The Relationship between Body Mass Index and Health-Related Quality of Life

Study Objectives: This paper explores the relationship between body mass index (BMI) and health-related quality of life (HRQoL), measured using EQ-5D, for men and women within a national population sample.Methods: Data were taken from the 1996 Health Survey for England, an annual survey commissioned by the UK Department of Health. HRQoL was measured using EQ-5D. Informants’ BMI was calculated from height and weight measurements collected by trained nurses. Details of any long-standing illness were also collected. Complete data was available for 11,783 cases aged 18 years or more. Main Results: There were significant differences in EQ-5D by BMI category, although the nature of the relationship between EQ-5D and BMI differed by gender. For women, significant differences in EQ-5Dindex could be observed for each BMI category, which was independent of age and the presence of long-standing illness. For men, being classified within the obese BMI range was associated with poor EQ- 5Dindex score, although this relationship disappeared after accounting for age and long-standing illness. The EQ-5D pain and mobility dimensions showed the greatest change in reported problems with increasing BMI. Analysis showed little relationship between BMI and the EQ-5D anxiety/depression dimension.Discussion: Most of the apparent relationship between BMI and HRQoL could be accounted for by age and the presence of long-standing illness. However women’s HRQoL did appear to be sensitive to their weight. Further investigation of the nature of the gender differences in the relationship between BMI and HRQoL would be useful.EQ-5D, UK, gender differences

UK population norms for EQ-5D

This discussion paper presents data from the Department of Health funded Measurement and Valuation of Health survey conducted at the Centre for Health Economics in 1993. This was a nationally representative interview survey of 3395 men and women aged 18 or over living in the UK. Amongst other things, the survey collected information on health status using the EuroQol (EQ-5D) descriptive system. The data is presented as a series of tables of age/sex population norms for the EQ-5D, for both self rated health status and weighted health state index. The tables are likely to be useful for researchers, clinicians, health care providers and policy makers, who are using EQ-5D to evaluate health care and who require baseline values for comparative purposes for monitoring population variations in health.MVH, EQ-5D

The development of a new measure of quality of life in the management of gastro-oesophageal reflux disease: the Reflux Questionnaire.

INTRODUCTION This paper reports on the development of a new measure of health-related quality of life for use among patients with gastro-oesophageal reflux disease (GORD), funded as part of the REFLUX trial. This is a large UK multi centre trial that aims to compare the clinical and cost effectiveness of minimal access surgery with best medical treatment for patients with GORD within the NHS. Method Potential items were identified via a series of interviews and focus groups carried out with patients who were receiving/had received medical or surgical treatment for GORD. The final measure consisted of 31 items covering 7 categories (Heartburn; Acid reflux; Wind; Eating and swallowing; Bowel movements; Sleep; Work, physical and social activities). The measure produced two outputs: a quality of life score (RQLS) and five Reflux symptom scores. Reliability (internal consistency), criterion validity with the SF-36 and, sensitivity to change in terms of relationship with reported change in prescribed medication were assessed amongst a sample of 794 patients recruited into the trial. RESULTS The measure was shown to be internally consistent, to show criterion validity with the SF-36 and sensitive to changes in patients use of prescribed medication at baseline and 3 month follow-up. DISCUSSION The Reflux questionnaire is a new self-administered questionnaire for use amongst patients with GORD. Initial findings suggest that the new measure is valid, reliable, acceptable to respondents and simple to administer in both a clinical and research context

Eliciting Social Preference Weights for Functional Assessment of Cancer Therapy-Lung Health States

Background: The Functional Assessment of Cancer Therapy-Lung (FACT-L) is a multidimensional measure of quality of life developed for use in the evaluation of interventions in lung cancer. Objective: To develop a set of utility weights that could be used to convert FACT-L into a single index capable of being used in the economic analysis of clinical trial data. Method: A core set of FACT-L items were valued in two versions of a 14-page postal survey of over 400 members of the UK general population. Respondents valued hypothetical FACT-L health states using a scale from 0 to 100 (worst to best health state). Respondents also valued their own health using the standard form of the EuroQol EQ-5D. Data were entered into an ordinary least squares regression model. Results: Item weights estimated in regression analysis yielded values for 10 items from the FACT-L. The summary index based on this selected set of FACT-L items has a maximum value of 0.703 and a minimum value of 0.111. Conclusion: This study demonstrates a practical method of converting a standard condition-specific measure into a form that has the requisite properties to legitimise its use in cost-utility analysis. The methodology used here is not unique to FACT-L and might be considered appropriate for use in converting similar instruments.Lung-cancer, Quality-of-life-rating-scales, Utility-measurement

Women's Employment Transitions Around Childbearing

The dynamics of women’s labour supply are examined at a crucial stage of the life-cycle. This paper uses the longitudinal employment history records for 3,893 33-year-old mothers in the 5th sweep of the 1958 National Child Development Study cohort. Models of binary recurrent events are estimated which correct for unobserved heterogeneity, using SABRE software. These models focus (a) on women’s first transition from first childbirth until the interview and (b) on all the monthly transitions. Evidence of a polarization was found between highly-educated, high-wage mothers and lower-educated, low-wage mothers.Labour Force Dynamics; Mothers' Employment Histories

A ‘new and improved’ EQ-5D valuation questionnaire?

EQ-5D, Visual analogue scale, Health state valuation,

An economic evaluation of adaptive e-learning devices to promote weight loss via dietary change for people with obesity.

BACKGROUND: The prevalence of obesity is over 25 % in many developed countries. Obesity is strongly associated with an increased risk of fatal and chronic conditions such as cardiovascular disease and type 2 diabetes. Therefore it has become a major public health concern for many economies. E-learning devices are a relatively novel approach to promoting dietary change. The new generation of devices are 'adaptive' and use interactive electronic media to facilitate teaching and learning. E-Learning has grown out of recent developments in information and communication technology, such as the Internet, interactive computer programmes, interactive television and mobile phones. The aim of this study is to assess the cost-effectiveness of e-learning devices as a method of promoting weight loss via dietary change. METHODS: An economic evaluation was performed using decision modelling techniques. Outcomes were expressed in terms of Quality-Adjusted Life-Years (QALYs) and costs were estimated from a health services perspective. All parameter estimates were derived from the literature. A systematic review was undertaken to derive the estimate of relative treatment effect. RESULTS: The base case results from the e-Learning Economic Evaluation Model (e-LEEM) suggested that the incremental cost-effectiveness ratio was approximately £102,000 per Quality-Adjusted Life-Year (QALY) compared to conventional care. This finding was robust to most alternative assumptions, except a much lower fixed cost of providing e-learning devices. Expected value of perfect information (EVPI) analysis showed that while the individual level EVPI was arguably negligible, the population level value was between £37 M and £170 M at a willingness to pay between £20,000 to £30,000 per additional QALY. CONCLUSION: The current economic evidence base suggests that e-learning devices for managing the weight of obese individuals are unlikely to be cost-effective unless their fixed costs are much lower than estimated or future devices prove to be much more effective