Mapping the QLQ-C30 quality of life cancer questionnaire to EQ-5D patient preferences Derivation of Utility Values from European Organization for Research and Treatment of Cancer Quality of Life-Core 30 Questionnaire Values in Lung Cancer Mapping the cancer-specific EORTC QLQ-C30 to the preference-based EQ-5D, SF-6D, and 15D instruments. Converting EORTC QLQ-C30 scores to utility scores in the brigatinib ALTA study Testing alternative regression models to predict utilities: mapping the QLQ-C30 onto the EQ-5D-5L and the SF-6D Mapping of the DLQI scores to EQ-5D utility values using ordinal logistic regression Quality of life after palliative treatment for oesophageal carcinoma -- a prospective comparison between stent placement and single dose brachytherapy. The potential for a generally applicable mapping model between QLQ-C30 and SF-6D in patients with different cancers: a comparison of regression-based methods 3L, 5L, What the L? A NICE Conundrum Mapping SF-36 onto the EQ-5D index: how reliable is the relationship? Validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) as a measure of psychosocial function in breast cancer patients. Mapping between the Roland Morris Questionnaire and generic preference-based measures. Mapping the SRS-22r questionnaire onto the EQ-5D-5L utility score in patients with adolescent idiopathic scoliosis Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population. Study protocol for valuing EQ-5D-3L and EORTC-8D health states in a representative population sample in Sri Lanka Cancer of Oesophagus or Gastricus - New Assessment of Technology of Endosonography (COGNATE): report of pragmatic randomised trial. Mapping utility scores from a disease-specific quality-of-life measure in bariatric surgery patients. Is baseline quality of life useful for predicting survival with hormone-refractory prostate cancer? A pooled analysis of three studies of the European Organisation for Research and Treatment of Cancer Genitourinary Group. Mapping FACT-melanoma quality-of-life scores to EQ-5D health utility weights. Mapping the clinical chronic obstructive pulmonary disease questionnaire onto generic preference-based EQ-5D values. Quality of life and cost-effectiveness of interferon-alpha in malignant melanoma: results from randomised trial Development of a transformation model to derive general population–based utility: Mapping the pruritus–visual analog scale (VAS) to the EQ‐5D utility Prognostic value of health-related quality-of-life data in predicting survival in patients with anaplastic oligodendrogliomas, from a phase III EORTC brain cancer group study. Mapping the Modified Rankin Scale (mRS) Measurement into the Generic EuroQol (EQ-5D) Health Outcome Predicting health-related quality of life (EQ-5D-5 L) and capability wellbeing (ICECAP-A) in the context of opiate dependence using routine clinical outcome measures: CORE-OM, LDQ and TOP Characteristics and quality of life of patients who choose home care at the end of life. Variability and sample size requirements of quality-of-life measures: a randomized study of three major questionnaires. Health-related quality of life among prostate cancer patients: real-life situation at the beginning of treatment Is progression-free survival associated with a better health-related quality of life in patients with lung cancer? Evidence from two randomised trials with afatinib Patient preference for either the EORTC QLQ-C30 or the FACIT Quality Of Life (QOL) measures: a study performed in patients suffering from carcinoma of an unknown primary site (CUP). Estimation of a Preference-Based Index from a Condition-Specific Measure: The King's Health Questionnaire Mapping the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) to EQ-5D Utility Scores Mapping from disease-specific measures to health-state utility values in individuals with migraine. Mapping the FACT-G cancer-specific quality of life instrument to the EQ-5D and SF-6D A single European currency for EQ-5D health states Assessing outcomes for cost-utility analysis in mental health interventions: mapping mental health specific outcome measure GHQ-12 onto EQ-5D-3L An international field study of the reliability and validity of a disease-specific questionnaire module (the QLQ-OV28) in assessing the quality of life of patients with ovarian cancer. The impact of acute urinary retention after iodine-125 prostate brachytherapy on health-related quality of life. Impact of oesophagectomy on physical fitness and health-related quality of life in patients with oesophageal cancer. Individual Psychosocial Support for Breast Cancer Patients: A Randomized Study of Nurse Versus Psychologist Interventions and Standard Care Measurement of Health-Related Quality of Life in the Early Follow-Up of Colon and Rectal Cancer Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35. Economic evaluation in short bowel syndrome (SBS): an algorithm to estimate utility scores for a patient-reported SBS-specific quality of life scale (SBS-QoL™) Modeling a preference-based index for two condition-specific measures (asthma and overactive bladder) using a nonparametric Bayesian method. US Valuation of the EQ-5D Health States: Development and Testing of the D1 Valuation Model Does Selecting Covariates Using Factor Analysis in Mapping Algorithms Improve Predictive Accuracy? A Case of Predicting EQ-5D-5L and SF-6D Utilities from the Women's Health Questionnaire. Measurement of health‐related quality of life in multiple myeloma Generic and disease-specific estimates of quality of life in macular degeneration: mapping the MacDQoL onto the EQ-5D-3L Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: a prognostic analysis of the multicenter Italian lung cancer in the elderly study. Cost-effectiveness and quality of life in surgeon versus general practitioner-organised colon cancer surveillance: a randomised controlled trial Generating EQ-5D-3L Utility Scores from the Dermatology Life Quality Index: A Mapping Study in Patients with Psoriasis. Development of the EXACT-U: a preference-based measure to report COPD exacerbation utilities. Effects of a 4-Week Multimodal Rehabilitation Program on Quality of Life, Cardiopulmonary Function, and Fatigue in Breast Cancer Patients Patient-Reported Outcomes and Quality of Life in PROFILE 1007: A Randomized Trial of Crizotinib Compared with Chemotherapy in Previously Treated Patients with ALK-Positive Advanced Non–Small-Cell Lung Cancer
Background Although cancer-specific Health-Related Quality of Life ( HRQOL ) are commonly included in r and omized clinical trials or other prospect i ve non-r and omized clinical studies , it is rare that preference-based instruments are used that allow the calculation of a utility weight suitable for estimating quality -adjusted life-years gained . Objective To develop a mapping algorithm to transform the EORTC QLQ-C30 question naire responses into EQ-5D derived utilities . Study design Retrospective data analysis of a multicentre , multicountry prospect i ve clinical trial in breast cancer patients . Methods Regression analysis of individual pairs of EQ-5D and QLQ-C30 scores . Results A model that explained 80 % of the variance was developed to estimate EQ-5D Utilities from QLQ-C30 scores at individual level . From this reliable group level means and deviations can be derived . Conclusions Mapping from QLQ-C30 scores to EQ-5D-derived utilities when only QLQ-C30 data are available has been shown to be possible with good accuracy . Validation of the proposed algorithm in other external clinical data sets should be encouraged Introduction : Cancer clinical trials frequently incorporate quality of life ( QoL ) measures but rarely patient utility . Utility information is required for cost utility evaluations of novel cancer therapies . We assessed the feasibility of converting QoL data into utility scores using the European Organization for Research and Treatment of Cancer Quality of Life-Core  30 question naire ( EORTC QLQ-C30 ) and the EQ-5D in patients with non-small cell lung cancer ( NSCLC ) . Methods : Out patients with all different disease states of NSCLC attending a major Canadian cancer center completed the QLQ-C30 and EQ5D on a single visit . Results of the QLQ-C30 summary scores were mapped to predict EQ-5D utility scores using linear regression . Backward variable elimination using the Akaike Information Criterion was used to reduce the full model that included all QLQ-C30 summary scores to examine which QLQ-C30 dimensions best predict a patient 's utility score . To test the predictive power of the model , 10-fold cross-validation was used . Results : A total of 172 patients participated in the study . Median age of the sample was 66 years ( range , 32–85 years ) ; 46.5 % were men . The cross-validation estimate of mean utility score was 0.76 ( SD : 0.20 ) , which was the same as the actual mean utility score . Of the 15 QLQ-C30 dimensions , 4 functional dimensions ( physical , role , emotional , and social ) and the pain symptom dimension were predictive of patient utility scores . Conclusions : Our study demonstrates the feasibility of deriving utility scores from prospect i ve QoL data . Validation of the QLQ-C30 predictors found in this study could further the ability to estimate cost utility of therapies for economic evaluations OBJECTIVES To estimate models , via ordinary least squares regression , for predicting Euro Qol 5D ( EQ-5D ) , Short Form 6D ( SF-6D ) , and 15D utilities from scale scores of the European Organization for Research and Treatment of Cancer Quality of Life Question naire ( EORTC QLQ-C30 ) . METHODS Forty-eight gastric cancer patients , split up into equal subgroups by age , sex , and chemotherapy scheme , were interviewed , and the survey included the QLQ-C30 , SF-36 , EQ-5D , and 15D instruments , along with sociodemographic and clinical data . Model predictive ability and explanatory power were assessed by root mean square error ( RMSE ) and adjusted R(2 ) values , respectively . Pearson 's r between predicted and reported utility indices was compared . Three r and om sub sample s , half in size the initial sample , were created and used for " external " validation of the modeling equations . RESULTS Explanatory power was high , with adjusted R(2 ) reaching 0.909 , 0.833 , and 0.611 for 15D , SF-6D , and EQ-5D , respectively . After normalization of RMSE to the range of possible values , the prediction errors were 12.0 , 5.4 , and 5.6 % for EQ-5D , SF-6D , and 15D , respectively . The estimation equations produced a range of utility scores similar to those achievable by the st and ard scoring algorithms . Predicted and reported indices from the validation sample s were comparable thus confirming the previous results . CONCLUSIONS Evidence on the ability of QLQ-C30 scale scores to validly predict 15D and SF-6D utilities , and to a lesser extent , EQ-5D , has been provided . The modeling equations must be tried in future studies with larger and more diverse sample s to confirm their appropriateness for estimating quality -adjusted life-year in cancer-patient trials including only the QLQ-C30 Abstract Aims : Health utilities summarize a patient ’s overall health status . This study estimated utilities based on the European Organization for Research and Treatment of Cancer Quality of Life Question naire Core-30 ( QLQ-C30 ) , a widely used measure of health-related quality -of-life ( HRQoL ) in oncology , using published mapping algorithms . Material s and methods : Data were from the Anaplastic Lymphoma Kinase ( ALK ) in Lung Cancer Trial of brigatinib ( ALTA ; NCT02094573 ) , an open-label , international , phase 2 study . ALTA evaluated the efficacy and safety of two r and omized dosing regimens of brigatinib in patients with locally advanced or metastatic ALK + non-small cell lung cancer ( NSCLC ) that had progressed on prior therapy with crizotinib . QLQ-C30 scores were mapped to European Quality -of-Life-5 Dimensions ( EQ-5D ) utility scores using two published algorithms ( Khan et al. for EQ-5D-5L ; Longworth et al. for EQ-5D-3L ) . The impact of brigatinib treatment on health utilities over time was assessed . Results : The analysis included 208 subjects . Mean baseline utility scores for both algorithms ranged between 0.60 − 0.71 and increased to 0.78 by cycle 5 . Utility improvements were sustained during most of the treatment , before disease progression . Minor variations were observed between utility scores ; Khan et al. estimates were approximately 0.01 or 0.02 points lower than Longworth et al. estimates . Limitations : Algorithms considered were limited to those available in the published literature at the time of the study . This utility analysis was exploratory , and the ALTA trial did not include an internal control group ( i.e. st and ard of care ) and was not powered to detect differences in QoL/utility outcomes between treatment arms . Conclusions : Converting QLQ-C30 scores into utilities in trials using established mapping algorithms can improve evaluation of medicines from the patient perspective . Both algorithms suggested that brigatinib  improved health utility in crizotinib-refractory ALK + NSCLC patients , and improvements were maintained during most of the treatment . Clinical trials.gov identifier : Purpose The purpose of the study was to compare alternative statistical techniques to find the best approach for converting QLQ-C30 scores onto EQ-5D-5L and SF-6D utilities , and to estimate the mapping algorithms that best predict these health state utilities . Methods 772 cancer patients described their health along the  cancer-specific instrument ( QLQ-C30 )  and two generic preference-based instruments ( EQ-5D-5L and SF-6D ) . Seven alternative regression models were applied : ordinary least squares , generalized linear model , extended estimating equations ( EEE ) , fractional regression model , beta binomial ( BB ) regression , logistic quantile regression and censored least absolute deviation .  