Mapping the FACT-G cancer-specific quality of life instrument to the EQ-5D and SF-6D Quality of Life and General Health After Elective Surgery for Cervical Spine Pathologies: Determining a Valid and Responsive Metric of Health State Utility. Mapping between the Roland Morris Questionnaire and generic preference-based measures. Comparison of EQ-5D and SF-6D utilities in mental health patients. An empirical evaluation of the SF-12, SF-6D, EQ-5D and Michigan Hand Outcome Questionnaire in patients with rheumatoid arthritis of the hand Assessing the empirical validity of alternative multi-attribute utility measures in the maternity context 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 How do the EQ-5D, SF-6D and the well-being rating scale compare in patients with ankylosing spondylitis? Putting the ‘Q’ in depression QALYs: a comparison of utility measurement using EQ-5D and SF-6D health related quality of life measures Testing alternative regression models to predict utilities: mapping the QLQ-C30 onto the EQ-5D-5L and the SF-6D Cost-utility estimates in depression: does the valuation method matter? Comparison of the SF-6D and the EQ-5D in patients with coronary heart disease Mapping the cancer-specific EORTC QLQ-C30 to the preference-based EQ-5D, SF-6D, and 15D instruments. Mapping utility scores from a disease-specific quality-of-life measure in bariatric surgery patients. 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. The impact of a revised EQ-5D population scoring on preference-based utility scores in an inflammatory arthritis cohort. A comparison of the measurement properties and estimation of minimal important differences of the EQ-5D and SF-6D utility measures in patients with systemic sclerosis. An empirical comparison of EQ-5D and SF-6D in liver transplant patients. Mapping SF-36 onto the EQ-5D index: how reliable is the relationship? Rapid and sustained improvement in health-related quality of life and utility for 72 weeks in patients with ankylosing spondylitis receiving etanercept. EQ-5D in a general population survey – A description of the most commonly reported EQ-5D health states using the SF-36 Quality of life and cost-effectiveness of a 3-year trial of lifestyle intervention in primary health care. Comparison of the EQ-5D and SF-12 health surveys in a general population survey in Alberta, Canada. The validity and responsiveness of three quality of life measures in the assessment of psoriasis patients: results of a phase II study Health-related quality of life in the Finnish trial of screening for prostate cancer. Accurately measuring outcomes after surgery for adult Chiari I malformation: determining the most valid and responsive instruments. Economic evaluation of dose–response resistance training in older women: a cost-effectiveness and cost-utility analysis Mapping MOS Sleep Scale scores to SF‑6D utility index The development of a model for translation of the Neck Disability Index to utility scores for cost-utility analysis in cervical disorders. Estimating the SF-6D value set for a population-based sample of Brazilians. Psychometric evaluation of the National Eye Institute Visual Function Questionnaire and Visual Function Questionnaire Utility Index in patients with non-infectious intermediate and posterior uveitis Cost-utility and cost-effectiveness analyses of a long-term, high-intensity exercise program compared with conventional physical therapy in patients with rheumatoid arthritis. Psychometric evaluation of the Hospital Anxiety and Depression Scale 3 months after acute lung injury. Predicting Health-Utility Scores From the Cervical Spine Outcomes Questionnaire in a Multicenter Nationwide Study of Anterior Cervical Spine Surgery A Portuguese value set for the SF-6D. Responsiveness of the EuroQol (EQ 5-D) and the SF-36 in elderly patients with displaced femoral neck fractures Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain. Assessing health-related quality of life pre- and post-liver transplantation: a prospective multicenter study. The effect of weight loss on changes in health-related quality of life among overweight and obese women with urinary incontinence Accurately measuring the quality and effectiveness of cervical spine surgery in registry efforts: determining the most valid and responsive instruments. Impact of Gender on General Health-Related Quality of Life in Patients with Chronic Sinusitis The bone-anchored hearing aid: quality-of-life assessment. Mapping Between the Sydney Asthma Quality of Life Questionnaire (AQLQ-S) and Five Multi-Attribute Utility Instruments (MAUIs) Health-related quality of life in hospital inpatients with pressure ulceration: assessment using generic health-related quality of life measures. Mapping chronic liver disease questionnaire scores onto SF-6D utility values in patients with primary sclerosing cholangitis Adalimumab treatment is associated with improvement in health‐related quality of life in psoriasis: Patient‐reported outcomes from a Phase II randomized controlled trial Assessment of the minimum clinically important difference in pain, disability, and quality of life after anterior cervical discectomy and fusion: clinical article. A view from the bridge: agreement between the SF-6D utility algorithm and the Health Utilities Index.
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 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 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 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 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 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 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 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 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 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 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 Background The SF-6D was derived from the SF-36 . A single summary score is obtained allegedly preserving the descriptive richness and sensitivity to change of the SF-36 into utility measurement . We compared the SF-6D and EQ-5D on domain content , scoring distribution , pre-treatment and change scores . Methods The SF-6D and the EQ-5D were completed prior to intervention and 1 , 3 , 6 and 12 months post-intervention in a study enrolling 561 patients with symptomatic coronary stenosis . Patients were r and omized to off-pump coronary artery bypass surgery ( CABG ) , st and ard on-pump CABG , or percutaneous transluminal coronary angioplasty ( PTCA ) .  Baseline and change over time scores were compared using parametric and non-parametric tests . Results The relative contribution of similar domains measuring daily functioning to the utility scores differed substantially . SF-6D focused more on social functioning , while EQ-5D gave more weight to physical functioning . Pain and mental health had similar contributions . The scoring range of the EQ-5D was twice the range of the SF-6D . Before treatment , EQ-5D and SF-6D mean scores appeared similar ( 0.64 versus 0.63 , p = 0.09 ) . Median scores , however , differed substantially ( 0.69 versus 0.60 ) , a difference exceeding the minimal important difference of both instruments . Agreement was low , with an intra-class correlation of 0.45.Finally , we found large differences in measuring change over time . The SF-6D recorded greater intra-subject change in the PTCA-group . Only the EQ-5D recorded significant change in the CABG-groups . In the latter groups changes in SF-6D domains cancelled each other out . Conclusion Although both instruments appear to measure similar constructs , the EQ-5D and SF-6D are quite different . The low agreement and the differences in median values , scoring range and sensitivity to change after intervention show that the EQ-5D and SF-6D yield incomparable scores in patients with coronary heart disease 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 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 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 BACKGROUND AND OBJECTIVE It is well established that there are problems with the EQ-5D . This is due to the original scoring methods used and how negative time trade-off ( TTO ) values were treated . A revised scoring method has been published . This article applies this to an inflammatory arthritis cohort . The objective is to examine the impact of a revised scoring system for the EQ-5D ( UK ) TTO on the utility estimates and in the case of rheumatoid arthritis , to explore the impact of using different utility metrics on the incremental cost-effectiveness ratio ( ICER ) results of an economic model . METHODS A total of 504 patients with inflammatory arthritis were rescored using revised EQ-5D scoring , which uses an episodic r and om utility model to deal with negative TTO values . Differences in utility scores were compared and the new mapping coefficients were obtained . These were then used in an economic model to examine the impact on the ICER . RESULTS In rheumatoid arthritis , the overall change is less for the revised EQ-5D scoring than with the original EQ-5D ( TTO ) but greater than the SF-6D : EQ-5D UK -0.22 ( 95 % confidence interval [ CI ] -0.30 to -0.15 ) , revised EQ-5D UK -0.16 ( 95 % CI -0.21 to -0.10 ) and SF-6D -0.08 ( 95 % CI -0.11 to -0.05 ) . A similar trend is seen in the psoriatic arthritis group . The economic model produced different ICERs , when different utility measures were used ; EQ-5D ( TTO ) € 42,402 , SF-6D € 111,788 , and revised EQ-5D ( TTO ) € 57,747 . CONCLUSION In the context of inflammatory arthritis , this article demonstrates that a revised scoring for EQ-5D may have a significant impact on utility estimates and on the output of the economic model OBJECTIVES To compare measurement properties of the EQ-5D and SF-6D utility measures , to assess the association and agreement between these measures and to estimate minimal important differences ( MID ) in patients with systemic sclerosis ( SSc ) . METHODS Both measures were assessed twice in an observational prospect i ve design over a 12-month period ( n=211 ) .  