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      A Review of Generic Preference-Based Measures of Health-Related Quality of Life in Visual Disorders

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          Abstract

          Objective

          This review examines generic preference-based measures and their ability to reflect health-related quality of life in patients with visual disorders.

          Methods

          A systematic search was undertaken to identify clinical studies of patients with visual disorders where health state utility values were measured and reported. Data were extracted to assess the validity and responsiveness of the measures. A narrative synthesis of the data was undertaken due to the heterogeneity between different studies.

          Results

          There was considerable heterogeneity in the 31 studies identified in terms of patient characteristics, visual disorders, and outcomes reported. Vision loss was associated with a reduction in scores across the preference-based measure, but the evidence on validity and responsiveness was mixed. The EQ-5D health-related assessment instrument's performance differed according to condition, with poor performance in age-related macular degeneration (AMD) and diabetic retinopathy. The more limited evidence on the HUI-3 instrument found it performed best in differentiating between severity groups of patients with glaucoma, AMD, cataracts, and diabetic retinopathy. One study reported data on the SF-6D instrument and showed it was able to differentiate between patients with AMD.

          Conclusions

          The performance of the EQ-5D in visual disorders was mixed. The HUI-3 seemed to perform better in some conditions, but the evidence on this and SF-6D is limited. More head to head comparisons of these three measures are required. The new five-level version of EQ-5D may do better at the milder end of visual function.

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          Most cited references43

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          Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)

          Purpose This article introduces the new 5-level EQ-5D (EQ-5D-5L) health status measure. Methods EQ-5D currently measures health using three levels of severity in five dimensions. A EuroQol Group task force was established to find ways of improving the instrument’s sensitivity and reducing ceiling effects by increasing the number of severity levels. The study was performed in the United Kingdom and Spain. Severity labels for 5 levels in each dimension were identified using response scaling. Focus groups were used to investigate the face and content validity of the new versions, including hypothetical health states generated from those versions. Results Selecting labels at approximately the 25th, 50th, and 75th centiles produced two alternative 5-level versions. Focus group work showed a slight preference for the wording ‘slight-moderate-severe’ problems, with anchors of ‘no problems’ and ‘unable to do’ in the EQ-5D functional dimensions. Similar wording was used in the Pain/Discomfort and Anxiety/Depression dimensions. Hypothetical health states were well understood though participants stressed the need for the internal coherence of health states. Conclusions A 5-level version of the EQ-5D has been developed by the EuroQol Group. Further testing is required to determine whether the new version improves sensitivity and reduces ceiling effects.
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            Health utilities using the EQ-5D in studies of cancer.

            Cancer is one of the most frequent disease-specific applications of the EQ-5D. The objective of this review was to summarise evidence to support the validity and reliability of the EQ-5D in cancer, and to provide a catalogue of utility scores based on the use of the EQ-5D in clinical trials and in studies of patients with cancer. A structured literature search was conducted in EMBASE and MEDLINE to identify papers using key words related to cancer and the EQ-5D. Original research studies of patients with cancer that reported EQ-5D psychometric properties, responses and/or summary scores were included. Of 57 identified articles, 34 were selected for inclusion, where 12 studies reported evidence of validity or reliability and 31 reported EQ-5D responses or summary scores. The majority of investigations using the EQ-5D concerned patients with prostate cancer (n = 4), breast cancer (n = 4), cancers of the digestive system (n = 7) and Hodgkin and/or non-Hodgkin lymphoma (n = 3). Mean index-based scores ranged from 0.33 (SD 0.4) to 0.93 (SD 0.12) and visual analogue scale scores ranged from 43 (SD 13.3) to 84 (SD 12.0) across subtypes of cancer. A substantial and growing body of literature using the EQ-5D in cancer that supports the validity and reliability of EQ-5D in cancer has emerged. This review provides utility estimates for cancer patients across a wide range of cancer subtypes, treatment regimens and tumour stage(s) that may inform the modelling of outcomes in economic evaluations of cancer treatment.
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              A checklist for judging preference-based measures of health related quality of life: learning from psychometrics.

              There have been a number of published reviews of measures of health related quality of life, but most of this work has been undertaken within a tradition of psychometrics outside of economics. This situation has often resulted in health status measures designed specifically for the purposes of economic evaluation being neglected and portrayed as 'invalid'. This paper utilizes and adapts the traditional psychometric concepts of practicality, reliability and validity for judging preference-based measures of health related quality of life. The psychometric and economic approaches are most different in relation to validity because they are seeking to measure different concepts. The former seeks to measure health change as perceived by patients, whilst economic evaluation requires a measure of the value or strength of preference for the health change. A checklist is presented to provide guidance in the design or review of economic evaluations using changes in health as the main measure of benefit.
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                Author and article information

                Journal
                Value Health
                Value Health
                Value in Health
                Elsevier
                1098-3015
                1524-4733
                January 2012
                January 2012
                : 15
                : 1
                : 118-127
                Affiliations
                [1 ]Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK
                [2 ]Health Economics Research Group, Brunel University, Uxbridge, Middlesex, UK
                Author notes
                [* ] Address correspondence to: Jonathan Tosh, Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, South Yorkshire, S1 4DA UK j.tosh@ 123456sheffield.ac.uk
                Article
                JVAL223
                10.1016/j.jval.2011.08.002
                3268858
                22264979
                72281a8c-0e3e-4334-a086-c722e350017b
                © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

                This document may be redistributed and reused, subject to certain conditions.

                History
                Categories
                Preference-Based Assessment

                Economics of health & social care
                vision,quality of life,utilities,health-related quality of life,qalys

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