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Is healthcare any good for patients? Measuring health outcomes using EQ-5D

Is healthcare any good for patients? Measuring health outcomes using EQ-5D. Professor Paul Kind Principal Investigator Outcomes Research Group Centre for Health Economics University of York England. Health care.

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Is healthcare any good for patients? Measuring health outcomes using EQ-5D

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  1. Is healthcare any good for patients? Measuring health outcomes using EQ-5D Professor Paul Kind Principal Investigator Outcomes Research Group Centre for Health Economics University of YorkEngland

  2. Health care • Designed / delivered with the intention of altering the “natural” health status of patients over time • Relieving pain, suffering • Prolonging (enabling) life • Easing process of dying • Cure (sometimes)

  3. Hippocratic Oath : First, do no harm • Fundamental question : how do you know if you are helping / harming the patient ? • You need to know • does treatment CHANGE anything ? • what is the DIRECTION of change ? • what is the MAGNITUDE of change ?

  4. Health care intervention Symptomatic relief, cure, palliation ? Yes Problem

  5. Measuring health outcomesthe biomedical model (a) [ FEV1 ]t0 - [ FEV1 ]t1  FEV1 (b) [ health]t0 - [ health ]t1  health status there is a calibrated test procedure for (a) what do we use for (b) ?

  6. Outcome measures'Classical' indicators • Survival rates • Readmission rates • Symptom counts • Employment status • Days lost through sickness • Clinical parameters

  7. Grading angina severityNew York Heart Association • Grade I • ordinary physical activity does not cause undue fatigue, palpitation or anginal pain • Grade II • comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnoea or anginal pain • Grade III • comfortable at rest. Less than ordinary physical activity causes fatigue, palpitation, dyspnoea or anginal pain • Grade IV • inability to carry on physical activity without discomfort. Symptoms of cardiovascular insufficiency or the anginal syndrome may be present even at rest

  8. Karnofsky Performance Scale

  9. FACT-L

  10. Health-related quality of lifea specialised measure of outcome What are the health outcomes ? EQ-5D Health-related quality of life

  11. The EuroQoL Group • Set up in 1987 by a multidisciplinary group of researchers concerned with EVALUATION in health and health care • Clinicians • Health economists • Others (sociology, psychology …)

  12. Founders Finland Netherlands (Norway) Sweden UK Extended network Argentina Canada China Denmark Germany Greece Hungary Italy Japan The EuroQoL Group Korea New Zealand Portugal Russia Slovenia Spain Taiwan USA . . . . Poland ?

  13. So .. what is EQ-5D ? • A generic measure of health status (health-related quality of life) capable of being represented as a single index • Health is defined in terms of 5 dimensions • mobility • self care • usual activity • pain / discomfort • anxiety / depression • Each dimension is divided into 3 levels • none • some • extreme

  14. Anxiety / Depression Mobility Health state Pain / Discomfort Self-Care Usual Activity What is EQ-5D ? • A generic, single index • measure of health status • Based on 5 dimensions • Mobility • Self-Care • Usual Activity • Pain / Discomfort • Anxiety / Depression • Defines a total of 35 • = 243 health states

  15. Self-care Pain / discomfort Mobility Health state Usual activities Anxiety / depression For example : no problems in walking about (1) some problems washing self (2) some problems with usual activity (2) no pain or discomfort (1) moderately anxiety or depression (2) State 12212

  16. In general we know NOTHING about the order or values of EQ-5D health states • There is a logical ordinal relationship between some states • For example 11111 is logically better than 33333 • But what is the distance between these states ?

  17. Does moving from state A to state B constitute a patient benefit ?If so, then by how much? Profile A : 1 1 2 2 3 Profile B : 1 1 3 2 2

  18. Shared objective : Valuing health • Needed a simple method • Self-administered • Capable of being used in population surveys • Relatively quick • Able to produce cardinal values

  19. Valuation method(s) • EuroQoL Group standard • Visual analogue scale rating using a vertical 20cm scale • Range 0 – 100 corresponding to “worst imaginable” and “best imaginable” health • Individual experimentation • Time Trade-Off (York MVH Project) • Ranking • Paired comparisons • Standard Gamble

  20. VAS rating of EQ-5D health states Health state E Health state A Health state F 1 1 1 1 1 Health state C 3 3 3 3 3 Health state H Health state D

