Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, P.O. Box 340, 00029, HUS, Helsinki, Finland.
Intensive Care Med. 2010 Dec;36(12):2090-3. doi: 10.1007/s00134-010-1979-1. Epub 2010 Aug 6.
Reliable measures are required for proper cost-utility analysis after critical care. No gold standard is available, but the EQ-5D health-related quality of life instrument (HRQoL) has been proposed. Our aim was to compare the EQ-5D with another utility measure, the 15D, after critical illness.
A total of 929 patients filled in both the EQ-5D and 15D HRQoL instruments 6 and 12 months after treatment at an intensive care or high-dependency unit. The difference in the medians and distributions of the scores of the instruments was tested with Wilcoxon signed-rank test and their association with Spearman rank correlation. Discriminatory power was compared by the ceiling effect and agreement between the instruments regarding the direction of the minimal clinically important change in the HRQoL scores between 6 and 12 months was tested with the McNemar-Bowker test and Cohen's kappa.
The utility scores produced by the instruments and their distributions were different. Agreement between the instruments was only moderate. The 15D appeared more sensitive than the EQ-5D both in terms of discriminatory power and responsiveness to clinically important change.
The agreement between the two utility measures was only moderate. The choice of the instrument may have a substantial effect on cost-utility results. Our results suggest that the 15D performs well after critical illness, but further large cohort studies comparing different utility instruments in this patient population are warranted before the gold standard for utility measurement can be announced.
重症监护后进行可靠的成本效用分析需要可靠的衡量标准。目前尚无金标准，但已提出 EQ-5D 健康相关生活质量量表（HRQoL）。我们的目的是比较 EQ-5D 与另一种效用衡量标准，即 15D，在重症疾病后。
共有 929 名患者在重症监护或高依赖病房接受治疗后 6 个月和 12 个月时填写了 EQ-5D 和 15D HRQoL 量表。使用 Wilcoxon 符号秩检验和 Spearman 等级相关检验测试了两种工具的评分中位数和分布差异，并比较了其关联。通过天花板效应比较了鉴别力，并通过 McNemar-Bowker 检验和 Cohen's kappa 检验测试了两种工具之间在 6 个月至 12 个月 HRQoL 评分的最小临床重要变化方向上的一致性。
仪器产生的效用得分及其分布不同。仪器之间的一致性仅为中等。15D 在鉴别力和对临床重要变化的反应方面似乎比 EQ-5D 更敏感。
两种效用衡量标准之间的一致性仅为中等。仪器的选择可能对成本效用结果产生重大影响。我们的结果表明，15D 在重症疾病后表现良好，但在宣布效用测量的金标准之前，需要在该患者群体中比较不同效用工具的进一步大型队列研究。
