36 and ODI subscales and total scores in the correct direction indicating a good criterion validity of the instrument. CONCLUSION: The Arabic version of EQ-5D-5 L is reliable and valid for assessment of HRQoL of Arabic speaking patients.

EQ-5D-3L and EQ-5D-5L population norms for Thailand.

BACKGROUND: The previous Thai norm-based scores for the EQ-5D-5L were established with Thai general population samples aged 20-70 years in 2019. Nevertheless, these values need to be updated after the COVID-19 pandemic because of its effects on both physical and mental health. This study therefore aimed to establish population norms of the Thai EQ-5D-3L, EQ-5D-5L and EQ-VAS scores as well as to estimate disutility values associated with self-reported main diseases. METHODS: Individual face-to-face interviews were conducted with 2000 adult (age ≥ 18 years) members of the general Thai population to estimate norm-based scores. Each participant completed the EQ-5D-3L and EQ-5D-5L as well as questions related to their sociodemographic factors and self-reported main diseases. Responses to the two instruments were converted to health utility (HU) scores on the basis of available value sets. Descriptive statistics were used to report the norm-based scores stratified by age and sex categories. Response redistribution determining the response consistency between EQ-5D versions was investigated. The HU score agreement from those two instruments was investigated using intraclass correlation coefficient (ICC). Tobit regression models were employed to investigate the relationships between sociodemographic factors and HU and EQ-VAS scores. Moreover, it was used to estimate the disutility values associated with self-reported main diseases. RESULTS: The means (percentage of ceiling effects) of EQ-5D-3L, EQ-5D-5L, and EQ-VAS scores were 0.845 (57.80%), 0.923 (49.05%), and 79.83 (3.20%), respectively. The average percentage of inconsistent response was 1.09%. A good agreement level was found between both EQ-5D versions with the ICCs of 0.789 (95% CI: 0.558-0.878). Female, older, and unemployed participants and those with BMI ≥ 30 reported lower EQ-5D-3L and EQ-5D-5L than their counterparts. Bone/Joint disorder and stroke contributed to the largest disutility value for those two instruments. CONCLUSIONS: The Thai norm-based scores from those two instruments were diminished when advancing age and among female, unemployed, and obese (BMI ≥ 30) participants. It is expected to provide information to policy makers to better allocate health care resources to those with diminished norm-based scores.

Comparing posterior cervical foraminotomy with anterior cervical discectomy and fusion in radiculopathic patients: an analysis from the Quality Outcomes Database.

OBJECTIVE: The objective of this study was to compare clinical and patient-reported outcomes (PROs) between posterior foraminotomy and anterior cervical discectomy and fusion (ACDF) in patients presenting with cervical radiculopathy. METHODS: The Quality Outcomes Database was queried for patients who had undergone ACDF or posterior foraminotomy for radiculopathy. To create two highly homogeneous groups, optimal individual matching was performed at a 5:1 ratio between the two groups on 29 baseline variables (including demographic characteristics, comorbidities, symptoms, patient-reported scores, underlying pathologies, and levels treated). Outcomes of interest were length of stay, reoperations, patient-reported satisfaction, increase in EQ-5D score, and decrease in Neck Disability Index (NDI) scores for arm and neck pain as long as 1 year after surgery. Noninferiority analysis of achieving patient satisfaction and minimal clinically important difference (MCID) in PROs was performed with an accepted risk difference of 5%. RESULTS: A total of 7805 eligible patients were identified: 216 of these underwent posterior foraminotomy and were matched to 1080 patients who underwent ACDF. The patients who underwent ACDF had more underlying pathologies, lower EQ-5D scores, and higher NDI and neck pain scores at baseline. Posterior foraminotomy was associated with shorter hospitalization (0.5 vs 0.9 days, p < 0.001). Reoperations within 12 months were significantly more common among the posterior foraminotomy group (4.2% vs 1.9%, p = 0.04). The two groups performed similarly in PROs, with posterior foraminotomy being noninferior to ACDF in achieving MCID in EQ-5D and neck pain scores but also having lower rates of maximal satisfaction at 12 months (North American Spine Society score of 1 achieved by 65.2% posterior foraminotomy patients vs 74.6% of ACDF patients, p = 0.02). CONCLUSIONS: The two procedures were found to be offered to different populations, with ACDF being selected for patients with more complicated pathologies and symptoms. After individual matching, posterior foraminotomy was associated with a higher reoperation risk within 1 year after surgery compared to ACDF (4.2% vs 1.9%). In terms of 12-month PROs, posterior foraminotomy was noninferior to ACDF in improving quality of life and neck pain. The two procedures also performed similarly in improving NDI scores and arm pain, but ACDF patients had higher maximal satisfaction rates.

