Wee Hwee-Lin, Machin David, Loke Wai-Chiong, Li Shu-Chuen, Cheung Yin-Bun, Luo Nan, Feeny David, Fong Kok-Yong, Thumboo Julian
Singapore General Hospital, Singapore.
Value Health. 2007 Jul-Aug;10(4):256-65. doi: 10.1111/j.1524-4733.2007.00174.x.
To characterize the differences in utility scores (dUTY) among four commonly used preference-based Health-Related Quality of Life instruments, to evaluate the potential impact of these differences on cost-utility analyses (CUA), and to determine if sociodemographic/clinical factors influenced the magnitude of these differences.
Consenting adult Chinese, Malay and Indian subjects in Singapore were interviewed using Singapore English, Chinese, Malay or Tamil versions of the EQ-5D, Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3), and SF-6D. Agreement between instruments was assessed using Bland-Altman (BA) plots. Changes in incremental cost-utility ratio (ICUR) from dUTY were investigated using eight hypothetical decision trees. The influence of sociodemographic/clinical factors on dUTY between instrument pairs was studied using multiple linear regression (MLR) models for English-speaking subjects (circumventing structural zero issues).
In 667 subjects (median age 48 years, 59% female), median utility scores ranged from 0.80 (95% confidence interval [CI] 0.80, 0.85) for the EQ-5D to 0.89 (95% CI 0.88, 0.89) for the SF-6D. BA plots: Mean differences (95% CI) exceeded the clinically important difference (CID) of 0.04 for four of six pairwise comparisons, with the exception of the HUI2/EQ-5D (0.03, CI: 0.02, 0.04) and SF-6D/HUI2 (0.02, CI: 0.006, 0.02). Decision trees: The ICER ranged from $94,661/QALY (quality-adjusted life-year; 6.3% difference from base case) to 100,693 dollars/QALY (0.3% difference from base case). MLR: Chronic medical conditions, marital status, and Family Functioning Measures scores significantly (P-value < 0.05) influenced dUTY for several instrument pairs.
Although CIDs in utility measurements were present for different preference-based instruments, the impact of these differences on CUA appeared relatively minor. Chronic medical conditions, marital status, and family functioning influenced the magnitude of these differences.
描述四种常用的基于偏好的健康相关生活质量工具在效用得分（dUTY）上的差异，评估这些差异对成本效用分析（CUA）的潜在影响，并确定社会人口统计学/临床因素是否会影响这些差异的大小。
使用新加坡英语、中文、马来语或泰米尔语版本的EQ-5D、健康效用指数Mark 2（HUI2）、Mark 3（HUI3）和SF-6D，对新加坡同意参与的成年华裔、马来裔和印度裔受试者进行访谈。使用Bland-Altman（BA）图评估工具之间的一致性。使用八个假设决策树研究dUTY导致的增量成本效用比（ICUR）的变化。使用多元线性回归（MLR）模型研究社会人口统计学/临床因素对工具对之间dUTY的影响（避免结构零问题）。
在667名受试者（中位年龄48岁，59%为女性）中，中位效用得分范围从EQ-5D的0.80（95%置信区间[CI]0.80，0.85）到SF-6D的0.89（95%CI 0.88，0.89）。BA图：六个两两比较中有四个的平均差异（95%CI）超过了0.04的临床重要差异（CID），HUI2/EQ-5D（0.03，CI：0.02，0.04）和SF-6D/HUI2（0.02，CI：0.006，0.02）除外。决策树：ICER范围从94,661美元/QALY（质量调整生命年；与基础情况相差6.3%）到100,693美元/QALY（与基础情况相差0.3%）。MLR：慢性疾病、婚姻状况和家庭功能测量得分对几个工具对的dUTY有显著影响（P值<0.05）。
虽然不同的基于偏好工具在效用测量中存在CID，但这些差异对CUA的影响似乎相对较小。慢性疾病、婚姻状况和家庭功能影响了这些差异的大小。
