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Preference-Based Health-Related Quality of Life Measures

Preference-Based Health-Related Quality of Life Measures. Ron D. Hays, Ph.D. January 26, 2015 (9:00-11:50 am) HPM 214 http://hpm214.med.ucla.edu/. Where we are now in HPM214. Introduction Profile Measures (SF-36 due ) Preference-Based Measures  Designing Measures

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Preference-Based Health-Related Quality of Life Measures

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  1. Preference-Based Health-Related Qualityof Life Measures Ron D. Hays, Ph.D. January 26, 2015 (9:00-11:50 am) HPM 214 http://hpm214.med.ucla.edu/

  2. Where we are now in HPM214 • Introduction • Profile Measures (SF-36 due) • Preference-Based Measures  • Designing Measures • Evaluating Measures • PROMIS/IRT/Internet Panels • Reviews of Manuscripts • Course Review (Cognitive interviews due) • Final Exam (3/16/15)

  3. 2015 HPM214 SF-36 Scores on 0-100 Possible Range

  4. 2015 HPM 214 SF-36 T-Scores

  5. 2013 HPM 214 SF-36 Scores Compared to U.S. General Population

  6. SF-12 • Items by Scale • General health (1) • Physical functioning (3b, 3d) • Role-Physical (4b, 4c) • Role-Emotional (5b, 5c) • Bodily pain (8) • Emotional well-being (9d, 9f) • Energy/fatigue (9e) • Social functioning (10)

  7. SF-36 PCS and MCS PCS_z = (PF_Z * 0.42) + (RP_Z * 0.35) + (BP_Z * 0.32) + (GH_Z * 0.25) + (EF_Z * 0.03) + (SF_Z * -.01) + (RE_Z * -.19) + (EW_Z * -.22) MCS_z = (PF_Z * -.23) + (RP_Z * -.12) + (BP_Z * -.10) + (GH_Z * -.02) + (EF_Z * 0.24) + (SF_Z * 0.27) + (RE_Z * 0.43) + (EW_Z * 0.49) PCS = (PCS_z*10) + 50 MCS = (MCS_z*10) + 50

  8. Farivar et al. alternative weights PCS_z = (PF_z * .20) + (RP_z * .31) + (BP_z * .23) + (GH_z * .20) + (EF_z * .13) + (SF_z * .11) + (RE_z * .03) + (EW_z * -.03) MCS_z = (PF_z * -.02) + (RP_z * .03) + (BP_z * .04) + (GH_z * .10) + (EF_z * .29) + (SF_z * .14) + (RE_z * .20) + (EW_z * .35) • Farivar, S. S., Cunningham, W. E., & Hays, R. D. (2007). Correlated physical and mental health summary scores for the SF-36 and SF-12 health survey, V. 1. Health andQuality of Life Outcomes, 5: 54. [PMCID: PMC2065865]

  9. Is New Treatment (X) Better Than Standard Care (O)? X 0 X 0 Physical Health X > 0 Mental Health 0 > X

  10. Ultimate Use of HRQOL Measures--Helping to Ensure Access to Cost-Effective Care Cost ↓ Effectiveness ↑

  11. Single Weighted Combination of Scores Perceived Health Index (n = 1,862; reliability = 0.94) Highest Lowest Quartile on Index • 35% 84% at least 1 moderate symptom • 7% 70% at least 1 disability day • 1% 11% hospital admission • 2% 14% performance of invasive • diagnostic procedure Perceived Health Index = 0.20 Physical functioning + 0.15 Pain + 0.41 Energy +0.10 Emotional well-being + 0.05 Social functioning + 0.09 Role functioning. Bozzette, S.A., Hays, R.D., Berry, S.H., & Kanouse, D.E. (1994). A perceived health index for use in persons with advanced HIV disease: Derivation, reliability, and validity. Medical Care, 32, 716-731.

  12. Is Medicine Related to Worse HRQOL? Medication Person Use HRQOL (0-100) 1 No dead 2 No dead 3 No 50 4 No 75 5 No 100 6 Yes 0 7 Yes 25 8 Yes 50 9 Yes 75 10 Yes 100 Group n HRQOL No Medicine 3 75 Yes Medicine 5 50

  13. Survival Analysis Dead 0.0 Alive 1.0 Marathoner 1.0 Person in coma 1.0

  14. Charges, Satisfaction, Mortalityand HRQOL for Acute MI (n=133) Nelson, E. C., et al. (1995). Comparing outcomes and charges for patients with acute myocardial infarction in three community hospitals: An approach for assessing "value.” International Journal for Quality in Health Care, 7, 95-108.