Health-related quality of life in Parkinson's disease: systematic review and meta-analysis of EuroQol (EQ-5D) utility scores.

INTRODUCTION: Evaluating the Health-related quality of life (HRQoL) of individuals with Parkinson's disease (PD) holds significant importance in clinical and research settings. The EQ-5D is a widely recognized tool for comprehensive measurement of HRQoL using utility values. This study aims to systematically review and synthesize EQ-5D utility values from existing literature on patients with PD and their caregivers. METHODS: We conducted a systematic search for studies that provided EQ-5D utility scores for patients with PD, using PubMed-Medline, Scopus, and Embase and selected the studies. The selected studies underwent systematic review, including an assessment of their quality. We performed a meta-analysis using a random-effect model and conducted a meta-regression analysis to investigate sources of heterogeneity among the studies. RESULTS: The search result of 13,417 articles that were reviewed, 130 studies with 33,914 participants were selected for systematic review, and 79 studies were included for meta-analysis. The pooled EQ-5D utility values and visual analog score (VAS) among PD were 62.72% (60.53-64.93, I2 = 99.56%) and 0.60 (0.55-0.65, I2 = 99.81%), respectively. The pooled scores for caregivers' EQ-VAS and EQ-5D utility were 70.10% (63.99-76.20, I2 = 98.25%) and 0.71 (0.61-0.81, I2 = 94.88%), respectively. Disease duration (P < 0.05) showed a negative correlation with EQ-5D utility values on meta-regression. CONCLUSION: The pooled utility values of PD and their caregivers help to understand their HRQoL and aid in conducting health economics research. The negative association between disease duration and utility values highlights the evolving nature of HRQoL challenges, suggesting the need for appropriate long-term disease management.

Poor rhinitis and asthma control is associated with decreased health-related quality-of-life and utilities: A MASK-air study.

BACKGROUND: Allergic rhinitis (AR) and asthma may impact health-related quality-of-life. However, national estimates on the quality-of-life of patients with AR or asthma are lacking. OBJECTIVE: To provide estimates for utility scores and EQ-5D Visual Analog Scale (VAS) for patients with AR or asthma. METHODS: We conducted a cross-sectional study using direct patient data from the MASK-air® app on European MASK-air® users with self-reported AR or asthma. We used a multiattribute instrument (EQ-5D) to measure quality-of-life (as utility scores and EQ-5D VAS values). Mean scores were calculated per country and disease control level using multilevel regression models with post-stratification, accounting for age and sex biases. RESULTS: We assessed data from up to 7905 MASK-air® users reporting a total of up to 82,737 days. For AR, utilities ranged from 0.86-0.99 for good control versus 0.72-0.85 for poor control; EQ-5D VAS levels ranged from 78.9-87.9 for good control versus 55.3-64.2 for poor control. For asthma, utilities ranged from 0.84-0.97 for good control versus 0.73-0.87 for poor control; EQ-5D VAS levels ranged from 68.4-81.5 for good control versus 51.4-64.2 for poor control. Poor disease control was associated with a mean loss of 0.14 utilities for both AR and asthma. For the same control levels, AR and asthma were associated with similar utilities and EQ-5D VAS levels. However, lower values were observed for asthma+AR when compared to AR alone. CONCLUSION: Poor AR or asthma control are associated with reduced quality-of-life. The estimates obtained from mHealth data may provide valuable insights for health technology assessment studies.

