比较 2 种健康效用测量方法在 Medicare 健康结果调查（HOS）中的表现。

Comparing the Performance of 2 Health Utility Measures in the Medicare Health Outcome Survey (HOS).

机构信息

Department of Biostatistics, Mailman School of Public Health and School of Nursing, Columbia University, New York, NY, (HJ).

Department of Community Health and Social Medicine, CUNY School of Medicine, New York, NY (EIL).

出版信息

Med Decis Making. 2018 Nov;38(8):983-993. doi: 10.1177/0272989X18808494.

DOI:10.1177/0272989X18808494

PMID:30403580

Abstract

BACKGROUND

The Medicare Health Outcomes Survey (HOS), a nationwide annual survey of Medicare beneficiaries, includes the Centers for Disease Control and Prevention's HRQOL-4 questionnaire and Veterans RAND 12-item Health Survey (VR-12). This study compared EQ-5D scores derived from the HRQOL-4 (dEQ-5D) to SF-6D scores derived from VR-12.

METHODS

Data were from Medicare HOS Cohort 15 (2012 baseline; 2014 follow-up). We included participants aged 65+ ( n = 105,473). We compared score distributions, evaluated known-groups validity, assessed each index as a predictor for mortality, and estimated quality-adjusted life years (QALYs) using the dEQ-5D and SF-6D.

RESULTS

Compared to the SF-6D, the dEQ-5D had a higher mean score (0.787 v. 0.691) and larger standard deviation (0.310 v. 0.101). The decreases in estimated scores associated with chronic conditions were greater for the dEQ-5D than for the SF-6D. For example, dEQ-5D scores for persons with depression decreased 0.456 points compared to 0.141 points for the SF-6D. The dEQ-5D strongly predicted mortality, as adjusted hazard ratios for the first to fourth quintiles, relative to the fifth quintile, were 2.2, 1.7, 1.8, and 1.5, respectively, while the association between SF-6D and mortality was weaker or nonexistent (adjusted hazard ratios were 1.3, 1.1, 1.0, and 0.6, respectively). Compared to the SF-6D, QALYs estimated using the dEQ-5D were higher overall (5.6 v. 4.9 years), higher for persons with less debilitating conditions (e.g., hypertension, 5.0 v. 4.4 years), and lower for more debilitating conditions (e.g. depression, 2.5 v. 2.8 years).

CONCLUSIONS

Compared to the SF-6D, the dEQ-5D was better able to measure individuals' overall health; detect the differential impact of chronic conditions, particularly among persons in poorer health; and predict mortality. The HRQOL-4 questionnaire may be valuable for monitoring and improving health outcomes for the Medical HOS data set.

摘要

背景

医疗保险健康结果调查（HOS）是一项针对医疗保险受益人的全国性年度调查，包括疾病预防控制中心的 HRQOL-4 问卷和退伍军人 RAND 12 项健康调查（VR-12）。本研究比较了 HRQOL-4 衍生的 EQ-5D 评分（dEQ-5D）与 VR-12 衍生的 SF-6D 评分。

方法

数据来自医疗保险 HOS 队列 15（2012 年基线；2014 年随访）。我们纳入了年龄在 65 岁及以上的参与者（n=105473）。我们比较了评分分布，评估了已知群体的有效性，评估了每个指数作为死亡率的预测指标，并使用 dEQ-5D 和 SF-6D 估计了质量调整生命年（QALYs）。

结果

与 SF-6D 相比，dEQ-5D 的平均评分更高（0.787 比 0.691），标准差更大（0.310 比 0.101）。与慢性疾病相关的估计评分下降，dEQ-5D 比 SF-6D 更大。例如，患有抑郁症的人的 dEQ-5D 评分下降了 0.456 分，而 SF-6D 评分下降了 0.141 分。dEQ-5D 对死亡率的预测能力很强，第一至第四五分位相对于第五五分位的调整危险比分别为 2.2、1.7、1.8 和 1.5，而 SF-6D 与死亡率的相关性较弱或不存在（调整危险比分别为 1.3、1.1、1.0 和 0.6）。与 SF-6D 相比，使用 dEQ-5D 估计的 QALYs 总体上更高（5.6 年比 4.9 年），身体状况较差者（如高血压，5.0 年比 4.4 年）更高，身体状况更差者（如抑郁症，2.5 年比 2.8 年）更低。