Spearman 's rank correlation between the EQ-5D and SF-6D was calculated at baseline . Agreement was assessed using Lin 's concordance coefficient ( LCC ) and a Bl and -Altman plot . MIDs were estimated using three anchors ; the global rating of change item ( SF-36 ) and changes on the Health Assessment Question naire-Disability Index ( HAQ-DI ) of ≥0.14 and ≥0.22 . RESULTS At baseline , the mean EQ-5D and SF-6D scores were 0.64 ( SD=0.25 ) and 0.65 ( SD=0.11 ) , respectively . The correlation between EQ-D and SF-6D scores was r=0.74 . Agreement was moderate ( LCC=0.49 ) , and the Bl and -Altman plot showed a mean difference of 0.003 but wide limits of agreement ( -0.38 to 0.39 ) and a structural bias for lower scores . The mean MID estimate for the EQ-5D was 0.08 for the improved subgroup , and -0.13 for the deteriorated subgroup . For the SF-6D , the MID estimate was 0.05 for the improved and -0.04 for the deteriorated subgroup . CONCLUSIONS Although there was a marked correlation between the measures , the moderate agreement implies that EQ-5D and SF-6D scores can not be used interchangeably . The MID estimates we provided can be used to calculate sample sizes for clinical trials involving SSc patients , and in interpreting the relevance and importance of treatment effects 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 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 OBJECTIVE To examine the longterm effect of etanercept ( ETN ) therapy on health-related quality of life ( HRQOL ) and utility in patients with ankylosing spondylitis . METHODS Patients completing a 24-week placebo-controlled trial were continued on ETN in a 72-week open-label extension study . Short Form-36 ( SF-36 ) , EuroQOL-5D ( EQ-5D ) , and EuroQOL visual analog scale ( EQ-VAS ) scores were collected at open-label baseline and every 12 weeks thereafter . Mental and physical component scores ( MCS and PCS ) of the SF-36 , EQ-5D and SF-6D utility scores , and quality -adjusted life-years ( QALY ) were calculated . RESULTS 257 patients [ 129 previous placebo ( PLA ) and 128 ETN recipients ] enrolled in this open-label extension study , and 85 % completed the 72-week followup . PCS , EQ-5D and SF-6D utilities , and EQ-VAS were significantly lower at open-label baseline in the previous PLA group ( PLA/ETN group ) than in the previous ETN group ( ETN/ETN group ; all p < 0.001 ) . At week 12 , PCS and MCS , EQ-5D and SF-6D utility scores , and EQ-VAS were similar in the PLA/ETN and ETN/ETN groups . As expected , mean change in EQ-5D in the PLA/ETN group was significantly greater than that for SF-6D ( 0.18 vs 0.06 ; p < 0.0001 ) . HRQOL and utility improvements were maintained in both groups for up to 72 weeks . The average 72-week QALY gain per person in the PLA/ETN group was 0.24 and 0.10 for EQ-5D and SF-6D , respectively . CONCLUSION Patients continuing ETN therapy sustained HRQOL and utility improvements attained during the original PLA-controlled trial . Patients previously taking PLA  showed rapid and sustained improvements in HRQOL and utility and substantial QALY gain with ETN therapy 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 BACKGROUND Lifestyle interventions reduce cardiovascular risk and risk of diabetes mellitus , but reports on long-term effects on quality of life ( QOL ) and health care utilization are rare . We investigated the impact of a primary health care-based lifestyle intervention program on QOL and cost-effectiveness over 3 years . METHODS A total of 151 men and women , aged 18 to 65 years , at moderate to high risk for cardiovascular disease , were r and omly assigned to either lifestyle intervention with st and ard care or st and ard care alone . Intervention consisted of supervised exercise sessions and diet counseling for 3 months , followed by regular group meetings over a 3-year period . Change in QOL was measured with EuroQol ( 5-dimensional EuroQol-5D [ EQ-5D ] and EuroQol-VAS [ EQ-VAS ] ) , the 36-Item Short-Form Health Survey ( SF-36 ) , and the 6-dimensional Short-Form 6D ( SF-6D ) . The health economic evaluation was performed from a societal view and a treatment perspective . In a cost-utility analysis , the costs , gained quality -adjusted life-years ( QALYs ) , and savings in health care were considered . Cost-effectiveness was also described using the net monetary benefit method . RESULTS Significant differences between the groups over the 3-year period were shown in the EQ-VAS ( P = .002 ) , SF-6D ( P = .01 ) , and SF-36 ( P = .04 ) physical component summary but not in the EQ-5D ( P = .24 ) or SF-36 ( P = .37 ) mental component summary . The net savings were $ 47 per participant . Costs per gained QALY , savings not counted , were $ 1668 to $ 4813 . Probabilities of cost-effectiveness were 89 % to 100 % when the amount of $ 50,000 was used as stakeholder 's threshold of willingness to pay for a gained QALY . CONCLUSION Lifestyle intervention in primary care improves QOL and is highly cost-effective in relation to st and ard care . Trial Registration clinical trials.gov Identifier : NCT00486941 OBJECTIVES The purpose s of this analysis were to evaluate the construct validity of the EQ-5D and compare responses on the EQ-5D with the Physical Component Summary ( PCS-12 ) and Mental Component Summary ( MCS-12 ) scores of the SF-12 Health Survey . METHODS Data were collected via a survey instrument mailed to 4,200 r and omly selected subjects in the province of Alberta , Canada . The instrument contained the EQ-5D and SF-12 health surveys , with additional questions eliciting clinical and demographic information from the respondents . RESULTS 1,555 respondents returned mailed question naires ; 606 question naires were returned undeliverable . The SF-12 summary scores were calculated for 1,380 respondents . Analysis of the EQ-5D responses by demographic variables found significant differences among categories of age , gender , and self-reported chronic medical conditions . Corresponding dimensions and summary scores were more strongly related ( eg , mobility and PCS-12 ; F ratio = 598.3 , P < 0.001 ) than dissimilar dimensions ( eg , mobility and MCS-12 ; F ratio = 18.8 , P < 0.001 ) . The EQ-5D index scores were moderately correlated with SF-12 summary scores ( r = 0.41 for MCS-12 and r = 0.68 for PCS-12 ) . For subjects reporting no problems on the EQ-5D , PCS-12 and MCS-12 scores were significantly lower for people reporting medical problems or feelings of depression . CONCLUSIONS The results of this investigation generally supported the validity of the EQ-5D . However , an important ceiling effect was observed for the EQ-5D in this sample . The combination of the EQ-5D and SF-12 provides relatively broad coverage of important health domains and scores for various purpose Background Patient-reported outcome ( PROs ) measures are being used more frequently in investigational studies of treatments for moderate to severe plaque psoriasis . The objective of this study was to examine the relationships among the Dermatology Life Quality Index ( DLQI ) , the Short Form 36 ( SF-36 ) , and the EuroQOL 5D ( EQ-5D ) and to assess their validity , responsiveness , and estimates of minimum important differences . Methods A Phase II , r and omized , double-blind , parallel group , placebo-controlled , multi-center clinical trial assessed the clinical efficacy and safety of two doses of subcutaneously administered adalimumab vs. placebo for 12 weeks in the treatment of 147 patients with moderate to severe plaque psoriasis . This study provided the opportunity to evaluate the validity and responsiveness to change in clinical status of PROs instruments . Patients completed the DLQI , SF-36 , and EQ-5D question naires at baseline and at 12 weeks . Blinded investigators assessed the Psoriasis Area and Severity Index ( PASI ) scores and the Physician 's Global Assessment ( PGA ) scores of enrolled patients . The responsiveness of the measures to changes in the clinical endpoints