Normalized mean absolute error ( NMAE ) , normalized root mean square error ( NRMSE ) , r-squared ( r2 ) and concordance correlation coefficient ( CCC ) were used as model performance criteria . Cross-validation was conducted by r and omly splitting internal data set into two equally sized groups to test the generalizability of each model . Results In predicting EQ-5D-5L utilities , the BB regression performed best . It gave better predictive accuracy in terms of all criteria in the full sample , as well as in the validation sample . In predicting SF-6D , the EEE performed best . It outperformed in all criteria : NRMSE = 0.1004 , NMAE = 0.0798 , CCC = 0.842 and r2 = 72.7 % in the full sample , and NRMSE = 0.1037 , NMAE = 0.0821 , CCC = 0.8345 and r2 = 71.4 % in cross-validation . Conclusions When only QLQ-C30 data are available , mapping provides an alternative approach to obtain health state utility data for use in cost-effectiveness analyses . Among seven alternative regression models , the BB and the EEE gave the most accurate predictions for EQ-5D-5L and SF-6D , respectively Purpose The Dermatology  Life Quality  Index ( DLQI ) and the European Quality of Life-5 Dimension ( EQ-5D ) are separate measures that may be used to gather health-related quality of life ( HRQoL ) information from patients . The EQ-5D is a generic measure from which health utility estimates can be derived , whereas the DLQI is a specialty-specific measure to assess HRQoL. To reduce the burden of multiple measures being administered and to enable a more disease-specific calculation of health utility estimates , we explored an established mathematical technique known as ordinal logistic regression ( OLR ) to develop an appropriate model to map DLQI data to EQ-5D-based health utility estimates . Methods Retrospective data from 4010 patients were r and omly divided five times into two groups for the derivation and testing of the mapping model . Split-half cross-validation was utilized result ing in a total of ten ordinal logistic regression models for each of the five EQ-5D dimensions against age , sex , and all ten items of the DLQI . Using Monte Carlo simulation , predicted health utility estimates were derived and compared against those observed . This method was repeated for both OLR and a previously tested mapping methodology based on linear regression . Results The model was shown to be highly predictive and its repeated fitting demonstrated a stable model using OLR as well as linear regression . The mean differences between OLR-predicted health utility estimates and observed health utility estimates ranged from 0.0024 to 0.0239 across the ten modeling exercises , with an average overall difference of 0.0120 ( a 1.6 % underestimate , not of clinical importance ) . Conclusions This modeling framework developed in this study will enable research ers to calculate EQ-5D health utility estimates from a specialty-specific study population , reducing patient and economic burden Metal stent placement and single dose brachytherapy are commonly used treatment modalities for the palliation of inoperable oesophageal carcinoma . We investigated generic and disease-specific health-related quality of life ( HRQoL ) after these palliative treatments . Patients with dysphagia from inoperable oesophageal carcinoma were r and omised to placement of a covered Ultraflex stent ( n = 108 ) or single dose ( 12 Gy ) brachytherapy ( n = 101 ) . We obtained longitudinal data on disease-specific ( dysphagia score , European Organisation for Research and Treatment of Cancer ( EORTC ) OES-23 , visual analogue pain scale ) and generic ( EORTC Quality of Life-Core 30 Question naire ( QLQ-C30 ) , Euroqol (EQ)-5D ) HRQoL at monthly home visits by a specially-trained research nurse . We compared HRQoL between the two treatments and analysed changes in HRQoL during follow-up . Dysphagia improved more rapidly after stent placement than after brachytherapy , but long-term relief of dysphagia was better after brachytherapy . For generic HRQoL , there was an overall significant difference in favour of brachytherapy on four out of five functional scales of the EORTC QLQ-C30 ( role , emotional , cognitive and social ) ( P < 0.05 ) . Generic HRQoL deteriorated over time on all functional scales of the EORTC QLQ C-30 and EQ-5D , in particular physical and role functioning ( on average -23 and -24 on a 100 points scale during 0.5 years of follow-up ) . This decline was more pronounced in the stent group . Major improvements were seen on the dysphagia and eating scales of the EORTC OES-23 , in contrast to other scales of this disease-specific measure , which remained almost stable during follow-up . Reported levels of chest or abdominal pain remained stable during follow-up in both treatment groups , general pain levels increased to a minor extent . The effects of single dose brachytherapy on HRQoL compared favourably to those of stent placement for the palliation of oesophageal cancer . Future studies on palliative care for oesophageal cancer should at least include generic HRQoL scales , since these were more responsive in measuring patients ' functioning and well-being during follow-up than disease-specific HRQoL scales Purpose To establish and compare generalized or “ global ” mapping relationships between QLQ-C30 and SF-6D , applicable across different cancer types . Methods Patients ( N = 671 ) with breast , myeloma , colorectal , lymphoma , bone marrow , prostate , lung and gastroenteric cancer were r and omly split into estimation ( 75 % ) and validation ( 25 % ) data sets . SF-6D was estimated from QLQ-C30 scores via ordinary least squares , generalized linear models and median ( least-absolute deviations ) regression approaches , and with Bayesian additive regression kernels . Predictive ability was assessed with root mean square error , mean absolute error and proportions of predictions with absolute errors > 0.05 and > 0.1 , whereas explanatory power with adjusted R2 or equivalent fit measures . Two external sample s ( breast and colorectal cancer ) were used to further test the models . Results The QLQ-C30 's global health item , the physical , emotional and social functioning scales , and the fatigue , pain and diarrhea symptom scales were significant predictors ( p < 0.05 or better ) in all models . Negligible deviations in models ’ performance were observed . All models overpredicted utilities for patients in worst health and underpredicted them for those in better health ( p < 0.01 or better ) . Regarding external validation , performance was better in the colorectal cancer than in the breast cancer sample . Conclusions This study has provided evidence to support the use of “ global ” mapping models to predict SF-6D utilities from QLQ-C30 in patients with different cancers . Testing with diverse patient sample s is required to confirm the generalizability ( or not ) of mapping models across cancer conditions For many years , the National Institute for Health and Care Excellence ( NICE ) has recommended use of the EQ-5D-3L ( 3L ) [ 1 ] and its value set for the UK [ 2 ] . Since 2011 , an exp and ed-level instrument , the EQ-5D-5L ( 5L ) , has been available [ 3 ] and value sets now exist to support its use , including a value set for Engl and [ 4 , 5 ] . This poses a challenge for NICE . Should it recommend the 5L rather than the 3L ? This is neither a trivial nor merely academic matter : the choice of whether to use the 5L ( and English value set ) or the 3L ( and UK value set ) is likely to impact estimates of quality -adjusted life-years ( QALYs ) and incremental cost-effectiveness ratios ( ICERs ) . The size and direction of that impact will depend on the disease and the nature of the health problems . In general , where technologies improve self-reported health , estimates of QALY gains will often be smaller with the 5L [ 6 ] . In contrast , where technologies extend the length of life , estimates of QALY gains will be higher ( to varying degrees ) : each year of additional life is assigned a higher utility . The ultimate impact on health technology assessment ( HTA ) will depend on whether the differences between the 3L and 5L push ICERs from one side of the cost-effectiveness threshold to the other . Given the implication s for NICE ’s technology appraisal process , and other decisions informed by EQ-5D data , the Department of Health for Engl and has called for an independent validation of the 5L value set , given its relevance to policy [ 7 ] . In 2017 , NICE released a ‘ position statement ’ [ 8 ] stating that : The 3L value set continues to be used for reference-case analyses . Where 5L data have been collected , reference-case analyses should calculate utilities by mapping the 5L descriptive system data onto the 3L value set , using the van Hout et al. [ 9 ] mapping function . NICE supports sponsors of prospect i ve clinical studies continuing to use the 5L to collect data on quality of life . A further position statement is planned for August 2018 , to be informed by evidence from various studies underway . These include studies commissioned by the English Department of Health to investigate the implication s for past NICE technology appraisal s had the 5L been used , and to collect 3L and 5L data in parallel to further improve functions for mapping from one to the other . Other studies , funded by the EuroQol Group , are also underway , investigating various aspects of the relationship between the 3L and 5L across disease areas . The 3L and its UK value set has occupied a special place in NICE ’s technology appraisal process since its inception , therefore any transition will inevitably pose challenges ; for example , reconciling potential inconsistencies between past and future decisions . Given that evidence will continue to be su bmi tted using both the 3L and 5L for years to come , if both value sets are able to be used , there is a risk of inconsistency between decisions being made in the future . HTA in other countries may also face similar issues . Given the difficulties with any transition away from the 3L , is there a case for NICE to adopt the 5L as its preferred instrument ? Papers in this issue of Pharmacoeconomics , which are cited in this commentary , address that question by investigating comparative performance of the 3L and 5L Background Mapping from health status measures onto generic preference-based measures is becoming a common solution when health state utility values are not directly available for economic evaluation . However the accuracy and reliability of the models employed is largely untested , and there is little evidence of their suitability in patient data sets . This paper examines whether mapping approaches are reliable and accurate in terms of their predictions for a large and varied UK patient data set . Methods SF-36 dimension scores are mapped onto the EQ-5D index using a number of different model specifications . The predicted EQ-5D scores for subsets of the sample are compared across inpatient and outpatient setting s and medical conditions . This paper compares the results to those obtained from existing mapping functions . Results The model including SF-36 dimensions , squared and interaction terms estimated using r and om effects GLS has the most accurate predictions of all models estimated here and existing mapping functions as indicated by MAE ( 0.127 ) and MSE ( 0.030 ) . Mean absolute error in predictions by EQ-5D utility range increases with severity for our models ( 0.085 to 0.34 ) and for existing mapping functions ( 0.123 to 0.272 ) . Conclusion Our results suggest that models mapping the SF-36 onto the EQ-5D have similar predictions across inpatient and outpatient setting and medical conditions . However , the models overpredict for more severe EQ-5D states ; this problem is also present in the existing mapping functions The European Organisation for Research and Treatment of Cancer ( EORTC ) quality of life question naire QLQ-C30 has been developed as a quantitative measure of health-related quality of life for use in clinical trials of cancer patients . Validity is an important measurement property of all scientific tests . This study contributes to the iterative process of validating the question naire by focusing on the psychosocial subscales of the QLQ-C30 , using baseline data from 150 patients participating in a r and omised trial of supportive group therapy for metastatic breast cancer . The results provide strong support for the discriminative validity of the global health/ quality of life , role function and social function subscales of the  QLQ-C30  , in patients differing according to clinical criteria . The psychosocial focus of the trial enabled expansion of criteria used to form patient subgroups , beyond medical factors , and consequently support was demonstrated for the discriminative validity of the emotional and cognitive function subscales . The degree of support for these subscales was less substantial than for the other QLQ-C30 subscales as there were fewer relevant criteria . Convergence assessed by correlations with