Overview of Health-Related Quality of Life Measures

Overview of Health-Related Quality of Life Measures May 22, 2014 (1:00 – 2:00 PDT) Kaiser Methods Webinar Series Ron D.Hays, Ph.D. [email protected]

Determinants of Health Quality Of Care Health Characteristics Behavior Environment Chronic Conditions

Indicators of Health Signs and Symptoms of Disease Functioning Well-Being

Functioning and Well-Being • Functioning (what you can do) • Self-care • Role • Social • Well-being (how you feel) • Pain • Energy • Depression • Positive affect

Indicators of Health Signs and Symptoms of Disease Functioning Well-Being

Health-Related Quality of Life (HRQOL) Quality of environment Type of housing Level of income Social Support

HRQOL Measurement Options • Multiple Scores (Profile) • Generic (SF-36) • How much of the time during the past 4 weeks have you been happy? (None of the time  All of the time) • Targeted (“Disease specific”) • KDQOL-36 • My kidney disease interferes too much with my life. • Single Score • Preference-based (EQ-5D, HUI, SF-6D) • Combinations of above

HRQOL Scoring Options • 0-100 possible range • T-scores (mean = 50, SD = 10) • (10 * z-score) + 50 • z-score = (score – mean)/SD • 0 (dead) to 1 (perfect health)

HRQOL in HIV Compared to other Chronic Illnesses and General Population T-score metric Hays et al. (2000), American Journal of Medicine

HRQOL in HIV Compared to other Chronic Illnesses and General Population T-score metric Hays et al. (2000), American Journal of Medicine

HRQOL in HIV Compared to other Chronic Illnesses and General Population T-score metric Hays et al. (2000), American Journal of Medicine

HRQOL in HIV Compared to other Chronic Illnesses and General Population T-score metric Hays et al. (2000), American Journal of Medicine

Physical Functioning in Relation to TimeSpent Exercising 2-years Before 84 82 80 78 76 74 72 70 68 66 64 62 Hypertension Diabetes 0-100 range Current Depression Low High Total Time Spent Exercising Stewart, A.L., Hays, R.D., Wells, K.B., Rogers, W.H., Spritzer, K.L., & Greenfield, S. (1994). Long-termfunctioning and well-being outcomes associated with physical activity and exercise in patients withchronic conditions in the Medical Outcomes Study. Journal of Clinical Epidemiology, 47, 719-730.

Physical Health Physical Health Physical function Role functionphysical Pain General Health

Mental Health Mental Health Emotional Well-Being Role function-emotional Energy Social function

SF-36 PCS and MCS PCS_z = (PF_Z * 0.42) + (RP_Z * 0.35) + (BP_Z * 0.32) + (GH_Z * 0.25) + (EF_Z * 0.03) + (SF_Z * -.01) + (RE_Z * -.19) + (EW_Z * -.22) MCS_z = (PF_Z * -.23) + (RP_Z * -.12) + (BP_Z * -.10) + (GH_Z * -.02) + (EF_Z * 0.24) + (SF_Z * 0.27) + (RE_Z * 0.43) + (EW_Z * 0.49) PCS = (PCS_z*10) + 50 MCS = (MCS_z*10) + 50

Is Complementary and Alternative Medicine (CAM) Better than Standard Care (SC)? CAM SC CAM SC Physical Health CAM > SC Mental Health SC > CAM

Does Taking Medicine for HIV Lead to Worse HRQOL? Subject Antiretrovirals HRQOL (0-100) 1 No dead 2 No dead 3 No 50 4 No 75 5 No 100 6 Yes 0 7 Yes 25 8 Yes 50 9 Yes 75 10 Yes 100 • Group n HRQOL • No Antiretroviral 3 75 • Yes Antiretoviral 5 50

Cost-Effectiveness of Health Care Cost ↓ Effectiveness (“Utility”) ↑

“QALYs: The Basics” • Value is … • Preference or desirability of health states • Preferences can be used to • Compare different interventions on a single common metric (societal resource allocation) • Help make personal decisions about whether to have a treatment Milton Weinstein, George Torrance, Alistair McGuire, Value in Health, 2009, vol. 12 Supplement 1.

Preference Elicitation • Standard gamble (SG) • Time trade-off (TTO) • Rating scale (RS) • http://araw.mede.uic.edu/cgi-bin/utility.cgi • SG > TTO > RS • SG = TTOa • SG = RSb(Where a and b are less than 1) • Also discrete choice experiments

SF-6D health state (424421) = 0.59 • Your health limits you a lot in moderate activities (such as moving a table, pushing a vacuum cleaner, bowling or playing golf) • You are limited in the kind of work or other activities as a result of your physical health • Your health limits your social activities (like visiting friends, relatives etc.) most of the time. • You have pain that interferes with your normal work (both outside the home and housework) moderately • You feel tense or downhearted and low a little of thetime. • You have a lot of energy all of the time

[email protected](310-794-2294). Powerpointfile available for downloading at: http://gim.med.ucla.edu/FacultyPages/Hays/