from baseline to Week 12 was assessed . Estimates of minimum important differences ( MID ) were derived . All analyses were performed with blinded data ; findings and conclusions were not biased based on treatment condition . Results The dermatology-specific DLQI was highly correlated to clinical endpoints at baseline and at Week 12 , and was the most responsive PRO to changes in endpoints . Compared with the SF-36 , the EQ-5D index score and VAS scores were generally more highly correlated with clinical endpoints , but displayed about the same degree of responsiveness . The most responsive SF-36 scales were the Bodily Pain and Social Functioning scales . Estimates of the MID for the DLQI ranged from 2.3–5.7 and for the SF-36 Physical Component Summary ( PCS ) score ranged from 2.5–3.9 . Conclusion This study provides support for the continued use of the DLQI and SF-36 PCS in the assessment of treatments for psoriasis . On the basis of the results from this trial , the EQ-5D should be considered as a general PRO measure in future clinical trials of patients with moderate to severe plaque psoriasis BACKGROUND Evidence of the potential impact of systematic screening for  prostate cancer ( PCa ) on health-related quality of life ( HRQoL ) at a population -based level is currently scarce . OBJECTIVE This study aims to quantify the long-term HRQoL impact associated with screening for PCa . DESIGN , SETTING , AND PARTICIPANTS Postal question naire surveys were conducted in 1998 , 2000 , 2004 , and 2011 among men in the Finnish PCa screening trial diagnosed with PCa ( total n=7011 ) and among a r and om sub sample of the trial population ( n=2200 ) . In 2011 , for example , 1587 responses were received from men with PCa in the screening arm and 1706 from men in the control arm . In addition , from the trial sub sample , 549 men in the screening arm and 539 in the control arm provided responses . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Health-state-value scores were compared between the intervention and control arms using three distinct HRQoL measures ( 15D , EQ-5D , and SF-6D ) , and statistical significance was assessed using t tests . In addition , differences over repeated assessment s of HRQoL between groups were evaluated using generalised estimating equations . RESULTS AND LIMITATIONS In the 2011 survey , a small but statistically significant difference emerged between the trial arms among men diagnosed with PCa ( mean scores , screening vs control arm : 15D : 0.872 vs 0.866 , p=0.14 ; EQ-5D : 0.852 vs 0.831 , p=0.03 ; and SF-6D : 0.763 vs 0.756 , p=0.06 ) . Such differences in favour of the screening arm were not found among the sample of men from the trial ( 15D : 0.889 vs 0.892 , p=0.62 ; EQ-5D : 0.831 vs 0.852 , p=0.08 ; and SF-6D : 0.775 vs 0.777 , p=0.88 ) . The slight advantage with screening among men with PCa was reasonably consistent across time in the longitudinal analysis and was strongest among men with early-stage disease . CONCLUSIONS These results show some long-term HRQoL benefit from screening for men with PCa but suggest little impact overall in the trial population BACKGROUND There has been a transition to using patient-reported outcome instruments ( PROi ) to assess surgical effectiveness . However , none of these instruments have been vali date d for outcomes of adult Chiari I malformation ( CMI ) . OBJECTIVE The aim of this study was to determine the relative validity and responsiveness of various PROi in measuring outcomes after surgery for CMI . METHODS Fifty patients undergoing suboccipital craniotomy for adult CMI were prospect ively followed for 1 year . Baseline and 1-year patient-reported outcomes ( visual analog scale for head pain and visual analog scale for neck pain , Neck Disability Index [ NDI ] , Headache Disability Index , SF-12 , Zung Self-Rating Depression Scale , and EuroQol-5D [ EQ-5D ] ) were assessed . A level of improvement in general health after surgery was defined as meaningful improvement . Receiver-operating characteristic curves were generated to assess the validity of PROi to discriminate between meaningful improvement and not . The difference between st and ardized response means ( SRMs ) in patients reporting meaningful improvement vs not as calculated to determine the relative responsiveness of each outcome instrument . RESULTS For pain and disability , the NDI was the most accurate discriminator of meaningful effectiveness ( area under the curve : 0.90 ) and also most responsive to postoperative improvement ( st and ardized response means difference : 1.87 ) . For general health and quality of life , the SF-12 PCS , EQ-5D , and Zung Self-Rating Depression Scale were all accurate discriminators ; however , SF-12 Physical Component Scale ( SF-12 PCS ) and EQ-5D were most accurate . SF-12 PCS was also most responsive . CONCLUSION For pain and disability , NDI is the most valid and responsive measure of improvement after surgery for CMI . For health-related quality of life , SF-12 PCS and EQ-5D are the most valid and responsive measures . NDI with SF-12 or EQ-5D is the most valid in patients with CMI and should be considered in cost-effectiveness studies Summary We estimated the incremental cost-effectiveness of a once-weekly or twice-weekly resistance training intervention compared with balance and tone classes in terms of falls prevented and quality -adjusted life years ( QALYs ) gained . Both resistance training interventions were more likely to save health care re source money and offer better health outcomes for falls prevention than balance and tone classes . Introduction This study aims to estimate the incremental cost-effectiveness and cost-utility of a once-weekly or twice-weekly resistance training intervention compared with twice-weekly balance and tone classes in terms of falls prevented and QALYs gained . Methods Economic evaluation was conducted concurrently with a three-arm r and omized controlled trial including 155 community-dwelling women aged 65 to 75 years , Mini Mental State Examination ≥24 , and visual acuity 20/40 or better . Participants received the once-weekly resistance training ( n = 54 ) , the twice-weekly resistance training ( n = 51 ) or the twice-weekly balance and tone ( the comparator ) classes ( n = 50 ) for 1 year . Measurements included the number of falls for each participant , healthcare re source utilization , and associated costs over 9 months ; health status was assessed using the EQ-5D and SF-6D to calculate QALYs . Results Based on the point estimates from our base case analysis , we found that both once- and twice-weekly resistance training groups were less costly ( p < 0.05 ) and more effective than twice-weekly balance and tone classes . The incremental QALYs assessed using the SF-6D were 0.003 for both the once- and twice-weekly resistance training groups , compared with the twice-weekly balance and tone classes . The incremental QALYs assessed using the EQ-5D were 0.084 for the once-weekly and 0.179 for the twice-weekly resistance training groups , respectively , compared with the twice-weekly balance and tone classes . Conclusions An individually tailored resistance training intervention delivered once or twice weekly provided better value for money for falls prevention than balance and tone classes ABSTRACT Objective : Deriving preference scores for the  Medical Outcomes Study  ( MOS ) Sleep Scale would enable its use in cost – utility analyses . The objective of this study was to map scores of the MOS Sleep Scale to a preference-based health-state utility index ( SF‑6D ) scored from the SF‑36 Health Survey ( SF‑36 ) . Research design and methods : Three data sets were used : ( 1 ) the MOS study , a 4-year observational study of chronically ill patients , ( 2 ) a 7-week open-label , non-comparative clinical trial of an osmotic controlled-release oral delivery system ( OROS ) hydromorphone in the treatment of chronic low back pain ( CLBP ) , and ( 3 ) a 6-week open-label r and omized controlled trial of OROS hydromorphone in the treatment of pain associated with chronic osteoarthritis ( OA ) . Various models were tested , where SF‑6D was regressed onto the Sleep Problem Index‑II ( SLP9 ) in 1000 r and om half ( developmental ) sample s of the MOS ( n = 1413 ) . The best fitting model was applied to the other 1000 r and om half ( cross-validation ) sample s of the MOS ( n = 1412 ) , and to the two trial sample s ( n = 199 in the CLBP trial ; n = 124 in the OA trial ) . Results : The best fitting model in the MOS sample s included a quadratic term for the SLP9 which explained 34 % of the variance in SF‑6D in the developmental sample s. Errors in prediction were greatest at higher SLP9 scores . Addition of demographic and clinical variables to the model explained minimal incremental amounts of variance ( < 5 % ) in SF‑6D scores . These results were replicated in the cross-validation MOS sample s. In both developmental and cross-validation MOS sample s , mean predicted and observed SF‑6D scores were nearly identical . When