Melsop Kathryn A, Boothroyd Derek B, Hlatky Mark A
Department of Health Research and Policy, Stanford University School of Medicine, Stanford, Calif 95305-5405, USA.
Am Heart J. 2003 Jan;145(1):36-41. doi: 10.1067/mhj.2003.37.
Contemporary clinical trials commonly measure quality of life and medical costs to establish whether therapies are both effective and cost effective. Cost-effectiveness analysis, however, requires a measure of patient utility or preferences for various health states. Because utilities are not often measured directly, we sought to develop a method of translating standard quality-of-life scales into a patient utility measure.
Five hundred fifty-three patients enrolled in the Bypass Angioplasty Revascularization Investigation Study of Economics and Quality of Life completed a battery of quality-of-life measures and a time trade-off utility assessment an average of 7.3 years after random assignment.
The mean time trade-off score was 8.54 (SD = 2.53) out of a maximum of 10; median score was 9.95. The distribution of scores was skewed, with 12% of patients at the highest possible score of 10. Patients with recurrent angina had significantly lower time trade-off scores than patients without angina (mean 7.03 vs 8.70, P <.05). Time trade-off scores were moderately correlated with each quality-of-life measure (Spearman coefficients 0.38-0.52). Time trade-off scores could be predicted by combinations of 4 (r2 = 0.29), 5 (r2 = 0.31), or 6 (r2 = 0.32) variables.
Time trade-off utility scores can be inferred from commonly used quality-of-life measures. Angina significantly reduces patient utility scores.
当代临床试验通常会衡量生活质量和医疗成本，以确定治疗方法是否既有效又具有成本效益。然而，成本效益分析需要衡量患者对各种健康状态的效用或偏好。由于效用通常不是直接测量的，我们试图开发一种将标准生活质量量表转化为患者效用量度的方法。
553名参与旁路血管成形术血运重建经济学与生活质量调查研究的患者在随机分组平均7.3年后，完成了一系列生活质量测量和时间权衡效用评估。
时间权衡得分的平均值为8.54（标准差=2.53），满分10分；中位数为9.95。得分分布呈偏态，12%的患者得分为最高的10分。复发性心绞痛患者的时间权衡得分显著低于无心绞痛患者（平均7.03对8.70，P<.05）。时间权衡得分与各项生活质量测量指标呈中度相关（斯皮尔曼系数为0.38 - 0.52）。时间权衡得分可由4个（r2 = 0.29）、5个（r2 = 0.31）或6个（r2 = 0.32）变量的组合预测。
时间权衡效用得分可从常用的生活质量测量指标中推断出来。心绞痛会显著降低患者的效用得分。