independent measures of psychosocial function provides strong support for the convergent validity of the emotional function , role function and global health/ quality of life subscales of the QLQ-C30 , and moderate support for the social function subscales . There was little opportunity for the cognitive function subscale to associate with conceptually analogous subscales . Further testing is recommended with more comprehensive and specific measures of cognitive status . In general , the psychosocial subscales of the QLQ-C30 appear to be measuring the concepts they are purported to measure OBJECTIVES The Rol and Morris Question naire ( RMQ ) is a widely used health status measure for low back pain ( LBP ) . It is not preference-based , and there are currently no established algorithms for mapping between the RMQ and preference-based health-related quality -of-life measures . Using data from r and omized controlled trials of treatment for LBP , we sought to develop algorithms for mapping between RMQ scores and health utilities derived using either the EuroQol five-dimensional question naire ( EQ-5D ) or the six-dimensional health state short form ( derived from Medical Outcomes Study 36-Item Short-Form Health Survey ) ( SF-6D ) . METHODS This study is based on data from the Back Skills Training Trial in which data were collected from 701 patients at baseline and subsequently at 3 , 6 , and 12 months postr and omization using a range of outcome measures , including the  RMQ , the EQ-5D , and the Short Form 12 item Health Survey ( SF-12 ) ( from which SF-6D utilities can be derived ) . We used baseline trial data to estimate models using both direct and response mapping approaches to predict EQ-5D and SF-6D health utilities and dimension responses . A multistage model selection process was used to assess the predictive accuracy of the models . We then explored different techniques and mapping models that made use of repeated follow-up observations in the data . The estimated mapping algorithms were vali date d using external data from the UK Back Pain Exercise and Manipulation trial . RESULTS A number of models were developed that accurately predict health utilities in this context . The best performing model for RMQ to EQ-5D mapping was a beta regression with Bayesian quasi-likelihood estimation that included 24 dummy variables for RMQ responses , age , and sex as covariates ( mean squared error 0.0380 ) based on repeated data . The model selected for RMQ to SF-6D mapping was a finite mixture model that included the overall RMQ score , age , sex , RMQ score squared , age squared , and an interaction term for age and RMQ score as covariates ( mean squared error 0.0114 ) based on repeated data . CONCLUSIONS It is possible to reasonably predict EQ-5D and SF-6D health utilities from RMQ scores and responses using regression methods . Our regression equations provide an empirical basis for estimating health utilities when EQ-5D or SF-6D data are not available . They can be used to inform future economic evaluations of interventions targeting LBP This is a prospect i ve study to establish prediction models that map the refined Scoliosis Research Society 22-item ( SRS-22r ) onto EuroQoL-5 dimension 5-level ( EQ-5D-5L ) utility scores in adolescent idiopathic scoliosis ( AIS ) patients . Comparison of treatment outcomes in AIS can be determined by cost-utility analysis . However , the mainstay spine-specific health-related quality of life outcome measure , the SRS-22r question naire does not provide utility assessment . In this study , AIS patients were prospect ively recruited to complete both the EQ-5D-5L and SRS-22r question naires by trained interviewers . Ordinary least squares regression was undertaken to develop mapping models , which the validity and robustness were assessed by using the 10-fold cross-validation procedure .  EQ-5D-5L utility scores were regressed on demographics , Cobb angle , curve types , treatment modalities , and five domains of the SRS-22r question naire . Three models were developed using stepwise selection method . EQ-5D-5L scores were regressed on 1 ) main effects of SRS-22r subscale scores , 2 ) as per 1 plus squared and interaction terms , and 3 ) as per 2 plus demographic and clinical characteristics . Model goodness-of-fit was assessed using R-square , adjusted R-square , and information criteria ; whereas the predictive performance was evaluated using root mean square error ( RMSE ) , mean absolute error ( MAE ) , and the proportion of absolute error within the threshold of 0.05 and 0.10 . A total of 227 AIS patients with mean age of 15.6 years were recruited . The EQ-5D-5L scores were predicted by four domains of SRS-22r ( main effects of ‘ Function ’ , ‘ Pain ’ , ‘ Appearance ’ and ‘ Mental Health ’ , and squared term of ‘ Function ’ and ‘ Pain ’ ) , and Cobb angle in Model 3 with the best goodness-of-fit ( R-square/adjusted R-square : 62.1%/60.9 % ) . Three models demonstrated an acceptance predictive performance in error analysis applying 10-fold cross-validation to three models where RMSE and MAE were between 0.063–0.065 and between 0.039–0.044 , respectively . Model 3 was therefore recommended out of three mapping models established in this paper . To our knowledge , this is the first study to map a spine-specific health-related quality of life measure onto EQ-5D-5L for AIS patients . With the consideration and incorporation of demographic and clinical characteristics , over 60 % variance explained by mapping model 3 enabled the satisfactory prediction of EQ-5D-5L utility scores from existing SRS-22r data for health economic appraisal of different treatment options The objective of this study was to obtain age- and sex-specific reference values for the European Organization for Research and Treatment of Cancer ( EORTC ) Quality of Life Question naire QLQ-C30 . A r and omly selected sample of the German adult population ( 3015 subjects ) was used , 2081 subjects agreed to take part in the investigation . Most of the scales and symptom items of the question naire proved to be dependent on age and sex . Men reported fewer symptoms than women . Age differences were even more pronounced . Younger people reported better functioning and fewer symptoms . Compared with the results of a similar Norwegian study ( Hjermstad MJ , Fayers PM , Bjordal K , Kaasa S. Health related quality of life in the general Norwegian population assessed by the European Organization for research and treatment of cancer core quality -of-life question naire : The QLQ-C30(+3 ) . J Clin Oncol 1998 , 16 , 1188 - 1196 ) the prevalence of some symptoms was markedly less . Norm values for age and sex groups are given and regression analyses are performed which help to calculate expected mean scores . The results show that age and sex differences must be taken into consideration when different groups of cancer patients are compared . The norm values help to interpret quality of life data for clinicians Background Economic evaluations to inform decisions about allocation of health re sources are scarce in Low and Middle Income Countries , including in Sri Lanka . This is in part due to a lack of country-specific utility weights , which are necessary to derive appropriate Quality Adjusted Life Years . The EQ-5D-3L , a generic multi-attribute instrument ( MAUI ) , is most widely used to measure and value health states in high income countries ; nevertheless , the sensitivity of generic MAUIs has been criticised in some conditions such as cancer . This article describes a protocol to produce both a generic EQ-5D-3L and cancer specific EORTC-8D utility index in Sri Lanka . Method EQ-5D-3L and EORTC-8D health states will be valued using the Time Trade-Off technique , by a representative population sample ( n = 780 invited ) identified using stratified multi-stage cluster sampling with probability proportionate to size method . Households will be r and omly selected within 30 clusters across four districts ; one adult ( ≥18 years ) within each household will be selected using the Kish grid method . Data will be collected via face-to-face interview , with a Time Trade-Off board employed as a visual aid . Of the 243 EQ-5D-3L and 81,290 EORTC-8D health states , 196 and 84 respectively will be directly valued . In EQ-5D-3L , all health states that combine level 3 on mobility with either level 1 on usual activities or self-care were excluded . Each participant will first complete the EQ-5D-3L , rank and value 14 EQ-5D-3L states ( plus the worst health state and “ immediate death ” ) , and then rank and value seven EORTC-8D states ( plus “ immediate death ” ) . Participant demographic and health characteristics will be also collected . Regression models will be fitted to estimate utility indices for EQ-5D-3L and EORTC-8D health states for Sri Lanka . The dependent variable will be the utility value . Different specifications of independent variables will be derived from the ordinal EQ-5D-3L to test for the best-fitting model . Discussion In Sri Lanka , a LMIC health state valuation will have to be carried out using face to face interview instead of online methods . The proposed study will provide the first country-specific health state valuations for Sri Lanka , and one of the first valuations to be completed in a South Asian Country BACKGROUND Endoscopic ultrasonography is recommended for staging gastro-oesophageal cancers , but has never been evaluated . OBJECTIVE COGNATE ( Cancer of Oesophagus or Gastricus - New Assessment of Technology of Endosonography ) therefore aim ed to evaluate whether adding ' endoscopic ultrasound ' ( EUS ) to the usual staging algorithm changes treatment , improves ( quality -adjusted ) survival , and uses re sources cost-effectively . DESIGN Pragmatic parallel-group trial . Patients with gastro-oesophageal cancer received st and ard staging algorithms .  Multidisciplinary teams chose provisional management plans from endoscopic mucosal resection , immediate surgery , surgery after chemotherapy , or chemotherapy and radiotherapy . We used dynamic r and omisation to allocate consenting patients remotely by telephone in equal proportions between EUS and not . Thereafter we recorded changes in management plan , use of health-care re sources , and three aspects of participant-reported quality of life : generic [ measured by European Quality of Life - 5 Dimensions ( EQ-5D ) ] , cancer related [ Functional Assessment of Cancer Therapy - General scale ( FACT-G ) ] and  condition-specific [ FACT - Additional Concerns scale ( FACT-AC ) ] . We followed participants regularly until death or the end of the trial - for between 1 and 4.5 years . We devised a quality assurance programme to maintain st and ards of endosonographic reporting . SETTING Eight British hospitals , of which two - one Scottish teaching hospital and one English district general hospital - contributed 80 % of participants ; we combined the other six for analysis . PARTICIPANTS Patients were eligible if they had a diagnosis of gastro-oesophageal cancer , had not started treatment , were free of metastatic disease , were fit for surgery ( even if not planned ) and had American Society of Anesthesiologists and World Health Organization grade s of less than 3 . INTERVENTIONS Intervention group : st and ard staging algorithm plus EUS ; control group : st and ard staging algorithm . MAIN OUTCOME MEASURES Primary : quality -adjusted survival . Secondary : survival ; health-related quality of life ( EQ-5D , FACT-G and FACT-AC scales ) ; changes in management plan ; and complete resection rate . Although blinding participants was neither possible nor desirable , those responsible for analysis remained blind until the Trial Steering Committee had review ed the definitive analysis . RESULTS We r and omised 223 patients , of whom 213 yielded enough data for primary analysis .  