生命质量量表EQ-5D与SF-6D的比较

目的:了解欧洲五维健康量表(EQ-5D)和六维度健康调查简表(SF-6D)之间的差异及适用范围,以期为我国药物经济学评价成本-效用分析中测量的工具选择及使用提供参考。方法:通过对该两量表进行比较研究,从维度结构、信息性、偏好估算方法、效用值计算公式和量表的可操作性进行对比分析。结果:两量表具有差异性及重叠性。结论:SF-6D在较为温和的疾病中,对活力影响较高容易使人疲惫的疾病中可能较为适用,调查对象最好具备一定的文化及理解能力。EQ-5D在较差的健康状态中可能较为适用且操作容易。     

近10年成本-效用分析中EQ-5D与SF-6D应用现状的文献计量研究：基于PubMed数据库

目的:分析欧洲5维健康量表(EQ-5D)与6维健康调查短表(SF-6D)在成本-效用分析研究中的应用现状。方法:以PubMed数据库为数据源对2003—2012年发表的相关文献进行文献计量分析。结果:近10年应用EQ-5D与SF-6D进行成本-效用分析的文献量未呈一定的增长趋势,主要的发表语言为英语,主要国家为英国。已形成6种核心期刊,核心作者尚未形成。文献所涉及的疾病分布广泛,且主要是运动系统和疼痛类疾病。效用绝大多数采用质量调整生命年表示,成本-效用分析的评价对象主要集中于药物、手术和健康干预3种。结论:应用EQ-5D与SF-6D进行成本-效用分析的文献及文献所研究内容分布范围均较广,虽然已经呈现出集中趋势,但未形成核心,有待于相关领域学者开展广泛的研究。     

CHU9D与EQ-5D-Y量表评估急性淋巴细胞白血病患儿健康效用值比较

目的探讨儿童健康效用9维(CHU9D)量表和欧洲生命质量学会5维量表-青少年版(EQ-5D-Y),评估急性淋巴细胞白血病(ALL)患儿健康效用值的一致性及相关性。方法选择2020年4月至2021年4月,于青海大学附属医院诊疗的85例ALL患儿(8~14岁)为研究对象。对其先采用EQ-5D-Y,间隔3 d,再采用CHU9D量表进行问卷调查,分别计算2个量表的健康效用值,评估患儿健康相关生命质量(HRQoL)。采用独立样本t检验或单因素方差分析,对受试儿的不同人口统计学变量及健康状况,采用上述2个量表的健康效用值进行统计学比较;分别采用同类相关系数(ICC)及绘制Bland-Altman散点图,评估纳入研究患儿2个量表健康效用值的一致性水平及一致性限度;采用Pearson相关性分析法,分别对2个量表的健康效用值相关性、各维度之间相关性进行分析。本研究通过青海大学附属医院伦理委员会批准(审批文号:QHG0223A),征得患儿及其监护人知情同意,并签署临床研究知情同意书。结果①2个量表评估均显示:男性、来自双亲家庭、家庭年收入≥10万元及健康状况好患儿的健康效用值,分别高于女性、来自单亲家庭(离异)、家庭年收入≤5万元及健康状况中等者,并且差异均有统计学意义(P均<0.05)。②本研究纳入患儿2个量表评估的健康效用值呈正相关关系(r=0.659,P<0.001)。对于EQ-5D-Y量表健康效用值≤0.3和健康效用值为1.0的患儿,其CHU9D量表健康效用值显著偏低,并且差异均有统计学意义(P<0.05)。③本研究纳入患儿EQ-5D-Y和CHU9D量表评估的健康效用值分别为(0.780±0.160)和(0.755±0.164),ICC为0.793(95%CI:0.682~0.866,P<0.001)。Bland-Altman分析显示,EQ-5D-Y与CHU9D量表健康效用值差值的平均值为-0.02,差值的绝对值最大为0.29。④2个量表的"疼痛"维度具有最高相关性(r=0.697);EQ-5D-Y量表的"焦虑或压抑"维度,分别与CHU9D量表的"伤心"维度(r=0.614)与"发愁"维度(r=0.596)相关性均较高。EQ-5D-Y量表的"自我照顾""日常活动"维度,分别与CHU9D量表的9个维度相关性均较差(r=0.109~0.459)。结论2个量表均可被用于评估ALL患儿HRQoL。CHU9D量表对健康效用值变化更敏感,并且2个量表不可相互替代。     

