Oddershede Lars, Andreasen Jan Jesper, Ehlers Lars
Department of Cardiothoracic Surgery, Center for Cardiovascular Research, Aalborg University Hospital, Aalborg, Denmark ; Danish Center for Healthcare Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg University, Aalborg East, Denmark.
Department of Cardiothoracic Surgery, Center for Cardiovascular Research, Aalborg University Hospital, Aalborg, Denmark.
Clinicoecon Outcomes Res. 2014 Jan 10;6:21-7. doi: 10.2147/CEOR.S55899.
In health economic evaluations, mapping can be used to estimate utility values from other health outcomes in order to calculate quality adjusted life-years. Currently, no methods exist to map visual analog scale (VAS) scores to utility values. This study aimed to develop and propose a statistical algorithm for mapping five dimensions of health, measured on VASs, to utility scores in patients suffering from cardiovascular disease.
Patients undergoing coronary artery bypass grafting at Aalborg University Hospital in Denmark were asked to score their health using the five VAS items (mobility, self-care, ability to perform usual activities, pain, and presence of anxiety or depression) and the EuroQol 5 Dimensions questionnaire. Regression analysis was used to estimate four mapping models from patients' age, sex, and the self-reported VAS scores. Prediction errors were compared between mapping models and on subsets of the observed utility scores. Agreement between predicted and observed values was assessed using Bland-Altman plots.
Random effects generalized least squares (GLS) regression yielded the best results when quadratic terms of VAS scores were included. Mapping models fitted using the Tobit model and censored least absolute deviation regression did not appear superior to GLS regression. The mapping models were able to explain approximately 63%-65% of the variation in the observed utility scores. The mean absolute error of predictions increased as the observed utility values decreased.
We concluded that it was possible to predict utility scores from VAS scores of the five dimensions of health used in the EuroQol questionnaires. However, the use of the mapping model may be inappropriate in more severe conditions.
在卫生经济评估中，映射可用于从其他健康结果估计效用值，以便计算质量调整生命年。目前，尚无将视觉模拟量表（VAS）评分映射到效用值的方法。本研究旨在开发并提出一种统计算法，将通过VAS测量的健康五个维度映射到心血管疾病患者的效用评分。
丹麦奥尔堡大学医院接受冠状动脉搭桥手术的患者被要求使用五个VAS项目（活动能力、自我护理、进行日常活动的能力、疼痛以及焦虑或抑郁情况）和欧洲五维健康量表问卷对其健康状况进行评分。回归分析用于根据患者的年龄、性别和自我报告的VAS评分估计四个映射模型。在映射模型之间以及观察到的效用评分子集上比较预测误差。使用Bland-Altman图评估预测值与观察值之间的一致性。
当纳入VAS评分的二次项时，随机效应广义最小二乘法（GLS）回归产生了最佳结果。使用Tobit模型和删失最小绝对偏差回归拟合的映射模型似乎并不优于GLS回归。映射模型能够解释观察到的效用评分中约63%-65%的变异。预测的平均绝对误差随着观察到的效用值降低而增加。
我们得出结论，从欧洲五维健康量表问卷中使用的健康五个维度的VAS评分预测效用评分是可行的。然而，在更严重的情况下使用映射模型可能不合适。
