McCrone Paul, Patel Anita, Knapp Martin, Schene Aart, Koeter Maarten, Amaddeo Francesco, Ruggeri Mirella, Giessler Anne, Puschner Bernd, Thornicroft Graham
Health Services and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK.
J Ment Health Policy Econ. 2009 Mar;12(1):27-31.
Economic evaluations of healthcare interventions increasingly measure outcomes using quality-adjusted life years (QALYs). The SF-6D and the EQ-5D are alternative ways of generating utility scores for use in QALY estimations, but it is unclear which is most sensitive to change in psychiatric symptom severity. There are also limited data on the sensitivity of these measures to changes in existing clinical indicators in long-term mental health conditions like schizophrenia.
To: (i) assess the relationship between SF-6D and EQ-5D utility scores for patients with schizophrenia at two points in time, (ii) assess the relationship in the change scores of these two measures, (iii) measure the sensitivity of these measures to changes in an established measure of symptomatology.
Patients with schizophrenia were recruited and the SF-36 and EQ-5D were administered at baseline and one-year follow-up and utility scores were computed and compared. Standardized response mean (SMR) scores were calculated for the SF-6D and EQ-5D and compared for patients who improved or deteriorated by at least 25% on the Brief Psychiatric Rating Scale.
EQ-5D ratings were available for 394 patients at baseline, 368 at follow-up and 358 at both time points. The respective figures for the SF-6D were 383, 367 and 345. Mean utility scores were very similar at baseline (EQ-5D 0.68, SF-6D 0.67) and follow-up (EQ-5D 0.71, SF-6D 0.68). Median scores were markedly higher for the EQ-5D (0.76 v 0.66 at baseline, 0.80 v 0.68 at follow-up). The SF-6D scores followed a normal distribution whilst the EQ-5D scores were negatively skewed with a clustering at 1.00. There were few differences in sensitivity to change between the EQ-5D and SF-6D.
From an analytical perspective the SF-6D has advantages over the EQ-5D due to its normal distribution and lack of ceiling effect. However, both measures produce similar mean utility scores. Overall the SF-6D appears more suitable as a measure of utility in this patient group.
Decisions made on the basis of cost-effectiveness results need to consider the method by which QALYs have been calculated.
Further comparisons of the EQ-5D and SF-6D are required.
医疗保健干预措施的经济评估越来越多地使用质量调整生命年（QALYs）来衡量结果。SF - 6D和EQ - 5D是生成用于QALY估计的效用分数的替代方法，但尚不清楚哪种方法对精神症状严重程度的变化最为敏感。关于这些测量方法对精神分裂症等长期精神健康状况下现有临床指标变化的敏感性的数据也有限。
（i）评估精神分裂症患者在两个时间点的SF - 6D和EQ - 5D效用分数之间的关系；（ii）评估这两种测量方法变化分数之间的关系；（iii）测量这些测量方法对既定症状测量变化的敏感性。
招募精神分裂症患者，在基线和一年随访时分别进行SF - 36和EQ - 5D评估，并计算和比较效用分数。计算SF - 6D和EQ - 5D的标准化反应均值（SMR）分数，并对在简明精神病评定量表上改善或恶化至少25%的患者进行比较。
基线时394例患者有EQ - 5D评分，随访时有368例，两个时间点都有的有358例。SF - 6D的相应数字分别为383、367和345。基线时平均效用分数非常相似（EQ - 5D为0.68，SF - 6D为0.67），随访时（EQ - 5D为0.71，SF - 6D为0.68）也是如此。EQ - 5D的中位数分数明显更高（基线时为0.76对0.66，随访时为0.80对0.68）。SF - 6D分数呈正态分布，而EQ - 5D分数呈负偏态，在1.00处聚集。EQ - 5D和SF - 6D在对变化的敏感性方面差异不大。
从分析角度来看，SF - 6D由于其正态分布和无天花板效应，比EQ - 5D具有优势。然而，两种测量方法产生的平均效用分数相似。总体而言，SF - 6D似乎更适合作为该患者群体效用的测量方法。
基于成本效益结果做出的决策需要考虑计算QALYs所采用的方法。
需要对EQ - 5D和SF - 6D进行进一步比较。
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