the mapping algorithm developed in the MOS was applied to the CLBP sample , mean predicted SF‑6D scores were 0.09 points higher than observed SF‑6D scores at both baseline and final visits , while changes in predicted and observed SF‑6D scores were identical . Conclusion : Results indicate that it is possible to map MOS SLP9 to SF‑6D yielding useable preference-based scores essential for cost – utility analyses . A limitation concerns the interpretation of SF‑6D scores estimated from SLP9 scores above 60 , where the prediction errors increased considerably BACKGROUND CONTEXT The Neck Disability Index ( NDI ) is a commonly used disease-specific instrument for cervical spine disorders with good responsiveness and psychometric properties compared with general health status measures . However , NDI scores are unitless and do not have an intrinsic value that is comparable to other health status measures , and these scores have limited value in cost-utility analysis . The translation of disease-specific measures to Short Form-6 Dimensions ( SF-6D ) utility scores may be useful in cost-utility analysis . PURPOSE The purpose of this study is to present a model for translating the NDI to SF-6D utility scores , permitting the use of NDI scores in the cost-utility analysis of cervical disorders . STUDY DESIGN / SETTING A secondary analysis of a multicenter prospect i ve clinical trial of the Synthes ProDisc-C ( Synthes , West Chester , PA , USA ) was performed . PATIENT SAMPLE Patients included were r and omized to receive either a total disc arthroplasty or anterior cervical discectomy and fusion for treatment of symptomatic cervical disc disease involving one vertebral level between C3 and C7 . All subjects completed NDI and 36-Item Short Form Health Survey ( SF-36 ) self- assessment s at preoperative and postoperative follow-ups of 6 weeks , 3 , 6 , 12 , 18 , and 24 months . OUTCOME MEASURES The NDI is a vali date d and widely used self-reported question naire design ed to assess patient-determined disability result ing from neck pain , including pain level and effects on activities of daily living . The SF-6D is a preference-based health state classification system derived from six health dimensions of the SF-36 self-reported question naire , including the domains of physical functioning , role limitation , social functioning , bodily pain , mental health , and vitality . METHODS The collected data points were divided into two cohorts : one for model formation and one for the assessment of model validity . SF-36 scores were converted to SF-6D utilities via three previously published methods . Correlation analyses and linear regression modeling between SF-6D and NDI created the models for translating scores . For validation , Spearman and Pearson correlations were calculated between the observed and predicted SF-6D utilities , and prediction errors were calculated . RESULTS Four hundred thirty patients with 2,137 time points were used for creation and validation of the model . Pearson and Spearman correlation coefficients between the NDI and the SF-6D derived from each conversion method were found to be between -0.8255 and -0.8504 ( p<.01 ) . R(2 ) values ranged from 0.68 to 0.71 and root mean squared error ( RMSE ) from 0.092 to 0.084 . Correlations between estimated and observed SF-6D scores ranged from 0.8325 to 0.8372 ( p<.01 ) . The mean prediction error was less than 0.006 , with st and ard deviation ( SD ) between 0.082 and 0.093 . DISCUSSION Correlations between NDI and SF-6D utility scores are strong and statistically significant . The model has a large R(2 ) and small RMSE . The prediction models produce a small mean prediction error , but the SD of the prediction errors is large . High correlations between NDI and SF-6D permit these models to be used to calculate overall utilities , changes in utilities , and quality -adjusted life-years for large data sample s. However , the relatively large observed prediction error SDs may limit the accuracy of translation of individual data points or small sample sizes OBJECTIVES SF-6D is a preference-based measure of health developed to estimate utility values from the SF-36 . The aim of this study was to estimate a weighting system for the SF-6D health states representing the preferences of a sample of the Southern Brazilian general population . METHODS A sample of 248 health states defined by the SF-6D was valued by a sample of the southern Brazilian population using the st and ard gamble . Mean and individual level multivariate regression models were fitted to the st and ard gamble valuation data to estimate preference weights for all SF-6D health states . The models were compared with those estimated in the UK study . RESULTS Five hundred twenty-eight participants were interviewed , but 58 ( 11 % ) were excluded for failing to value the worst state . Data from 469 subjects producing 2696 health states valuations were used in the regression analysis . In contrast to the best performing model for the UK data , the best performing model for the Brazilian data was a r and om effects model using only the main effects variables , highlighting the importance of adopting a country-specific algorithm to derive SF-6D health states values . Inconsistent coefficients were merged to produce the final recommended model , which has all significant coefficients and a mean absolute difference between observed and predicted st and ard gamble values of 0.07 . CONCLUSIONS The results provide the first population -based value set for Brazil for SF-6D health states , making it possible to generate quality -adjusted life years for cost-utility studies using regional data . Besides , utility weights derived using the preferences of a sample from a southern Brazilian population can be derived from existing SF-36 data sets Objective To evaluate the psychometric properties of the National Eye Institute Visual Function Question naire-25 ( NEI VFQ-25 ) and Visual Function Question naire Utility Index ( VFQ-UI ) in patients with non-infectious intermediate and posterior uveitis . Methods Secondary analysis of pooled data from a 26-week , multicenter , masked , r and omized , sham-controlled Phase 3 clinical trial . Health-related quality of life was assessed using the NEI VFQ-25 , the EQ-5D , and SF-36 . Internal consistency reliability , reproducibility , convergent validity , and known groups of BCVA and vitreous haze severity were assessed . Clinical ly significant difference was assessed using anchor-based and distribution-based methods . Results The study included 224 subjects with non-infectious intermediate ( 80.4 % ) or posterior uveitis ( 19.6 % ) . The NEI VFQ-25 and the VFQ-UI demonstrated good internal consistency ( Cronbach ’s alpha 0.87–0.94 ) and test – retest reliability ( ICCs 0.58–0.88 ) . Spearman ’s product – moment rank correlations between the NEI VFQ-25  and VFQ-UI scores and the SF-6D , EQ-5D , and BCVA ranged from small to moderate . There was a significant association between visual functioning and known groups of visual acuity ( p < 0.05 ) . Clinical significance , using the anchor-based method ( difference between visual acuity groups ≥10–<15 letter better and no change ) , was 10.2 for change from baseline to week 26 for the NEI VFQ-25 composite score and 0.05 for the VFQ-UI . Using the distribution-based method , the clinical significance was 3.86 for the composite score and 0.04 for the VFQ-UI . Conclusion The NEI VFQ-25 and the VFQ-UI are reliable and valid measures of vision-related functioning and preference-based status in patients with non-infectious intermediate and posterior uveitis OBJECTIVE To estimate the cost utility and cost effectiveness of long-term , high-intensity exercise classes compared with usual care in rheumatoid arthritis ( RA ) patients . METHODS RA patients ( n = 300 ) were r and omly assigned to either exercise classes or UC ; followup lasted for 2 years . Outcome measures were quality -adjusted life years ( QALYs ) according to the EuroQol ( EQ-5D ) , Short Form 6D ( SF-6D ) , and a transformed visual analog scale ( VAS ) rating personal health ; functional ability according to the Health Assessment Question naire ( HAQ ) and McMaster Toronto Arthritis Patient Preference Interview ( MACTAR ) ; and societal costs . RESULTS QALYs in both r and omization groups were similar according to the EQ-5D and SF-6D , but were in favor of usual care according to the VAS ( annual difference 0.037 QALY ; 95 % confidence interval [ 95 % CI ] 0.002 , 0.069 ) . Functional ability was similar according to the HAQ , but in favor of the exercise classes according to the MACTAR ( annual difference 2.9 QALY ; 95 % CI 0.9 , 4.9 ) . Annual medical costs of the exercise program were estimated at 780 per participating patient ( 1 approximately $ 1.05 ) . The increase per patient in total medical costs of physical therapy was estimated at 430 ( 95 % CI 318 , 577 ) , and the increase in total societal costs at 602 ( 95 % CI -490 , 1,664 ) . For societal willingness-to-pay equal to 50,000 per