Association between physical activity and health-related quality of life among adults in China: the moderating role of age.

Objective: The aim of the study was to examine the association between physical activity (PA) and health-related quality of life (HRQOL) among adults and explore the role of age in the association between PA and HRQOL in Shandong, China. Methods: We investigated the relationship between PA and HRQOL and examined the moderated role of age in this association among adults with different age groups and physical activity levels. Data were obtained from the sixth China National Health Services Survey conducted in Shandong province in 2018. The multi-stage-stratified cluster random sampling method was used to selected respondents, with individuals aged 18 and above included in the present study. The tool of assessing HRQOL was the three-level EuroQol Five Dimensions Questionnaire (EQ-5D-3L). Results: The study found PA was significantly related to HRQOL (P < 0.05). The interaction analysis indicated that the relationship between PA and HRQOL was significantly different across young, middle-aged, and older adults (P < 0.05). Older adults with the sufficient PA (coefficient = 0.090, 95%CI: [0.081, 0.100]) and active PA (coefficient = 0.057, 95%CI: [0.043, 0.072]) had significantly higher HRQOL compared with young and middle-aged groups. Conclusion: PA was positively associated with HRQOL among the adults. Age played a moderate role between the association between PA and HRQOL. Guidelines for PA should be specifically tailored to adults of different age groups in order to enhance their HRQoL.

Is smokeless tobacco use associated with lower health-related quality of life? A cross-sectional survey among women in Bangladesh.

INTRODUCTION: Bangladesh has 22 million adult users of smokeless tobacco (ST). The prevalence among women is higher (24.8%). Health-related quality of life outcome (HRQoL) for ST use is little known. We investigated the association between HRQoL and daily ST use among adult women in Bangladesh. METHODS: Using multi-stage design, a cross-sectional survey was conducted. Adult women (randomly selected) were surveyed from 4 purposively selected divisions (Dhaka, Chittagong, Khulna and Rangpur). Female ST users and non-users were compared using HRQoL scores. Self-perceived Visual Analogue Scale (EQ-VAS) values and HRQoL scores were modelled to examine their association with ST use. RESULTS: A total of 2610 women (1149 users and 1461 non-users) were surveyed. The proportion reported any type of problem in all health dimensions was significantly higher among female ST users than non-users (mobility: 43.3% vs 19.5%, self-care: 29.6% vs 11.9%, usual activities: 48.7% vs 21.8%, pain or discomfort: 69.8% vs 40.6%, and anxiety or depression: 61.3% vs 37.5%). The average HRQoL scores were 0.79 (95% CI: 0.78-0.81) and 0.90 (95% CI: 0.89-0.90) for users and non-users, respectively. Moreover, EQ-VAS average values were significantly higher for non-users [80.7 (95% CI: 79.9-81.6) vs 70.27 (95% CI: 69.2-71.2)]. Controlling the sociodemographics, ST use significantly reduced the HRQoL score by an average of 0.15 points. The EQ-VAS values on average decreased by 0.04 points for ST use. CONCLUSIONS: ST use is significantly associated with the HRQoL of females in Bangladesh. Considering the higher prevalence of ST, especially among women, HRQoL hazards need to be communicated for awareness building.

Health-related quality of life in Thai patients with chronic hepatitis B.