  15. Quality of Life for Individual Over Time

  16. http://www.ukmi.nhs.uk/Research/pharma_res.asp

  17. “QALYs: The Basics” • Value is … • Preference or desirability of health states • Preferences can be used to • Compare different interventions on a single common metric (societal resource allocation) • Help make personal decisions about whether to have a treatment Milton Weinstein, George Torrance, Alistair McGuire, Value in Health, 2009, vol. 12 Supplement 1.

  18. Preference Elicitation • Standard gamble (SG) • Time trade-off (TTO) • Rating scale (RS) • http://araw.mede.uic.edu/cgi-bin/utility.cgi • SG > TTO > RS • SG = TTOa • SG = RSb (Where a and b are less than 1) • Also discrete choice experiments

  19. Direct Preference Measures • Underlying attributes unknown • Rating Scale • Standard gamble • Time tradeoff

  20. Rating Scale Overall, how would you rate your current health? (Circle One Number) 0 1 2 3 4 5 6 7 8 9 10 Worst possible health (as bad or worse than being dead) Half-way between worst and best Best possible health

  21. Standard Gamble

  22. Standard Gamble (SG) p = probability of perfect health p = 1.00  QALY = 1.00 p = 0.50  QALY = 0.50 p = 0.25  QALY = 0.25 p = 0.00  QALY = 0.00

  23. Time Tradeoff Alternative 1 is current health for time “t” (given), followed by death. Alternative 2 is full health for time “x” (elicited), followed by death. x/t = preference for current health

  24. http://araw.mede.uic.edu/cgi-bin/utility.cgi http://araw.mede.uic.edu/cgi-bin/utility.cgi

  25. Indirect Preference Measures • Attributes know • Based on “societal preferences” a single score is assigned • Quality of Well-Being (QWB) Scale • EQ-5D • HUI2 and HUI3 • SF-6D

  26. Quality of Well-Being (QWB) Scale Well-Being Dead 0 1 • Summarize HRQOL in QALYs – Mobility (MOB) – Physical activity (PAC) – Social activity (SAC) – Symptom/problem complexes (SPC) • Well-Being Formula: w = 1 + MOB + PAC + SAC + SPC

  27. Quality of Well-Being Weighting Procedure Perfect Health 10 9 8 7 6 5 4 3 2 1 0 Death Each page in this booklet tells how an imaginary person is affected by a health problem on one day of his or her life. I want you to look at each health situation and rate it on a ladder with steps numbered from zero to ten. The information on each page tells 1) the person's age group, 2) whether the person could drive or use public transportation, 3) how well the person could walk, 4) how well the person could perform the activities usual for his or her age, and 5) what symptom or problem was bothering the person. Adult (18-65) Drove car or used public transportation without help (MOB) Walked without physical problems (PAC) Limited in amount or kind of work, school, or housework (SAC) Problem with being overweight or underweight (SYM)

  28. Quality of Well-Being States and Weights Component Measures States Weights Physical activity Physical function In bed, chair, couch, or wheelchair* -.077 In wheelchair+ or had difficulty lifting, -.060 stooping, using stairs, walking, etc. Mobility Ability to get around or In hospital, nursing home, or hospice. -.090 transport oneself Did not drive car or use public -.062 transportation Social activity Role function and self-care Did not feed, bath, dress, or toilet -.106 Limited or did not perform role -.061 Symptom/problem Physical symptoms and Worst symptom from loss of -.407 complexes problems consciousness to breathing -.101 smog or unpleasant air * did not move oneself in wheelchair +moved oneself in wheelchair

  29. EQ-5D (243 states, 3 levels each) • Mobility • Self-care • Usual activities • Pain/discomfort • Anxiety/depression • http://www.euroqol.org/

  30. HUI-3 Vision Hearing Speech Ambulation Dexterity Cognition Pain and discomfort Emotion http://www.healthutilities.com/hui3.htm 972,000 states, 5-6 levels per attribute

