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      Convergent validity of the EQ-5D-3L in a randomized-controlled trial of the Housing First model

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          Abstract

          Background

          Health utility assessments are important for economic evaluations but few instruments have been validated in homeless people with mental illness. We examined the convergent validity of the EuroQol-5 Dimension 3-level questionnaire (EQ-5D-3L) as a measure of quality of life in homeless adults with mental illness.

          Methods

          Data were from Toronto participants in At Home/Chez Soi, a 24-month randomized controlled trial of Housing First (immediate access to scattered site housing and mental health support services) compared to treatment as usual for homeless adults with a mental disorder ( n = 575). Participants completed the EQ-5D-3L at 6 month intervals. We tested convergent validity, hypothesizing strong correlation ( r > 0.6) with the Lehman Quality of Life Interview 20 (QOLI-20) index and moderate correlations ( r > 0.3) with the Colorado Symptom Index (CSI), Recovery Assessment Scale (RAS), and number of comorbidities. We also examined correlations between EQ-5D-3L scores and the QOLI-20 over time using a linear mixed-effects model.

          Results

          The EQ-5D-3L was not strongly correlated with the QOLI-20 (r ranged from 0.31–0.52 at various time points). The EQ-5D-3L was moderately correlated with the CSI, RAS, and number of comorbidities. The Snijders/Bosker r 2 for longitudinal validity between the EQ-5D-3L and QOLI-20 within subjects over time was 0.2094 (square-root r = 0.4576).

          Conclusions

          The EQ-5D-3L did not demonstrate strong convergent validity in homeless people with mental illness but was moderately correlated with several instruments. Further research is warranted to determine the optimal method for measuring health utilities in this population.

          Trial registration

          International Standard Randomised Control Trial Registry ISRCTN42520374 assigned on August 18, 2009.

          Electronic supplementary material

          The online version of this article (10.1186/s12913-019-4310-z) contains supplementary material, which is available to authorized users.

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          Most cited references29

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          Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes.

          I B Wilson, P D Cleary (1995)
          Our model proposes a taxonomy or classification scheme for different measures of health outcome. We divide these outcomes into five levels: biological and physiological factors, symptoms, functioning, general health perceptions, and overall quality of life. In addition to classifying these outcome measures, we propose specific causal relationships between them that link traditional clinical variables to measures of HRQL. As one moves from left to right in the model, one moves outward from the cell to the individual to the interaction of the individual as a member of society. The concepts at each level are increasingly integrated and increasingly difficult to define and measure. AT each level, there are an increasing number of inputs that cannot be controlled by clinicians or the health care system as it is traditionally defined.
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            Recommendations of the Panel on Cost-effectiveness in Health and Medicine.

            M Weinstein, J E Siegel, M R Gold … (1996)
            To develop consensus-based recommendations for the conduct of cost-effectiveness analysis (CEA). This article, the second in a 3-part series, describes the basis for recommendations constituting the reference case analysis, the set of practices developed to guide CEAs that inform societal resource allocation decisions, and the content of these recommendations. The Panel on Cost-Effectiveness in Health and Medicine, a nonfederal panel with expertise in CEA, clinical medicine, ethics, and health outcomes measurement, was convened by the US Public Health Service (PHS). The panel reviewed the theoretical foundations of CEA, current practices, and alternative methods used in analyses. Recommendations were developed on the basis of theory where possible, but tempered by ethical and pragmatic considerations, as well as the needs of users. The panel developed recommendations through 2 1/2 years of discussions. Comments on preliminary drafts prepared by panel working groups were solicited from federal government methodologists, health agency officials, and academic methodologists. The panel's methodological recommendations address (1) components belonging in the numerator and denominator of a cost-effectiveness (C/E) ratio; (2) measuring resource use in the numerator of a C/E ratio; (3) valuing health consequences in the denominator of a C/E ratio; (4) estimating effectiveness of interventions; (5) incorporating time preference and discounting; and (6) handling uncertainty. Recommendations are subject to the ¿rule of reason,¿ balancing the burden engendered by a practice with its importance to a study. If researchers follow a standard set of methods in CEA, the quality and comparability of studies, and their ultimate utility, can be much improved.
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              Multiattribute and single-attribute utility functions for the health utilities index mark 3 system.

