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      Validating the Transformation of PROMIS-GH to EQ-5D in Adult Spine Patients

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          Abstract

          Spinal disorders and associated interventions are costly in the United States, putting them in the limelight of economic analyses. The Patient-Reported Outcomes Measurement Information System Global Health Survey (PROMIS-GHS) requires mapping to other surveys for economic investigation. Previous studies have proposed transformations of PROMIS-GHS to EuroQol 5-Dimension (EQ-5D) health index scores. These models require validation in adult spine patients. In our study, PROMIS-GHS and EQ-5D were randomly administered to 121 adult spine patients. The actual health index scores were calculated from the EQ-5D instrument and estimated scores were calculated from the PROMIS-GHS responses with six models. Goodness-of-fit for each model was determined using the coefficient of determination ( R 2), mean squared error (MSE), and mean absolute error (MAE). Among the models, the model treating the eight PROMIS-GHS items as categorical variables (CAT Reg) was the optimal model with the highest R 2 (0.59) and lowest MSE (0.02) and MAE (0.11) in our spine sample population. Subgroup analysis showed good predictions of the mean EQ-5D by gender, age groups, education levels, etc. The transformation from PROMIS-GHS to EQ-5D had a high accuracy of mean estimate on a group level, but not at the individual level.

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          Most cited references20

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          US valuation of the EQ-5D health states: development and testing of the D1 valuation model.

          The EQ-5D is a brief, multiattribute, preference-based health status measure. This article describes the development of a statistical model for generating US population-based EQ-5D preference weights. A multistage probability sample was selected from the US adult civilian noninstitutional population. Respondents valued 13 of 243 EQ-5D health states using the time trade-off (TTO) method. Data for 12 states were used in econometric modeling. The TTO valuations were linearly transformed to lie on the interval [-1, 1]. Methods were investigated to account for interaction effects caused by having problems in multiple EQ-5D dimensions. Several alternative model specifications (eg, pooled least squares, random effects) also were considered. A modified split-sample approach was used to evaluate the predictive accuracy of the models. All statistical analyses took into account the clustering and disproportionate selection probabilities inherent in our sampling design. Our D1 model for the EQ-5D included ordinal terms to capture the effect of departures from perfect health as well as interaction effects. A random effects specification of the D1 model yielded a good fit for the observed TTO data, with an overall R of 0.38, a mean absolute error of 0.025, and 7 prediction errors exceeding 0.05 in absolute magnitude. The D1 model best predicts the values for observed health states. The resulting preference weight estimates represent a significant enhancement of the EQ-5D's utility for health status assessment and economic analysis in the US.
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            A review of studies mapping (or cross walking) non-preference based measures of health to generic preference-based measures.

            Clinical studies use a wide variety of health status measures to measure health related quality of life, many of which cannot be used in cost-effectiveness analysis using cost per quality adjusted life year (QALY). Mapping is one solution that is gaining popularity as it enables health state utility values to be predicted for use in cost per QALY analysis when no preference-based measure has been included in the study. This paper presents a systematic review of current practice in mapping between non-preference based measures and generic preference-based measures, addressing feasibility and validity, circumstances under which it should be considered and lessons for future mapping studies. This review found 30 studies reporting 119 different models. Performance of the mappings functions in terms of goodness-of-fit and prediction was variable and unable to be generalised across instruments. Where generic measures are not regarded as appropriate for a condition, mapping does not solve this problem. Most testing in the literature occurs at the individual level yet the main purpose of these functions is to predict mean values for subgroups of patients, hence more testing is required.
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              Using instrument-defined health state transitions to estimate minimally important differences for four preference-based health-related quality of life instruments.

              To estimate minimally important differences (MIDs) for the EQ-5D, Health Utilities Index Mark II (HUI2), HUI3, and SF-6D health index scores using health-state transitions defined by each instrument's multiattribute health classification (MAHC) system. We assume that changes in preference scores associated with the smallest health transitions defined by an MAHC system are minimally important. Any transitions between 2 health states defined by an MAHC system which differ in only one health dimension or attribute and by only one functional level are considered "smallest health transitions." Thus, each such health transition provides 1 MID estimate. The MID for each of the 4 instruments was estimated using all the hypothetical smallest health transitions defined by its MAHC system. Based on our definitions, the total number of smallest health transitions was 405 for the EQ-5D, 127,600 for the HUI2, 6,382,800 for the HUI3, and 86,700 for the SF-6D. The mean (standard deviation) MID estimate was 0.040 (0.026) for the EQ-5D (US algorithm), 0.082 (0.032) for the EQ-5D (UK algorithm), 0.045 (0.039) for the HUI2, 0.032 (0.027) for the HUI3, and 0.027 (0.028) for the SF-6D. The effect sizes of these MID estimates ranged from 0.11 to 0.37. These MID estimates are quite comparable to published values estimated from empirical data using anchor-based methods. It is possible to use health transitions defined by the MAHC system to estimate the MIDs for preference-based health index scores. This study provides new information regarding MID estimates for the 4 health indices examined.
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                Author and article information

                Journal
                J Clin Med
                J Clin Med
                jcm
                Journal of Clinical Medicine
                MDPI
                2077-0383
                20 September 2019
                October 2019
                : 8
                : 10
                : 1506
                Affiliations
                [1 ]Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06511, USA
                [2 ]Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA
                [3 ]Department of Neurosurgery, University of Cincinnati, Cincinnati, OH 45267, USA
                [4 ]Department of Neurosurgery, Geneva University Hospitals, 1205 Geneva, Switzerland
                [5 ]Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
                [6 ]Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
                Author notes
                [* ]Correspondence: chengj6@ 123456ucmail.uc.edu ; Tel.: +1-513-558-35562
                [†]

                Authors contributed equally.

                Author information
                https://orcid.org/0000-0002-4965-3059
                https://orcid.org/0000-0002-1881-012X
                Article
                jcm-08-01506
                10.3390/jcm8101506
                6832387
                31547030
                041e67e3-044f-4fb9-92ef-f4c69c0f9542
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 01 August 2019
                : 12 September 2019
                Categories
                Article

                eq-5d,promis,spine,transformation,quality of life,patient outcomes,validation

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