  31. SF-6D Brazier et al. (1998, 2002) — 6-dimensional classification (collapsed role scales, dropped general health) — Uses 12 SF-36 items (PF: 3a, b, j; R: 4c, 5b; SF: 10; BP: 7, 8; MH: 9b, f; EN: 9e) --- About 18,000 possible states -— 249 states rated by sample of 836 from UK general population http://www.shef.ac.uk/scharr/sections/heds/mvh/sf-6d

  32. Health state 424421 (0.59) • Your health limits you a lot in moderate activities (such as moving a table, pushing a vacuum cleaner, bowling or playing golf) • You are limited in the kind of work or other activities as a result of your physical health • Your health limits your social activities (like visiting friends, relatives etc.) most of the time. • You have pain that interferes with your normal work (both outside the home and housework) moderately • You feel tense or downhearted and low a little of thetime. • You have a lot of energy all of the time

  33. Fryback, D. G. et al., (2007). US Norms for Six Generic Health-Related Quality-of-Life Indexes from the National Health Measurement Study. Medical Care, 45, 1162- 1170. Correlations Among Indirect Measures

  34. Change in Indirect Preference Measures Over Time Kaplan, R. M. et al. (2011). Five preference-based indexes in cataract and heart failure patients were not equally responsive to change. J Clinical Epidemiology, 64, 497-506. ICC for change was 0.16 for cataract and 0.07 for heart failure. Feeny, D. et al. (2011). Agreement about identifying patients who change over time: Cautionary results in cataract and heart failure patients. Medical Decision Making, 32 (2), 273-286.

  35. Mapping Health States to Preference Score Exists Measured Perfect HRQOL 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 Dead P3, M3 P2, M3 P3, M2 P3, M1 P2, M2 P1, M3 P2, M1 P1, M2 P1, M1

  36. “Disease-Targeted” Preference-Based Measure (VFQ-UI) 6. How much difficulty do you have doing work or hobbies that require you to see well up close, such as cooking, sewing, fixing things around the house, or using hand tools? 14. Because of your eyesight, how much difficulty do you have going out to see movies, plays, or sports events? 18. Are you limited in how long you can work or do other activities because of your vision? 25. I worry about doing things that will embarrass myself or others, because of my eyesight. 20. I stay home most of the time because of my eyesight. 11. Because of your eyesight, how much difficulty do you have seeing how people react to things you say? Near vision, distance vision, role function, mental health, dependency, social function

  37. VFQ-UI • 6 item subset of NEI VFQ-25 (11 scales) • general vision, near vision, distance vision, driving, peripheral vision, color vision, ocular pain, role function, dependency, social function, mental health • 8 vision-related health states (out of 15,625) ranging from no difficulty to stopped doing work • TTOs from sample of 607 from Australia, Canada, U.K. and U.S. ranged from 0.34-0.96 Kowalski, J.W., et al. (2012). Rasch analysis in the development of a simplified version of the National Eye Institute Visual-Function Questionnaire-25 for utility estimation. Quality of Life Research, 21, 323-334. Rentz, A., et al. (2014). Development of a preference-based index from the National Eye Institute Visual Function Questionnaire-25. JAMA Ophthalmology. 132 (3), 310-318. • e

  38. TTO Mobility Self-Care Usual Activities VA Vision HRQOL EQ-5D Pain Anxiety/Dep

  39. Ad Hoc Preference Score Estimates Comprehensive Geriatric Assessment (n = 363 community-dwelling older persons) lead to improvements in SF-36 energy, social functioning, and • Physical functioning (4.69 points) in 64 weeks • Cost of $746 over 5 years beyond control group Keeler, E. B., et al. Cost-effectiveness of outpatient geriatric assessment with an intervention to increase adherence. Med Care, 1999, 37 (12), 1199-1206.

  40. Is CGA worth paying for? Change in QALYs associated with 4.69 change in SF-36 physical functioning scale • r = 0.69 -> b = .003 • QWB = 4.69 x .003 = .014 • .014 x 5 yrs. = 0.07 QALYs • Cost/QALY: $10,600+ <$20,000 per QALY worthwhile

  41. Quiz • What is the difference between a profile and preference-based measure? • Name a profile measure. • Name a preference-based measure. • What is a quality-adjusted life year?

  42. Finding HRQOL Surveys http://www.proqolid.org/ http://www.nihpromis.org/ http://www.healthmeasurement.org/ http://www.chime.ucla.edu/analysis.htm

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