  21. Profile A : 1 1 2 2 3 Population preference weights Profile B : 1 1 3 2 2

  22. MOBILITY I have no problems in walking about I have some problems in walking about I am confined to bed   ·For each group of statements please indicate the one that best describes your health today ·Please tick one box for each group of statements. SELF-CARE   I have no problems with self-care I have some problems washing or dressing myself I am unable to wash or dress myself  USUAL ACTIVITIES   I have no problems with performing my usual activities  (e.g. work, study, housework, family or leisure activities) I have some problems with performing my usual activities  I am unable to perform my usual activities   PAIN / DISCOMFORT   I have no pain or discomfort  I have moderate pain or discomfort  I have extreme pain or discomfort   ANXIETY / DEPRESSION I am not anxious or depressed  I am moderately anxious or depressed  I am extremely anxious or depressed  

  23. Best imaginablehealth 100 90 80 70 60 50 40 30 20 10 0 Worst imaginablehealth Your own health today TThink about how good or bad your own health is today This scale may help. The best health you can imagine is marked 100 and the worst health you can imagine is marked 0 Please write in the box below, the number between 0 and 100 that you feel best shows how good your health is today

  24. Page 3 : Patient Perspective

  25. MOBILITY • I have no problems in walking about • I have some problems in walking about • I am confined to bed SELF-CARE • I have no problems with self-care • I have some problems washing or dressing myself • I am unable to wash or dress myself USUAL ACTIVITIES (e.g. work, study, housework family or leisure activities) • I have no problems with performing my usual activities • I have some problems with performing my usual activities • I am unable to perform my usual activities PAIN/DISCOMFORT • I have no pain or discomfort • I have moderate pain or discomfort • I have extreme pain or discomfort ANXIETY/DEPRESSION • I am not anxious or depressed • I am moderately anxious or depressed • I am extremely anxious or depressed MOBILITY • I have no problems in walking about • I have some problems in walking about • I am confined to bed SELF-CARE • I have no problems with self-care • I have some problems washing or dressing myself • I am unable to wash or dress myself USUAL ACTIVITIES (e.g. work, study, housework family or leisure activities) • I have no problems with performing my usual activities • I have some problems with performing my usual activities • I am unable to perform my usual activities PAIN/DISCOMFORT • I have no pain or discomfort • I have moderate pain or discomfort • I have extreme pain or discomfort ANXIETY/DEPRESSION • I am not anxious or depressed • I am moderately anxious or depressed • I am extremely anxious or depressed Page 2 : Societal Perspective ?

  26. As a profile based on reported level of problem on each dimension As a health state As a weighted index based on values of the general public As self-rated health status EQ-5D Part I Part II profile self-rated health status health state weighted index How are EQ-5D data presented ?

  27. Some examples

  28. Frequency of reported problemsby age group in UK population

  29. Population “norms”mean EQ-5Dindex Source: Health Survey for England, 1996

  30. EQ-5Dindex by age / smoking behaviour

  31. EQ-5Dfor GP clinic attenders

  32. Primary care clinic attendees EQ-5D profile by diagnostic group

  33. Rheumatoid arthritisFunctional Class • I .. complete functional capacity • ability to carry out all normal activities • II .. adequate for normal activities • despite discomfort or limited motion at 1 or more joints • III .. limited functional capacity • only little or none of duties of normal occupation or selfcare • IV .. incapacitated • largely or wholly bed-ridden or confined to wheelchair; little or no selfcare

  34. EQ-5Dindex by Functional Class rheumatoid arthritis patients

  35. EQ-5D in treatment of HIV/AIDS

  36. Where are we now ?Science • Likely to increase number of response levels from 3 to 5 • Investigating a “child-friendly” version of EQ-5D • Computer-based valuation and self-assessment methods • Electronic data capture – web based technologies

  37. 5-level or 3-level ? • One suggested modification to existing 3-level descriptive system • Place unmarked level between existing levels

  38. Where are we now ?Application • Nearly 100 language versions available • Worldwide take-up with many normative population studies • Widespread incorporation in clinical studies that involve economic evaluation • Major head:head study in US of the leading generic HrQoL measures

  39. ends Paul Kind : pk1@york.ac.uk EuroQoL Group : http://www.euroqol.org

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