Showing papers by "Claire Gudex published in 1995"

A social tariff for EuroQol: results from a UK general population survey

Abstract: An important consideration when establishing priorities in health care is the likely effects that alternative allocations of resources will have on health-related quality of life (HRQoL). This paper reports on the analysis of data from a study which elicited health state valuations (using the time trade-off (TTO) method) from a representative sample of the UK health population. Health states were defined in terms of the EuroQol Descriptive System which generates 243 theoretically possible states. Because it was impossible to generate direct valuations for all of these states, it was necessary to find a procedure that allowed interpolation of valuations for all EuroQol states from direct valuations on a subset of these. This paper describes (in as non-technical manner as possible) the modelling technique used to generate a set of EuroQol valuations from directly observed valuations on 45 states. The specification of the models tested was derived from the ordinal nature of the EuroQol descriptive system, in which the value assigned to a particular state depends on the level of each dimension. Data were analysed at the individual level using a generalised least squares regression technique. A model that fitted the data well and that was readily interpretable was one in which valuations were explained in terms of three different elements: 1) the level of severity associated with each dimension independently of the levels of the other dimensions; 2) an intercept associated with any move away from full health; and 3) a term which identified whether any dimension was at its most severe level. The coefficients on these variables can be used to build up a fill ‘tariff’ of EuroQol values representing the views of a representative sample of the UK adult population. This social tariff has a number of potential uses, including the measurement of the likely impact on health status of different health care programmes or policies.

Time preference, duration and health state valuations

Abstract: There is increasing interest in health status measurement and the relative weights that people attach to different states of health and illness. One important issue which has been raised is the effect that the time spent in a health state may have on the way that state is perceived. Previous studies have suggested that the worse a state is, the more intolerable it becomes as it lasts longer. However, for most of these studies, it is impossible to determine how much of what was observed is attributable to the time spent in the state and how much is attributable to when it was occurring. This paper reports on a pilot study designed to test the feasibility of using the Time Trade-Off (TTO) method to isolate the effect of pure time preference from the effect of duration per se. Interviews were conducted with 39 members of the general population who were asked to rate 5 health states for durations of one month, one year and ten years. In aggregate, rates of time preference were very close to zero which suggests that the implicit assumption of the TTO method that there is no discounting may be a valid one. However, that more respondents had negative (rather than positive) rates, casts some doubt on the axions of discounted utility theory. In addition, implied valuations for states lasting for short periods were often counter-intuitive which questions the feasibility of using the TTO method to measure preferences for temporary health states.

Health-related quality of life in endstage renal failure.

Abstract: The objective of this study was to describe the health-related quality of life (HRQOL) of patients on different forms of treatment for endstage renal failure in such a way that the data could be used in a cost-utility analysis of renal failure treatment in Britain. Twenty-four British renal units participated in this study. 997 adult dialysis and transplant patients were randomly selected from these units using the European Dialysis and Transplant (EDTA) Registry Database. The Health Measurement Questionnaire was completed by 705 of the 900 patients who were alive at the time of the survey (response rate of 78%). The HRQOL data were linked with comorbidity data and with clinical data from the EDTA Registry. Compared to the general population, patients with endstage renal failure experienced a lower quality of life. Many factors contributed to this, but uncertainty about the future and lack of energy emerged as key components. Transplant recipients reported better HRQOL than dialysis patients, they reported fewer problems with physical mobility, self-care, social and personal relationships and usual activities. They also experienced significantly less distress, while dialysis patients reported problems with depression, anxiety, pain and uncertainty about the future. These differences remained after controlling for age and comorbidity.

Quality of life in liaison psychiatry. A comparison of patient and clinician assessment.

Abstract: BACKGROUND This exploratory study investigates the performance of the Health Measurement Questionnaire (HMQ), as compared with the Psychiatric Assessment Schedule (PAS) and the Nottingham Health Profile (NHP), and compares self- and observer-completed measures. METHOD A total of 138 medical patients scoring over the screening threshold for probable psychiatric illness completed the HMQ, NHP and PAS, and were rated by a psychiatrist on Rosser disability and distress. RESULTS HMQ disability correlated well with NHP and PAS physical health items, while HMQ distress correlated well with the NHP emotional reactions and PAS Index of Definition. There was significant correlation between self-report and psychiatrist ratings, the latter being more sensitive to distress. CONCLUSION The HMQ is a useful measure of generic health status in liaison psychiatry settings.

Valuing health states: the effect of duration

Abstract: A central task in the field of health status measurement involves eliciting valuations for health states. When these valuations are then used in estimating patient benefit as part of a cost-utility analysis, a key issue is how the duration of a health state affects its value. Previous studies suggest that while people adapt to chronic illness over time there is a “maximal endurable time” beyond which the state becomes intolerable. The pilot study reported here examines the feasibility of using the visual analogue scale method to elicit within-respondent valuations for health states of different durations. It explores the hypothesis that while less severe states are seen as more acceptable the longer they last, more severe health states are seen as increasingly intolerable. 18 members of the general population ranked and rated 15 health states with durations of 1 month, 1 year and 10 years. The valuation given to a health state appeared to be a function of both its severity and its duration. The median score for a state lasting 10 years was lower when the same state lasted for 1 year or 1 month, supporting the concept of a “maximal endurable time”. Valuations for mild states did not, however, increase with duration.