Faculty of Social Sciences, Hellenic Open University, Bouboulinas 57-59, 26222 Patras, Greece.
Eur J Health Econ. 2012 Feb;13(1):111-20. doi: 10.1007/s10198-010-0290-y. Epub 2010 Dec 5.
Diabetes patients suffer from comorbid conditions and disease-related complications. Combined with demographic, clinical and treatment satisfaction variables, they have a confounding effect on health-related quality of life (HRQoL). This study compared the sensitivity of EQ-5D, SF-6D and 15D utilities to the specific effect of diabetes complications.
Utilities were compared in 319 type II diabetics with and without comorbidities and complications. Based on subsample size and confirmed diagnoses, coronary heart disease (CHD) and diabetic retinopathy (DR) were two complications chosen for further analysis. Significant EQ-5D, SF-6D and 15D predictors were identified with OLS regression and subsequently controlled for with ANCOVA.
The presence of CHD resulted in utility decrements (P < 0.001) for all instruments, whereas DR only decreased 15D utilities (P < 0.05). Gender, age, treatment satisfaction, arthropathy and diabetic foot were significant predictors throughout, whereas BMI, neuropathy and CHD for at least two utilities. After controlling for these confounding variables, 15D still discriminated between diabetics with and without CHD (P < 0.01) and DR (P < 0.05), with seven and five dimensions affected, respectively.
After removing the effect of background variables, 15D utilities remain sensitive to CHD and DR. The obvious explanation is its richer descriptive system, which provides increased discriminative ability compared to EQ-5D and SF-6D, and this might be evidence for preferring the 15D in economic evaluations of interventions for diabetics. However, the need remains for further testing in other diabetes complications and more diverse patient samples.
糖尿病患者患有合并症和与疾病相关的并发症。结合人口统计学、临床和治疗满意度变量，这些因素对健康相关生活质量（HRQoL）有混杂影响。本研究比较了 EQ-5D、SF-6D 和 15D 效用对糖尿病并发症特定影响的敏感性。
比较了 319 例有或无合并症和并发症的 2 型糖尿病患者的效用。根据样本量和确诊诊断，选择冠心病（CHD）和糖尿病视网膜病变（DR）作为进一步分析的两种并发症。使用 OLS 回归确定 EQ-5D、SF-6D 和 15D 的显著预测因素，并随后用 ANCOVA 进行控制。
CHD 的存在导致所有仪器的效用降低（P < 0.001），而 DR 仅降低 15D 效用（P < 0.05）。性别、年龄、治疗满意度、关节炎和糖尿病足在整个过程中都是显著的预测因素，而 BMI、神经病变和 CHD 至少对两种效用有影响。在控制这些混杂变量后，15D 仍然能够区分有和无 CHD（P < 0.01）和 DR（P < 0.05）的糖尿病患者，分别有七个和五个维度受到影响。
在去除背景变量的影响后，15D 效用仍然对 CHD 和 DR 敏感。明显的解释是其更丰富的描述性系统，与 EQ-5D 和 SF-6D 相比，提供了更高的区分能力，这可能证明在评估糖尿病干预措施的经济效果时更倾向于使用 15D。然而，仍需要在其他糖尿病并发症和更多样化的患者样本中进一步测试。
