Centre for Applied Health Economics, Menzies Health Institute Queensland, School of Medicine, Griffith University, Nathan, Queensland, Australia.
Centre for Applied Health Economics, Menzies Health Institute Queensland, School of Medicine, Griffith University, Nathan, Queensland, Australia; The NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia.
Value Health. 2018 Apr;21(4):471-481. doi: 10.1016/j.jval.2017.09.005. Epub 2017 Nov 7.
Several utility-based instruments have been applied in cost-utility analysis to assess health state values for people with dementia. Nevertheless, concerns and uncertainty regarding their performance for people with dementia have been raised.
To assess the performance of available utility-based instruments for people with dementia by comparing their psychometric properties and to explore factors that cause variations in the reported health state values generated from those instruments by conducting meta-regression analyses.
A literature search was conducted and psychometric properties were synthesized to demonstrate the overall performance of each instrument. When available, health state values and variables such as the type of instrument and cognitive impairment levels were extracted from each article. A meta-regression analysis was undertaken and available covariates were included in the models.
A total of 64 studies providing preference-based values were identified and included. The EuroQol five-dimension questionnaire demonstrated the best combination of feasibility, reliability, and validity. Meta-regression analyses suggested that significant differences exist between instruments, type of respondents, and mode of administration and the variations in estimated utility values had influences on incremental quality-adjusted life-year calculation.
This review finds that the EuroQol five-dimension questionnaire is the most valid utility-based instrument for people with dementia, but should be replaced by others under certain circumstances. Although no utility estimates were reported in the article, the meta-regression analyses that examined variations in utility estimates produced by different instruments impact on cost-utility analysis, potentially altering the decision-making process in some circumstances.
已有多种基于效用的工具被应用于成本效用分析，以评估痴呆患者的健康状态值。然而，针对这些工具在痴呆患者中的表现，人们仍存在担忧和不确定性。
通过比较其心理测量特性，评估现有基于效用的工具在痴呆患者中的表现，并通过进行荟萃回归分析，探索导致这些工具报告的健康状态值存在差异的因素。
进行文献检索并综合心理测量特性，以展示每个工具的整体表现。当有可用数据时，从每篇文章中提取健康状态值和变量，如工具类型和认知障碍程度。进行荟萃回归分析，并将可用的协变量纳入模型。
共确定并纳入了 64 项提供偏好值的研究。EuroQol 五维问卷在可行性、可靠性和有效性方面表现最佳。荟萃回归分析表明，不同工具之间、受访者类型以及管理方式存在显著差异，且估计效用值的差异对增量质量调整生命年的计算有影响。
本综述发现，EuroQol 五维问卷是最适合痴呆患者的基于效用的工具，但在某些情况下需要被其他工具替代。尽管文章中没有报告效用估计值，但荟萃回归分析检查了不同工具产生的效用估计值的差异对成本效用分析的影响，在某些情况下可能会改变决策过程。