              David H. Feeny, William Furlong, George Torrance … (2002)
              The Health Utilities Index Mark 3 (HUI3) is a generic multiattribute preference-based measure of health status and health-related quality of life that is widely used as an outcome measure in clinical studies, in population health surveys, in the estimation of quality-adjusted life years, and in economic evaluations. HUI3 consists of eight attributes (or dimensions) of health status: vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain with 5 or 6 levels per attribute, varying from highly impaired to normal. The objectives are to present a multiattribute utility function and eight single-attribute utility functions for the HUI3 system based on community preferences. Two preference surveys were conducted. One, the modeling survey, collected preference scores for the estimation of the utility functions. The other, the direct survey, provided independent scores to assess the predictive validity of the utility functions. Preference measures included value scores obtained on the Feeling Thermometer and standard gamble utility scores obtained using the Chance Board. A random sample of the general population (> or =16 years of age) in Hamilton, Ontario, Canada. Estimates were obtained for eight single-attribute utility functions and an overall multiattribute utility function. The intraclass correlation coefficient between directly measured utility scores and scores generated by the multiattribute function for 73 health states was 0.88. The HUI3 scoring function has strong theoretical and empirical foundations. It performs well in predicting directly measured scores. The HUI3 system provides a practical way to obtain utility scores based on community preferences.
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                Author and article information

                Contributors
                Nicole Kozloff:
                ORCID: http://orcid.org/0000-0003-1389-1351
                n.kozloff@mail.utoronto.ca
                Andrew D. Pinto: andrew.pinto@mail.utoronto.ca
                Vicky Stergiopoulos: vicky.stergiopoulos@camh.ca
                Stephen W. Hwang: hwangs@smh.ca
                Patricia O’Campo: ocampop@smh.ca
                Ahmed M. Bayoumi: ahmed.bayoumi@utoronto.ca
                Journal
                Journal ID (nlm-ta): BMC Health Serv Res
                Journal ID (iso-abbrev): BMC Health Serv Res
                Title: BMC Health Services Research
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-6963
                Publication date (Electronic): 12 July 2019
                Publication date PMC-release: 12 July 2019
                Publication date Collection: 2019
                Volume: 19
                Electronic Location Identifier: 482
                Affiliations
                [1 ]ISNI 0000 0000 8793 5925, GRID grid.155956.b, Centre for Addiction and Mental Health, ; 250 College Street, 7th floor, Toronto, ON M5T 1R8 Canada
                [2 ]GRID grid.415502.7, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, ; 30 Bond Street, Toronto, ON M5B1W8 Canada
                [3 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Department of Psychiatry, , University of Toronto, ; 250 College Street, Toronto, ON M5T1R8 Canada
                [4 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Institute of Health Policy, Management, and Evaluation, , University of Toronto, ; Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6 Canada
                [5 ]GRID grid.415502.7, Department of Family and Community Medicine, , St. Michael’s Hospital, ; 30 Bond Street, Toronto, ON M5B 1W8 Canada
                [6 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Department of Family and Community Medicine, Faculty of Medicine, , University of Toronto, ; 500 University Avenue, 5th Floor, Toronto, ON M5G 1V7 Canada
                [7 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Dalla Lana School of Public Health, , University of Toronto, ; Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON M5T 3M7 Canada
                [8 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Department of Medicine, , University of Toronto, ; Suite RFE 3-805, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
                [9 ]GRID grid.415502.7, Division of General Internal Medicine, , St. Michael’s Hospital, ; 30 Bond Street, Toronto, ON M5B 1W8 Canada
                Author information
                http://orcid.org/0000-0003-1389-1351
                Article
                Publisher ID: 4310
                DOI: 10.1186/s12913-019-4310-z
                PMC ID: 6626335
                PubMed ID: 31300051
                SO-VID: 58f26448-e78d-4542-bf9a-9d2df497a353
                Copyright © © The Author(s). 2019
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted 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. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 21 February 2019
                Date accepted : 30 June 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;
                Award ID: Funding Reference Number 140822
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100000874, Brain and Behavior Research Foundation;
                Award ID: 23673
                Award Recipient :
                Funded by: Fondation Alma and Baxter Ricard
                Award ID: Chair in Inner City Health at St. Michael's Hospital
                Award Recipient :
                Funded by: Mental Health Commission of Canada
                Award ID: N/A
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Health & Social care
                Keywords: vulnerable populations/access to care,psychiatry,utility measurement,eq-5d,qol in special populations
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: vulnerable populations/access to care, psychiatry, utility measurement, eq-5d, qol in special populations

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