QALY , usual care had better cost utility than exercise classes , and significantly so according to the VAS . CONCLUSION From a societal perspective and without taking possible preventive health effects into account , long-term , high-intensity exercise classes provide insufficient improvement in the valuation of health to justify the additional costs PURPOSE To conduct a psychometric evaluation of the Hospital Anxiety and Depression Scale ( HADS ) and to evaluate associations of 2 measures of psychological distress with the HADS Anxiety ( HADS-A ) and HADS Depression ( HADS-D ) subscales in acute lung injury ( ALI ) survivors . MATERIAL S AND METHODS We used 3-month post-ALI follow-up data from 151 participants in a multisite prospect i ve cohort study to evaluate the internal consistency and structure of the HADS subscales and items , respectively . We used Spearman ρ correlations and other statistics to relate the 3-level version of the  EuroQol-5D ( EQ-5D-3L ) anxiety/depression item and Medical Outcomes Study Short Form-36 ( SF-36 ) " mental health"-related domains to the HADS subscales . RESULTS Internal consistency was good for each of the HADS subscales ( α ≥ .70 ) . Exploratory factor analysis revealed a 2-factor structure ( anxiety and depression ) . The EQ-5D-3L item and the SF-36 mental health-related domain scores were associated with HADS-A ( ρ = 0.54 and -0.48 to -0.70 , respectively ) and HADS-D ( ρ = 0.41 and -0.48 to -0.52 , respectively ) scores ( all P < .01 ) . The relationship between the SF-36 mental health domain score and the HADS-A subscale score was particularly strong ( ρ = -0.70 , P < .01 ) . CONCLUSIONS When evaluated in ALI survivors , the HADS has good internal consistency and a 2-factor structure . The HADS subscales were substantially correlated with the EQ-5D-3L anxiety/depression item and SF-36 mental health-related domain scores , suggesting convergent validity for these measures of psychological distress in ALI survivors Study Design . Cross-sectional analysis of the Cervical Spine Research Society Outcomes Study , a longitudinal multicenter cohort study . Objective . To provide a statistical model for estimating health utility from the Cervical Spine Outcomes Question naire ( CSOQ ) domain scores . Summary of Background Data . There is consensus among health-policy research ers that the results of economic evaluations of health can be reported in quality -adjusted life-years ( QALY ) . The CSOQ is a condition-specific instrument that assesses individuals across several domains , including neck and arm/shoulder pain and psychological distress . Methods . The  CSOQ and 36-Item Short Form Health Survey ( SF-36 )  were prospect ively administered before surgery ( within 4 weeks ) and after surgery ( at 3 , 6 , and 24 months ) to individuals undergoing anterior cervical decompression and fusion for degenerative disc disease of the cervical spine . Using methods reported by Brazier et al , health utility ( SF-6D ) was estimated using the SF-36 . Regression analyses were used on a training data set ( n = 164 ) to compute the SF-6D from the domain scores of the CSOQ . A validation data set ( n = 328 ) was used to estimate the SF-6D for comparison to the calculated health utility from the SF-36 . Results . Domain scores were moderately correlated with health utility ( SF-6D ) ( P < 0.001 ) with correlation coefficients ranging from 0.48 to 0.70 . The regression equation to predict SF-6D on the basis of CSOQ domain scores and patient age using the training data set accounted for 65 % of the variation in health utility . In the validation data set , predicted SF-6D was positively correlated with observed SF-6D ( r = 0.680 , P < 0.001 ) . Conclusion . Our findings show that the CSOQ 's domain scores can be used to estimate health-utility scores among those undergoing elective anterior cervical decompression and fusion for cervical degenerative disc disease . The ability to assess health utility , coupled with the psychometric properties of the CSOQ , should increase the clinical utility of this patient-reported outcomes instrument OBJECTIVES The SF-6D is a preference-based measure of health derived from the SF-36 that can be used for cost-effectiveness analysis using cost-per- quality adjusted life-year analysis . This study seeks to estimate a system weight for the SF-6D for Portugal and to compare the results with the UK system weights . METHODS A sample of 55 health states defined by the SF-6D has been valued by a representative r and om sample of the Portuguese population , stratified by sex and age ( n = 140 ) , using the St and ard Gamble ( SG ) . Several models are estimated at both the individual and aggregate levels for predicting health-state valuations . Models with main effects , with interaction effects and with the constant forced to unity are presented . R and om effects ( RE ) models are estimated using generalized least squares ( GLS ) regressions . Generalized estimation equations ( GEE ) are used to estimate RE models with the constant forced to unity . Estimations at the individual level were performed using 630 health-state valuations . Alternative functional forms are considered to account for the skewed distribution of health-state valuations . RESULTS The models are analyzed in terms of their coefficients , overall fit , and the ability for predicting the SG-values . The RE models estimated using GLS and through GEE produce significant coefficients , which are robust across model specification . However , there are concerns regarding some inconsistent estimates , and so parsimonious consistent models were estimated . There is evidence of under prediction in some states assigned to poor health . The results are consistent with the UK results . CONCLUSION The models estimated provide preference-based quality of life weights for the Portuguese population when health status data have been collected using the SF-36 . Although the sample was r and omly drowned findings should be treated with caution , given the small sample size , even knowing that they have been estimated at the individual level Objectives : To evaluate the responsiveness of the EuroQol ( EQ-5D ) and Short-Form 36 ( SF-36 ) instruments , i.e. their ability to capture clinical ly important changes , in elderly patients with a displaced femoral neck fracture . The study was part of a prospect i ve r and omised study comparing two different surgical procedures , internal fixation ( IF ) and total hip replacement ( THP ) . Setting : University hospital . Patients : A total of 110 patients , mean age 80 years with an acute displaced femoral neck fracture ( Garden III and IV ) . The inclusion criteria were age ≥70 , absence of severe cognitive dysfunction , independent living status and independent walking capability . Intervention : The patients were r and omised to IF or to a THR . Main outcome measurements : Health-related quality of life according to EQ-5D and SF-36 . Responsiveness measured by the ability of the EQ-5D and the SF-36 to detect clinical ly relevant differences in the study population according to an external criterion ( EC ) for outcome ( good or less good clinical outcome ) . Responsiveness was measured in terms of change scores , st and ardised effect size ( SES ) and st and ardised response mean ( SRM ) . Results : The rated prefracture EQ-5Dindex scores and SF-36 scores showed good correspondence with the scores of age-matched Swedish reference population s. The relationship between the EC and EQ-5Dindex score and the SF-36 global score showed significant differences in both comparisons ( p < 0.001 ) . The responsiveness expressed with the SES and SRM were large for both the EQ-5D ( 1.37 and 0.90 , respectively ) and for the SF-36 global score ( 0.89 and 0.82 , respectively ) . The correlation between the change scores for the SF-36 global score and the EQ-5D was 0.39 ( p < 0.001 ) . Conclusion : The results showed high responsiveness for both the EQ-5D and the SF-36 , indicating that both instruments are suitable for use as outcome measures in clinical trials in elderly hip fracture patients OBJECTIVES To test whether patients with persistent non-specific low back pain , when offered access to traditional acupuncture care alongside conventional primary care , gained more long-term relief from pain than those offered conventional care only , for equal or less cost . Safety and acceptability of acupuncture care to patients , and the heterogeneity of outcomes were also tested . DESIGN A pragmatic , two parallel group , r and omised controlled trial . Patients in the experimental arm were offered the option of referral to the acupuncture service comprising six acupuncturists . The control group received usual care from their general practitioner ( GP ) . Eligible patients were r and omised in a ratio of 2:1 to the offer of  acupuncture to allow between-acupuncturist effects to be tested . SETTING Three non-NHS acupuncture clinics , with referrals from 39 GPs working in 16 practice s in York , UK . PARTICIPANTS