Abstract
Objectives
The objective of this study was to compare the performance of the 5-level EuroQol 5-dimension (EQ-5D-5L) and the Short Form 6-dimension (SF-6D) instruments in assessing patients with end-stage renal disease (ESRD) in Singapore.
Methods
In a cross-sectional study, ESRD patients attending a tertiary hospital were interviewed using a battery of questionnaires including the EQ-5D-5L, the kidney disease quality of life instrument (KDQOL-36), and questions assessing dialysis history and socio-demographic characteristics. We reviewed patients’ medical records for their clinical information. We assessed the construct validity of the EQ-5D-5L and SF-6D index scores and compared their ability to distinguish between patients differing in health status and the magnitude of between-group difference they quantified.
Results
One hundred and fifty ESRD patients on dialysis (mean age, 60.1 years; female, 48.7 %) participated in the study. Both EQ-5D-5L and SF-6D demonstrated satisfactory known-groups validity; the EQ-5D-5L was more sensitive to differences in clinical outcomes and the SF-6D was more sensitive to differences in health outcomes measured by KDQOL scales. The intraclass correlation coefficient between the measures was 0.36. The differences in the EQ-5D-5L index score for patients in better and worse health status were greater than those measured by the SF-6D index score.
Conclusions
Both EQ-5D-5L and SF-6D are valid instruments for assessing ESRD patients. However, the two preference-based measures cannot be used interchangeably and it appears that EQ-5D-5L would lead to more favorable cost-effectiveness results than SF-6D if they are used in economic evaluations of interventions for ESRD.
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Abbreviations
- HRQOL:
-
Health-related quality of life
- ESRD:
-
End-stage renal disease
- QALY:
-
Quality-adjusted life year
- HD:
-
Hemodialysis
- PD:
-
Peritoneal dialysis
- EQ-5D:
-
EuroQol group’s 5-dimension questionnaire
- EQ-5D-5L:
-
5-Level EuroQol group’s 5-dimension questionnaire
- EQ-5D-3L:
-
3-Level EuroQol group’s 5-dimension questionnaire
- SF-6D:
-
Short Form 6-dimension questionnaire
- KDQOL-36:
-
36-Item Kidney Disease Quality of Life questionnaire
- CCI:
-
Charlson comorbidity index
- SF-12:
-
12-Item Short-Form health survey
- ICC:
-
Intraclass correlation coefficient
- RE:
-
Relative efficiency
- ANOVA:
-
Analysis of variance
- ICER:
-
Incremental cost-effectiveness ratio
References
Dolan, P.: Modeling valuations for EuroQol health states. Med. Care 35(11), 1095–1108 (1997)
Brazier, J., Roberts, J., Deverill, M.: The estimation of a preference-based measure of health from the SF-36. J. Health Econ. 21(2), 271–292 (2002)
Conner-Spady, B., Suarez-Almazor, M.E.: Variation in the estimation of quality-adjusted life-years by different preference-based instruments. Med. Care 41(7), 791–801 (2003). doi:10.1097/01.MLR.0000068537.83456.36
Xie, F., Li, S.C., Luo, N., Lo, N.N., Yeo, S.J., Yang, K.Y., Fong, K.Y., Thumboo, J.: Comparison of the EuroQol and short form 6D in Singapore multiethnic Asian knee osteoarthritis patients scheduled for total knee replacement. Arthr. Rheum. 57(6), 1043–1049 (2007). doi:10.1002/art.22883
Brazier, J., Roberts, J., Tsuchiya, A., Busschbach, J.: A comparison of the EQ-5D and SF-6D across seven patient groups. Health Econ. 13(9), 873–884 (2004). doi:10.1002/hec.866
Cunillera, O., Tresserras, R., Rajmil, L., Vilagut, G., Brugulat, P., Herdman, M., Mompart, A., Medina, A., Pardo, Y., Alonso, J., Brazier, J., Ferrer, M.: Discriminative capacity of the EQ-5D, SF-6D, and SF-12 as measures of health status in population health survey. Qual. Life Res. 19(6), 853–864 (2010). doi:10.1007/s11136-010-9639-z
Petrou, S., Hockley, C.: An investigation into the empirical validity of the EQ-5D and SF-6D based on hypothetical preferences in a general population. Health Econ. 14(11), 1169–1189 (2005). doi:10.1002/hec.1006
Luo, N., Wang, P., Fu, A.Z., Johnson, J.A., Coons, S.J.: Preference-based SF-6D scores derived from the SF-36 and SF-12 have different discriminative power in a population health survey. Med. Care 50(7), 627–632 (2012). doi:10.1097/MLR.0b013e31824d7471