EUS improved survival adjusted for generic quality of life with a hazard ratio of 0.705 [ 95 % confidence interval ( CI ) 0.499 to 0.995 ] , and crude survival with a hazard ratio of 0.706 ( 95 % CI 0.501 to 0.996 ) . The benefits of EUS were significantly greater for those with poor initial quality of life , but did not differ between centres . EUS  reduced net use of health-care re sources by £ 2860 ( 95 % ' bootstrapped ' CI from -£2200 to £ 8000 ) . Combining benefits and savings shows that EUS is likely to be cost-effective , with 96 % probability of achieving the National Institute for Health and Care Excellence criterion of costing of < £ 20,000 to gain a QALY . There were no serious adverse reactions attributable to EUS . EUS enhanced the management plan for many participants , increased the proportion of tumours completely resected from 80 % ( 44 out of 55 ) to 91 % ( 48 out of 53 ) , and improved the survival of those who changed plan ; although underpinning the significant differences in outcome , none of these process differences was itself significant . CONCLUSION Endoscopic ultrasound  significantly improves ( quality -adjusted ) survival , has the potential to reduce health-care re source use ( not statistically significant ) and is probably cost-effective ( with 96 % probability ) . We recommend research into the best time to evaluate new technologies . TRIAL REGISTRATION IS RCT N1444215 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 17 , No. 39 . See the HTA programme website for further project information OBJECTIVES To develop algorithms for a conversion of disease-specific quality -of-life into health state values for morbidly obese patients before or after bariatric surgery . METHODS A total of 893 patients were enrolled in a prospect i ve cross-sectional multicenter study . In addition to demographic and clinical data , health-related quality -of-life ( HRQoL ) data were collected using the disease-specific Moorehead-Ardelt II question naire ( MA-II ) and two generic question naires , the EuroQoL-5D ( EQ-5D ) and the Short Form-6D ( SF-6D ) . Multiple regression models were constructed to predict EQ-5D- and SF-6D-based utility values from MA-II scores and additional demographic variables . RESULTS The mean body mass index was 39.4 , and 591 patients ( 66 % ) had already undergone surgery . The average EQ-5D and SF-6D scores were 0.830 and 0.699 . The MA-IIwas correlated to both utility measures ( Spearman 's r = 0.677 and 0.741 ) . Goodness-of-fit was highest ( R(2 ) = 0.55 in the validation sample ) for the following item-based transformation algorithm : utility ( MA-II-based ) = 0.4293 + ( 0.0336 x MA1 ) + ( 0.0071 x MA2 ) + ( 0.0053 x MA3 ) + ( 0.0107 x MA4 ) + ( 0.0001 x MA5 ) . This EQ-5D-based mapping algorithm outperformed a similar SF-6D-based algorithm in terms of mean absolute percentage error ( P = 0.045 ) . CONCLUSIONS Because the mapping algorithm estimated utilities with only minor errors , it appears to be a valid method for calculating health state values in cost-utility analyses . The algorithm will help to define the role of bariatric surgery in morbid obesity PURPOSE Patients with symptomatic metastatic hormone-resistant prostate cancer ( HRPC ) survive a median of 10 months and are often regarded as a homogeneous group . Few prognostic factors have been identified so far . We examined whether baseline health-related quality of life ( HRQOL ) parameters assessed by the European Organisation for Research and Treatment of Cancer Quality of Life Question naire C30 ( EORTC QLQ-C30 )  were independent prognostic factors of survival and whether they bring extra precision to the predictions achievable with models based on clinical and biochemical factors only . PATIENTS AND METHODS Data of 391 symptomatic ( bone ) metastatic HRPC patients from three r and omized EORTC trials were used in multivariate Cox proportional hazards models . The significance level was set at alpha = .05 . RESULTS Of the 391 patients , 371 died  , most of prostate cancer . Bone scan result , performance status , hemoglobin level , and insomnia and appetite loss as measured by the EORTC QLQ-C30 were independent predictors of survival . This model 's area under the receiver operating curve was 0.65 compared with 0.63 without the two HRQOL factors . CONCLUSION Certain HRQOL sores , at baseline , seem to be predictors for duration of survival in HRPC . However , such measurements do not add to the predictive ability of models based only on clinical and biochemical factors OBJECTIVES We sought to develop a mapping function from functional assessment of cancer therapy-melanoma ( FACT-M ) quality of life scores to the EuroQol-5D ( EQ-5D ) utility scores . METHODS FACT-M and EQ-5D scores were collected during a prospect i ve study of melanoma-related quality of life at a tertiary cancer care center in the United States . The study sample was divided into development and validation data sets with equal distributions by cancer stage and treatment status . Censored Least Absolute Deviation ( CLAD ) and Ordinary Least Squares ( OLS ) regression analyses were performed using the developmental data set to derive mapping functions , and model performance was examined through comparisons of residuals and measures of fit in the validation data set . Exploratory analyses examined the predictive ability of clinical factors and individual subscales . RESULTS Of 273 patients , 75 were undergoing treatment with 198 in follow-up surveillance . Relatively even distributions were observed by melanoma stage : I/II ( n = 102 ) , III ( n = 100 ) , and IV ( n = 71 ) . OLS regression result ed in a mapping function of EQ-5D = 0.0037*FACT-M+0.2238 with an R(2 ) 0.499 . CLAD regression result ed in a mapping function of EQ-5D = 0.0042*FACT-M+0.1648 with pseudo R(2 ) 0.328 . When applied to the validation data set , correlations between observed and predicted values result ed in identical coefficients ( r = 0.824 , P < 0.001 ) . Though the mapping functions were similar , residuals were smaller at the 20th , 40th , and 60th percentiles using the OLS model . The CLAD derived mapping function result ed in smaller residuals only for patients whose EQ-5D = 1 . CONCLUSIONS The OLS mapping function demonstrated better predictive ability and will facilitate the derivation of utilities when direct population preference measures are not available OBJECTIVES To develop a model to predict  EuroQol five-dimensional question naire ( EQ-5D ) values from clinical chronic obstructive pulmonary disease ( COPD ) question naire ( CCQ ) scores . METHODS We used data from three clinical trials ( the R and omized Clinical Trial on Effectiveness of Integrated COPD Management in Primary Care [ RECODE ] , the Assessment Of Going Home Under Early Assisted Discharge [ GO-AHEAD ] , and the Health Status Guided COPD Care [ MARCH ] ) . Data were r and omly split into an estimation sample and a validation sample . The conceptual similarity between patient-reported CCQ and preference-based EQ-5D scores was assessed using correlation and principal-component analysis . Different types of models were estimated with increasing complexity . We selected the final models on the basis of mean absolute error and root mean square error when comparing predicted and observed values from the same population ( internal validity ) and from different trial population s ( external validity ) . We also developed models for different country-specific EQ-5D value sets . RESULTS The principal-component analysis showed that the CCQ domains functional state and mental state are associated with four dimensions of the EQ-5D . The EQ-5D dimension pain/discomfort formed a separate construct on which no CCQ item loaded . The mean observed EQ-5D values were not significantly different from the mean predicted EQ-5D values in internal validation sample s but did significantly differ in external validation sample s. The models underestimated EQ-5D values in milder health states and overestimated them in more severe health states . The predictive ability of the models was similar across different EQ-5D value sets . CONCLUSIONS The models can predict mean EQ-5D values that are similar to observed mean values in a similar population . The overestimating/underestimating of the low/high EQ-5D values , however , limits its use in Markov models . Therefore , mapping should be used cautiously A definitive conclusion regarding the value of low-dose extended duration adjuvant interferon-alpha therapy in the treatment of malignant melanoma is only possible once data on health-related quality of life ( HRQoL ) and costs have been considered . This trial r and omised 674 patients to interferon alpha-2a  ( 3 megaunits three times per week for 2 years or until recurrence ) or placebo . Health-related quality of life ( QoL ) was to be assessed up to 60 months using the European Organisation for Research and Treatment of Cancer ( EORTC ) QLQ-C30 . Data for the economic analysis , including cost information and the EQ-5D were also collected . Patients in the observation ( OBS ) group had significantly better mean follow-up quality of on five dimensions of the EORTC QLQ-C30 functional scales : role functioning ( P=0.033 ) , emotional functioning ( P=0.003 ) , cognitive functioning ( P=0.001 ) , social functioning ( P=0.003 ) and global health status ( P=0.001 ) . Patients in the OBS group had significantly better mean follow-up symptom scores on seven dimensions of the EORTC QLQ-C30 V1 symptom scales . Economic data showed that costs were £ 3066 higher in the interferon group and produces an incremental cost per quality -adjusted life year of £ 41 432 at 5 years . The results show that interferon has significant effects on QoL and symptomatology and is unlikely to be cost-effective in this patient group in the UK RATIONALE , AIMS , AND OBJECTIVES Although nonpreference-based disease-specific measures are widely used in clinical studies , they can not generate utilities for economic evaluation . A solution to this problem is to estimate utilities from disease-specific instruments using the mapping function . This study aim ed to develop a transformation model for mapping the pruritus-visual analog scale ( VAS ) to the EuroQol 5-Dimension 3-Level ( EQ-5D-3L ) utility index in pruritus . METHODS A cross-sectional survey was conducted with a sample ( n = 268 ) drawn from the general population of South Korea . Data were r and omly divided into 2 groups , one for estimating and the other for validating mapping models . To select the best model , we developed and compared 3 separate models using demographic information and the pruritus-VAS as independent variables . The predictive performance was assessed using the mean absolute deviation and root mean square error in a separate data set . RESULTS Among the 3 models , model 2 using age , age squared , sex , and the pruritus-VAS as independent variables had the best performance based on the goodness of fit and model simplicity , with a log likelihood of 187.13 . The 3 models had similar precision errors based on mean absolute deviation and root mean square error in the validation data set . No statistically significant difference was observed between the mean observed and predicted values in all models . CONCLUSIONS In conclusion , model 2 was chosen as the preferred mapping model . Outcomes measured as the pruritus-VAS can be transformed into the EQ-5D-3L utility index using this mapping model , which makes an economic evaluation possible when only pruritus-VAS data are available PURPOSE This is one of a few studies that have explored the value of baseline symptoms and  health-related quality of life ( HRQOL )  in predicting survival in patients with brain cancer . PATIENTS AND METHODS Baseline  HRQOL scores ( from the European Organisation for Research and Treatment of Cancer [ EORTC ] Quality of Life Question naire C30 and the EORTC Brain Cancer Module ) were examined in 247 patients with anaplastic oligodendrogliomas to determine the relationship with overall survival by using Cox proportional hazards regression models .  Refined techniques as the bootstrap resampling procedure and the computation of C indexes and R2 coefficients were used to explore the stability of the models as well as better assess the potential benefit of using HRQOL to predict survival in clinical practice and research . RESULTS Classical analysis controlled for major clinical prognostic factors selected emotional functioning ( P = .0016 ) , communication deficit ( P = .0261 ) , future uncertainty ( P = .0481 ) , and weakness of legs ( P = .0001 ) as statistically significant prognostic factors of survival . However , several issues question the validity of these findings and no single model was found to be preferable over all others . C indexes , which estimate the probability of a model to correctly predict which patient among a r and omly chosen pair of patients will survive longer , and R2 coefficients , which measure the proportion of variability explained by the model , did not exhibit major improvement when adding selected or all HRQOL scores to clinical factors . CONCLUSION While classical techniques lead to positive results , more refined analyses suggest that baseline HRQOL scores add relatively little to clinical factors to predict survival . These results may have implication s for future use of HRQOL as a prognostic factor for patients with cancer Background . Mapping disease-specific instruments into generic health outcomes or utility values is an exp and ing field of interest in health economics . This article constructs an algorithm to translate the modified Rankin scale ( mRS ) into EQ-5D utility values . Methods .  mRS and  EQ-5D  information was derived from stroke or transient ischemic attack ( TIA ) patients identified as part of the Oxford Vascular study ( OXVASC ) .  