Background: Chronic hepatitis B (CHB) significantly impacts the health-related quality of life (HRQoL), but remains underexplored in the Thai population. Health state utilities (HSU) are indicators reflecting HRQoL which serve as fundamental inputs for economic evaluation analyses. This study aimed at assessing differences in HRQoL across five CHB stages in Thai patients, including non-cirrhotic CHB, compensated cirrhosis, decompensated cirrhosis, early-/intermediate-stage hepatocellular carcinoma (HCC) and advanced-/terminal-stage HCC. Methods: We conducted a cross-sectional study to collect HRQoL data from patients with CHB at five stages. The study included patients with CHB who were followed up at a super-tertiary care centre between March 2021 and February 2022. The participants completed the EQ-5D-5L questionnaire and provided demographic data. Disease stage and relevant data were obtained from medical records. HSU and Euroqol-visual analogue scale (EQ-VAS) scores, calculated using Thai-specific conversion coefficients, were assessed. Results: Among 422 patients, 236 did not have cirrhosis, 92 had compensated cirrhosis, 13 had decompensated cirrhosis, 55 had early-/intermediate-stage HCC, and 26 had advanced-/terminal-stage HCC. The HSU scores for non-cirrhotic, compensated cirrhosis, decompensated cirrhosis, early-/intermediate-stage HCC and advanced-/terminal-stage HCC were 0.95 ± 0.08, 0.89 ± 0.16, 0.79 ± 0.19, 0.89 ± 0.12 and 0.52 ± 0.39, respectively. Similarly, the EQ-VAS scores for various CHB stages were 83.56 ± 12.90, 80.48 ± 13.03, 68.76 ± 17.40, 79.00 ± 14.38 and 62.92 ± 20.62, respectively. A significant correlation (r = 0.469, P < 0.001) was observed between the HSU and EQ-VAS scores. The disease progression led to a notable HSU decline, particularly in the advanced-/terminal-stage HCC group (regression coefficient: -0.436, P < 0.001). The EQ-VAS scores indicated reduced quality of life in advanced liver disease. Conclusions: Later CHB stages compromise the HRQoL. Decompensated cirrhosis and advanced-/terminal-stage HCC profoundly affect physical health and quality of life, whereas patients with compensated cirrhosis and early-/intermediate-stage HCC report better HRQoL.

Creating a Multiply Imputed Value Set for the EQ-5D-5L in Canada: State-Level Misspecification Terms Are Needed to Characterize Parameter Uncertainty Correctly.

BACKGROUND: Parameter uncertainty in EQ-5D-5L value sets often exceeds the instrument's minimum important difference, yet this is routinely ignored. Multiple imputation (MI) accounts for parameter uncertainty in the value set; however, no valuation study has implemented this methodology. Our objective was to create a Canadian MI value set for the EQ-5D-5L, thus enabling users to account for parameter uncertainty in the value set. METHODS: Using the Canadian EQ-5D-5L valuation study (N = 1,073), we first refit the original model followed by models with state-level misspecification. Models were compared based on the adequacy of 95% credible interval (CrI) coverage for out-of-sample predictions. Using the best-fitting model, we took 100 draws from the posterior distribution to create 100 imputed value sets. We examined how much the standard error of the estimated mean health utilities increased after accounting for parameter uncertainty in the value set by using the MI and original value sets to score 2 data sets: 1) a sample of 1,208 individuals from the Canadian general public and 2) a sample of 401 women with breast cancer. RESULTS: The selected model with state-level misspecification outperformed the original model (95% CrI coverage: 94.2% v. 11.6%). We observed wider standard errors for the estimated mean utilities on using the MI value set for both the Canadian general public (MI: 0.0091; original: 0.0035) and patients with breast cancer (MI: 0.0169; original: 0.0066). DISCUSSION AND CONCLUSIONS: We provide 1) the first MI value sets for the EQ-5D-5L and 2) code to construct MI value sets while accounting for state-level model misspecification. Our study suggests that ignoring parameter uncertainty in value sets leads to falsely narrow SEs. HIGHLIGHTS: Value sets for health state utility instruments are estimated subject to parameter uncertainty; this parameter uncertainty may exceed the minimum important difference of the instrument, yet it is not fully captured using current methods.This study creates the first multiply imputed value set for a multiattribute utility instrument, the EQ-5D-5L, to fully capture this parameter uncertainty.We apply the multiply imputed value set to 2 data sets from 1) the Canadian general public and 2) women with invasive breast cancer.Scoring the EQ-5D-5L using a multiply imputed value set led to wider standard error estimates, suggesting that the current practice of ignoring parameter uncertainty in the value set leads to falsely low standard errors.Our work will be of interest to methodologists and developers of the EQ-5D-5L and users of the EQ-5D-5L, such as health economists, researchers, and policy makers.

Testing the psychometric properties of 9 bolt-ons for the EQ-5D-5L in a general population sample.