Patients aged 18 - 65 years with non-specific low back pain of 4 - 52 weeks ' duration , assessed as suitable for primary care management by their general practitioner . INTERVENTIONS The trial protocol allowed up to ten individualised acupuncture treatments per patient . The acupuncturist determined the content and the number of treatments according to patient need . MAIN OUTCOME MEASURES The Short Form 36 ( SF-36 ) Bodily Pain dimension ( range 0 - 100 points ) , assessed at baseline , and 3 , 12 and 24 months . The study was powered to detect a 10-point difference between groups at 12 months post-r and omisation . Cost -- utility analysis was conducted at 24 months using the EuroQoL 5 Dimensions ( EQ-5D ) and a preference-based single index measure derived from the SF-36 ( SF-6D ) . Secondary outcomes included the McGill Present Pain Index ( PPI ) , Oswestry Pain Disability Index ( ODI ) , all other SF-36 dimensions , medication use , pain-free months in the past year , worry about back pain , satisfaction with care received , and safety and acceptability of acupuncture care . RESULTS A total of 159 patients were in the ' acupuncture offer ' arm and 80 in the ' usual care ' arm . All 159 patients r and omised to the offer of acupuncture care chose to receive acupuncture treatment , and received an average of eight acupuncture treatments within the trial . Analysis of covariance , adjusting for baseline score , found an intervention effect of 5.6 points on the SF-36 Pain dimension [ 95 % confidence interval ( CI ) -1.3 to 12.5 ] in favour of the acupuncture group at 12 months , and 8 points ( 95 % CI 0.7 to 15.3 ) at 24 months . No evidence of heterogeneity of effect was found for the different acupuncturists . Patients receiving acupuncture care did not report any serious or life-threatening events . No significant treatment effect was found for any of the SF-36 dimensions other than Pain , or for the PPI or the ODI . Patients receiving  acupuncture care reported a significantly greater reduction in worry about their back pain at 12 and 24 months compared with the usual care group . At 24 months , the acupuncture care group was significantly more likely to report 12 months pain free and less likely to report the use of medication for pain relief . The acupuncture service was found to be cost-effective at 24 months ; the estimated cost per quality -adjusted ( QALY ) was 4241 pounds sterling ( 95 % CI 191 pounds sterling to 28,026 pounds sterling ) using the SF-6D scoring algorithm based on responses to the SF-36 , and 3598 pounds sterling ( 95 % CI 189 pounds sterling to 22,035 pounds sterling ) using the EQ-5D health status instrument . The NHS costs were greater in the acupuncture care group than in the usual care group . However , the additional re source use was less than the costs of the acupuncture treatment itself , suggesting that some usual care re source use was offset . CONCLUSIONS Traditional acupuncture care delivered in a primary care setting was safe and acceptable to patients with non-specific low back pain . Acupuncture care and usual care were both associated with clinical ly significant improvement at 12- and 24-month follow-up . Acupuncture care was significantly more effective in reducing bodily pain than usual care at 24-month follow-up . No benefits relating to function or disability were identified . GP referral to a service providing traditional acupuncture care offers a cost-effective intervention for reducing low back pain over a 2-year period . Further research is needed to examine many aspects of this treatment including its impact compared with other possible short-term packages of care ( such as massage , chiropractic or physiotherapy ) , various aspects of cost-effectiveness , value to patients and implementation protocol We report on a prospect i ve multicenter study to assess pretransplantation and posttransplantation health-related quality of life ( HRQL ) of liver transplant recipients .  HRQL was assessed at several timepoints using a self-completion question naire consisting of the EuroQol instrument ( EQ-5D ) and the 36-Item Short-Form Health Survey ( SF-36 ) health status profile measure . All individuals selected to receive treatment as part of the UK NHS liver transplantation program at each of six liver transplantation centers in Engl and and Wales during a 2-year period ( n = 542 ) were eligible to be included on the study . An overall response rate of 84 % ( 455 responses ) was achieved . A paired comparison of HRQL at listing and 3 months posttransplantation showed statistically significant improvements ( P < .05 ) in all dimensions of the SF-36 ( with the exception of Bodily Pain [ P = .686 ] ) and the EQ-5D tariff and visual analogue scale ( VAS ) scores . An analysis of posttransplantation HRQL over time for patients who survived until the end of the study ( 24 months posttransplantation ) showed a statistically significant improvement ( P < .05 ) for all dimensions of the SF-36 ( apart from Mental Health [ P = .245 ] and Role-Emotional dimensions [ P = .265 ] ) and the EQ-5D VAS and tariff scores . Adjusting for patients who died posttransplantation reduced mean EQ-5D tariff scores substantially , and the change over time in EQ-5D tariff scores was no longer statistically significant ( P = .55 ) . Results of regression analysis conducted to assess the importance of patient characteristics and center size on EQ-5D tariff and VAS scores generated posttransplantation indicated there was variation in scores according to patient age and center size Objective To estimate the effect of change in weight and change in urinary incontinence ( UI ) frequency on changes in preference-based measures of health-related quality of life ( HRQL ) among overweight and obese women with UI participating in a weight loss trial . Methods We conducted a longitudinal cohort analysis of 338 overweight and obese women with UI enrolled in a r and omized clinical trial comparing a behavioral weight loss intervention to an educational control condition . At baseline , 6 , and 18 months , health utilities were estimated using the Health Utilities Index Mark 3 ( HUI3 ) , a transformation of the SF-36 to the preference-based SF-6D , and the estimated Quality of Well-Being ( eQWB ) score ( a summary calculated from the SF-36 physical functioning , mental health , bodily pain , general health perceptions , and role limitations –physical subscale scores ) . Potential predictors of changes in these outcomes were examined using generalized estimating equations . Results In adjusted multivariable models , weight loss was associated with improvement in HUI3 , SF-6D , and eQWB at 6 and 18 months ( P < 0.05 ) . Increases in physical activity also were independently associated with improvement in HUI3 ( P = 0.01 ) and SF-6D ( P = 0.006 ) scores at 18 months . In contrast , reduction in UI frequency did not predict improvements in HRQL at 6 or 18 months . Conclusion Weight loss and increased physical activity , but not reduction in UI frequency , were strongly associated with improvements in health utilities measured by the HUI3 , SF-6D , and eQWB . These findings provide important information that can be used to inform cost – utility analyses of weight loss interventions BACKGROUND CONTEXT There is a growing dem and to measure the real-world effectiveness and value of care across all specialties and disease states . Prospect i ve registries have emerged as a feasible way to capture real-world care across large patient population s. However , the proven validity of more robust and cumbersome patient-reported outcome instruments ( PROi ) must be balanced with what is feasible to apply in large-scale registry efforts . Hence , commercial registry efforts that measure quality and effectiveness of care in an attempt to guide quality improvement , pay for performance , or value-based purchasing should incorporate measures that most accurately represent patient-centered improvement . PURPOSE We set out to establish the relative validity and responsiveness of common PROi in accurately determining effectiveness of cervical surgery for neck and arm pain in registry efforts . STUDY DESIGN Prospect i ve cohort study . PATIENT SAMPLE Eighty-eight patients undergoing primary anterior cervical discectomy and fusion ( ACDF ) for neck and arm pain . OUTCOME MEASURES Patient-reported outcome measures for pain ( numeric rating scale for neck pain [ NRS-NP ] and arm pain [ NRS-AP ] ) , disability ( neck disability index [ NDI ] ) , general health ( short-form 12-item survey physical component summary [ SF-12 PCS ] and mental component summary [ SF-12 MCS ] ) , and quality of life ( Euro-Qol-5D [ EQ-5D ] ) were assessed . METHODS Eighty-eight patients undergoing primary ACDF for neck and arm pain were entered into a Web-based prospect i ve registry . Baseline and 12-month patient-reported outcomes ( NRS-NP , NRS-AP , NDI , SF-12 PCS , SF-12 MCS , and EQ-5D ) were assessed . Patients were also asked whether they experienced a level of improvement