Ordinary least squares ( OLS ) regression was used to predict UK EQ-5D tariffs from mRS scores . An alternative method , using multinomial logistic regression with a Monte Carlo simulation approach ( MLogit ) to predict responses to each EQ-5D question , was also explored . The performance of the models was compared according to the magnitude of their predicted-to-actual mean EQ-5D tariff difference , their mean absolute and mean squared errors ( MAE and MSE ) , and associated 95 % confidence intervals ( CIs ) . Out-of- sample validation was carried out in a subset of coronary disease and peripheral vascular disease ( PVD ) patients also identified as part of OXVASC but not used in the original estimation . Results . The OLS and MLogit yielded similar MAE and MSE in the internal and external validation data sets . Both approaches also underestimated the uncertainty around the actual mean EQ-5D tariff producing tighter 95 % CIs in both data sets . Conclusions . The choice of algorithm will be dependent on the study aim . Individuals outside the United Kingdom may find it more useful to use the multinomial results , which can be used with different country-specific tariff valuations . However , these algorithms should not replace prospect i ve collection of utility data Background Economic evaluation normally requires information to be collected on outcome improvement using utility values . This is often not collected during the treatment of substance use disorders making cost-effectiveness evaluations of therapy difficult . One potential solution is the use of mapping to generate utility values from clinical measures . This study develops and evaluates mapping algorithms that could be used to predict the EuroQol-5D ( EQ-5D-5 L ) and the ICEpop CAPability measure for Adults ( ICECAP-A ) from the three commonly used clinical measures ; the CORE-OM , the LDQ and the TOP measures . Methods Models were estimated using pilot trial data of heroin users in opiate substitution treatment . In the trial the EQ-5D-5 L , ICECAP-A , CORE-OM , LDQ and TOP were administered at baseline , three and twelve month time intervals . Mapping was conducted using estimation and validation data sets . The normal estimation data set , which comprised of baseline sample data , used ordinary least squares ( OLS ) and tobit regression methods . Data from the baseline and three month time periods were combined to create a pooled estimation data set . Cluster and mixed regression methods were used to map from this data set . Predictive accuracy of the models was assessed using the root mean square error ( RMSE ) and the mean absolute error ( MAE ) . Algorithms were vali date d using sample data from the follow-up time periods . Results Mapping algorithms can be used to predict the ICECAP-A and the EQ-5D-5 L in the context of opiate dependence . Although both measures can be predicted , the ICECAP-A was better predicted by the clinical measures . There were no advantages of pooling the data . There were 6 chosen mapping algorithms , which had MAE scores ranging from 0.100 to 0.138 and RMSE scores ranging from 0.134 to 0.178 . Conclusion It is possible to predict the scores of the ICECAP-A and the EQ-5D-5 L with the use of mapping . In the context of opiate dependence , these algorithms provide the possibility of generating utility values from clinical measures and thus enabling economic evaluation of alternative therapy options . Trial registration IS RCT N22608399 . Date of registration : 27/04/2012 . Date of first r and omisation : 14/08/2012 Cancer patients with advanced disease and short-survival expectancy were given hospital-based advanced home care ( AHC ) or conventional care ( CC ) , according to their preference . The two groups were compared at baseline to investigate whether there were differences between the AHC and the CC patients that may help explain their choice of care . The patients were consecutively recruited over 2(1/2 ) years .  Sociodemographic and medical data , and the health-related quality of life ( HRQL ) of the two groups were compared . HRQL was assessed using a self-reporting question naire , including the European Organization for Research and Treatment of Cancer Core Quality of Life Question naire ( EORTC QLQ-C30 ) , the Impact of Event Scale ( IES ) , five questions about social support , and two items concerning general well-being . The AHC group showed significantly poorer functioning on all the EORTC QLQ-C30 scales and an overall higher symptom burden than the CC patients . Fewer of the AHC patients were receiving cancer treatment . The AHC patients had lived longer with their cancer diagnosis , had a significantly shorter survival after study enrollment , and a significantly poorer performance status . The major differences between the two groups seemed to be related to being at different stages in their disease . The results indicate that patients are reluctant to accept home care until absolutely necessary due to severity of functioning impairments and symptom burden . These findings should be taken into consideration in planning palliative care services PURPOSE To compare the variability and sample size requirements of the global quality -of-life ( QOL ) scores of the following three major QOL instruments : the Functional Assessment of Cancer Therapy-General ( FACT-G ) , Functional Living Index-Cancer ( FLIC ) , and European Organisation for Research and Treatment of Cancer Core Quality of Life Question naire C30 ( EORTC QLQ-C30 ) . PATIENTS AND METHODS Cancer patients were r and omly assigned to answer two of the three instruments using an incomplete block design ( n = 1,268 ) . The instruments were compared in terms of coefficient of variation , effect size in detecting a difference between patients with different performance status , and correlation coefficient between scores at baseline and follow-up . RESULTS The FACT-G and FLIC had significantly smaller coefficients of variation than the EORTC QLQ-C30 ( both P < .05 ) . The FLIC also had significantly larger correlation coefficients between scores at baseline and follow-up than the EORTC QLQ-C30 ( P < .05 ) . The FACT-G and the FLIC had a larger effect size in a cross-sectional and longitudinal setting , respectively , than the EORTC QLQ-C30 in differentiating patients with different performance status ( both P < .05 ) . CONCLUSION In some aspects , the FACT-G and FLIC global QOL scores had smaller variability and larger discriminative ability than the EORTC QLQ-C30 . Further research using other criteria to compare the three instruments is recommended Abstract Objective : The aims of this study were to measure the real-life health-related quality of life ( HRQoL ) of newly diagnosed prostate cancer ( PCa ) patients , to compare it with that of the general male population and to explore factors affecting HRQoL. Methods : All newly diagnosed PCa patients in the Helsinki University Hospital were asked to fill in 15D and EORTC QLQ-C30 question naires . Clinical background information was collected retrospectively from patient charts . Patients were categorized into three mutually exclusive groups based on the disease stage : Local , Locally advanced and Metastatic groups . Multivariate linear regression analysis was conducted to explore which factors explained variance in 15D scores . A regression model was built to map the EORTC QLQ-C30 to 15D in a r and om sample of 50 % of patients and the model was tested in the other half of the patients . Results : In total , 1050 men with a mean age of 67 years responded to the question naires . The mean ± SD 15D score of patients was slightly lower than that of the age-st and ardized general male population : 0.905 ± 0.089 vs 0.915 ± 0.082 ( p = .057 ) . The mean ± SD 15D utility scores were 0.912 ± 0.084 , 0.897 ± 0.102 and 0.855 ± 0.109 for Local , Locally advanced and Metastatic groups , respectively . The mapping model of EORTC QLQ-C30 to 15D was robust and fitted well ( root mean square error = 0.042 , adjusted R² = .79 ) . Conclusions : The HRQoL of PCa patients entering treatment was similar to that of the general population . HRQoL was most impaired among patients with metastatic disease , whereas the difference between patients with localized PCa and the general population was minor . Mapping indicated that the 15D score aggregates quite accurately the information from the EORTC QLQ-C30 Objective Progression-free survival ( PFS ) is frequently used as an efficacy end point in oncology clinical trials . However , there is limited evidence to support a positive association between improvement in PFS and improvement in health-related quality of life ( HRQoL ) . The association between PFS and HRQoL was evaluated in two r and omised trials . Material s and methods Data from two r and omised controlled trials in patients with non-small cell lung cancer ( NSCLC ; LUX-Lung 1 and LUX-Lung 3 ) were used to investigate HRQoL in patients to determine whether tumour progression is accompanied by worsening HRQoL.  HRQoL was assessed using the cancer-specific European Organization for Research and Treatment of Cancer ( EORTC ) core question naire QLQ-C30 ,  the EuroQol EQ-5D overall utility and EuroQol EQ visual analogue scale .  In both studies , progression was evaluated by independent review using RECIST criteria ( primary end point ) and also by investigator assessment . The relationship between tumour progression and HRQoL was evaluated using analysis of covariance and a longitudinal model . Results Compliance with HRQoL question naire completion was high . In both studies , patients with progression consistently experienced numerically poorer HRQoL at the time of progression than patients without progression . Differences in mean scores were statistically significant ( p<0.05 ) between patients with and without progression at week 4 in all analyses in LUX-Lung 1 and at multiple time points in LUX-Lung 3 . Results from the longitudinal analysis showed that progression ( by independent review and investigator assessment ) appears to have consistent negative impact on all three HRQoL measures ( all p<0.0001 ) . Conclusions Tumour progression in patients with NSCLC was associated with statistically significant worsening in HRQoL. These findings confirm the value of PFS as a patient-relevant end point The objective of this study was to examine and compare two core measures of Quality Of Life ( QOL ) used in cancer clinical trials : the European Organisation for Research and Treatment of Cancer QOL  Core Question naire 30 ( EORTC QLQ-30 ) and the Functional Assessment of Chronic Illness Therapy ( FACIT ) , in order to identify which one patients have the strongest preference for using . 68 patients suffering from Carcinomas of an Unknown Primary site ( CUP ) were recruited in a multicentric study ; all of them completed both question naires , administered in a r and omised manner . The criteria were the percentage of preferences , and four indicators of acceptability . The results indicated that an equal proportion of patients preferred the QLQ-C30 ( 19 % ) and FACIT ( 19 % ) . 54 % of patients felt both question naires were acceptable . All the indicators of acceptability favoured the QLQ-C30 . Analysis of open-ended questions shed light on the difficulties encountered by the patients . As no significant preference was observed for one of the question naires , the QLQ-C30 was chosen on the basis of its significantly better acceptability criteria Background . Generic preference-based measures of health may not adequately cover the impact of some conditions . There is therefore increasing interest in developing condition-specific preference-based measures . Objectives . The purpose of this study was to estimate a preference-based measure from a condition-specific measure of health for urinary incontinence , the 21-item King 's Health Question naire , for use in economic evaluation . Methods . The King 's Health Question naire ( KHQ ) was revised into a 5-dimensional health state classification amenable to valuation using items selected using psychometric evidence . Forty-nine states were valued using st and ard gamble by a representative sample of patients with urinary incontinence attending UK hospital outpatient clinics . Each respondent was asked to value 9 health states . Models have been estimated for predicting health state valuations for all 1024 states defined by the KHQ classification . The modeling had to cope with the clustering of data by respondent and its skewed distribution . Results . In total , 110 usable interviews were obtained from 169 patients approached to participate in the study . These responders generated 959 health state valuations . Mean health state values ranged from 0.77 to 0.98 . Models were estimated using mean health state values and r and om effects models of individual-level health state values . These models generated robust estimates of the ` main effects , ` and in general , the results support the ordinality of the KHQ health state classification . There were problems modeling interaction effects , and a number of alternatives were explored . Conclusion . The recommended model for estimating a preference-based measure from the condition-specific KHQ is presented Abstract Purpose : To develop a mapping algorithm for the estimation of EQ-5D-based utility scores from observed 25-item National Eye Institute Visual Functioning Question naire ( NEI VFQ-25 ) scores , a disease-specific , patient-reported outcome measure used in several retinal disorders to evaluate vision-specific functioning . Methods : The data set comprised 951 paired EQ-5D/NEI VFQ-25 observations from 344 patients in RESTORE , a 12-month , r and omized , double-blind trial in individuals with visual impairment due to diabetic macular edema .  