Barton, G.R., Bankart, J., Davis, A.C., Summerfield, Q.A.: Comparing utility scores before and after hearing-aid provision : results according to the EQ-5D, HUI3 and SF-6D. Appl. Health Econ. Health Policy 3(2), 103–105 (2004)
Longworth, L., Bryan, S.: An empirical comparison of EQ-5D and SF-6D in liver transplant patients. Health Econ. 12(12), 1061–1067 (2003). doi:10.1002/hec.787
Lee, A.J., Morgan, C.L., Conway, P., Currie, C.J.: Characterisation and comparison of health-related quality of life for patients with renal failure. Curr. Med. Res. Opin. 21(11), 1777–1783 (2005). doi:10.1185/030079905X65277
Manns, B.J., Johnson, J.A., Taub, K., Mortis, G., Ghali, W.A., Donaldson, C.: Dialysis adequacy and health related quality of life in hemodialysis patients. ASAIO J. 48(5), 565–569 (2002)
Gerard, K., Nicholson, T., Mullee, M., Mehta, R., Roderick, P.: EQ-5D versus SF-6D in an older, chronically Ill patient group. Appl. Health Econ. Health Policy 3(2), 91–102 (2004)
Rajan, M., Lai, K.C., Tseng, C.L., Qian, S., Selim, A., Kazis, L., Pogach, L., Sinha, A.: Estimating utilities for chronic kidney disease, using SF-36 and SF-12-based measures: challenges in a population of veterans with diabetes. Qual. Life Res. 22(1), 53–64 (2013). doi:10.1007/s11136-012-0139-1
Janssen, M.F., Birnie, E., Bonsel, G.J.: Quantification of the level descriptors for the standard EQ-5D three-level system and a five-level version according to two methods. Qual. Life Res. 17(3), 463–473 (2008). doi:10.1007/s11136-008-9318-5
Janssen, M.F., Birnie, E., Haagsma, J.A., Bonsel, G.J.: Comparing the standard EQ-5D three-level system with a five-level version. Value Health 11(2), 275–284 (2008). doi:10.1111/j.1524-4733.2007.00230.x
Sullivan, P.W., Ghushchyan, V.: Preference-based EQ-5D index scores for chronic conditions in the United States. Med. Decis. Mak 26(4), 410–420 (2006). doi:10.1177/0272989X06290495
Herdman, M., Gudex, C., Lloyd, A., Janssen, M., Kind, P., Parkin, D., Bonsel, G., Badia, X.: Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual. Life Res. 20(10), 1727–1736 (2011). doi:10.1007/s11136-011-9903-x
Pickard, A.S., De Leon, M.C., Kohlmann, T., Cella, D., Rosenbloom, S.: Psychometric comparison of the standard EQ-5D to a 5 level version in cancer patients. Med. Care 45(3), 259–263 (2007). doi:10.1097/01.mlr.0000254515.63841.81
Kim, S.H., Kim, H.J., Lee, S.I., Jo, M.W.: Comparing the psychometric properties of the EQ-5D-3L and EQ-5D-5L in cancer patients in Korea. Qual. Life Res. 21(6), 1065–1073 (2012). doi:10.1007/s11136-011-0018-1
Agborsangaya, C.B., Lahtinen, M., Cooke, T., Johnson, J.A.: Comparing the EQ-5D 3L and 5L: measurement properties and association with chronic conditions and multimorbidity in the general population. Health Qual. Life Outcomes 12, 74 (2014). doi:10.1186/1477-7525-12-74
Di Iorio, B., Cillo, N., Cirillo, M., De Santo, N.G.: Charlson Comorbidity Index is a predictor of outcomes in incident hemodialysis patients and correlates with phase angle and hospitalization. Int. J. Artif. Organs 27(4), 330–336 (2004)
Rabin, R., de Charro, F.: EQ-5D: a measure of health status from the EuroQol group. Ann. Med. 33(5), 337–343 (2001). doi:10.3109/07853890109002087
Lee, C.F., Nan, L., Ng, R., Wong, N.S., Yap, Y.S., Lo, S.K., Chia, W.K., Yee, A., Krishna, L., Wong, C., Goh, C., Cheung, Y.B.: Comparison of the measurement properties between a short and generic instrument, the 5-level EuroQoL Group’s 5-dimension (EQ-5D-5L) questionnaire, and a longer and disease-specific instrument, the Functional Assessment Of Cancer Therapy—Breast (FACT-B), in Asian breast cancer patients. Qual. Life Res. 22(7), 1745–1751 (2012)
Wong, K.Y., How, H.C., Thumboo J., Shen, L., Tay, E.G., Luo, N.: Testing the equivalence of the label wording for EQ-5D-5L responses options across different languages in Singapore. Paper presented at the ISPOR 5th Asia-Pacific conference, Taipei International Convention Center, Taipei, Taiwan, 2–4 Sept 2012
van Hout, B., Janssen, M.F., Feng, Y.S., Kohlmann, T., Busschbach, J., Golicki, D., Lloyd, A., Scalone, L., Kind, P., Pickard, A.S.: Interim scoring for the EQ-5D-5L: mapping the EQ-5D-5L to EQ-5D-3L value sets. Value Health 15(5), 708–715 (2012). doi:10.1016/j.jval.2012.02.008
Kalantar-Zadeh, K., Unruh, M.: Health related quality of life in patients with chronic kidney disease. Int. Urol. Nephrol. 37(2), 367–378 (2005). doi:10.1007/s11255-004-0012-4
