Quality of Life and General Health After Elective Surgery for Cervical Spine Pathologies: Determining a Valid and Responsive Metric of Health State Utility. Assessing the empirical validity of alternative multi-attribute utility measures in the maternity context Mapping between the Roland Morris Questionnaire and generic preference-based measures. An empirical evaluation of the SF-12, SF-6D, EQ-5D and Michigan Hand Outcome Questionnaire in patients with rheumatoid arthritis of the hand An empirical comparison of EQ-5D and SF-6D in liver transplant patients. How do the EQ-5D, SF-6D and the well-being rating scale compare in patients with ankylosing spondylitis? EQ-5D in a general population survey – A description of the most commonly reported EQ-5D health states using the SF-36 Comparison of EQ-5D and SF-6D utilities in mental health patients. Putting the ‘Q’ in depression QALYs: a comparison of utility measurement using EQ-5D and SF-6D health related quality of life measures Cost-utility estimates in depression: does the valuation method matter? Mapping utility scores from a disease-specific quality-of-life measure in bariatric surgery patients. SF-6D and EQ-5D result in widely divergent incremental cost-effectiveness ratios in a clinical trial of older women: implications for health policy decisions
BACKGROUND As part of the Affordable Care Act , health utility metrics are being investigated to define a cost-effective , value-based health care model . EuroQOL-5D ( EQ-5D ) and Short Form-6D ( SF-6D ) are commonly used quality -of-life instruments . Domains in the EQ-5D question naire are thought to be less responsive in measuring quality of life after cervical surgery . OBJECTIVE To evaluate the validity and responsiveness of SF-6D and EQ-5D in determining health and quality of life after elective cervical spine surgery . METHODS A total of 420 patients undergoing elective cervical spine surgery over a period of 2 years were enrolled in a prospect i ve longitudinal registry . Patient-reported outcomes Neck Disability Index ( NDI ) , EQ-5D , and SF-12 were recorded . Based on previously published equations , SF-6D was calculated using NDI and SF-12 scores . Patients were asked whether " surgery met their expectations " ( meaningful improvement ) . The validity and relative responsiveness of SF-6D ( NDI ) , SF-6D ( SF-12 ) , and EQ-5D to discriminate between meaningful and nonmeaningful improvement were calculated . RESULTS Sixty-six percent of patients ( 277 ) reported a level of improvement after surgery that met their expectations ( meaningful improvement ) . SF-6D ( NDI ) ( area under the curve [ AUC ] = 0.69 ) was a more valid discriminator of meaningful improvement compared with the SF-6D ( SF-12 ) ( AUC = 0.65 ) and EQ-5D ( AUC = 0.62 ) . SF-6D ( NDI ) was also a more responsive measure compared with SF-6D ( SF-12 ) and EQ-5D ( st and ardized response mean difference : 0.66 , 0.48 , and 0.44 , respectively ) . CONCLUSION SF-6D is a more valid and responsive measure of general health and quality of life compared with EQ-5D . SF-6D derived from disease-specific disability scores was more valid and responsive than that derived from the generic preference-based SF-12 . Cost-effective studies should use SF-6D as a measure of QALY after cervical spine surgery Background Multi-attribute utility measures are preference-based health-related quality of life measures that have been developed to inform economic evaluations of health care interventions . The objective of this study was to compare the empirical validity of two multi-attribute utility measures ( EQ-5D and SF-6D ) based on hypothetical preferences in a large maternity population in Engl and . Methods Women who participated in a r and omised controlled trial of additional postnatal support provided by trained community support workers represented the study population for this investigation . The women were asked to complete the EQ-5D descriptive system ( which defines health-related quality of life in terms of five dimensions : mobility , self care , usual activities , pain/discomfort and anxiety/depression ) and the SF-36 ( which defines health-related quality of life , using 36 items , across eight dimensions : physical functioning , role limitations ( physical ) , social functioning , bodily pain , general health , mental health , vitality and role limitations ( emotional ) ) at six months postpartum . Their responses were converted into utility scores using the York A1 tariff set and the SF-6D utility algorithm , respectively . One-way analysis of variance was used to test the hypothetically-constructed preference rule that each set of utility scores differs significantly by self-reported health status ( categorised as excellent , very good , good , fair or poor ) . The degree to which EQ-5D and SF-6D utility scores reflected alternative dichotomous configurations of self-reported health status and the Edinburgh Postnatal Depression Scale score was tested using the relative efficiency statistic and receiver operating characteristic ( ROC ) curves . Results The mean utility score for the EQ-5D was 0.861 ( 95 % CI : 0.844 , 0.877 ) , whilst the mean utility