Campbell Julie A, Hensher Martin, Neil Amanda, Venn Alison, Otahal Petr, Wilkinson Stephen, Palmer Andrew J
Menzies Institute for Medical Research, University of Tasmania, Medical Sciences 2 Building, 17 Liverpool Street, Hobart, TAS, 7000, Australia.
Department of Health and Human Services, Level 2, 22 Elizabeth Street, Hobart, TAS, 7000, Australia.
Pharmacoecon Open. 2018 Dec;2(4):443-458. doi: 10.1007/s41669-017-0060-1.
Choice of a multi-attribute utility instrument (MAUI) that appropriately assesses an intervention's health-related quality-of-life (HRQoL) impacts is a vital part of healthcare resource allocation and clinical assessment.
Our exploratory study compared the EuroQol (EQ)-5D-5L and Assessment of Quality of Life (AQoL)-8D MAUIs, which were used to assess the effect of bariatric surgery for a cohort of long-term publicly waitlisted, severely obese patients.
The study was conducted at the Hobart Private Hospital (Tasmania, Australia). To compare the sensitivity and instrument content of the two MAUIs, we used dimensional comparisons by investigating the distribution of patient-reported responses (number/percentage) across the MAUIs' levels and dimensions; summary health-state utility valuations (utilities); and individual/super-dimension scores (AQoL-8D) to investigate discriminatory power and HRQoL improvements preoperatively and 3 months postoperatively.
Participants' (n = 23) overall MAUI completion rate was 74%. Postoperative total weight loss was 9.9%. EQ-5D-5L utilities were relatively higher pre- and postoperatively than AQoL-8D utilities [mean standard deviation (SD) EQ-5D-5L 0.70 (0.25) to 0.80 (0.25); AQoL-8D 0.51 (0.24) to 0.61 (0.24)]. AQoL-8D Psychosocial super dimension was relatively low postoperatively [0.37 (0.25)], driving the instrument's lower utility. These results were supported by the dimensional comparisons that revealed an overall greater dispersion for the AQoL-8D. Nevertheless, there were clinical improvements in utilities for both instruments. AQoL-8D utilities were lower than population norms; not so the EQ-5D-5L utilities. The AQoL-8D dimensions of Happiness, Coping, and Self-worth improved the most.
AQoL-8D more fully captured the impact of obesity and bariatric surgery on HRQoL (particularly psychosocial impacts) for long-term waitlisted bariatric surgery patients, even 3 months postoperatively. AQoL-8D preoperative utility revealed our population's HRQoL was lower than people with cancer or heart disease.
选择一种能够恰当评估干预措施对健康相关生活质量（HRQoL）影响的多属性效用工具（MAUI）是医疗资源分配和临床评估的重要组成部分。
我们的探索性研究比较了欧洲五维度健康量表（EQ）-5D-5L和生活质量评估量表（AQoL）-8D这两种MAUI，它们被用于评估减肥手术对一组长期在公共等候名单上的重度肥胖患者的效果。
该研究在霍巴特私立医院（澳大利亚塔斯马尼亚）进行。为了比较这两种MAUI的敏感性和工具内容，我们通过调查患者报告的反应（数量/百分比）在MAUI各水平和维度上的分布进行维度比较；汇总健康状态效用值（效用）；以及个体/超维度得分（AQoL-8D），以研究术前和术后3个月的区分能力和HRQoL改善情况。
参与者（n = 23）的MAUI总体完成率为74%。术后总体体重减轻了9.9%。EQ-5D-5L效用值在术前和术后相对高于AQoL-8D效用值[平均标准差（SD）EQ-5D-5L为0.70（0.25）至0.80（0.25）；AQoL-8D为0.51（0.24）至0.61（0.24）]。AQoL-8D心理社会超维度在术后相对较低[0.37（0.25）]，导致该工具的效用较低。这些结果得到了维度比较的支持，该比较显示AQoL-8D的总体离散度更大。然而，两种工具的效用在临床上均有改善。AQoL-8D效用值低于人群规范；EQ-5D-5L效用值则不然。AQoL-8D中幸福、应对和自我价值维度改善最为明显。
对于长期等候减肥手术的患者，即使在术后3个月，AQoL-8D也更全面地捕捉了肥胖和减肥手术对HRQoL的影响（尤其是心理社会影响）。AQoL-8D术前效用显示我们研究人群的HRQoL低于癌症或心脏病患者。
