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      EQ-5D-5L and SF-6Dv2 utility scores in people living with chronic low back pain: a survey from Quebec

      research-article
      1 , 2 , , 3 , 4
      BMJ Open
      BMJ Publishing Group
      health economics, back pain, pain management

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          Abstract

          Objective

          To describe how chronic low back pain (CLBP) impacts on utility scores and which patients’ characteristics most affect these scores in the province of Quebec.

          Settings

          Province of Quebec, Canada.

          Participants

          569 adult patients with CLBP.

          Methods and outcomes

          An online survey on low back pain was conducted between October 2018 and January 2019. The EuroQol Five Dimensions (EQ-5D-5L) and the Short Form Six Dimensions version 2 (SF-6Dv2) are two generic preference-based measures used to evaluate health-related quality of life (HRQoL) and provide quality-adjusted life-year utility values.

          Results

          The number of subjects who agreed to participate was 610, but 41 were excluded because 8 had low back pain for less than 3 months and 33 did not start the survey. A total of 569 subjects were analysed, but only 410 completed the survey up to the EQ-5D-5L or SF-6Dv2 sections. Median (range) of EQ-5D-5L was 0.622 (−0.072 to 0.905), and mean (range) of SF-6Dv2 and EQ-Visual Analogue Scale was 0.561 (0.301–0.829) and 51.0 (0–100), respectively. In all multivariate models, health or life satisfaction increased the health utility score, while pain reduced it. Co-occurring health problems were present for a majority (68%) of participants, mainly fatigue/insomnia (57.4%), musculoskeletal disorder (56.2%) and mental disorder (44%).

          Conclusion

          This study provided utility scores with EQ-5D-5L and SF-6Dv2 in patients with CLBP in Quebec, and results were similar to other studies conducted in different settings. These values were well below those reported in the Quebec general population and highlight the association between CLBP and HRQoL.

          Related collections

          Most cited references29

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          Non-specific low back pain.

          Non-specific low back pain affects people of all ages and is a leading contributor to disease burden worldwide. Management guidelines endorse triage to identify the rare cases of low back pain that are caused by medically serious pathology, and so require diagnostic work-up or specialist referral, or both. Because non-specific low back pain does not have a known pathoanatomical cause, treatment focuses on reducing pain and its consequences. Management consists of education and reassurance, analgesic medicines, non-pharmacological therapies, and timely review. The clinical course of low back pain is often favourable, thus many patients require little if any formal medical care. Two treatment strategies are currently used, a stepped approach beginning with more simple care that is progressed if the patient does not respond, and the use of simple risk prediction methods to individualise the amount and type of care provided. The overuse of imaging, opioids, and surgery remains a widespread problem.
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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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              QALYs: the basics.

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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2020
                15 September 2020
                : 10
                : 9
                : e035722
                Affiliations
                [1 ]departmentSchool of Public Health , University of Montreal , Montreal, Québec, Canada
                [2 ]departmentCentre de recherche de l'IUSMM , CIUSSS de l'Est de l'île de Montréal , Montréal, Québec, Canada
                [3 ]departmentDepartment of Economics , Concordia University , Montreal, Québec, Canada
                [4 ]Centre de recherche du CHUS, CIUSSS de l'Estrie - CHUS , Sherbrooke, Quebec, Canada
                Author notes
                [Correspondence to ] Pr Thomas G Poder; thomas.poder@ 123456umontreal.ca
                Author information
                http://orcid.org/0000-0001-7017-096X
                Article
                bmjopen-2019-035722
                10.1136/bmjopen-2019-035722
                7493112
                888f75d2-401e-466b-9000-e081d9805d20
                © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 15 November 2019
                : 30 April 2020
                : 16 July 2020
                Categories
                Health Economics
                1506
                1701
                Original research
                Custom metadata
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                Medicine
                health economics,back pain,pain management
                Medicine
                health economics, back pain, pain management

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