Yang, F., Wang, V.W., Joshi, V.D., Lau, T.W., Luo, N.: Validation of the English version of the Kidney Disease Quality of Life questionnaire (KDQOL-36) in haemodialysis patients in Singapore. Patient 6(2), 135–141 (2013). doi:10.1007/s40271-013-0015-2
Brazier, J.E., Roberts, J.: The estimation of a preference-based measure of health from the SF-12. Med. Care 42(9), 851–859 (2004)
Wee, H.L., Cheung, Y.B., Fong, K.Y., Luo, N., Machin, D., Thumboo, J.: Are English- and Chinese-language versions of the SF-6D equivalent? A comparison from a population-based study. Clin. Ther. 26(7), 1137–1148 (2004)
Bland, J.M., Altman, D.G.: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476), 307–310 (1986)
Fayers, Peter M., M, D.: Quality of Life: The Assessment, Analysis and Interpretation of Patient-Reported Outcomes, 2nd edn. John Wiley & Sons Ltd, England (2007)
Luo, N., Johnson, J.A., Shaw, J.W., Feeny, D., Coons, S.J.: Self-reported health status of the general adult U.S. population as assessed by the EQ-5D and health utilities index. Med. Care 43(11), 1078–1086 (2005)
Molsted, S., Prescott, L., Heaf, J., Eidemak, I.: Assessment and clinical aspects of health-related quality of life in dialysis patients and patients with chronic kidney disease. Nephron. Clin. Pract. 106(1), C24–C33 (2007). doi:10.1159/000101481
Cohen, J.: Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Lawrence Erlbaum Associates, Hillsdale (1988)
Hawthorne, G., Richardson, J., Day, N.A.: A comparison of the Assessment of Quality of Life (AQoL) with four other generic utility instruments. Ann. Med. 33(5), 358–370 (2001)
van Stel, H.F., Buskens, E.: Comparison of the SF-6D and the EQ-5D in patients with coronary heart disease. Health Qual. Life Outcomes 4, 20 (2006). doi:10.1186/1477-7525-4-20
Sorensen, J., Linde, L., Ostergaard, M., Hetland, M.L.: Quality-adjusted life expectancies in patients with rheumatoid arthritis—comparison of index scores from EQ-5D, 15D, and SF-6D. Value Health 15(2), 334–339 (2012). doi:10.1016/j.jval.2011.09.010
Obradovic, M., Lal, A., Liedgens, H.: Validity and responsiveness of EuroQol-5 dimension (EQ-5D) versus Short Form-6 dimension (SF-6D) questionnaire in chronic pain. Health Qual. Life Outcomes 11, 110 (2013). doi:10.1186/1477-7525-11-110
Barton, G.R., Sach, T.H., Avery, A.J., Doherty, M., Jenkinson, C., Muir, K.R.: Comparing the performance of the EQ-5D and SF-6D when measuring the benefits of alleviating knee pain. Cost Eff. Resour Alloc. 7, 12 (2009). doi:10.1186/1478-7547-7-12
Adams, R., Walsh, C., Veale, D., Bresnihan, B., FitzGerald, O., Barry, M.: Understanding the relationship between the EQ-5D, SF-6D, HAQ and disease activity in inflammatory arthritis. Pharmacoeconomics 28(6), 477–487 (2010). doi:10.2165/11533010-000000000-00000
Sach, T.H., Barton, G.R., Jenkinson, C., Doherty, M., Avery, A.J., Muir, K.R.: Comparing cost-utility estimates: does the choice of EQ-5D or SF-6D matter? Med. Care 47(8), 889–894 (2009). doi:10.1097/MLR.0b013e3181a39428
McDonough, C.M., Tosteson, A.N.: Measuring preferences for cost-utility analysis: how choice of method may influence decision-making. Pharmacoeconomics 25(2), 93–106 (2007)
Stavem, K., Froland, S.S., Hellum, K.B.: Comparison of preference-based utilities of the 15D, EQ-5D and SF-6D in patients with HIV/AIDS. Qual. Life Res. 14(4), 971–980 (2005)
Harrison, M.J., Davies, L.M., Bansback, N.J., McCoy, M.J., Verstappen, S.M., Watson, K., Symmons, D.P.: The comparative responsiveness of the EQ-5D and SF-6D to change in patients with inflammatory arthritis. Qual. Life Res. 18(9), 1195–1205 (2009). doi:10.1007/s11136-009-9539-2
EuroQolGroup. http://www.euroqol.org/about-eq-5d/valuation-of-eq-5d/eq-5d-5l-value-sets.html
Acknowledgments
This study was supported by the National University Health System (NUHS) Cross Department Collaborative Grant.
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Yang, F., Lau, T., Lee, E. et al. Comparison of the preference-based EQ-5D-5L and SF-6D in patients with end-stage renal disease (ESRD). Eur J Health Econ 16, 1019–1026 (2015). https://doi.org/10.1007/s10198-014-0664-7
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DOI: https://doi.org/10.1007/s10198-014-0664-7