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      Measuring Health Spillover Effects in Caregivers of Children with Autism Spectrum Disorder: A Comparison of the EQ-5D-3L and SF-6D

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          Abstract

          Background and Objective

          Healthcare interventions that improve the health of children with autism spectrum disorder (ASD) have the potential to affect the health of caregivers. This study compares the three-level EuroQoL-5 Dimension (EQ-5D-3L) and the Short Form-6 Dimension (SF-6D) in their ability to value such spillover effects in caregivers.

          Methods

          Clinical data collected from two Autism Treatment Network (ATN) sites was combined with survey data of caregivers of children diagnosed with ASD. Caregivers completed instruments by proxy describing child health and completed the EQ-5D-3L and SF-6D preference-weighted instruments to describe their own health.

          Results

          There was a strong correlation between the health utility scores of the two preference-weighted instruments ( ρ = 0.6172, p < 0.001) measuring caregiver health-related quality of life. There was a similar correlation between both the SF-6D and EQ-5D-3L scores with a previously validated care-related quality of life measure (Care-related Quality of Life instrument [CarerQol-7D]) ( ρ = 0.569, p < 0.001 and ρ = 0.541, p < 0.001, respectively). The mean SF-6D scores for caregivers differed significantly in relation to four of the five child health or behavior measures whereas the EQ-5D-3L differed for only two of them.

          Conclusions

          Health utility values of caregivers for children with ASD vary by the health characteristics of the child, suggesting significant potential for spillover effects. The comparison of the EQ-5D-3L and SF-6D demonstrated that both instruments can be used to estimate spillover effects of interventions to improve child health, but the SF-6D exhibited greater sensitivity to child health among children with ASD.

          Electronic supplementary material

          The online version of this article (10.1007/s40273-019-00789-2) contains supplementary material, which is available to authorized users.

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          Most cited references38

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          EuroQol: the current state of play.

          R. Brooks (1996)
          The EuroQol Group first met in 1987 to test the feasibility of jointly developing a standardised non-disease-specific instrument for describing and valuing health-related quality of life. From the outset the Group has been multi-country, multi-centre, and multi-disciplinary. The EuroQol instrument is intended to complement other forms of quality of life measures, and it has been purposefully developed to generate a cardinal index of health, thus giving it considerable potential for use in economic evaluation. Considerable effort has been invested by the Group in the development and valuation aspects of health status measurement. Earlier work was reported upon in 1990; this paper is a second 'corporate' effort detailing subsequent developments. The concepts underlying the EuroQol framework are explored with particular reference to the generic nature of the instrument. The valuation task is reviewed and some evidence on the methodological requirements for measurement is presented. A number of special issues of considerable interest and concern to the Group are discussed: the modelling of data, the duration of health states and the problems surrounding the state 'dead'. An outline of some of the applications of the EuroQol instrument is presented and a brief commentary on the Group's ongoing programme of work concludes the paper.
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            Measurement in Medicine: The Analysis of Method Comparison Studies

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              The estimation of a preference-based measure of health from the SF-12.

              The SF-12 is a multidimensional generic measure of health-related quality of life. It has become widely used in clinical trials and routine outcome assessment because of its brevity and psychometric performance, but it cannot be used in economic evaluation in its current form. We sought to derive a preference-based measure of health from the SF-12 for use in economic evaluation and to compare it with the original SF-36 preference-based index. The SF-12 was revised into a 6-dimensional health state classification (SF-6D [SF-12]) based on an item selection process designed to ensure the minimum loss of descriptive information. A sample of 241 states defined by the SF-6D (of 7500) have been valued by a representative sample of 611 members of the UK general population using the standard gamble (SG) technique. Models are estimated of the relationship between the SF-6D (SF-12) and SG values and evaluated in terms of their coefficients, overall fit, and the ability to predict SG values for all health states. The models have produced significant coefficients for levels of the SF-6D (SF-12), which are robust across model specification. The coefficients are similar to those of the SF-36 version and achieve similar levels of fit. There are concerns with some inconsistent estimates and these have been merged to produce the final recommended model. As for the SF-36 model, there is evidence of over prediction of the value of the poorest health states. The SF-12 index provides a useful tool for researchers and policy makers wishing to assess the cost-effectiveness of interventions.
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                Author and article information

                Contributors
                501-526-6642 , tilfordmickj@uams.edu
                Journal
                Pharmacoeconomics
                Pharmacoeconomics
                Pharmacoeconomics
                Springer International Publishing (Cham )
                1170-7690
                1179-2027
                13 March 2019
                13 March 2019
                2019
                : 37
                : 4
                : 609-620
                Affiliations
                [1 ]ISNI 0000 0004 4687 1637, GRID grid.241054.6, Department of Health Policy and Management, , University of Arkansas for Medical Sciences, ; 4301 W. Markham, Slot 820, Little Rock, AR 72205 USA
                [2 ]ISNI 0000 0004 4687 1637, GRID grid.241054.6, Division of Pharmaceutical Evaluation and Policy, , University of Arkansas for Medical Sciences, ; Little Rock, AR USA
                [3 ]ISNI 0000 0004 4687 1637, GRID grid.241054.6, Department of Biostatistics, , University of Arkansas for Medical Sciences, ; Little Rock, AR USA
                [4 ]ISNI 000000041936754X, GRID grid.38142.3c, Department of Pediatrics, , Harvard Medical School, ; Boston, MA USA
                [5 ]ISNI 0000 0004 0386 9924, GRID grid.32224.35, Center for Adolescent Health Policy, , Massachusetts General Hospital, ; Boston, MA USA
                [6 ]ISNI 0000 0004 4687 1637, GRID grid.241054.6, Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System and Psychiatric Research Institute, University of Arkansas for Medical Sciences, ; Little Rock, AR USA
                [7 ]ISNI 0000000092621349, GRID grid.6906.9, Erasmus School of Health Policy and Management, , Erasmus University, ; Rotterdam, The Netherlands
                Article
                789
                10.1007/s40273-019-00789-2
                6469595
                30864066
                014f63c3-bf6b-4c35-859d-328e98d68575
                © The Author(s) 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000025, National Institute of Mental Health;
                Award ID: R01MH089466
                Award ID: R01MH089466
                Award ID: R03MH102495
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100000102, Health Resources and Services Administration;
                Award ID: UA3MC11054
                Award Recipient :
                Categories
                Original Research Article
                Custom metadata
                © Springer Nature Switzerland AG 2019

                Economics of health & social care
                Economics of health & social care

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