EQ-5D index scores ( utilities ) were calculated based on the UK tariff . We evaluated 11 models using predictor sets based on the NEI VFQ-25 subscales to estimate utility as a function of NEI VFQ-25 score , based on four modeling techniques . Model performance was assessed by 10-fold cross-validation comparing root mean squared error ( RMSE ) , mean absolute error ( MAE ) and correlation with EQ-5D score ( Pearson and Spearman correlation coefficients ) . Results : Mapping results were similar across all techniques and predictor sets . The reverse two-part generalized estimating equation model used fewest predictors and had the best predictive performance ( RMSE 0.200 , MAE 0.140 ) . Predicted and original EQ-5D values were not strongly correlated ( squared Spearman correlation coefficient , 0.34 ) . Conclusions : Although mapping disease-specific instruments to EQ-5D utilities is a preferred method by some reimbursement bodies , finding an appropriate mapping equation is not straightforward . In this study , mapping NEI VFQ-25 scores to EQ-5D utilities provided low predictive power , independent of the modeling methodology applied , suggesting an inability of the EQ-5D to discriminate vision-related activities , and highlighting that mapping exercises may lead to inaccurate utility values that do not represent patients ’ preferences OBJECTIVE The objective of this study was to develop empirical algorithms that estimate health-state utility values from disease-specific quality -of-life scores in individuals with migraine . METHODS Data from a cross-sectional , multicountry study were used . Individuals with episodic and chronic migraine were r and omly assigned to training or validation sample s. Spearman 's correlation coefficients between paired EuroQol five-dimensional ( EQ-5D ) question naire utility values and both Headache Impact Test ( HIT-6 ) scores and Migraine-Specific Quality -of-Life Question naire version 2.1 ( MSQ ) domain scores ( role restrictive , role preventive , and emotional function ) were examined . Regression models were constructed to estimate EQ-5D question naire utility values from the HIT-6 score or the MSQ domain scores . Preferred algorithms were confirmed in the validation sample s. RESULTS In episodic migraine , the preferred HIT-6 and MSQ algorithms explained 22 % and 25 % of the variance ( R(2 ) ) in the training sample s , respectively , and had similar prediction errors ( root mean square errors of 0.30 ) . In chronic migraine , the preferred HIT-6 and MSQ algorithms explained 36 % and 45 % of the variance in the training sample s , respectively , and had similar prediction errors ( root mean square errors 0.31 and 0.29 ) . In episodic and chronic migraine , no statistically significant differences were observed between the mean observed and the mean estimated EQ-5D question naire utility values for the preferred HIT-6 and MSQ algorithms in the validation sample s. CONCLUSIONS The relationship between the EQ-5D question naire and the HIT-6 or the MSQ is adequate to use regression equations to estimate EQ-5D question naire utility values . The preferred HIT-6 and MSQ algorithms will be useful in estimating health-state utilities in migraine trials in which no preference-based measure is present Objective To help facilitate economic evaluations of oncology treatments , we mapped responses on cancer-specific instrument to generic preference-based measures . Methods Cancer patients ( n = 367 ) completed one cancer-specific instrument , the FACT-G , and two preference-based measures , the  EQ-5D and SF-6D . Responses were r and omly divided to form development ( n = 184 ) and cross-validation ( n = 183 ) sample s. Relationships between the instruments were estimated using ordinary least squares ( OLS ) , generalized linear models ( GLM ) , and censored least absolute deviations ( CLAD ) regression approaches . The performance of each model was assessed in terms of how well the responses to the cancer-specific instrument predicted EQ-5D and SF-6D utilities using mean absolute error ( MAE ) and root mean squared error ( RMSE ) . Results Physical , functional , and emotional well-being domain scores of the FACT-G best explained the EQ-5D and SF-6D . In terms of accuracy of prediction as measured in RMSE , the CLAD model performed best for the EQ-5D ( RMSE = 0.095 ) whereas the GLM model performed best for the SF-6D ( RMSE = 0.061 ) . The GLM predicted SF-6D scores matched the observed values more closely than the CLAD and OLS . Conclusion Our results demonstrate that the estimation of both EQ-5D and SF-6D utility indices using the FACT-G responses can be achieved . The CLAD model for the EQ-5D and the GLM model for the SF-6D are recommended . Thus , it is possible to estimate quality -adjusted life years for economic evaluation from studies where only cancer-specific instrument have been administered Abstract The EQ-5D question naire is a widely used generic instrument for describing and valuing health that was developed by the EuroQol Group . A primary objective of the EuroQol Group is the investigation of values for health states in the general population in different countries . As part of the EuroQol enterprise 11 population surveys were carried out in six Western European countries ( Finl and , Germany , The Netherl and s , Spain , Sweden and the UK ) to value health states as defined by the EQ-5D using a st and ardised visual analogue scale ( EQ-5D VAS ) . This contribution reports how a European set of general population preference weights was derived from the data collected in the 11 valuation studies . The scores from this set of preference weights can be applied to generate a VAS-based weighted health status index for all the potential 243 EQ-5D health states for use in multi-national studies . To estimate the preference weights a multi-level regression analysis was performed on 82,910 valuations of 44 EQ-5D health states elicited from 6,870 respondents . Stable and plausible solutions were found for the model parameters . The R2 value was 75 % . The analysis showed that the major source of variance , apart from ' r and om error ' , was variance between individuals ( 28.3 % of the total residual variance ) . These results suggest that VAS values for EQ-5D health states in six Western European countries can be described by a common model Background Many intervention-based studies aim ing to improve mental health do not include a multi-attribute utility instrument ( MAUI ) that produces quality -adjusted life-years ( QALYs ) and it limits the applicability of the health economic analyses . This study aims to develop ‘ crosswalk ’ transformation algorithm between a measure for psychological distress General Health Question naire ( GHQ-12 ) and MAUI EuroQoL ( EQ-5D-3L ) . Methods The study is based on a survey question  naire sent to a r and om sample in four counties in Sweden in 2012 . The survey included  GHQ-12 and EQ-5D instruments  , as well as a question about self-rated health . The EQ-5D index was calculated using the UK and the Swedish tariff values . Two OLS models were used to estimate the EQ-5D health state values using the GHQ-12 as exposure , based on the respondents ( n = 17 , 101 ) of two counties . The algorithms were applied to the data from two other counties , ( n = 15 , 447 ) to check the predictive capacity of the models . Results The final models included gender , age , self-rated health and GHQ-12 scores as a quantitative variable . The regression equations explained 40 % ( UK tariff ) and 46 % ( Swedish tariff ) of the variances . The model showed a satisfying predictive capacity between the observed and the predicted EQ-5D index score , with Pearson correlation = 0.65 and 0.69 for the UK and Swedish models , respectively . Conclusion The algorithms developed in this study can be used to determine cost-effectiveness of services or interventions that use GHQ-12 as a primary outcome where the utility measures are not collected This study defines the psychometric properties of the European Organisation for Research and Treatment of Cancer ( EORTC ) quality of life ( QOL ) question naire design ed to measure the QOL of patients with ovarian cancer . The ovarian cancer module ( EORTC QLQ-OV28 ) was developed to supplement the EORTC QLQ-C30 . The core question naire and the QLQ-OV28 were prospect ively administered to 368 ovarian cancer patients after they had been treated with radical or debulking surgery followed by chemotherapy .  The QLQ-OV28 module assesses abdominal/gastrointestinal symptoms , peripheral neuropathy , other chemotherapy side-effects , hormonal/menopausal symptoms , body image , attitude to disease/treatment and sexual functioning . Question naires were well accepted by patients , baseline compliance rates were 86 % , 72 % provided a second assessment , less than 3 % of the items had missing data . Multi-trait scaling analyses confirmed the hypothesised scales . All hypothesised scales exhibited good psychometric properties . These results support the clinical and psychometric validity of the EORTC QLQ-OV28 module as a supplement to the EORTC QLQ-C30 PURPOSE To evaluate the impact of acute urinary retention ( AUR ) in patients treated with (125)I prostate brachytherapy on short- and long-term  health-related quality of life ( HRQOL ) ; and to assess whether pretreatment HRQOL has additional value in the prediction of AUR . METHODS AND MATERIAL S For 127 patients treated with (125)I brachytherapy for localized prostate cancer between December 2000 and June 2003 , toxicity and HRQOL data were prospect ively collected . Patients received a HRQOL question naire at five time points : before and 1 month , 6 months , 1 year , and 6 years after treatment . The question naire included the R AND -36 generic health survey , the cancer-specific European Organization for Research and Treatment of Cancer core question naire ( EORTC QLQ-C30 ) , the tumor-specific EORTC prostate cancer module ( EORTC QLQ-PR25 ) , and the American Urological Association ( AUA ) symptom index . RESULTS Of 127 patients , 13 ( 10.2 % ) developed AUR . Patients with AUR had a significantly worse urinary QOL at all time points compared with patients without AUR . The mean difference over time ( 6 years ) between both groups for the EORTC QLQ-PR25 urinary symptom score was 13.0 points ( p < 0.001 ) and for the AUA urinary symptom score was 15.7 points ( p = 0.001 ) . Global QOL scores ( EORTC QLQ-C30 ) over time for patients who developed AUR were significantly worse compared with patients without AUR ( mean difference 6.7 points ; p = 0.043 ) . In multivariate logistic regression analysis , pretreatment International Prostate Symptom Score ( p = 0.004 ) and neoadjuvant hormonal treatment ( p = 0.034 ) were predictors of AUR . Quality of life did not have added predictive value . CONCLUSION Acute urinary retention after prostate brachytherapy has a significant negative impact on patient 's HRQOL up to 6 years after treatment , in terms of both global QOL measures and urinary symptom scores . Furthermore , our results suggest limited value of pretreatment HRQOL measures for the prediction of AUR Although several studies have reported the impact of oesophagectomy on health-related quality of life ( HRQOL ) , none has objective ly assessed its impact on physical fitness . This study aim ed to evaluate the impact of oesophagectomy on physical fitness and HRQOL in patients with oesophageal cancer . In this prospect i ve study , we investigated 30 consecutive patients with newly diagnosed resectable oesophageal cancer who were scheduled to receive either neoadjuvant chemotherapy followed by surgery or surgery alone .  The primary end-points were change from baseline in two measures of physical fitness ( knee-extensor muscle strength and 6-min walking distance ) after oesophagectomy . The secondary end-point was change from baseline in HRQOL measured with the European Organization for the Research and Treatment of Cancer Quality of Life Core Question naire with 30 items ( EORTC QLQ-C30 ) . Physical fitness was significantly lower after oesophagectomy than before oesophagectomy ( P < 0.001 ) . With regard to HRQOL , there was a significant pre- to post-oesophagectomy change in most of the scales . In the multiple regression analysis , the change in 6-min walking distance was the only significant variable affecting the change in physical functional score on the EORTC QLQ-C30 ( P = 0.032 ) . In conclusion , oesophagectomy adversely affects physical fitness and HRQOL in patients with oesophageal cancer .  Six-minute walking distance may be a good indicator of HRQOL shortly after oesophagectomy In a prospect i ve , r and omized study , an individual psychosocial support intervention performed by specially trained oncology nurses , or psychologists , were compared with st and ard care .  Consecutive primary breast cancer patients about to start adjuvant therapy ( n = 179 ) were included . Data were supplied by the question naires European Organisation for Research and Treatment of Cancer Quality of Life Study Group Core Quality of life question naire with 30 questions ( EORTC QLQ-C30 ) and Breast Cancer Module with 23 questions ( BR23 ) , the Hospital Anxiety and Depression Scale , Spielberger 's State-Trait Anxiety Inventory , and the Impact of Event Scale before r and omization and 1 , 3 , and 6 months later . Patient files provided data on utilization of psychosocial support offered in routine care . Global quality of life/health status , nausea and vomiting , and systemic therapy side effects were the subscales showing significant Group by Time interactions , favoring the interventions . Intervention groups improved statistically significantly more than the st and ard care group regarding insomnia , dyspnea , and financial difficulties . Nurse patients experienced less intrusion compared with the st and ard care group . All groups showed statistically and clinical ly significant improvements with time on several subscales . The intervention groups , however , improved to a greater extent . Fewer patients in the intervention groups used psychosocial hospital support compared with the st and ard care group . In conclusion , psychosocial support by specially trained nurses using techniques derived from cognitive behavioral therapy is beneficial for breast cancer patients and may be a realistic alternative in routine cancer care Purpose Little is known about factors that affect health-related quality of life during the early follow-up of colorectal cancer . This study was design ed to identify the factors that contribute to poor health-related quality of life after six weeks of follow-up and to compare the relative performance of instruments best suited to measure it . Methods A single-center , prospect i ve study was design ed to examine health-related quality of life after  potentially curative surgery for colorectal cancer .  