Stavem K
HELTEF Foundation for Health Services Research, Central Hospital of Akershus, Nordbyhagen, Norway.
Qual Life Res. 1999;8(1-2):45-54. doi: 10.1023/a:1026475531996.
The objective of the study was to evaluate the reliability, validity and responsiveness of two generic multiattribute methods for measuring utility for health states: a 15-dimensional (15D) and a five-dimensional method (EuroQol and EQ-TTO). A self-administered questionnaire with both measures was used in 59 outpatients with chronic obstructive pulmonary disease and the findings compared with standard gamble (SG) and time trade-off (TTO) utilities, spirometry and arterial blood gases. Quality of life scores were smallest for EQ-TTO (median 0.73) and highest for SG and TTO (median 0.91 and 0.95 respectively), while 15D gave intermediate values (median 0.80). The test-retest reliability over 14 days was: 15D (p = 0.90) and EQ-TTO (p = 0.73), using Spearman's rank correlation. 15D was better than EQ-TTO at discriminating between groups of patients after reported global rating of change over 12 months (P = 0.004 versus P = 0.09), indicating that 15D was more responsive. The 15D instrument has many attractive properties when compared to the EQ-TTO method, including a better reliability and responsiveness. Validity depends on validation method. The findings in this study indicate that the different utility measures measure different aspects of health-related quality of life (HRQoL). Caution should be taken when choosing utility instruments in cost-utility studies, as this can strongly influence the results.
本研究的目的是评估两种用于测量健康状态效用的通用多属性方法的可靠性、有效性和反应性：一种是15维度（15D）方法，另一种是五维度方法（欧洲五维度健康量表和欧洲五维度健康量表时间权衡法）。对59名慢性阻塞性肺疾病门诊患者使用了包含这两种测量方法的自填式问卷，并将结果与标准博弈法（SG）和时间权衡法（TTO）得出的效用、肺活量测定和动脉血气结果进行比较。欧洲五维度健康量表时间权衡法的生活质量得分最低（中位数为0.73），标准博弈法和时间权衡法的得分最高（中位数分别为0.91和0.95），而15维度方法得出的是中间值（中位数为0.80）。使用斯皮尔曼等级相关法，14天的重测信度为：15维度方法（p = 0.90）和欧洲五维度健康量表时间权衡法（p = 0.73）。在报告了12个月的总体变化评级后，15维度方法在区分患者组方面比欧洲五维度健康量表时间权衡法表现更好（P = 0.004，而P = 0.09），表明15维度方法反应性更强。与欧洲五维度健康量表时间权衡法相比，15维度方法具有许多吸引人的特性，包括更好的可靠性和反应性。有效性取决于验证方法。本研究的结果表明，不同的效用测量方法测量的是健康相关生活质量（HRQoL）的不同方面。在成本效用研究中选择效用工具时应谨慎，因为这可能会对结果产生重大影响。
