Examining the impact of 11 long-standing health conditions on health-related quality of life using the EQ-5D in a general population sample

Objectives Health-related quality of life (HRQoL) measures have been increasingly used in economic evaluations for policy guidance. We investigate the impact of 11 self-reported long-standing health conditions on HRQoL using the EQ-5D in a UK sample. Methods We used data from 13,955 patients in the South Yorkshire Cohort study collected between 2010 and 2012 containing the EQ-5D, a preference-based measure. Ordinary least squares (OLS), Tobit and two-part regression analyses were undertaken to estimate the impact of 11 long-standing health conditions on HRQoL at the individual level. Results The results varied significantly with the regression models employed. In the OLS and Tobit models, pain had the largest negative impact on HRQoL, followed by depression, osteoarthritis and anxiety/nerves, after controlling for all other conditions and sociodemographic characteristics. The magnitude of coefficients was higher in the Tobit model than in the OLS model. In the two-part model, these four long-standing health conditions were statistically significant, but the magnitude of coefficients decreased significantly compared to that in the OLS and Tobit models and was ranked from pain followed by depression, anxiety/nerves and osteoarthritis. Conclusions Pain, depression, osteoarthritis and anxiety/nerves are associated with the greatest losses of HRQoL in the UK population. The estimates presented in this article should be used to inform economic evaluations when assessing health care interventions, though improvements can be made in terms of diagnostic information and obtaining longitudinal data

Changing healthcare utilization patterns in diabetes mellitus: case-control studies 1 year and 8 years after diagnosis

Aim: To analyse how healthcare utilisation, healthcare costs and health-related quality of life (HRQoL) differ for individuals with diabetes compared to control individuals from the general population and how these differences are associated with disease duration and changes in the health care over time. A further aim was to explore diabetes care from an equity perspective. Methods: The research was based on four cohorts with disease durations of 1, 8, 15 or 24 years. These cohorts were selected from the Diabetes Incidence Study in Sweden, which registers all incident cases of diabetes in the age group 15 to 34 years, the majority Type 1 and insulin-treated. Control individuals were selected from the population register matched by age, sex and county of residence. In January 2008, a survey questionnaire was mailed by post to the 1983, 1992 and 1999 cohorts and their matching control groups. In 2009, the same survey questionnaire was quarterly sent to the 2008 cohort and to matching controls. The overall response rates were 54% (n=864) for individuals with diabetes and 51% (n=1616) for control individuals. Results: Higher utilisation of healthcare services by patients with diabetes compared to control individuals, and the necessary medication, led to an annual excess costs of 40 000 to 50 000 Swedish crowns per patient with no significant differences among the four cohorts. The costs of health care for women (in both the diabetes groups and the control groups) were almost double the costs for men in most cohorts. Living with diabetes had a negative impact on HRQoL and the difference to control individuals increased by disease duration for women with diabetes. However, there were no significant differences between individuals with diabetes 1 year after diagnosis and the control individuals, which may be related to good early management of diabetes care and an early adaptation to the disease. Compared to a previous study conducted in the early 1990s, excess costs increased mainly due to the greater use of insulin pumps and insulin analogues. Utilisation patterns for patients with diabetes were stable except for a significant decrease in hospital inpatient care 1 year after diagnosis (60% to 13%), and an increase in daycare 8 years after diagnosis (11% to 44%). The excess costs 1 year after diagnosis were similar whereas excess costs 8 years after diagnosis more than doubled, but while the largest proportion of costs in 2009 was for hospital outpatient care, 16 years earlier most costs were for hospital inpatient care. In line with the results from the previous study, the largest proportion of costs 8 years after diagnosis were attributable to insulin treatment and monitoring of blood glucose, followed by the costs for hospital outpatient care. Conclusions: Individuals with diabetes seem to lead rather unrestricted lives with less hospital inpatient care and a higher degree of self-management than 16 years earlier. However, the findings indicate that healthcare utilisation, costs and HRQoL vary by gender and socio-economic background. In addition to having diabetes, being a women, having a low education level or low income, and not being married all had a negative effect on almost all outcome measures addressed in this thesis. Utilisation patterns, costs and HRQoL can be described and analysed by continued health services research, and may be a valuable complement to more clinically oriented research. Health services research may also provide valuable information in the formulation of future healthcare policies. In contrast to randomised controlled trials, long-term studies of diabetes populations in real-world health systems can shed light on issues of access to the healthcare systems as well as on associated equity issues

Diabetes duration and health-related quality of life in individuals with onset of diabetes in the age group 15-34 years - a Swedish population-based study using EQ-5D

Background: Diabetes with onset in younger ages affects both length of life and health status due to debilitating and life-threatening long-term complications. In addition, episodes and fear of hypoglycaemia and of long-term consequences may have a substantial impact on health status. This study aims to describe and analyse health-related quality of life (HRQoL) in individuals with onset of diabetes at the age of 15-34 years and with a disease duration of 1, 8, 15 and 24 years compared with control individuals matched for age, sex and county of residence. Methods: Cross-sectional study of 839 individuals with diabetes and 1564 control individuals. Data on socioeconomic status and HRQoL using EQ-5D were collected by a postal questionnaire. Insulin treatment was self-reported by 94% of the patients, the majority most likely being type 1. Results: Individuals with diabetes reported lower HRQoL, with a significantly lower mean EQ VAS score in all cohorts of disease duration compared with control individuals for both men and women, and with a significantly lower EQ-5D(index) for women, but not for men, 15 years (0.76, p = 0.022) and 24 years (0.77, p = 0.016) after diagnosis compared with corresponding control individuals. Newly diagnosed individuals with diabetes reported significantly more problems compared with the control individuals in the dimension usual activities (women: 13.2% vs. 4.0%, p = 0.048; men: 11.4% vs. 4.1%, p = 0.033). In the other dimensions, differences between individuals with diabetes and control individuals were found 15 and 24 years after diagnosis: for women in the dimensions mobility, self-care, usual activities and pain/discomfort and for men in the dimension mobility. Multivariable regression analysis showed that diabetes duration, being a woman, having a lower education and not being married or cohabiting had a negative impact on HRQoL. Conclusions: Our study confirms the negative impact of diabetes on HRQoL and that the difference to control individuals increased by disease duration for women with diabetes. The small difference one year after diagnosis could imply a good management of diabetes care and a relatively quick adaptation. Our results also indicate that gender differences still exist in Sweden, despite modern diabetes treatment and management in Sweden