Halling Hastrup Lene, Nordentoft Merete, Hjorthøj Carsten, Gyrd-Hansen Dorte
Psychiatric Research Unit, Region Zealand, Roskilde, Denmark.
J Ment Health Policy Econ. 2011 Dec;14(4):187-96.
Most health economic evaluations in mental care include outcome measures aimed at specific aspects of health, like symptom improvement, functional improvement and quality of life instead of generic preference based outcome measures. The health economic guidelines (NICE) recommend to include a generic preference based outcome measure, like EQ-5D, in health economic evaluations in order to allow for comparisons of health related quality of life of patient groups across different diseases, providing information particular useful to support health policy decisions and cost-effectiveness analysis. Although the EQ-5D is by far the most widespread outcome measure within the context of economic evaluations, its validity in psychiatric populations has not yet been established unambiguously. An increasing number of articles have tested the validity of the EQ-5D in comparisons with clinical measures in mental health, but only few studies have addressed the correlation between the EQ-5D and a condition-specific quality of life measure in mental health.
The aim of the article is to test for a potential correlation between the preferred generic outcome measure in health economic evaluations EQ-5D and Manchester Short Assessment of Quality of Life (MANSA) in order to assess to what extent quality of life dimensions measured by a psychiatric quality of life measure are captured in the EQ-5D in a population of patients with schizophrenia and cannabis abuse.
Data analysed is a part of a study of 103 patients with schizophrenia and abuse of cannabis participating in a randomized controlled trial testing a specialized addiction intervention during the period 2008-09. The correlation of the EQ-5D and scores of MANSA was assessed using the Spearman's correlation coefficient. In addition, we tested how the EQ-5D and MANSA correlated with PANSS, GAF and WHO-DAS in order to make comparisons with earlier studies.
We found moderate, statistically significant correlations between the EQ-5D index score and MANSA total score (rho = 0.358**). The dimensions 'Mobility', 'Self-Care' and 'Pain/discomfort' on the EQ-5D were overall not sensitive in this population, while the dimensions 'Usual activities' and 'Anxiety/depression' were moderately correlated with MANSA. The EQ-5D and MANSA both showed statistically significant moderate correlations with the clinical measures in the study PANSS, GAF and WHO-DAS.
Our results suggest that the EQ-5D and MANSA are complementary measures rather than substitutes.
Mental health interventions often seek to improve the patients' quality of life in a broader perspective, like improving the patients' relationship with family, friends and other network, financial situation, employment and accommodation. If the EQ-5D is used as a single outcome in health economic evaluations of e.g. mental health community interventions, these factors may be overlooked. Based on a relatively small sample, we therefore recommend applying the EQ-5D together with condition-specific quality of life measures in future health economic evaluations in mental health.
大多数精神卫生保健领域的卫生经济评估所纳入的结果指标旨在针对健康的特定方面，如症状改善、功能改善和生活质量，而非基于偏好的通用型结果指标。卫生经济指南（英国国家卫生与临床优化研究所）建议在卫生经济评估中纳入基于偏好的通用型结果指标，如EQ-5D，以便能够比较不同疾病患者群体的健康相关生活质量，为支持卫生政策决策和成本效益分析提供特别有用的信息。尽管在经济评估背景下，EQ-5D是目前应用最为广泛的结果指标，但其在精神疾病人群中的有效性尚未得到明确证实。越来越多的文章对EQ-5D与精神卫生临床指标进行比较时的有效性进行了测试，但仅有少数研究探讨了EQ-5D与精神卫生领域特定疾病生活质量指标之间的相关性。
本文旨在测试卫生经济评估中首选的通用型结果指标EQ-5D与曼彻斯特简易生活质量评估量表（MANSA）之间是否存在潜在相关性，以评估在患有精神分裂症和大麻滥用的患者群体中，精神科生活质量量表所测量的生活质量维度在EQ-5D中得到体现的程度。
所分析的数据是一项针对103名患有精神分裂症和大麻滥用患者的研究的一部分，该研究在2008 - 2009年期间参与了一项测试专门成瘾干预措施的随机对照试验。使用Spearman相关系数评估EQ-5D与MANSA得分之间的相关性。此外，我们还测试了EQ-5D和MANSA与阳性和阴性症状量表（PANSS）、大体功能评定量表（GAF）以及世界卫生组织残疾评定量表（WHO-DAS）之间的相关性，以便与早期研究进行比较。
我们发现EQ-5D指数得分与MANSA总分之间存在中度的、具有统计学意义的相关性（rho = 0.358**）。在该人群中，EQ-5D的“行动能力”“自我照顾”和“疼痛/不适”维度总体上不敏感，而“日常活动”和“焦虑/抑郁”维度与MANSA存在中度相关性。EQ-5D和MANSA与研究中的临床指标PANSS、GAF和WHO-DAS均显示出具有统计学意义的中度相关性。
我们的结果表明，EQ-5D和MANSA是互补指标而非替代指标。
精神卫生干预措施通常试图从更广泛的角度改善患者的生活质量，如改善患者与家人、朋友及其他社交网络的关系、财务状况、就业和住宿条件等。如果在例如精神卫生社区干预措施的卫生经济评估中仅将EQ-5D用作单一结果指标，这些因素可能会被忽视。基于相对较小的样本量，因此我们建议在未来精神卫生领域的卫生经济评估中，将EQ-5D与特定疾病生活质量指标一起应用。