score for the SF-6D was 0.809 ( 95 % CI : 0.796 , 0.822 ) , representing a mean difference in utility score of 0.052 ( 95 % CI : 0.040 , 0.064 ; p < 0.001 ) . Both measures demonstrated statistically significant differences between subjects who described their health status as excellent , very good , good , fair or poor ( p < 0.001 ) , as well as monotonically decreasing utility scores ( test for linear trend : p < 0.001 ) . The SF-6D was between 29.1 % and 423.6 % more efficient than the EQ-5D at detecting differences in self-reported health status , and between 129.8 % and 161.7 % more efficient at detecting differences in the Edinburgh Postnatal Depression Scale score . In addition , the SF-6D generated higher area under the curve ( AUC ) scores generated by the ROC curves than the EQ-5D , indicating greater discriminatory power , although in all but one analysis the differences in AUC scores between the measures were not statistically significant . Conclusion This study provides evidence that the SF-6D is an empirically valid and efficient alternative multi-attribute utility measure to the EQ-5D , and is capable of discriminating between external indicators of maternal health 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 Background The aim of this study was to assess the psychometric properties , namely acceptability , validity , reliability , interpretability and responsiveness of the EuroQol EQ-5D ( EQ-5D visual analogue ( VAS ) and EQ-5D ( utility ) ) , Short Form 12 Dimensions ( SF-12 ) , SF-6D and Michigan H and Outcome Question naire ( MHQ ) in patients with rheumatoid arthritis ( RA ) of the h and . Methods The empirical investigation was based upon data from a r and omised controlled trial of 488 adults with rheumatoid arthritis who had pain and dysfunction of the h and s and /or wrists . Participants completed the EQ-5D , SF-12 and MHQ at baseline and at 4 and 12 months follow up . Acceptability was measured using completion rates over time ; construct validity using the “ known groups ” approach , based on pain troublesomeness ; convergent validity using spearman ’s rho correlation ( ρ ) ; reliability using internal consistency ( Cronbach ’s alpha ) ; interpretability using minimal important differences ( MID ) ; and responsiveness using effect sizes and st and ardised response means ( SRM ) stratified by level of self-rated improvement in h and and wrist function or level of self-rated benefit and satisfaction from trial treatments . Results At baseline , the study population had a mean age of 62.4 years , a mean MHQ score of 52.1 and included 76 % women . The EQ-5D ( utility ) had the highest completion rates across time points . All instruments discriminated between pre-specified groups based on pain troublesomeness . Convergent validity analysis indicated that the MHQ score correlated strongly with the EQ-5D ( ρ = 0.65 ) and SF-6D ( ρ = 0.63 ) utility scores . The MHQ was most responsive at detecting change in indicators of RA pain severity between baseline and 4 months , whilst minimal important differences varied considerably across PROMs . Conclusions The instruments evaluated in this study displayed varying psychometric properties in the context of RA of the h and . The selection of a preferred instrument in evaluative studies should ultimately depend on the relative importance placed on individual psychometric properties and the importance placed on generation of health utilities for economic evaluation purpose There remains disagreement about the preferred utility-based measure of health-related quality of life for use in constructing quality -adjusted life years ( QALYs ) . The recent development of a new measure , the SF-6D , has highlighted this issue . The SF-6D and EuroQol EQ-5D measure health-related utilities on a scale where 0 represents death and 1 represents full health , and both have utility scores generated from r and om sample s of the general UK population . This study explored whether , in a large sample of liver transplant patients , the two instruments provide similar results . The empirical data highlight important variation in the results generated from the use of the two instruments . The data are consistent with a view that the SF-6D does not describe health states at the lower end of the utility scale but is more sensitive than EQ-5D in detecting small changes towards the top of the scale Purpose : To compare aspects of validity of EuroQol—5 Dimensions ( EQ-5D ) and Short-Form—6 Dimensions ( SF-6D ) , two indirect utility instruments , and the well-being rating scale ( RS ) in ankylosing spondylitis ( AS ) . Methods : EQ-5D , SF-6D and RS were available for 254 patients fulfilling modified New York criteria . 