after ACDF that met their expectation ( meaningful improvement ) . To assess the validity of NRS-NP , NRS-AP , and NDI ( measures of pain and disability ) to discriminate between meaningful and nonmeaningful improvement and the validity of SF-12 PCS , SF-12 MCS , and EQ-5D ( measures of general health and quality of life ) to discriminate between meaningful and nonmeaningful improvement , receiver-operating characteristic curves were generated for each outcome instrument . The greater the area under the curve ( AUC ) , the more valid the discriminator . The difference between st and ardized response means ( SRMs ) in patients reporting meaningful improvement versus not was calculated to determine the relative responsiveness of each outcome instrument to changes in  pain and QOL after surgery . RESULTS For pain and disability , both NDI ( AUC=0.75 ) and NRS-AP ( AUC=0.74 ) were valid discriminators of meaningful improvement . Numeric rating scale for neck pain ( AUC=0.69 ) was a poor discriminator . Neck disability index was also most responsive to postoperative improvement ( SRM difference 0.78 ) , followed by NRS-AP ( SRM difference 0.59 ) and NRS-NP ( SRM difference 0.46 ) . For general health and quality of life , SF-12 PCS ( AUC=0.79 ) was the only valid discriminator of meaningful improvement . Euro-Qol-5D ( AUC=0.68 ) and SF-12 MCS ( AUC=0.44 ) were poor discriminators . Short-form 12 physical component summary ( SRM difference 1.08 ) was also most responsive compared with EQ-5D ( SRM difference 0.89 ) and SF-12 MCS ( SRM difference 0.01 ) . CONCLUSIONS For pain and disability , NDI is the most valid and responsive measure of improvement after surgery for neck and arm pain . Numeric rating scale for neck pain and NRS-AP are poor substitutes for NDI when measuring effectiveness of care in registry efforts . For health-related quality of life , only SF-12 PCS could accurately discriminate meaningful improvement after cervical surgery and was found to be most valid and responsive . Large-scale registry efforts aim ed at measuring effectiveness of cervical spine surgery should use NDI and SF-12 to accurately assess improvements in pain , disability , and quality of life Background The aim of this study was to evaluate the impact of gender on health-related quality of life ( HRQOL ) in patients with chronic sinusitis Methods A prospect ively administered survey was performed . For measuring HRQOL , we used the German versions of the Short Form 36 ( SF-36 ; eight subscales ) and the  European Quality of Life—5 Dimensions ( EQ-5D ) ( two subscales ) . For all SF-36 subscales we used norm-based scoring of the general German population . Results One hundred twenty-three patients ( 45 women and 78 men ) underwent  HRQOL evaluation  at baseline ( preoperatively ) and 3 months after endonasal sinus surgery .  Compared with male patients , female patients scored a significantly worse baseline in all SF-36 and one EQ-5D subscales and 3 months later in only one SF-36 subscale . Compared with the norm-based scores , both women 's and men 's SF-36 scores reached normal levels in seven subscales after 3 months . Conclusion Compared with men , women assessed preoperative HRQOL as being worse . Most women 's and men 's SF-36 subscales reached normal levels at the 3-month follow-up OBJECTIVES To assess the impact of a bone-anchored hearing aid ( BAHA )  on the  quality of life ( QOL ) of adults and to test the hypothesis that a BAHA improves QOL because otorrhea and /or skin irritations decrease . DESIGN Prospect i ve postal-based question naire study using vali date d health-related QOL instruments , combined with hearing-aid-related questions . PATIENTS AND METHODS The study included 56 consecutive adult patients with acquired conductive or mixed hearing loss who were scheduled for BAHA implantation at the University Medical Centre Nijmegen , Nijmegen , the Netherl and s. All 56 patients completed the 36-Item Short-Form  Health  Survey  ( SF-36 ) , the EuroQol-5D ( EQ-5D ) , and the Hearing H and icap and Disability Inventory ( HHDI ) ; 36 patients had been using an air-conduction hearing aid ( ACHA ) and 20 patients a conventional bone-conduction hearing aid ( CBHA ) .  Question naires were filled out before surgery and after 6 months of experience with the BAHA . RESULTS In the SF-36 group , there was significant improvement in the scores of the mental health domain ( P = .02 ) . When the SF-36 patients were classified according to previous hearing aid , there was no statistically significant change in the scores in any of the domains . In the EQ-5D group and in its ACHA and CBHA subgroups , there were no important differences in the results before and after the patients received their BAHAs . In the HHDI group , the h and icap and disability scales showed significant improvement ( P<.01 ) irrespective of the type of previously worn hearing aid . CONCLUSIONS Overall , generic health-related QOL was not influenced significantly by the use of a BAHA according to the SF-36 and the EQ-5D . The more disease-specific scales ( HHDI ) did show improved QOL with a BAHA Purpose Economic evaluation of health services commonly requires information regarding health-state utilities . Sometimes this information is not available but non-utility measures of quality of life may have been collected from which the required utilities can be estimated . This paper examines the possibility of mapping a non-utility-based outcome , the Sydney Asthma Quality of Life Question naire ( AQLQ-S ) , onto five multi-attribute utility instruments :  Assessment of Quality of Life 8 Dimensions ( AQoL-8D ) ,  EuroQoL 5 Dimensions 5-Level ( EQ-5D-5L ) , Health Utilities Index Mark 3 ( HUI3 ) , 15 Dimensions ( 15D ) , and the Short-Form 6 Dimensions ( SF-6D ) . Methods Data for 856 individuals with asthma were obtained from a large Multi-Instrument Comparison ( MIC ) survey . Four statistical techniques were employed to estimate utilities from the AQLQ-S. The predictive accuracy of 180 regression models was assessed using six criteria : mean absolute error ( MAE ) , root mean squared error ( RMSE ) , correlation , distribution of predicted utilities , distribution of residuals , and proportion of predictions with absolute errors < 0.0.5 . Validation of initial ‘ primary ’ models was carried out on a r and om sample of the MIC data . Results Best results were obtained with non-linear models that included a quadratic term for the AQLQ-S score along with demographic variables . The four statistical techniques predicted models that performed differently when assessed by the six criteria ; however , the best results , for both the estimation and validation sample s , were obtained using a generalised linear model ( GLM estimator ) . Conclusions It is possible to predict valid utilities from the AQLQ-S using regression methods . We recommend GLM models for this exercise The objective of this study was to determine the impact of pressure ulceration on health-related quality of life ( HRQoL ) and to undertake a pilot study for a future larger study . The study comprised two parts . First , data from a large UK prospect i ve cohort study were analyzed and the HRQoL of 218 people with pressure ulcers was compared with that of 2,289 people without ulcers using the Short Form-36 ( SF-36 ) question naire . After adjusting for age , sex , and comorbidities , patients with pressure ulceration had significantly lower scores for both the physical ( coefficient=-3.12 , p<0.001 ) and mental ( coefficient=-1.50 , p=0.04 ) component summary scores of the SF-36 . Second , a small pilot study was conducted to explore use of other tools . HRQoL was assessed in six patients with and 16 patients without pressure ulcers using the SF-36 , the EQ-5D and a pain visual analog scale . SF-36 scores indicated that patients with pressure ulcers had significantly poorer physical functioning ( d=22.3 , p=0.001 ) , role limitations due to physical problems ( d=12.9 , p=0.02 ) , and vitality ( d=20.6 , p=0.04 ) than those without . EQ-5D scores were also poorer for patients with pressure ulceration , for both the visual analog scale ( d=19.2 , p=0.02 ) and the index ( d=0.29 , p=0.08 ) . Patients with pressure ulceration had more perceived pain than those without ; however , this difference was of borderline significance ( d=-23.9 , p=0.06 ) . Pressure ulceration therefore has an impact on HRQoL that is measurable and persists after adjusting for potential confounding Purpose The chronic liver disease question naire ( CLDQ ) is a frequently used liver-specific quality of life instrument , but it does not provide information on preference-adjusted health status , which is essential for cost-utility analysis . We aim ed to develop a mapping function deriving utilities from the CLDQ in primary sclerosing cholangitis ( PSC ) . Methods  Short form-6D ( SF-6D ) utilities  were calculated from SF-36 data collected in a recent prospect i ve study in which unselected patients with PSC also completed the CLDQ . Ordinary least squares ( OLS ) , generalized linear , median , and kernel regression analyses were employed to devise a mapping function predicting utilities . This was vali date d in three r and om sub sample s of the cohort and in a separate sample of PSC patients following liver transplantation .  