title: The Minimally Clinically Important Difference in Generic Utility-Based Measures Do medical house officers value the health of veterans differently from the health of non-veterans? Efficacy of peritoneal ultrafiltration in the treatment of refractory congestive heart failure. Performance of two measures of general health-related quality of life, the EQ-5D and the RAND-36 among critically ill patients Comparison of the EQ-5D and SF-12 health surveys in a general population survey in Alberta, Canada. Agreement about Identifying Patients Who Change over Time
abstract: Purpose : To evaluate the use of utility-based generic quality of life measures for establishing the minimally clinical ly important difference ( MCID ) . Background : Utility-based quality of life measures place levels of wellness on a continuum anchored by death ( 0.00 ) and optimum function ( 1.00 ) . Preference measurement studies are used to define the meaning of points along the continuum . Health states that differ by less than 0.03 units can not be discriminated by panels of judges as different from one another . Thus , 0.03 is a reasonable MCID for these measures . Method : Three published studies of patients with Chronic Obstructive Pulmonary Disease ( COPD ) reported data on the Quality of Well-being Scale ( QWB ) before and after pulmonary rehabilitation . One of the studies also r and omly assigned patients to lung volume reduction surgery or to maximal medical therapy . These patients were followed for an average of 29 months . Results : All three evaluations of pulmonary rehabilitation showed changes on the QWB in excess of the proposed 0.03 MCID . QWB changes for patients assigned to lung volume reduction surgery were close to the MCID threshold at one year but grew stronger in subsequent years . Using Norman 's 0.50 st and ard deviation method , all three estimates of rehabilitation effectiveness and the outcomes one year following surgery fall below the MCID . Conclusion : Different methods for estimating MCID lead to different conclusions about the meaning of quality of life changes following pulmonary rehabilitation and lung volume reduction surgery . The preference scaling system in generic utility-based quality of life measures provides a metric that is directly interpretable and avoids many of the criticisms of MCID measures . The method is sensitive enough to suggest clinical ly meaningful benefits of rehabilitation and surgery . Further , quality adjusted life years offer a valuable metric for policy analysis . Utility-based measures of health related quality of life should gain greater use in COPD outcomes research Background Little information is available regarding medical residents ' perceptions of patients ' health-related quality of life . Patients cared for by residents have been shown to receive differing patterns of care at Veterans Affairs facilities than at community or university setting s. We therefore examined : 1 ) how resident physicians value the health of patients ; 2 ) whether values differ if the patient is described as a veteran ; and 3 ) whether residency-associated variables impact values . Methods All medicine residents in a teaching hospital were asked to watch a digital video of an actor depicting a 72-year-old patient with mild-moderate congestive heart failure . Residents were r and omized to 2 groups : in one group , the patient was described as a veteran of the Korean War , and in the other , he was referred to only as a male . The respondents assessed the patient 's health state using 4 measures : rating scale ( RS ) , time tradeoff ( TTO ) , st and ard gamble ( SG ) , and willingness to pay ( WTP ) . We also ascertained residents ' demographics , risk attitudes , residency program type , post-graduate year level , current rotation , experience in a Veterans Affairs hospital , and how many days it had been since they were last on call . We performed univariate and multivariable analyses using the RS , TTO , SG and WTP as dependent variables . Results Eighty-one residents ( 89.0 % of eligible ) participated , with 36 ( 44.4 % ) viewing the video of the veteran and 45 ( 55.6 % ) viewing the video of the non-veteran . Their mean ( SD ) age was 28.7 ( 3.1 ) years ; 51.3 % were female ; and 67.5 % were white . There were no differences in residents ' characteristics or in RS , TTO , SG and WTP scores between the veteran and non-veteran groups . The mean RS score was 0.60 ( 0.14 ) ; the mean TTO score was 0.80 ( 0.20 ) ; the mean SG score was 0.91 ( 0.10 ) ; and the median ( 25th , 75th percentile ) WTP was $ 10,000 ( $ 7600 , $ 20,000 ) per year . In multivariable analyses , being a resident in the categorical program was associated with assigning higher RS scores , but no residency-associated variables were associated with the TTO , SG or WTP scores . Conclusion Physicians in training appear not to be biased either in favor of or against military veterans when judging the value of a patient 's health BACKGROUND Heart failure ( HF ) is a major health problem in developed countries . HF is a progressive , lethal disorder , even with adequate treatment . There exists a vicious circle in the pathophysiology of HF that perpetuates and magnifies the problem . Concomitant fluid accumulation may worsen the congestive HF , it is responsible for numerous hospitalizations and it is an important cause of mortality . In this situation , any means of fluid removal may aid in the management of these patients . The objective of this study was to evaluate the efficacy of peritoneal dialysis ( PD ) in the treatment of refractory HF in terms of functional status , hospitalization and mortality . We also determined the improvement in health-related quality of life with the use of PD , and examined the economic consequences of its use . METHODS We conducted a single centre , prospect i ve , non-r and omized study involving patients showing symptoms and signs of congestive HF refractory to maximum tolerable drug treatment . All of them were treated with PD .  