Two condition-specific and two generic instruments ( QLQ-C30 , FACT-C , SF12 and EQ-5D ) measured quality  of life six weeks after discharge . Univariate and multivariate analyses were used to assess the impact of 16 treatment factors , demographic variables , and symptoms on seven global health-related quality of life scores . Results Question naires were obtained from 201 consecutive patients . Five factors were associated with poor health-related quality of life scores at six-week follow-up in the multivariate analysis : reduced preoperative performance status , stomas , diarrhea , constipation , and younger than aged 65 years . No instrument out performed the others . However , condition-specific instruments and those in which patients subjectively rated their overall health-related quality of life were better suited to detect health-related quality of life differences relating to the effects of colorectal cancer treatment . Conclusions Younger patients , those with stomas , and those suffering from diarrhea or constipation are more likely to report poor health-related quality of life at six-week follow-up . The routine measurement of health-related quality of life using an instrument that includes a patient-rated scale together with condition-specific items could be used to detect patients at risk of poorer short-term health-related quality of life outcomes PURPOSE The aim of this study was to define the scales and test the validity , reliability , and sensitivity of the European Organization for Research and Treatment of Cancer Quality of Life Question naire ( EORTC QLQ)-H&N35 , a question naire design ed to assess the quality of life of head and neck ( H&N ) cancer patients in conjunction with the general cancer-specific EORTC QLQ-C30 . PATIENTS AND METHODS Question naires were given to 500 H&N cancer patients from Norway , Sweden , and the Netherl and s as part of two prospect i ve studies . The patients completed the question naires before , during ( Norway and Sweden only ) , and after treatment , yielding a total of 2070 completed question naires . RESULTS The compliance rate was high , and the question naires were well accepted by the patients . Seven scales were constructed ( pain , swallowing , senses , speech , social eating , social contact , sexuality ) . Scales and single items were sensitive to differences between patient subgroups with relation to site , stage , or performance status . Most scales and single items were sensitive to changes , with differences of various magnitudes according to the site in question . The internal consistency , as assessed by Cronbach 's alpha coefficient , varied according to assessment point and within sub sample s of patients . A low overall alpha value was found for the speech and the senses scales , but values were higher in assessment s of patients with laryngeal cancer and in patients with nose , sinus , and salivary gl and tumors . Scales and single items in the QLQ-H&N35 seem to be more sensitive to differences between groups and changes over time than do the scales and single items in the core question naire . CONCLUSION The QLQ-H&N35 , in conjunction with the QLQ-C30 , provides a valuable tool for the assessment of health-related quality of life in clinical studies of H&N cancer patients before , during , and after treatment with radiotherapy , surgery , or chemotherapy Purpose Condition-specific preference-based measures can offer utility data where they would not otherwise be available or where generic measures may lack sensitivity , although they lack comparability across conditions . This study aim ed to develop an algorithm for estimating utilities from the short bowel syndrome health-related quality of life scale ( SBS-QoL ™ ) . Methods SBS-QoL ™ items were selected based on factor and item performance analysis of a European SBS-QoL ™ data set and consultation with 3 SBS clinical experts . Six-dimension health states were developed using 8 SBS-QoL ™ items ( 2 dimensions combined 2 SBS-QoL ™ items ) . SBS health states were valued by a UK general population sample ( N = 250 ) using the lead-time time trade-off method . Preference weights or ‘ utility decrements ’ for each severity level of each dimension were estimated by regression models and used to develop the scoring algorithm . Results Mean utilities for the SBS health states ranged from −0.46 ( worst health state , very much affected on all dimensions ) to 0.92 ( best health state , not at all affected on all dimensions ) . The r and om effects model with maximum likelihood estimation regression had the best predictive ability and lowest root mean squared error and mean absolute error , and was used to develop the scoring algorithm . Conclusions The preference-weighted scoring algorithm for the SBS-QoL ™ developed is able to estimate a wide range of utility values from patient-level SBS-QoL ™ data . This allows estimation of SBS HRQL impact for the purpose of economic evaluation of SBS treatment benefits BACKGROUND Conventionally , parametric models were used for health state valuation data . Recently , research ers started to explore the use of nonparametric Bayesian methods in this area . OBJECTIVES We present a nonparametric Bayesian model to estimate a preference-based index for two condition-specific five-dimensional health state classifications , one for asthma ( five-dimensional Asthma Quality of Life Utility Index ) and the other for overactive bladder ( five-dimensional Overactive Bladder Quality of Life-Utility Index ) . METHODS Sample s of 307 and 311 members of the UK general population valued 99 health states selected from a total of 3125 health states defined by each of the measures using the time trade-off technique . The article presents the results of the nonparametric model and compares it with the original model estimated using a conventional parametric r and om-effects model . The different methods are compared theoretically and in terms of empirical performance across the two data sets . It also reports the effect of respondent characteristics on health state valuations . RESULTS The nonparametric models were found to be better at predicting health state values within the estimation sample than without in terms of root mean square error and the patterns of st and ardized residuals . Some respondent characteristics were found to explain variation in health state values , but these did not have a significant effect on the health states values when estimates were adjusted for sample differences with the general population . CONCLUSIONS The nonparametric Bayesian models are theoretically more appropriate than previously used parametric models and provide better utility estimates from the two condition-specific measures . Furthermore , the model is more flexible in estimating the effect of covariates Purpose : The EQ-5D is a brief , multiattribute , preference-based health status measure . This article describes the development of a statistical model for generating US population -based EQ-5D preference weights . Methods : A multistage probability sample was selected from the US adult civilian noninstitutional population . Respondents valued 13 of 243 EQ-5D health states using the time trade-off ( TTO ) method . Data for 12 states were used in econometric modeling . The TTO valuations were linearly transformed to lie on the interval [ −1 , 1 ] . Methods were investigated to account for interaction effects caused by having problems in multiple EQ-5D dimensions . Several alternative model specifications ( eg , pooled least squares , r and om effects ) also were considered . A modified split- sample approach was used to evaluate the predictive accuracy of the models . All statistical analyses took into account the clustering and disproportionate selection probabilities inherent in our sampling design . Results : Our D1 model for the EQ-5D included ordinal terms to capture the effect of departures from perfect health as well as interaction effects . A r and om effects specification of the D1 model yielded a good fit for the observed TTO data , with an overall R2 of 0.38 , a mean absolute error of 0.025 , and 7 prediction errors exceeding 0.05 in absolute magnitude . Conclusions : The D1 model best predicts the values for observed health states . The result ing preference weight estimates represent a significant enhancement of the EQ-5D 's utility for health status assessment and economic analysis in the US BACKGROUND In addition to theoretical justifications , many statistical methods have been used for selecting covariates to include in algorithms mapping nonutility measures onto utilities . However , it is not clear whether using exploratory factor analysis ( EFA ) as one such method improves the predictive ability of these algorithms . OBJECTIVE This question is addressed within the context of mapping a non-utility-based outcome , the core 23-item Women 's Health Question naire ( WHQ-23 ) , onto two utility instruments : five-level EuroQol five-dimensional question naire ( EQ-5D-5L ) and the six-dimensional health state short form ( derived from short form 36 health survey ) ( SF-6D ) . METHODS Data on all three outcomes were collected from 455 women from the Australian general population participating in a study assessing attitudes toward in vitro fertilization . Statistical methods for selecting covariates included stepwise regression ( SW ) , including all covariates ( Include all ) , multivariable fractional polynomial ( MFP ) , and EFA . The predictive accuracy of 108 regression models was assessed using five criteria : mean absolute error , root mean squared error , correlation , distribution of predicted utilities , and proportion of predictions with absolute errors of less than 0.0.5 . Validation of " primary " models was carried out on r and om sample s of the in vitro fertilization study . RESULTS The best results for EQ-5D-5L and SF-6D predictions were obtained from models using SW , " Include all , " and MFP covariate- selection approaches . Root mean squared error ( 0.0762 - 0.1434 ) and mean absolute error ( 0.0590 - 0.0924 ) estimates for these models were within the range of published estimates . EFA was outperformed by other covariate- selection methods . CONCLUSIONS It is possible to predict valid utilities from the WHQ-23 using regression methods based on SW , " Include all , " and MFP covariate- selection techniques When a r and omized trial ( NMSG 4/90 ) comparing treatment with melphalan/prednisone to melphalan/prednisone + interferon α‐2b in newly diagnosed multiple myeloma was inititated in 1990 , a quality ‐of‐life assessment was integrated into the study . We used the question naire ( QLQ‐C30 ) developed by the European Organization of Research and Treatment of Cancer ( EORTC ) Study Group on Quality of Life . The QLQ‐C30 incorporates five functional scales , three symptom scales , a global health and quality ‐of‐life scale and some single symptom measures . The question naire was completed prior to treatment and after 1 , 6 , 12 , 24 , 36 and 48 months . 524 ( 90.2 % ) of 581 patients enrolled in the NMSG 4/90 completed the first question naire , and 484 ( 83.3 % ) completed all question naires given to them . All but one of the scales met the minimum criteria of reliability ( Cronbach ’s alpha ≥0.70 ) . Validity was shown by ( 1 ) the ability of the scales to discriminate clearly between patients differing in clinical status as defined by pre‐treatment W.H.O. performance index and Durie & Salmon stage , and ( 2 ) the sensitivity to changes in objective disease status ( response and relapse ) . This is the first report of the measurement of health‐related quality of life in a prospect i ve clinical trial in multiple myeloma . The results demonstrate that the QLQ‐C30 is a reliable and valid instrument for the measurement of quality of life in these patients . The data will be used for a cost – utility analysis of the results of the NMSG 4/90 trial Purpose The macular degeneration quality of life ( MacDQoL ) instrument is a vali date d condition-specific measure of quality of life in patients with macular degeneration . This paper presents the first mapping algorithm to predict EQ-5D from responses to the MacDQoL instrument . Methods Responses to the MacDQoL and EQ-5D-3L instruments from 482 patients were collected from the IVAN multicentre trial of two alternative drug treatments for neovascular age-related macular degeneration . Regression specifications were estimated using OLS , censored least absolute deviation , Tobit and two-part models . Their predictive performance was assessed using mean squared error . An internal validation sample based on a r and om selection of 25 % of patients was used to assess the performance of the model estimated on the remaining 75 % of patients . Results A two-part model had the best predictive performance on the full sample . The covariates of this model include responses and weighted impact scores for all 23 condition-specific domains of the MacDQoL , and responses to a general MacDQoL quality of life question . The selected models were successful at predicting means and st and ard deviations of target population s , but prediction is weaker at the upper and lower extremes of the EQ-5D-3L distribution . Conclusion The mapping algorithms provide a means of predicting EQ-5D-3L index scores from MacDQoL scores , and could facilitate cost-effectiveness analyses when the latter but not the former are available to research ers . Further validation of the performance of the algorithms using external data would provide a means of establishing the robustness of the algorithms PURPOSE To study the prognostic value for overall survival of baseline assessment of functional status , comorbidity , and quality of life ( QoL ) in elderly patients with advanced non-small-cell lung cancer treated with chemotherapy .  