OBJECTIVES: We aim to assess the psychometric performance and added value of nine existing bolt-ons (breathing problems, cognition, hearing, self-confidence, skin irritation, sleep, social relationships, tiredness and vision) for the EQ-5D-5L in a general population sample. METHODS: The EQ-5D-5L, nine bolt-ons, SF-6Dv1, PROMIS-29+2, PROMIS Global Health and Satisfaction With Life Scale were completed in an online cross-sectional survey among a general adult population sample in Hungary (n=1587). The following psychometric properties were tested for the EQ-5D-5L+bolt-on(s): ceiling, divergent and convergent validity, structural validity, known-group validity and explanatory power. RESULTS: Adding sleep (30%), tiredness (24%) or vision (21%) substantially reduced the ceiling of the EQ-5D-5L (41%). Cognition, sleep, social relationships and tiredness correlated with corresponding PROMIS and SF-6D items (rs=ǀ0.32ǀ-ǀ0.73ǀ). All bolt-ons, except cognition and self-confidence, loaded on a different factor from the EQ-5D-5L dimensions. Breathing, hearing, skin irritation and vision significantly improved known-group validity in relevant health condition groups. The sleep bolt-on improved known-group validity in 9 out of 13 chronic health conditions. Tiredness had the largest impact on explaining EQ VAS score variance in 8 out of 13 conditions. Hearing and vision improved the ability of the EQ-5D-5L to capture declining health with age, while self-confidence and social relationships were valuable for mental health assessment. CONCLUSIONS: This study established the validity of multiple bolt-ons for the EQ-5D-5L and highlights the usefulness of including relevant bolt-ons in population-based and patient surveys. Our findings inform the further development of these bolt-ons and the bolt-on item selection for clinical studies.

Validity and measurement equivalence of EQ-5D-5L questionnaire among heart failure patients in Malaysia: a cohort study.

AIM: This study aimed to examine the validity of EQ-5D-5L among HFrEF patients in Malaysia, and to explore the measurement equivalence of three main language versions. METHODS: We surveyed HFrEF patients from two hospitals in Malaysia, using Malay, English or Chinese versions of EQ-5D-5L. EQ-5D-5L dimensional scores were converted to utility scores using the Malaysian value set. A confirmatory factor analysis longitudinal model was constructed. The utility and visual analog scale (VAS) scores were evaluated for validity (convergent, known-group, responsiveness), and measurement equivalence of the three language versions. RESULTS: 200 HFrEF patients (mean age = 61 years), predominantly male (74%) of Malay ethnicity (55%), completed the admission and discharge EQ-5D-5L questionnaire in Malay (49%), English (26%) or Chinese (25%) languages. 173 patients (86.5%) were followed up at 1-month post-discharge (1MPD). The standardized factor loadings and average variance extracted were ≥ 0.5 while composite reliability was ≥ 0.7, suggesting convergent validity. Patients with older age and higher New York Heart Association (NYHA) class reported significantly lower utility and VAS scores. The change in utility and VAS scores between admission and discharge was large, while the change between discharge and 1MPD was minimal. The minimal clinically important difference for utility and VAS scores was ±0.19 and ±11.01, respectively. Malay and English questionnaire were equivalent while the equivalence of Malay and Chinese questionnaire was inconclusive. LIMITATION: This study only sampled HFrEF patients from two teaching hospitals, thus limiting the generalizability of results to the entire heart failure population. CONCLUSION: EQ-5D-5L is a valid questionnaire to measure health-related quality of life and estimate utility values among HFrEF patients in Malaysia. The Malay and English versions of EQ-5D-5L appear equivalent for clinical and economic assessments.