SF-6D量表不同国家和地区效用积分体系的比较

多属性效用量表已成为主要的健康效用值测量工具。尽管六维健康调查简表(SF-6D)在国内的应用日益增多,但各个国家不同的积分体系,影响到效用值的测量。为促进SF-6D量表在国内的进一步应用,文章简要梳理了当前各个国家和地区的SF-6D积分体系,包括描述系统的差异、积分体系构建过程和所用模型的比较,最后对各个国家和地区的SF-6D积分体系的局限和应用前景进行了展望,这将为国内开展经济学评价研究,尤其是效用值测量和成本-效用分析提供基础支持。     

基于EQ-5D-3L和ICECAP-A量表的我国普通人群生命质量研究

目的:分析EQ-5D-3L和ICECAP-A量表评价我国普通人群生命质量的差异以及对干预方案价值评价的影响,为研究者选择合适的生命质量测量工具提供参考。方法:采用配额抽样选取802名受访者进行生命质量评价,并分别采用因子分析、多分格相关性和Bland-Altman plot一致性分析等方法探讨两量表测量结果的差异。结果:Wilcoxon秩和检验表明EQ-5D-3L量表的健康效用均值高于ICECAP-A量表的测量结果;ICECAP-A量表五个维度均主要加载于反映社会心理健康的因子1,而EQ-5D-3L量表的大部分维度主要加载于反映生理健康的因子2。部分维度之间也存在显著的相关性,但均较弱。两量表效用值的ICC为0.32,一致性分析显示5.74%的受访者超出了95%的一致性界限。结论:前者的测量内涵是健康相关生命质量,而后者则反映的是幸福感、可行能力等更广义的生命质量,其对于旨在提升公众广义幸福感和社会福祉的干预措施效果评估方面具有较好的适用性。研究者可根据测量目的及量表属性选择合适的量表,鉴于两个量表在测量内涵中的互补性,也可以在研究中同时采用两种量表以便更全面地反映干预措施的效果或受访者的生命质量。     

EQ-5D-3L两种积分效用体系对成都市城镇居民的适用性评价

目的通过比较英国与中国EQ-5D-3L两种积分效用体系对成都市城镇居民生命质量健康效用值的评价,探讨两种体系对研究对象的适用性。方法用EQ-5D量表测量患者的生命质量,数据用SPSS 19.0进行统计分析。结果通过spearmen相关矩阵分析得出两种积分体系具有高度的相关性,所得健康指数的分布均为偏态分布,但是相较于英国的积分体系,中国积分体系模型拟合优度的R2、F值比英国高,且AIC值与BIC值低于英国。结论相比于英国的效用积分体系,我国的积分体系对研究人群健康效用评价有更好的适用性。     

SF系列量表演变及SF-6D多属性效用量表的介绍

多属性效用量表已成为主要的健康效用值测量工具。尽管六维健康调查简表(SF-6D)在国内的应用日益增多,但缺乏对SF系列量表如何演变为SF-6D多属性效用量表的相关介绍。为促进SF-6D量表在国内的进一步应用,首先简要梳理了SF系列量表的演变,包括SF-18、SF-20、SF-36、SF-12以及SF-8等量表;然后介绍了SF-6D量表的健康状态描述系统和效用积分体系评分;最后对SF-6D量表在国内外的应用进行了总结,并对应用前景进行了展望。这将为国内开展经济学评价研究,尤其是效用值测量和成本–效用分析提供基础支持。     