PATIENTS AND METHODS Data from 566 patients enrolled onto the phase III r and omized Multicenter Italian Lung Cancer in the Elderly Study ( MILES ) study were analyzed . Functional status was measured as activities of daily living ( ADL ) and instrumental ADL ( IADL ) . The presence of comorbidity was assessed with a checklist of 33 items ; items 29 and 30 of the European Organisation for Research and Treatment of Cancer ( EORTC ) core question naire QLQ-C30 ( EORTC QLQ-C30 ) were used to estimate QoL. ADL was dichotomized as none versus one or more dependency . For IADL and QoL , three categories were defined using first and third quartiles as cut points . Comorbidity was summarized using the Charlson scale . Analysis was performed by Cox model , and stratified by treatment arm . RESULTS Better values of baseline QoL ( P = .0003 ) and IADL ( P = .04 ) were significantly associated with better prognosis , whereas ADL ( P = .44 ) and Charlson score ( P = .66 ) had no prognostic value . Performance status 2 ( P = .006 ) and a higher number of metastatic sites ( P = .02 ) also predicted shorter overall survival . CONCLUSIONS Pretreatment global QoL and IADL scores , but not ADL and comorbidity , have significant prognostic value for survival of elderly patients with advanced non-small-cell lung cancer who were treated with chemotherapy .  Using these scores in clinical practice might improve prognostic prediction for treatment planning Objective To assess whether colon cancer follow-up can be organised by general practitioners ( GPs ) without a decline in the patient 's quality of life ( QoL ) and increase in cost or time to cancer diagnoses , compared to hospital follow-up . Design R and omised controlled trial . Setting Northern Norway Health Authority Trust , 4 trusts , 11 hospitals and 88 local communities . Participants Patients surgically treated for colon cancer , hospital surgeons and community GPs . Intervention 24-month follow-up according to national guidelines at the community GP office . To ensure a high follow-up guideline adherence , a decision support tool for patients and GPs were used . Main outcome measures Primary outcomes were QoL , measured by the global health scales of the European Organisation for Research and Treatment of Cancer QoL Question naire ( EORTC QLQ C-30 ) and EuroQol-5D ( EQ-5D ) . Secondary outcomes were cost-effectiveness and time to cancer diagnoses . Results 110 patients were r and omised to intervention ( n=55 ) or control ( n=55 ) , and followed by 78 GPs ( 942 follow-up months ) and 70 surgeons ( 942 follow-up months ) , respectively . Compared to baseline , there was a significant improvement in postoperative QoL ( p=0.003 ) , but no differences between groups were revealed ( mean difference at 1 , 3 , 6 , 9 , 12 , 15 , 18 , 21 and 24-month follow-up appointments ) : Global Health ; Δ−2.23 , p=0.20 ; EQ-5D index ; Δ−0.10 , p=0.48 , EQ-5D VAS ; Δ−1.1 , p=0.44 . There were no differences in time to recurrent cancer diagnosis ( GP 35 days vs surgeon 45 days , p=0.46 ) ; 14 recurrences were detected ( GP 6 vs surgeon 8) and 7 metastases surgeries performed ( GP 3 vs surgeon 4 ) . The follow-up programme initiated 1186 healthcare contacts ( GP 678 vs surgeon 508 ) , 1105 diagnostic tests ( GP 592 vs surgeon 513 ) and 778 hospital travels ( GP 250 vs surgeon 528 ) . GP organised follow-up was associated with societal cost savings ( £ 8233 vs £ 9889 , p<0.001 ) . Conclusions GP-organised follow-up was associated with no decline in QoL , no increase in time to recurrent cancer diagnosis and cost savings . Trial registration Clinical Trials.gov identifier NCT00572143 OBJECTIVES To develop an algorithm to predict the three-level EuroQol five-dimensional question naire ( EQ-5D-3L ) utility scores from the Dermatology Life Quality Index ( DLQI ) in psoriasis . METHODS This mapping study used data from the British Association of Dermatologists Biologic Interventions Register-a pharmacovigilance register comprising patients with moderate to severe psoriasis on systemic therapies . Conceptual overlap between the EQ-5D-3L and DLQI was assessed using Spearman rank correlation coefficients and exploratory factor analysis . Six regression methods to predict the EQ-5D-3L index ( direct mapping ) and two regression methods to predict EQ-5D-3L domain responses ( response mapping ) were tested . R and om effects models were explored to account for repeated observations from the same individual . Estimated and actual EQ-5D-3L utility scores were compared using 10-fold cross-validation ( in- sample ) to evaluate predictive performance . Final models were selected using root mean squared error , mean absolute error , and mean error . RESULTS The data set comprised 22,085 observations for which DLQI and EQ-5D-3L were recorded on the same day . A moderate correlation was found between the measures ( r = -0.47 ) . Exploratory factor analysis showed that two EQ-5D-3L domains ( pain/discomfort and depression/anxiety ) were associated with all six DLQI domains . The best-performing model used ordinary least squares with DLQI items , age , and sex as explanatory variables ( with squared , cubic , and interaction terms ) . A tool was produced to allow users to map their data to the EQ-5D-3L , and includes algorithms that require fewer variables ( e.g. , total DLQI scores ) . CONCLUSIONS This study produced mapping algorithms that can generate EQ-5D-3L utility scores from DLQI data for economic evaluations of health interventions for patients with psoriasis BACKGROUND The exacerbations of chronic obstructive pulmonary disease tool ( EXACT ) is a condition-specific daily diary recently developed to evaluate the frequency , severity , and duration of chronic obstructive pulmonary disease ( COPD ) exacerbations . A preference-based algorithm for the EXACT would allow utilities to be reported from patients during an exacerbation when EQ-5D data are not available . OBJECTIVE To develop the exacerbations of chronic obstructive pulmonary disease tool-utility ( EXACT-U ) , a condition-specific preference-based measure to report utilities from the EXACT for use in cost-effectiveness studies . METHODS Five items with three to five levels comprise the EXACT-U. Two groups of health states and respondents were constructed to allow for model development ( Development group ) and predictive validity testing ( Validation group ) using independent sample s. Members of the UK general public each valued 11 r and omized health states using time trade-offs ( TTOs ) scaled from full health/dead with 10-year duration s. Regression models estimated from the Development group using individual data , mean data , and panel design s. Models assessed by number of inconsistent coefficients estimated and R(2 ) and tested against observed utilities from the Validation group using mean absolute error ( MAE ) and root mean squared error ( RMSE ) . RESULTS A total of 55 health states , including the best and worst states , were valued in TTO interviews conducted with 400 respondents . Ten models were developed . The final preferred model contained no logical inconsistencies and found MAE = 0.04 and RMSE = 0.05 with a predicted utility range from 0.09 to 0.95 . CONCLUSIONS The EXACT-U is a condition-specific preference-based measure with strong predictive validity to report daily utilities during an exacerbation Purpose This study examines the effects of a rehabilitation program on quality of life ( QoL ) , cardiopulmonary function , and fatigue in breast cancer patients . The program included aerobic exercises as well as stretching and strengthening exercises . Methods Breast cancer patients ( n=62 ) who had completed chemotherapy were r and omly assigned to an early exercise group ( EEG ; n=32 ) or a delayed exercise group ( DEG ; n=30 ) . The EEG underwent 4 weeks of a multimodal rehabilitation program for 80 min/day , 5 times/wk for 4 weeks . The DEG completed the same program during the next 4 weeks . The European Organization for Research and Treatment of Cancer-Core Quality of Life Question naire ( EORTC QLQ-C30 ) , EORTC Breast Cancer-Specific Quality of Life Question naire ( EORTC QLQ-BR23 ) , predicted maximal volume of oxygen consumption ( VO2max ) , and fatigue severity scale ( FSS ) were used for assessment at baseline , and at 2 , 4 , 6 , and 8 weeks . Results After 8 weeks , statistically significant differences were apparent in global health , physical , role , and emotional functions , and cancer-related symptoms such as fatigue and pain , nausea , and dyspnea on the EORTC QLQ-C30 ; cancer-related symptoms involving the arm and breast on the EORTC QLQ-BR23 ; the predicted VO2max ; muscular strength ; and FSS ( p<0.050 ) , according to time , between the two groups . Conclusion The results of our study suggest that a supervised multimodal rehabilitation program may improve the physical symptoms , QoL , and fatigue in patients with breast cancer Introduction : The main objective of the current post hoc analysis was to compare patient-reported outcomes between  crizotinib ( N = 172 ) and chemotherapy subgroups ( pemetrexed [ N = 99 ]  and docetaxel  [ N = 72 ] ) in previously treated patients with advanced ALK-positive non – small-cell lung cancer , in PROFILE 1007 study ( Pfizer ; NCT0093283 ) . Methods : Patient-reported outcomes were assessed at baseline , day 1 of each cycle , and end of treatment . General health status was measured using the EuroQol-5D visual analog scale and health utility index scores were assessed using the EuroQol-5D descriptive system . Functioning , lung cancer symptoms , and global quality of life ( QOL ) were assessed using European Organisation for Research and Treatment of Cancer QLQ-C30 and the QLQ-LC13 lung cancer module . Repeated measures mixed-effects analyses compared overall scores and change from baseline scores , controlling for baseline scores . Results : The overall mean EQ-5D health utility index scores ( 95 % CI ) on treatment were significantly greater ( p < 0.05 ) for crizotinib ( 0.82 [ 0.79−0.85 ] ) than for chemotherapy ( 0.73 [ 0.70−0.77 ] ; 0.74 [ 0.70−0.79 ] for pemetrexed and 0.66 [ 0.58−0.74 ] for docetaxel ) . A significantly greater improvement from baseline was observed with crizotinib versus pemetrexed and versus docetaxel treatment groups for general health status , physical functioning , global QOL , dyspnea , fatigue , and pain . Improvement rates for fatigue , cough , pain , dyspnea , and global QOL were significantly greater on crizotinib compared with pemetrexed and docetaxel , respectively . Worsening rates for diarrhea and constipation were higher with crizotinib . Conclusion : The benefits of crizotinib in improving symptoms and QOL are demonstrated regardless of whether the comparator is pemetrexed or docetaxel
RESULTS ( 1 ) EQ-5D was valid and responsive for skin conditions and most cancers ; in vision , its performance varied according to aetiology ; and performance was poor for hearing impairments .
The HUI3 performed well for hearing and vision disorders .
It also performed well in cancers although evidence was limited and there was no evidence in skin conditions .
Response mapping using all the domain scores was the best performing model for the EORTC QLQ-C30 .
In an exploratory analysis , a limited dependent variable mixture model performed better than an equivalent linear model .
3 ) The exploratory valuation study found that bolt-on items for vision , hearing and tiredness had a significant impact on values of the health states , but the direction and magnitude of differences depended on the severity of the health state .
The vision bolt-on item had a statistically significant impact on EQ-5D health state values and a full valuation model was estimated .
EQ-5D performs well in studies of cancer and skin conditions .
Mapping techniques provide a solution to predict EQ-5D values where EQ-5D has not been administered .
For conditions where EQ-5D was found to be inappropriate , including some vision disorders and for hearing , bolt-ons provide a promising solution .
BACKGROUND The National Institute for Health and Care Excellence recommends the use of generic preference-based measures ( GPBMs ) of health for its Health Technology Assessment s ( HTAs ) .
However , these data may not be available or appropriate for all health conditions .
OBJECTIVES To determine whether GPBMs are appropriate for some key conditions and to explore alternative methods of utility estimation when data from GPBMs are unavailable or inappropriate .
( 2 ) Potential modelling approaches to ' map ' EQ-5D values from condition-specific and clinical measures of health [ European Organisation for Research and Treatment of Cancer Quality -of-life Question naire Core 30 ( EORTC QLQ-C30 ) and Functional Assessment of Cancer Therapy - General Scale ( FACT-G ) ] are compared for predictive ability and goodness of fit using two separate data sets . (