EQ-5D is the most commonly used questionnaire to measure patients' health-related quality of life in clinical trials and health technology assessments. To increase confidence over clinical trial findings that heart failure interventions improve health-related quality of life and quality-adjusted life years (number of years alive with equivalence health-related quality of life), the questionnaire used to measure health-related quality of life needs to be validated in the specific population. Since EQ-5D-5L has not been validated in Malaysia's heart failure with reduced ejection fraction (HFrEF) population, this study evaluated the psychometric properties (validity) of EQ-5D-5L among HFrEF patients in Malaysia and the equivalence of different versions of languages (i.e. Malay, Chinese and English) of EQ-5D-5L in measuring the health-related quality of life. The findings suggested that EQ-5D-5L is a valid questionnaire to measure the health-related quality of life in HFrEF patients and estimate the quality-adjusted life years. The Malay and English versions of EQ-5D-5L appear to be equivalent for use in clinical trials and health technology assessments.

Health status based on EQ-5D-5L for the cancer patient population in Malaysia.

The EQ-5D is a common generic tool used in clinical trials and economic evaluations to evaluate the health-related quality of life as a proxy of health outcomes. To date, studies using EQ-5D-5L to evaluate the health status of cancer patients remain scarce in Malaysia. In this study, EQ-5D-5L dimensions, EQ-5D-5L index, and EQ-VAS scores were applied to assess the health status of Malaysian cancer patients. A cross-sectional study was conducted March-December 2022 to collect data relevant to the EQ-5D-5L valuation of health status via the Research Electronic Data Capture (REDCap) platform. Respondents rated their health states using EQ-5D-5L and EQ-VAS. Among the 235 respondents, the mean EQ-5D-5L index and EQ-VAS score were 0.76 (SD 0.223) and 81.06 (SD 16.36). Most of the patients reported some problems in the pain/discomfort and anxiety/depression dimensions. The level of education, stage of cancer, and comorbidity were significantly associated with better health status on EQ-5D-5L (p < 0.05) but only the stage of cancer was significantly associated with EQ-VAS scores. This study highlighted the disparities in self-reported health status across patients of different sociodemographic and medical profiles with EQ-5D-5L valuation. Thus, future research should use EQ-5D norm scores as a benchmark of comparison among cancer patients.

Health-related quality of life measured using the EQ-5D-3L: iranian population norms.

BACKGROUND: Normative values are valuable for comparing a specific population with the general population, making them particularly useful in disease burden studies and cost-effectiveness analysis. The objective of this study was to estimate HRQoL normative values for the EQ-5D measure in Iran. METHODS: The analysis was performed using a sample (n = 27,704) of the Iranian adult population, which was extracted from a nationwide survey conducted in 2021. Participants assessed their health-related quality of life using the EQ-5D-3 L instrument and a visual analogue scale (EQ VAS). Multivariable regression analyses were performed to examine the relationships between utility scores, EQ VAS scores, and various socio-demographic factors. RESULTS: The mean utility and EQ VAS scores of the total sample were 0.87 (95% CI: 0.86, 0.88) and 72.9 (95% CI: 72.7, 73.1), respectively. Almost half of the respondents (46.8%) reported a health state without any problems. The most prevalent problems were pain/discomfort (38.3%) and anxiety/depression (35.2%). Furthermore, EQ-5D values and EQ VAS scores were associated with gender, age, employment status, education level, marital status, and chronic illness. CONCLUSIONS: This study provided normative values for the general population in Iran. Policymakers and researchers can use these values as a reference for population norms in economic assessments and studies focusing on the population's health.

Measurement properties of the EQ-5D-3L, EQ-5D-5L, and SF-6Dv2 in patients with late-onset Pompe disease.