六维健康状态分类系统SF-6D介绍及研究现状

六维健康状态分类系统(SF-6D)是常用的健康效用测量方法之一。文章系统介绍SF-6D并概述其在国际上最新的研究及应用进展。相较于欧洲五维健康量表,SF-6D在某些疾病领域测量患者效用值时效度更高、结果更可靠。另一方面,可通过转化文献报导的简明健康状况调查问卷(SF-36)的调查结果来估计SF-6D效用值。用此方法估计患者健康效用值将最大化使用现有的SF-36数据,进而极大节省药物经济学研究成本,但此转化模型是否适合国内研究还有待进一步验证。     

中国四地城乡居民生命质量的比较分析

目的:应用中国大样本人群调查的EQ-5D量表,对中国城乡居民的生命质量进行多维测量与比较分析。方法:按年龄和性别配额进行抽样,对沈阳、北京、成都和南京睦个地区的城乡居民进行生命质量相关问卷的入户调查。使用基于中国人群偏好的效用值积分体系,将测量的健康结果转换成健康效用值,对不同类别居民的健康效用值、EQ-5D量表及其天花板效应进行系统分析。结果:描述统计显示,样本地居民的健康效用均值为0.951,区间为[0.364,1];其中,城市居民和农村居民的健康效用均值分别为0.955和0.948。在全样本中,城乡居民分别有20.0%和12.7%的人具有不同程度的疼痛或不舒服和焦虑或抑郁问题。在16岁~34岁亚组人群中,最主要的健康问题是焦虑或抑郁,35岁及以上的人群逐渐面临疼痛或不舒服的健康问题。进一步的计量模型分析显示,在控制其他影响因素后,农村居民比城市居民处于完全健康的概率高5.4个百分点,农村居民在疼痛或不舒服和焦虑或抑郁两个维度处于健康的概率也高于城市居民,但在行动、自我照顾和日常生活3个维度上,农村居民的健康概率低于城市居民。结论:样本地城乡居民的健康效用均值相近,但农村居民在疼痛或不舒服、焦虑或抑郁维度处于优势,城市居民在行动、自我照顾和日常生活维度处于优势。     

两种常用EQ-5D量表效用值积分体系的比较及其对成本效用分析结果的影响探讨

我国尚没有开发基于我国人群偏好的EQ-5D量表效用值积分体系,目前采用该量表进行的成本效用分析大多是以英国及日本的积分体系计算健康状态效用值。文章通过分析这两种体系对量表中所有状态的预测效用值发现,相比日本的结果,采用英国积分体系所得的效用值较低,且当其用于成本效用分析时更倾向于接受成本较高效用值也较高的治疗方案。研究人员在比较不同研究结果时应充分关注因使用不同积分体系而产生的差异,同时认为鉴于该体系与各国文化背景紧密相连,应尽早开发适合我国人群的EQ-5D量表效用值积分体系。     

Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D

Background: The SF-6D and EQ-5D are both preference-based measures of health. Empirical work is required to determine what the smallest change is in utility scores that can be regarded as important and whether this change in utility value is constant across measures and conditions. Objectives: To use distribution and anchor-based methods to determine and compare the minimally important difference (MID) for the SF-6D and EQ-5D for various datasets. Methods: The SF-6D is scored on a 0.29–1.00 scale and the EQ-5D on a −0.59–1.00 scale, with a score of 1.00 on both, indicating ‘full health’. Patients were followed for a period of time, then asked, using question 2 of the SF-36 as our anchor, if their general health is much better (5), somewhat better (4), stayed the same (3), somewhat worse (2) or much worse (1) compared to the last time they were assessed. We considered patients whose global rating score was 4 or 2 as having experienced some change equivalent to the MID. This paper describes and compares the MID and standardised response mean (SRM) for the SF-6D and EQ-5D from eight longitudinal studies in 11 patient groups that used both instruments. Results: From the 11 reviewed studies, the MID for the SF-6D ranged from 0.011 to 0.097, mean 0.041. The corresponding SRMs ranged from 0.12 to 0.87, mean 0.39 and were mainly in the ‘small to moderate’ range using Cohen’s criteria, supporting the MID results. The mean MID for the EQ-5D was 0.074 (range −0.011–0.140) and the SRMs ranged from −0.05 to 0.43, mean 0.24. The mean MID for the EQ-5D was almost double that of the mean MID for the SF-6D. Conclusions: There is evidence that the MID for these two utility measures are not equal and differ in absolute values. The EQ-5D scale has approximately twice the range of the SF-6D scale. Therefore, the estimates of the MID for each scale appear to be proportionally equivalent in the context of the range of utility scores for each scale. Further empirical work is required to see whether or not this holds true for other utility measures, patient groups and populations.     

An investigation into the empirical validity of the EQ-5D and SF-6D based on hypothetical preferences in a general population

BACKGROUND: An important consideration for studies that derive utility scores using multi-attribute utility measures is the psychometric integrity of the measurement instrument. Of particular importance is the requirement to establish the empirical validity of multi-attribute utility measures; that is, whether they generate utility scores that, in practice, reflect people's preferences. We compared the empirical validity of EQ-5D versus SF-6D utility scores based on hypothetical preferences in a large, representative sample of the English population. METHODS: Adult participants in the 1996 Health Survey for England (n=16 443) formed the basis of the investigation. The subjects were asked to complete the EQ-5D and SF-36 measures. Their responses were converted into utility scores using the York A1 tariff set and the SF-6D utility algorithm, respectively. One-way analysis of variance was used to test the hypothetically constructed preference rule that each set of utility scores differs significantly by self-reported health status (categorised as very good, good, fair, bad or very bad). The degree to which EQ-5D and SF-6D utility scores reflect alternative configurations of self-reported health status; illness, disability or infirmity, and medication use was tested using the relative efficiency statistic and receiver operating characteristic (ROC) curves. RESULTS: The mean utility score for the EQ-5D was 0.845 (95% CI: 0.842, 0.849), whilst the mean utility score for the SF-6D was 0.799 (95% CI: 0.797, 0.802), representing a mean difference in utility score of 0.046 (95% CI: 0.044, 0.049; p<0.001). Bland-Altman plots displayed considerable lack of agreement between the two measures, particularly at the lower end of the utility scale. Both measures demonstrated statistically significant differences between subjects who described their health status as very good, good, fair, bad or very bad (p<0.001), as well as monotonically decreasing utility scores (test for linear trend: p<0.001). The SF-6D was between 30.9 and 100.4% more efficient than the EQ-5D at detecting differences in self-reported health status, and between 10.4 and 45.6% more efficient at detecting differences in illness, disability or infirmity and medication use. The area under the curve scores generated by the ROC curves were significantly higher for the SF-6D at the 0.1% significance level when self-reported health status was dichotomised as very good versus good, fair, bad or very bad. However, the AUC scores did not reveal any significant differences in the discriminatory powers of the measures when alternative configurations of illness, disability or infirmity and medication use were examined. CONCLUSIONS: This study provides evidence that the SF-6D is an empirically valid and efficient alternative multi-attribute utility measure to the EQ-5D, and is capable of discriminating between external indicators of health status. However, health economists should also consider other psychometric properties, such as practicality and reliability, when selecting either measure for evaluative purposes.     