134 patients were part of an observational cohort and 120 were part of a r and omised controlled trial ( RCT ) . Aspects of validity assessed were truth ( agreement and correlation with external health measures ) and discrimination ( differentiation between health states , repeatability and detection of treatment effect ) . Results : Median ( range ) values were 0.69 ( −0.08–1.00 ) for the EQ-5D , 0.65 ( 0.35–0.95 ) for the SF-6D and 0.65 ( 0.14–1.00 ) for the RS . Agreement ( intraclass correlation coefficient ) was moderate ( 0.46–0.55 ) . Instruments correlated equally with disease activity , functioning and quality of life . The SF-6D showed smaller average differences in utility between patients with better and worse disease compared with the EQ-5D and the RS . The smallest detectable difference ( SDD ) ( in the control group of RCT ) was 0.36 , 0.17 and 0.33 for EQ-5D , SF-6D and RS , respectively . The ability to detect treatment effect ( in the intervention trial ) showed st and ardised effect sizes that were moderate for EQ-5D and SF-6D ( 0.63 and 0.64 ) and low for the RS ( 0.23 ) . Conclusion : In patients with AS , EQ-5D , SF-6D and the RS correlate equally well with external measures of health , but have different psychometric properties . The SDD is most favourable for the SF-6D , but it discriminates less well between patients with different disease severities . The RS has a poorer ability to detect treatment effects . It is difficult to recommend one of the instruments The importance of study ing health-related quality of life in the general population has increasingly been emphasized . From a public health perspective , this benefits the identification of population inequalities in health status . One of the currently most popular instruments is the EQ-5D . Evaluations of the EQ-5D generally focus on the overall preference-based index . As this index has a built-in value , exploration of the information from the underlying health states is also important . In this study , the ten most commonly reported EQ-5D health states are described using the SF-36 . Data collected in 1999 by question naires mailed to a r and om sample aged 20–74 in south-eastern Sweden were used ( n = 9489 ) . Almost 43 % reported the best possible EQ-5D health state and 78 % were accounted for by three EQ-5D health states . The EQ-5D health state classification was largely reflected by the SF-36 , with the EQ-5D items mobility , usual activities , pain/discomfort and anxiety/depression tapping most clearly on the SF-36 scales physical functioning , role limitations due to physical health problems , bodily pain , and mental health , respectively . However , within the same level of EQ-5D ( i.e. , moderate problems ) there was a rather large variation of SF-36 scale scores , particularly regarding the EQ-5D item pain/discomfort and the SF-36 scale BP Various  preference-based measures of health are available for use as an outcome measure in cost-utility analysis . The aim of this study is to compare two such measures EQ-5D and SF-6D in mental health patients . Baseline data from a Dutch multi-centre r and omised trial of 616 patients with mood and /or anxiety disorders were used . Mean and median  EQ-5D  and  SF-6D utilities were compared , both in the total sample and between severity subgroups based on quartiles of SCL-90 scores . Utilities were expected to decline with increased severity . Both EQ-5D and SF-6D utilities differed significantly between patients of adjacent severity groups . Mean utilities increased from 0.51 at baseline to 0.68 at 1.5 years follow-up for EQ-5D and from 0.58 to 0.70 for SF-6D . For all severity subgroups , the mean change in EQ-5D utilities as well as in SF-6D utilities was statistically significant . St and ardised response means were higher for SF-6D utilities . We concluded that both EQ-5D and SF-6D discriminated between severity subgroups and captured improvements in health over time . However , the use of EQ-5D result ed in larger health gains and consequent lower cost-utility ratios , especially for the subgroup with the highest severity of mental health problems Background Generic health preference measures that capture quality of life improvements in depression are important for economic analysis of new technologies . Aim To compare two widely used preference measures , the EQ-5D and SF-6D , in terms of their dimensions and health utility values . Method EQ-5D and SF-6D data collected from 114 patients with depression , who participated in a cluster , r and omised controlled trial to evaluate a collaborative care intervention in UK , primary care practice s.  Utilities were examined across the whole sample and by level of depression severity using the PHQ-9 . Results Depression was associated with disutility at baseline . At 3 month follow-up mean utility increased 0.147 for EQ-5D and 0.082 for SF-6D . Health gains were observed in patients in remission from depression and those with the mildest level of depression severity . Conclusions Both generic preference measures were sensitive to health gains in depression within a relatively short follow-up period ; larger health gain was observed for the EQ-5D BACKGROUND Depression imposes a substantial burden on society . In view of the economic burden of depression , studies evaluating depression treatment increasingly incorporate a cost-utility analysis . Outcomes of these analyses are used by decision makers to prioritize healthcare . Although generic preference-based instruments have been recommended for measuring utility , depression research often uses a disease-specific method , based on depression-free days ( DFD ) , to measure utilities . AIMS OF THE STUDY The objective of this study was to compare utility measurement techniques in the context of a r and omized controlled trial . In particular , we studied the agreement between QALYs measured with the  EuroQol ( EQ-5D ) , the Short Form 6D ( SF-6D ) , and the DFD method , using the EQ-5D as the reference method . We also studied whether the use of different techniques leads to different conclusions for decision makers . METHODS Data were derived from the Depression in Elderly with Long-Term Afflictions ( DELTA ) study . This r and omized controlled trial was design ed to study the effectiveness and cost-effectiveness of a minimal psychological intervention for chronically ill patients with co-occurring minor or mild to moderate major depression . The  EQ-5D , SF-6D and Beck Depression Inventory  ( to estimate DFDs ) were assessed at baseline , and at three , six and twelve months after baseline . RESULTS Poor agreement was found between the EQ-5D and DFD ( Kendall 's Tau : 0.33 ; ICC : 0.21 ( 95 % CI:-0.07 - 0.45 ) ) and moderate agreement between the EQ-5D and SF-6D ( Kendall 's Tau : 0.60 ; ICC : 0.47 ( 95 % CI : 0.36 - 0.57 ) ) . The incremental cost-utility ratio led to similar conclusions for decision makers across techniques . DISCUSSION In conclusion , utilities from the disease-specific DFD method should not be compared directly with utilities derived from the EQ-5D . Although a disease-specific method might yield similar cost-utility ratios as generic instruments , generic instruments remain the preferred option for prioritizing healthcare . Limitations of this study include the presence of minor depression and chronic illnesses in our study population . IMPLICATION S Generic instruments remain preferred for cost-utility analyses , especially when results are used to prioritize healthcare . If the DFD method is a way forward , further research is required to vali date utility weights assigned to the DFDs 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 Summary Using two instruments ( SF-6D and EQ-5D ) to estimate quality adjusted life years ( QALYs ) , we conducted an economic evaluation of a 12-month r and omized controlled trial with a 12-month follow-up study in older women to evaluate the value for money of two doses of resistance training compared with balance and tone classes . We found that the incremental QALYs estimated from the SF-6D were two- to threefold greater than those estimated from the EQ-5D . Introduction Decision makers must continually choose between existing and new interventions . Hence , economic evaluations are increasingly prevalent . The impact of quality -adjusted life year ( QALY ) estimates using different instruments on the incremental cost-effectiveness ratios ( ICERs ) is not well understood in older adults . Thus , we compared ICERs , in older women , estimated by the EuroQol-5D ( EQ-5D ) and the Short Form-6D ( SF-6D ) to discuss implication s on decision making . Methods Using both the EQ-5D and the SF-6D , we compared the incremental cost per QALY gained in a r and omized controlled trial of  resistance training in 155 community-dwelling women aged 65 to 75 years . The 12-month r and omized controlled trial included a subsequent 12-month follow-up . Our focus , the follow-up study , included 123 of the 155 participants from the Brain Power study ; 98 took part in the economic evaluation ( twice-weekly balance and tone exercises , n = 28 ; once-weekly resistance training , n = 35 ; twice-weekly resistance training , n = 35 ) . Our primary outcome measure was the incremental cost per QALY gained of once- or twice-weekly resistance training compared with balance and tone exercises . Results At cessation of the follow-up study , the incremental QALY was −0.051 ( EQ-5D ) and −0.144 ( SF-6D ) for the once-weekly resistance training group and −0.081 ( EQ-5D ) and −0.127 ( SF-6D ) for the twice-weekly resistance training group compared with balance and tone classes . Conclusion The incremental QALYs estimated from the SF-6D were two- to threefold greater than those estimated from the EQ-5D . Given the large magnitude of difference , the choice of preference-based utility instrument may substantially impact health care decisions
Most of the evidence concerns the SF-36 and EQ-5D , and for these instruments there was evidence for known group validity .
Although the evidence base is limited in a number of important respects , including problems with the measures used to develop constructs in the validation studies , it is sufficient to raise doubts about the use of generic measures of health like the EQ-5D and SF-36 in patients with schizophrenia
OBJECTIVES Generic health status measures such as the short form health survey ( SF-36 ) and EuroQol-5D ( EQ-5D ) are increasingly being used to inform health policy .
They are cl aim ed to be applicable across disease areas and have started to be used within mental health research .
This review aims to assess the construct validity and responsiveness of four generic health status measures in schizophrenia , including the preference-based SF-6D and EQ-5D .