Pickard A Simon, Hung Yu-Ting, Lin Fang-Ju, Lee Todd A
*Department of Pharmacy Systems, Outcomes and Policy, and Center for Pharmacoepidemiology Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago †Department of Medical Research, China Medical University Hospital, Taichung, Taiwan ‡Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago §Graduate Institute of Clinical Pharmacy, College of Medicine ∥Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
Med Care. 2017 Nov;55(11):979-984. doi: 10.1097/MLR.0000000000000802.
Although societal preference weights are desirable to inform resource-allocation decision-making, patient experienced health state-based value sets can be useful for clinical decision-making, but context may matter.
To estimate EQ-5D value sets using visual analog scale (VAS) ratings for patients undergoing knee replacement surgery and compare the estimates before and after surgery.
We used the Patient Reported Outcome Measures data collected by the UK National Health Service on patients undergoing knee replacement from 2009 to 2012. Generalized least squares regression models were used to derive value sets based on the EQ-5D-3 level using a development sample before and after surgery, and model performance was examined using a validation sample.
A total of 90,450 preoperative and postoperative valuations were included. For preoperative valuations, the largest decrement in VAS values was associated with the dimension of anxiety/depression, followed by self-care, mobility, usual activities, and pain/discomfort. However, pain/discomfort had a greater impact on VAS value decrement in postoperative valuations. Compared with preoperative health problems, postsurgical health problems were associated with larger value decrements, with significant differences in several levels and dimensions, including level 2 of mobility, level 2/3 of usual activities, level 3 of pain/discomfort, and level 3 of anxiety/depression. Similar results were observed across subgroups stratified by age and sex.
Findings suggest patient experience-based value sets are not stable (ie, context such as timing matters). However, the knowledge that lower values are assigned to health states postsurgery compared with presurgery may be useful for the patient-doctor decision-making process.
尽管社会偏好权重有助于为资源分配决策提供依据，但基于患者体验的健康状态价值集对临床决策可能也有用，不过背景情况可能很重要。
使用视觉模拟量表（VAS）评分来估计接受膝关节置换手术患者的EQ-5D价值集，并比较手术前后的估计值。
我们使用了英国国家医疗服务体系收集的2009年至2012年接受膝关节置换手术患者的患者报告结局测量数据。使用广义最小二乘回归模型，基于手术前后的一个开发样本，根据EQ-5D-3水平得出价值集，并使用一个验证样本检验模型性能。
共纳入90450份术前和术后评估。对于术前评估，VAS值下降最大的与焦虑/抑郁维度相关，其次是自我护理、活动能力、日常活动以及疼痛/不适。然而，在术后评估中，疼痛/不适对VAS值下降的影响更大。与术前健康问题相比，术后健康问题与更大的价值下降相关，在几个水平和维度上存在显著差异，包括活动能力的2级、日常活动的2/3级、疼痛/不适的3级以及焦虑/抑郁的3级。在按年龄和性别分层的亚组中观察到了类似结果。
研究结果表明基于患者体验的价值集不稳定（即时机等背景情况很重要）。然而，与术前相比术后健康状态被赋予较低值这一认识可能对医患决策过程有用。