Estimating health utilities in patients with asthma and COPD: evidence on the performance of EQ-5D and SF-6D

Objective  The objective of this study was to understand systematic differences in utility values derived from the EQ-5D and the SF-6D in two respiratory populations with heterogeneous disease severity. Methods  This study involved secondary analysis of data from two cross-sectional surveys of patients with asthma (N = 228; Hungary) and COPD (N = 176; Sweden). Disease severity was defined according to GINA and GOLD guidelines for asthma and COPD, respectively. EQ-5D and SF-6D scores and their distributional characteristics were compared across the two samples by disease severity level. Results  Within each patient population, mean EQ-5D and SF-6D scores were similar for the overall group and for those with moderate disease. Mean scores varied for patients with mild and severe disease. EQ-5D versus SF-6D scores in the asthma group by severity levels were 0.89 versus 0.80, 0.70 versus 0.73, 0.63 versus 0.64, and 0.51 versus 0.63, respectively. EQ-5D versus SF-6D scores in the COPD group by severity levels were 0.85 versus 0.80, 0.73 versus 0.73, 0.74 versus 0.73, and 0.53 versus 0.62, respectively. Conclusions  Results suggest the EQ-5D and SF-6D do not yield consistent utility values in patients with asthma and COPD due to differences in underlying valuation techniques and the EQ-5D’s limited response options relative to mild disease.     

Mapping the Cancer-Specific EORTC QLQ-C30 to the Preference-Based EQ-5D, SF-6D, and 15D Instruments

Objectives:  To estimate models, via ordinary least squares regression, for predicting Euro Qol 5D (EQ-5D), Short Form 6D (SF-6D), and 15D utilities from scale scores of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30).
Methods:  Forty-eight gastric cancer patients, split up into equal subgroups by age, sex, and chemotherapy scheme, were interviewed, and the survey included the QLQ-C30, SF-36, EQ-5D, and 15D instruments, along with sociodemographic and clinical data. Model predictive ability and explanatory power were assessed by root mean square error (RMSE) and adjusted R ² values, respectively. Pearson's r between predicted and reported utility indices was compared. Three random subsamples, half in size the initial sample, were created and used for "external" validation of the modeling equations.
Results:  Explanatory power was high, with adjusted R ² reaching 0.909, 0.833, and 0.611 for 15D, SF-6D, and EQ-5D, respectively. After normalization of RMSE to the range of possible values, the prediction errors were 12.0, 5.4, and 5.6% for EQ-5D, SF-6D, and 15D, respectively. The estimation equations produced a range of utility scores similar to those achievable by the standard scoring algorithms. Predicted and reported indices from the validation samples were comparable thus confirming the previous results.
Conclusions:  Evidence on the ability of QLQ-C30 scale scores to validly predict 15D and SF-6D utilities, and to a lesser extent, EQ-5D, has been provided. The modeling equations must be tried in future studies with larger and more diverse samples to confirm their appropriateness for estimating quality-adjusted life-year in cancer-patient trials including only the QLQ-C30.     

Comparison of EQ-5D and SF-6D utilities in mental health patients

Various preference-based measures of health are available for use as an outcome measure in cost-utility analysis. The aim of this study is to compare two such measures EQ-5D and SF-6D in mental health patients. Baseline data from a Dutch multi-centre randomised trial of 616 patients with mood and/or anxiety disorders were used. Mean and median EQ-5D and SF-6D utilities were compared, both in the total sample and between severity subgroups based on quartiles of SCL-90 scores. Utilities were expected to decline with increased severity.Both EQ-5D and SF-6D utilities differed significantly between patients of adjacent severity groups. Mean utilities increased from 0.51 at baseline to 0.68 at 1.5 years follow-up for EQ-5D and from 0.58 to 0.70 for SF-6D. For all severity subgroups, the mean change in EQ-5D utilities as well as in SF-6D utilities was statistically significant. Standardised response means were higher for SF-6D utilities. We concluded that both EQ-5D and SF-6D discriminated between severity subgroups and captured improvements in health over time. However, the use of EQ-5D resulted in larger health gains and consequent lower cost-utility ratios, especially for the subgroup with the highest severity of mental health problems.     