Adjusted R2 and root-mean-square error ( RMSE ) as well as Pearson ’s r coefficients and mean absolute errors between predicted and observed values were used to determine model performance . Results Decompensated liver disease and fatigue , systemic symptoms , and emotional distress , assessed with the CLDQ , were related to worse SF-6D utilities . The final OLS prediction model explained 66.3 % of the variance in the derivation sample . Predicted and observed utilities were strongly correlated ( r = 0.807 , p < 0.001 ) , but the mean absolute error ( 0.0604 ) and adjusted RMSE ( 10.6 % ) were of intermediate size . Similar model characteristics were observed after employment of generalized linear and median regression models and at validation . Conclusions A model has been constructed , showing good validity predicting SF-6D utilities from CLDQ scores at the group level in PSC . Further testing is required to externally vali date the model Background : Psoriasis substantially impairs the health‐related quality of life ( HRQOL ) of patients , and a comprehensive evaluation of treatment includes HRQOL measures . Objective : To assess the impact of adalimumab on patient‐reported outcomes ( PROs ) of patients with moderate to severe psoriasis . Methods : In a Phase II , r and omized , controlled trial , the efficacy and safety of two dosages of adalimumab ( 40 mg weekly or every other week ) versus placebo were assessed for 12 weeks in the treatment of moderate to severe plaque psoriasis . Patients completed the Dermatology Life Quality Index ( DLQI ) , Short‐Form 36 ( SF‐36 ) Health Survey , and EuroQOL‐5D ( EQ‐5D ) at baseline and 12 weeks . The primary endpoint was the percentage of patients achieving a ⩾75 % reduction in the Psoriasis Area and Severity Index score ( PASI 75 ) . Investigators assessed PASI and Physician 's Global Assessment ( PGA ) scores . Results : Adalimumab patients ( either dosage ) displayed significantly greater improvements versus placebo patients in DLQI , EQ‐5D , and SF‐36 Mental Component Summary scores , as well as in Bodily Pain , Vitality , Social Functioning , Role – Emotional , and Mental Health domains . The adalimumab 40‐mg weekly group also reported significantly greater improvements in SF‐36 Physical Component Summary scores versus the placebo group . Conclusion : Both adalimumab dosages were efficacious in improving dermatology‐specific and general PROs in patients with moderate to severe psoriasis OBJECT Treatment effectiveness following spine surgery is usually gauged with the help of patient-reported outcome ( PRO ) question naires . Although these question naires assess pain , disability , and general health state , their numerical scores lack direct , clinical ly significant meaning . Thus , the concept of minimum clinical ly important difference ( MCID ) has been introduced , which indicates the smallest change in an outcome measure that reflects clinical ly meaningful improvement to patients . The authors set out to determine anterior cervical discectomy and fusion (ACDF)-specific MCID values for the visual analog scale ( VAS ) , Neck Disability Index ( NDI ) , 12-Item Short-Form Health Survey ( SF-12 ) , and EQ-5D ( the EuroQol health survey ) in patients undergoing ACDF for cervical radiculopathy . METHODS Data on 69 patients who underwent ACDF for cervical radiculopathy were collected in the authors ' web-based , prospect i ve registry during the study enrollment period . Patient-reported outcome question naires ( VAS-neck pain [ NP ] ) , VAS-arm pain [ AP ] , NDI , SF-12 , and EQ-5D ) were administered preoperatively and 3 months postoperatively , allowing 3-month change scores to be calculated . Four established calculation methods were used to calculate anchor-based MCID values using the North American Spine Society ( NASS ) patient satisfaction scale as the anchor : 1 ) average change , 2 ) minimum detectable change ( MDC ) , 3 ) change difference , and 4 ) receiver operating characteristic ( ROC ) curve analysis . RESULTS Sixty-one patients ( 88 % ) were available at follow-up . At 3 months postoperatively , statistically significant improvement ( p < 0.001 ) was observed for the following PROs assessed : VAS-NP ( 2.7 ± 3.3 ) , VAS-AP ( 3.7 ± 3.6 ) , NDI ( 23.2 % ± 19.7 % ) , SF-12 physical component score ( PCS ; 10.7 ± 9.7 ) , and EQ-5D ( 0.20 ± 0.23 QALY ) . Improvement on the SF-12 mental component score ( MCS ) trended toward significance ( 3.4 ± 11.4 , p = 0.07 ) . The 4 MCID calculation methods generated a range of MCID values for each of the PROs : VAS-NP 2.6 - 4.0 , VAS-AP 2.4 - 4.2 , NDI 16.0%-27.6 % , SF-12 PCS 7.0 - 12.2 , SF-12 MCS 0.0 - 7.2 , and EQ-5D 0.05 - 0.24 QALY . The maximum area under the curve ( AUC ) was observed for NDI ( 0.80 ) , and the minimum AUC was observed for SF-12 MCS ( 0.66 ) and EQ-5D ( 0.67 ) . Based on the MDC approach , the MCID threshold was 2.6 points for VAS-NP , 4.1 points for VAS-AP , 17.3 % for NDI , 8.1 points for SF-12 PCS , 4.7 points for SF-12 MCS , and 0.24 QALY for EQ-5D . The mean improvement in patient scores at 3 months surpassed the MCID threshold for VAS-NP , NDI , and SF-12 PCS but not for VAS-AP , SF-12 MCS , and EQ-5D . CONCLUSIONS The ACDF-specific MCID is highly variable depending on the calculation technique used . The MDC approach seems to be most appropriate for MCID calculations in the ACDF population , as it provided a threshold value above the 95 % confidence interval of nonresponders ( greater than the measurement error ) and was closest to the average change of most PROs reported by responders . When the MDC method was applied with the NASS patient satisfaction scale as the anchor , the MCID thresholds were 2.6 points for VAS-NP , 4.1 points for VAS-AP , 17.3 % for NDI , 8.1 points for SF-12 PCS , 4.7 points for SF-12 MCS , and 0.24 QALY for EQ-5D BACKGROUND The SF-6D is a new health state classification and utility scoring system based on 6 dimensions ( ' 6D ' ) of the Short Form 36 , and permits a " bridging " transformation between SF-36 responses and utilities . The Health Utilities Index , mark 3 ( HUI3 ) is a valid and reliable multi-attribute health utility scale that is widely used . We assessed within-subject agreement between SF-6D utilities and those from HUI3 . METHODS Patients at increased risk of sudden cardiac death and participating in a r and omized trial of implantable defibrillator therapy completed both instruments at baseline . Score distributions were inspected by scatterplot and histogram and mean score differences compared by paired t-test . Pearson correlation was computed between instrument scores and also between dimension scores within instruments . Between-instrument agreement was by intra-class correlation coefficient ( ICC ) . RESULTS SF-6D and HUI3 forms were available from 246 patients .  Mean scores for HUI3 and SF-6D were 0.61 ( 95 % CI 0.60 - 0.63 ) and 0.58 ( 95 % CI 0.54 - 0.62 ) respectively ; a difference of 0.03 ( p<0.03 ) . Score intervals for HUI3 and SF-6D were ( -0.21 to 1.0 ) and ( 0.30 - 0.95 ) . Correlation between the instrument scores was 0.58 ( 95 % CI 0.48 - 0.68 ) and agreement by ICC was 0.42 ( 95 % CI 0.31 - 0.52 ) . Correlations between dimensions of SF-6D were higher than for HUI3 . CONCLUSIONS Our study casts doubt on the whether utilities and QALYs estimated via SF-6D are comparable with those from HUI3 . Utility differences may be due to differences in underlying concepts of health being measured , or different measurement approaches , or both . No gold st and ard exists for utility measurement and the SF-6D is a valuable addition that permits SF-36 data to be transformed into utilities to estimate QALYs . The challenge is developing a better underst and ing as to why these classification-based utility instruments differ so markedly in their distributions and point estimates of derived utilities
The EQ-5D and SF-36 achieved mixed results in the quantitative testing against psychometric criteria .
The qualitative analysis suggests this is because they provide a very limited coverage of themes identified by people with mental health problems .
BACKGROUND Generic preference-based measures of health like the EQ-5D and SF-6D ( ® ) are increasingly being used in economic evaluation and outcome assessment .
However , there are concerns as to whether or not these generic measures are appropriate for use in people with mental health problems .
OBJECTIVES The EQ-5D and SF-36 ( ® ) ( including its derivatives the SF-12 ( ® ) and SF-6D ) were assessed using the psychometric criteria of validity and responsiveness using quantitative and qualitative methods .
Another aim was to estimate mapping functions between the EQ-5D and SF-6D and condition-specific measures , where appropriate .