Developing accessible, pictorial versions of health-related quality of life instruments suitable for economic evaluation: a report of preliminary studies conducted in Canada and the United Kingdom

A key component of the current framework for economic evaluation is the measurement and valuation of health outcomes using generic preference-based health-related quality of life (HRQoL) instruments. In 2015, a research synthesis reported the absence of conceptual and empirical research regarding the appropriateness of current preference-based instruments for people with aphasia – a disorder affecting the use and understanding of language – and suggested the development and validation of an accessible, pictorial variant could be an appropriate direction for further research. This paper describes the respective rationale and development process for each of three preliminary studies that have been undertaken to develop pictorial variants of two widely-used preference-based HRQoL instruments (EQ-5D-3L and EQ-5D-5L). The paper also proposes next steps for this program of research, drawing on the lessons learned from the preliminary work and the demand for a pictorial preference-based instrument in the research community. Guidance for the use of the preliminary, pictorial instruments is also provided

Exploring psychometric properties of the SF-6D, a preference-based health-related quality of life measure, in the context of spinal cord injury

PURPOSE: The validity of the SF-6D, a preference-based measure of health-related quality of life, is not well explored in the context of spinal cord injury (SCI). The aim of this analysis was to assess appropriate measurement properties of the SF-6D in a sample of individuals living with SCI. METHODS: Longitudinal data from the Rick Hansen Spinal Cord Injury Registry were used. Responses to the 36-item short-form health survey were transformed into SF-6D utility scores. We investigated practicality, floor and ceiling effects, and responsiveness to change. Responsiveness to change was explored using three different anchors that reflected changes in self-reported health, functional independence, and life satisfaction. Discriminative validity was assessed by ten a priori defined hypotheses, with a distinction made between \u27strong\u27 and \u27weak\u27 hypotheses. RESULTS: Three hundred and fifty-eight individuals with SCI were included in this analysis. Practicality was deemed acceptable based on a completion rate of 94%. The SF-6D showed low responsiveness to detect important health changes over time, and differences in responsiveness were found between individuals with paraplegia and tetraplegia. All five strong hypotheses and three weak hypotheses were confirmed. CONCLUSION: The SF-6D demonstrated good practicality and discriminative validity in this sample. The failure to detect self-reported and clinically important health changes requires further consideration. Comparative performance of the SF-6D (i.e., how the SF-6D performs against other preference-based measures) is unknown in the SCI context and requires further research

A brief pain management program compared with physical therapy for low back pain: results from an economic analysis alongside a randomized clinical trial

Objective: guidelines for the management of acute low back pain in primary care recommend early intervention to address psychosocial risk factors associated with long-term disability. We assessed the cost utility and cost effectiveness of a brief pain management program (BPM) targeting psychosocial factors compared with physical therapy (PT) for primary care patients with low back pain of <12 weeks' duration.Methods: a total of 402 patients were randomly assigned to BPM or PT. We adopted a health care perspective, examining the direct health care costs of low back pain. Outcome measures were quality-adjusted life years (QALYs) and 12-month change scores on the Roland and Morris disability questionnaire. Resource use data related to back pain were collected at 12-month followup. Cost effectiveness was expressed as incremental ratios, with uncertainty assessed using cost-effectiveness planes and acceptability curves.Results: there were no statistically significant differences in mean health care costs or outcomes between treatments. PT had marginally greater effectiveness at 12 months, albeit with greater health care costs (BPM £142, PT £195). The incremental cost-per-QALY ratio was £2,362. If the UK National Health Service were willing to pay £10,000 per additional QALY, there is only a 17% chance that BPM provides the best value for money.Conclusion: PT is a cost-effective primary care management strategy for low back pain. However, the absence of a clinically superior treatment program raises the possibility that BPM could provide an additional primary care approach, administered in fewer sessions, allowing patient and doctor preferences to be consider

Estimation of a Canadian preference-based scoring algorithm for the Veterans RAND 12-item Health Survey (VR-12): a population survey using a discrete choice experiment

Background: The Veterans RAND 12-item Health Survey (VR-12) is a generic patient-reported outcome measure derived from the widely used SF-36 and SF-12 instruments. The objective of this study was to estimate a Canadian preference-based scoring algorithm for the VR-12, enabling the derivation of health utility values for generating quality-adjusted life years (QALYs). Methods: A discrete choice experiment (DCE) was conducted in a sample of the Canadian population between January and February 2019. Participants—recruited from a consumer research panel—completed an online survey, in English or French, that included 11 DCE questions, each comprising two health profiles. Health profiles were defined using eight VR-12 items and a duration attribute. Using conditional logit regressions, where each level of the respective VR-12 items was interacted with duration, the coefficients were used to estimate health utility values interpretable on a zero (dead) to one (full health) scale. Negative values reflect states considered worse than dead. Results: The survey was completed by 3380 individuals. Across all models, ‘feel downhearted and blue all of the time’ and ‘pain interferes with your normal work extremely’ were associated with the largest health utility decrements. Excluding respondents who provided inconsistent responses (20.3%) had a negligible impact on the results. The recommended model, weighted to match population demographics, has health utility values ranging from -0.589 to 1.000. Interpretation: Health utility values that reflect the preferences of the Canadian population can now be derived from responses to the VR-12. These values can be used to generate QALYs in future analyses