OBJECTIVE: The objective of this study was to evaluate the psychometric properties of the EQ-5D (3L and 5L) and SF-6Dv2 in a group of Chinese patients with late-on Pompe disease (PD), and compare their performance in this patient group. METHODS: The data used in this study were obtained from a web-based and cross-sectional survey conducted in China. All participants completed the 3L, 5L, and SF-6Dv2. Information about their sociodemographic status and health conditions was also collected. The measurement properties were assessed by examining ceiling and floor effects, evaluating convergent validity, known-group validity, and test-retest reliability (Intraclass correlation coefficient [ICC] and Gwet's AC). RESULTS: A total of 117 PD patients completed the questionnaire. All dimensions of the 3L showed strong ceiling effects, ranging between 17.1 and 42.7%. All three measures showed good test-retest reliability, with ICC values ranging from 0.85 to 0.87. The Gwet's AC values showed that four out of five dimensions of the 3L showed very good agreement. All hypothesized correlations between the 3L, 5L, SF-6Dv2, and items of WHODAS were supported, indicating satisfactory convergent validity. The 5L showed stronger correlations (|r|= 0.53-0.84) with WHODAS than the other two measures. The outcomes of ANOVA indicated that the 5L had higher F-statistics than the 3L and SF-6Dv2, indicating a stronger discriminant ability to differentiate most condition groups. CONCLUSION: The 5L demonstrates lower ceiling and floor effects, higher discriminant ability, and better convergent validity than the SF-6Dv2 and 3L in patients with PD. In addition, the 5L may generate a larger utility gain compared to the other two instruments when conducting cost-effectiveness analysis.

Impact of Work-Life Balance on the Quality of Life of Spanish Nurses during the Sixth Wave of the COVID-19 Pandemic: A Cross-Sectional Study.

This study addresses the health-related quality of life (HRQoL) of Spanish nurses during the sixth wave of the COVID-19 pandemic, assessed through the EQ-5D and EQ-VAS indices. METHODS: This cross-sectional 334 study used online surveys, recruiting 305 Spanish nurses. RESULTS: Nurses generally perceived a good HRQoL. "Negative work-family interaction" is adversely associated with the EQ-VAS (ß = -0.337, 95% CI [-1.733, -0.723]) and EQ-5D (ß = -0.399, 95% CI [-0.021, -0.01]) indices, while "positive work-family interaction" shows a positive relationship with the EQ-VAS (ß = 0.218, 95% CI [0.381, 1.759]). The presence of a "paid supportive caregiver" is positively associated with the EQ-VAS (ß = 0.18, 95% CI [1.47, 12.3]) and EQ-5D (ß = 0.149, 95% CI [0.004, 0.117]) indices, but a higher "number of children" is negatively linked with the EQ-5D index (ß = -0.146, 95% CI [-0.061, -0.002]). In addition, living with a partner (EQ-VAS ß = 0.16, 95% CI [1.094, 14.67] and EQ-5D index ß = 0.174, 95% CI [0.018, 0.163]) and working a "rotating shift" (EQ-5D index ß = 0.158, 95% CI [0.005, 0.098]) are positively associated. CONCLUSIONS: These findings highlight the need to comprehensively address nurses' well-being, considering both their working conditions and their home environment, especially in crisis contexts such as the current pandemic.

A Head-to-Head Comparison of EQ Health and Wellbeing and EQ-5D-5L in Patients, Carers, and General Public in China.

OBJECTIVES: This study aimed to understand the psychometric properties of EQ Health and Wellbeing (EQ-HWB) and to examine its relationship with EQ-5D-5L in a sample covering patients, carers, and general public. METHODS: A cross-sectional study was conducted in Guizhou Province, China. The acceptability, convergent validity (using Spearman correlation coefficients), internal structure (using exploratory factor analysis), and known-group validity of EQ-HWB, EQ-HWB-Short (EQ-HWB-S), and EQ-5D-5L were reported and compared. RESULTS: A total of 323 participants completed the survey, including 106 patients, 101 carers, and 116 individuals from the general public. Approximately 7.4% of participants had at least 1 missing response. In the EQ-HWB and EQ-5D-5L items related to activities, there were more level 1 responses. The correlations between EQ-HWB and EQ-5D-5L items ranged from low to high, confirming the convergent validity of similar aspects between the 2 instruments. Notably, EQ-HWB measures 2 additional factors compared with EQ-5D-5L or EQ-HWB-S, both of which share 3 common factors. When the patient group was included, EQ-5D-5L had the largest effect size, but it failed to differentiate between the groups of general public and carers. Both EQ-HWB and EQ-HWB-S demonstrated better known-group validity results when carers were included. CONCLUSIONS: EQ-HWB measures a broader quality of life construct that goes beyond health measured by EQ-5D-5L. By encompassing a broader scope, the impact of healthcare interventions may become diluted, given that other factors can influence wellbeing outcomes as significantly as health conditions do.

