Usefulness of EQ-5D in Assessing Health Status in Primary Care Patients with Major Depressive Disorder

Objectives Major depressive disorder (MDD) is a prevalent psychiatric disorder associated with impaired patient functioning and reductions in health-related quality of life (HRQL). The present study describes the impact of MDD on patients' HRQL and examines preference-based health state differences by patient features and clinical characteristics. Methods 95 French primary care practitioners recruited 250 patients with a DSM-IV diagnosis of MDD for inclusion in an eight-week follow-up cohort. Patient assessments included the Montgomery Asberg Depression Rating Scale (MADRS), the Clinical Global Impression of Severity (CGI), the Short Form-36 Item scale (SF-36), the Quality of Life Depression Scale (QLDS) and the EuroQoL (EQ-5D). Results The mean EQ-5D utility at baseline was 0.33, and 8% of patients rated their health state as worse than death. There were no statistically significant differences in utilities by demographic features. Significant differences were found in mean utilities by level of disease severity assessed by CGI. The different clinical response profiles, assessed by MADRS, were also revealed by EQ-5D at endpoint: 0.85 for responders remitters, 0.72 for responders non-remitter, and 0.58 for non-responders. Even if HRQL and EQ-5D were moderately correlated, they shared only 40% of variance between baseline and endpoint. Conclusions Self-reported patient valuations for depression are important patient-reported outcomes for cost-effectiveness evaluations of new antidepressant compounds and help in further understanding patient compliance with antidepressant treatment

The design and construction of quality of life measures

There is growing acceptance of the need for improved outcome measures in monitoring and evaluating the impact of health care. Past emphasis on indicators of mortality and morbidity is being replaced with a greater awareness of the possibilities for measuring quality of life (QoL). This discussion paper describes some of the methodological issues which lie behind the design and construction of such measures and reviews some of the principle examples. The derivation and application of disease-specific and generic measures is documented, and the bibliography provides ready access to the main sources of reference material in this field.

Caring for children - counting the costs

Children who come into care of Local Authorities are likely to have significantly poorer health statuses than other children. Foster carers play an increasingly important role as substitute families for such children, a valuable but scarce resource that is costly to recruit and retain. Despite their status as coprofessional members of an extended social work team, foster carers are typically not paid for the work they do. Allowances intended to cover costs incurred in looking after a child are paid, but these vary widely across the country. Many foster carers receive less than £55 per week (the average kennel fees for looking after a dog), for the children in their care. The present method of calculating these allowances is based on a complex procedure which is difficult for carers to understand or challenge. A simpler method is required and this paper sets out one such costing framework. Reimbursing foster carers for their costs is only a start – increased demand for their valuable skills dictates that sooner or later they will also be rewarded for their work.Children Act, Social Services, Local Authority

Hospital deaths - the missing link: measuring outcomes in hospital activity data

Although fairly detailed information on NHS inputs can be identified, little or no corresponding data on outcomes are available to those concerned with the management and delivery of health care. The absence of any significant outcome data is a longstanding problem which has so far been largely by-passed. Non-financial systems in hospitals are directed mainly at the task of logging and tracking patients. They are designed to generate the routine administrative data which is demanded of local Health Authorities, and to enable the construction of various performance indicators. Despite this apparent restriction, it has proved possible to extract information on one health outcome – death. This Discussion Paper describes the analysis of mortality data embedded in the 1985 HIPE sample. Death rates by consultant specialty and diagnostic category are presented for 14 Regional Health Authorities. Standardised mortality rates are also listed for 192 local Health Authorities. Crude rates vary from 2.5 to 14.3 deaths per 100 admissions with a national average of 5.5. There is wide variation too in standardised mortality rates – ranging from 50% below the national average to 50% above. Proper monitoring and control of hospital services requires the measurement of outcomes. Without such measures, decision makers will continue to reply on imperfect indicators of activity and performance. The potential already exists to redress this information deficit. This paper may help to encourage such a process.HIPE sample

Measuring valuations for health states: a survey of patients in general practice

Despite growing interest in the measurement of health-related quality of life, no single means of achieving such measurement has so far emerged as a standard. Researchers from 5 European and Scandinavian countries have jointly developed a common generic measure. The Euroqol questionnaire was designed as a self-administered instrument to complement other forms of quality of life measurement. A postal survey of some 1300 patients in General Practice was carried out to check the feasibility of collecting valuations for health states using the Euroqol questionnaire. This paper describes the results of that survey which revealed significant differences in values for more severe health states, particularly associated with respondents’ level of educational achievement.Euroqol questionnaire

Subjective well-being and its association with subjective health status, age, sex, region, andsSocio-economic characteristics in a chinese population study

This study analyse how subjective well-being (SWB) in a Chinese population varies with subjective health status, age, sex, region and socio-economic characteristics. In the Household Health Survey 2010, face-to-face interviews were carried out in urban and rural counties in eastern, middle and western areas of China (n = 8,000, aged 15–102 years). To measure subjective health status, a global self-rated health question, the EQ-5D descriptive system, and a visual analogue scale of health status was included. To measure SWB, a validated Chinese version of a question on self-reported happiness, adopted from the World Values Survey, was included. SWB increased with socio-economic status (income and education), and was lower among unemployed individuals and divorced individuals. SWB also increased strongly with subjective health status. When health status was divided into different dimensions using the EQ-5D, the anxiety/depression dimension was the most important dimension for SWB. The reported SWB was also higher in rural counties than in urban counties in the same area, after controlling for socio-economic characteristics and subjective health statusThe Swedish Research Council (Swedish Research Links Programme 348-2009-6538Karolinska Institutet’s Research Foundation Grantsish Research Links Programme 348-2009-6538), Karolinska Institutet’s Research Foundation Grants and the National Natural Science Foundation of China (Project 70873064).Publishe

CT Scanning in a District General Gospital: A primer for planning & management

This document is intended as a use guide for individuals and groups concerned with planning for and management of a CT scanner in a district general hospital.