An empirical comparison of EQ-5D and SF-6D in liver transplant patients

There remains disagreement about the preferred utility-based measure of health-related quality of life for use in constructing quality-adjusted life years (QALYs). The recent development of a new measure, the SF-6D, has highlighted this issue. The SF-6D and EuroQol EQ-5D measure health-related utilities on a scale where 0 represents death and 1 represents full health, and both have utility scores generated from random samples of the general UK population. This study explored whether, in a large sample of liver transplant patients, the two instruments provide similar results. The empirical data highlight important variation in the results generated from the use of the two instruments. The data are consistent with a view that the SF-6D does not describe health states at the lower end of the utility scale but is more sensitive than EQ-5D in detecting small changes towards the top of the scale.     

Validation and Comparison of EuroQol and Short Form 6D in Chronic Prostatitis Patients

ObjectiveGeneric, preference-based health-related quality of life (HRQoL) instruments is increasingly used in health-care decision-making process. However, to our knowledge, no such HRQoL instrument has been validated or used in chronic prostatitis. We therefore aimed to assess and compare the psychometric properties of EuroQol (EQ-5D) and Short Form 6D (SF-6D) among chronic prostatitis patients in China.MethodsConsenting patients were interviewed using EQ-5D and SF-6D. Convergent and discriminative construct validities were examined with five and two a priori hypotheses, respectively. Sensitivity was compared using receiver operating characteristic (ROC) curves and relative efficiency (RE) statistics. Agreement between instruments was assessed with intra-class correlation coefficients and Bland–Altman plot, while factors affecting utility difference were explored with multiple liner regression models.ResultsIn 268 subjects, mean (SD) EQ-5D and SF-6D utility scores were comparable at 0.73 (0.15) and 0.75 (0.10), respectively. Five of the seven hypotheses for construct validity were fulfilled in both instruments. The areas under ROC of them all exceeded 0.5 (P < 0.001). SF-6D had 9.7–19.9% higher efficiency than EQ-5D at detecting the difference in chronic prostatitis symptom severity. Despite no significant difference in utility scores between two instruments, lack of agreement was observed with low intraclass correlation coefficient (0.218–0.630) and Bland–Altman plot analysis. Chronic prostatitis symptom severity significantly (P < 0.05) influenced differences in utility scores between EQ-5D and SF-6D.ConclusionsBoth EQ-5D and SF-6D are demonstrated to be valid and sensitive HRQoL measures in Chinese chronic prostatitis patients, with SF-6D showing better HRQoL dimension coverage, greater sensitivity, lower ceiling effect, and more rational distribution. Further research is needed to determine longitudinal response and reliability.     

A comparison of the performance of the EQ-5D and SF-6D for individuals aged >or= 45 years

We sought to compare the performance of the EQ-5D and SF-6D with regard to the criteria of practicality, convergent validity, and construct validity, the level of agreement between the two measures was also assessed. Responses from 1865 individuals aged >or= 45 years in one general practice were analysed. Of these, 93.1% completed the EQ-5D, compared with 86.4% for the SF-6D, where individuals who were older, female, of a lower occupational skill level, from an area of lower deprivation, or used prescribed medication were significantly less likely to complete the SF-6D. The performance of both measures was comparable with regard to both convergent and construct validities, as both the EQ-5D and SF-6D scores were closely related to scores on the EuroQol visual analogue scale (VAS) (p<0.001) and able to discriminate between people who did and did not take: (i) analgesics and (ii) other prescribed medication. Despite EQ-5D and SF-6D scores being highly correlated (p<0.001), individuals who were healthier (according to the VAS) had higher mean scores on the EQ-5D (p<0.001), whereas less healthy individuals had higher mean scores on the SF-6D (individuals with knee pain, osteoarthritis, back pain, rheumatoid arthritis, and hip pain had significantly lower mean scores on the EQ-5D, p<0.001).