Construct validity of EQ-5D-5L among patients with inflammatory bowel disease-a study based on real-world data from the Swedish Inflammatory Bowel Disease Registry.

OBJECTIVES: The Swedish Inflammatory Bowel Disease Registry (SWIBREG) includes approximately 84% of all patients with inflammatory bowel disease (IBD) treated with immunomodulators, biologics or surgery in Sweden. Data on health-related quality of life (HRQoL) have been collected using EQ-5D-5L in the registry since 2012. Nevertheless, there are few studies assessing the validity of EQ-5D-5L in this patient population. Thus, the aim of this study was to assess the construct validity of EQ-5D-5L amongst patients with IBD (ulcerative colitis and Crohn's disease). METHODS: Individual-level data on EQ-5D-5L and other disease-specific measures were extracted from SWIBREG. Known-groups validity was assessed by analysing whether the EQ-5D-5L captured expected differences between patient groups with different activity levels of the disease. Convergent validity was assessed by analysing whether the reported problems in the dimensions of EQ-5D-5L, EQ VAS, and the EQ-5D-5L index value correlated, as hypothesized, with the four dimensions in the Short Health Scale, a symptom index question, and the Physician Global Assessment (PGA) score. RESULTS: In total, 9769 patients with IBD were included in the study. Patients with active IBD reported more health problems in the EQ-5D-5L descriptive system than patients being in remission. The effect sizes for the differences in reported problems between patients with active and inactive disease were at least small (≥0.1) or medium (≥0.3) in all dimensions except self-care. Differences in the mean EQ-5D-5L index and EQ-VAS score between patients with active and inactive disease were statistically significant (p < 0.001) and larger than pre-defined cut-offs for minimally important differences (>0.08 for the index and >11.0 for EQ-VAS). The analysis of convergent validity showed that EQ-5D-5L results correlated as expected with the disease-specific measures in 16 of the 21 analyses. In total, 22 (79%) of the 28 hypotheses were supported. CONCLUSION: The findings support the construct validity of EQ-5D-5L amongst patients with IBD and contribute to the scarce literature on the validity of the five-level version of EQ-5D in this patient population. These findings have important implications for the choice of HRQoL measure in routine health care registries like SWIBREG as well as for future clinical or health economic studies considering using EQ-5D-5L as a measure of HRQoL.

Evaluating health utility score through direct and indirect methods in patients with chronic rhinosinusitis.

INTRODUCTION: EuroQol-5-dimensions-5-levels (EQ-5D-5L), visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG) are used for the assessment of Health Utility Scores (HUS) of chronic rhinosinusitis (CRS). This study aimed to determine the overall HUS of CRS, the factors which influence the HUS, and the preferable method. METHODS: A cross-sectional study was conducted. Patients with primary CRS were recruited. Clinical and socioeconomic data together with HUS were assessed. Four HUS scores determined from the four different methods were compared. RESULTS: A total of 335 patients were enrolled. The overall HUS, as measured by EQ-5D-5L, VAS, TTO, and SG, was 0.88 ± 0.14, 0.79 ± 0.17, 0.89 ± 0.15, and 0.86 ± 0.16, respectively. The multivariable linear regression revealed that each increasing 22-item sinonasal outcome test (SNOT-22) score predicted a reduction of 0.002 to 0.003 in HUS (all methods, p < 0.01). Patients who scheduled for endoscopic sinus surgery had 0.06 to 0.11 HUS lower than other groups in EQ-5D-5L and VAS (all p < 0.05). Higher endoscopy score, age, presence of comorbid airway diseases, and lower education correlated with lower HUS (p < 0.05). Given the HUS results and regression models, the EQ-5D-5L is likely the preferable choice. CONCLUSION: The overall HUS of CRS was approximately 0.79-0.89. High SNOT-22 score and those who failed medications, presence of comorbid AR/asthma, increased age, high endoscopy score, and low education negatively impacted HUS. Our data suggest that EQ-5D-5L is a preferable method for measuring HUS in patients with CRS.