We analysed physical and biochemical determinations , functional status ( according to the NYHA classification ) and echocardiogram parameters . Also , to determine the efficacy of the technique we compared the perceived state of health ( measured by the EQ5D ) to PD patients respect to those reported with conservative therapies . Finally , we carried out a cost-utility evaluation measured by the incremental cost-utility ratio between these two options . RESULTS Seventeen patients ( 65 % men , 64 + /- 9 years ) were included in the study , and 12 were still undergoing PD treatment at the end of the follow-up period ( 15 + /- 9 months ) . All patients improved their NYHA functional status ( 65 % two classes ; the rest , one ; P < 0.001 ) , with an important improvement in their pulmonary artery systolic pressure ( 44 + /- 12 versus 27 + /- 9 mmHg ; P = 0.007 ) , but no changes in left ventricular ejection fraction . Hospitalization rates underwent a dramatic reduction ( from 62 + /- 16 to 11 + /- 5 days/patient/year ; P = 0.003 ) before and after PD treatment . PD treatment raised life expectancy of 82 % after 12 months of treatment , and 70 % and 56 % after 18 and 24 months , respectively , much better outcomes than those reported about conservative therapies , which only use diverse diuretic regimens . PD was associated with a higher perception state of health than the conservative therapy ( 0.6727 versus 0.4305 ; P < 0.01 ) . Finally , we found that PD is cost-effective compared with the conservative therapy . CONCLUSIONS We demonstrate that congestive HF programmes should consider offering PD in hope of seeing better functional status , reduced morbidity and mortality , better quality of life as well as reduced health care costs Objective To compare two health-related quality of life measures , the preference-based EQ-5D with five questions and the profile-based R AND -36 with 36 questions , in previous critically ill patients . Design Prospect i ve observational study . Setting A ten-bed medical-surgical intensive care unit ( ICU ) in a tertiary care university hospital . Patients Of the 2,709 critically ill patients , treated during the years 1995–2000 , the 1,099 patients of the 1,443 still alive who returned both mailed measures were included in the study . Interventions None . Measurements and main results The EQ-5D and the R AND -36 correlated well ( P < .001 ) . Ceiling effect was more obvious with the EQ-5D ; the values of the R AND -36 varied usually from 0 to 100 in all the three levels of the corresponding EQ-5D question , and the weakest statistically significant differences were between the EQ levels 2 and 3 . In particular , the R AND -36 proved to differentiate better the levels of mobility , self-care , and poor outcome . Conclusions The EQ-5D and the R AND -36 correlated well , but when more precisely stated information is needed , especially regarding mobility , self-care , or low quality of life levels of previous critically ill patients , the profile-based R AND -36 may discriminate better OBJECTIVES The purpose s of this analysis were to evaluate the construct validity of the EQ-5D and compare responses on the EQ-5D with the Physical Component Summary ( PCS-12 ) and Mental Component Summary ( MCS-12 ) scores of the SF-12 Health Survey . METHODS Data were collected via a survey instrument mailed to 4,200 r and omly selected subjects in the province of Alberta , Canada . The instrument contained the EQ-5D and SF-12 health surveys , with additional questions eliciting clinical and demographic information from the respondents . RESULTS 1,555 respondents returned mailed question naires ; 606 question naires were returned undeliverable . The SF-12 summary scores were calculated for 1,380 respondents . Analysis of the EQ-5D responses by demographic variables found significant differences among categories of age , gender , and self-reported chronic medical conditions . Corresponding dimensions and summary scores were more strongly related ( eg , mobility and PCS-12 ; F ratio = 598.3 , P < 0.001 ) than dissimilar dimensions ( eg , mobility and MCS-12 ; F ratio = 18.8 , P < 0.001 ) . The EQ-5D index scores were moderately correlated with SF-12 summary scores ( r = 0.41 for MCS-12 and r = 0.68 for PCS-12 ) . For subjects reporting no problems on the EQ-5D , PCS-12 and MCS-12 scores were significantly lower for people reporting medical problems or feelings of depression . CONCLUSIONS The results of this investigation generally supported the validity of the EQ-5D . However , an important ceiling effect was observed for the EQ-5D in this sample . The combination of the EQ-5D and SF-12 provides relatively broad coverage of important health domains and scores for various purpose Background . Preference-based measures of health-related quality of life all use the same dead = 0.00 to perfect health = 1.00 scale , but there are substantial differences among measures . Objective . The objective was to examine agreement in classifying patients as better , stable , or worse . Methods . The EQ-5D , Health Utilities Index Mark 2 and Mark 3 , Quality of Well-Being – Self-Administered scale , Short-Form 36 ( Short-Form 6D ) , and disease-targeted measures were administered prospect ively in 2 clinical cohorts . The study was conducted at academic medical centers : University of California , Los Angeles ; University of California , San Diego ; University of Wisconsin – Madison ; and University of Southern California . Patients undergoing cataract extraction surgery with lens replacement completed the 25-item National Eye Institute Visual Function Question naire ( NEI-VFQ-25 ) .  Patients newly referred to congestive heart failure specialty clinics completed the Minnesota Living with Heart Failure Question naire ( MLHF ) . In both cohorts , subjects completed surveys at baseline and at 1 and 6 months . The NEI-VFQ-25 and MLHF were used as gold st and ards to assign patients to categories of change . Agreement was assessed using κ . Results . There were 376 cataract patients recruited . Complete data for baseline and the 1-month follow-up were available on all measures for 210 cases . Using criteria specified by Altman , agreement was poor for 6 of 9 pairs of comparisons and fair for 3 pairs . There were 160 heart failure patients recruited . Complete data for baseline and the 6-month follow-up were available for 86 cases . Agreement was negligible for 5 pairs and fair for 1 . The study was conducted on selected patients at a few academic medical centers . Conclusions . The results underscore the lack of interchangeability among different preference-based measures
target: In this sub-set , it was found that method ological differences contributed to variation in utility values .
  Direct methods often yielded higher scores than did indirect methods .
  Within direct methods , there were no clear trends in head-to-head studies ( st and ard gamble [ SG ] vs time trade-off ) ; but general population respondents often provided lower scores than did patients with the disease when evaluating the same health states with SG methods .
  When comparing indirect methods , the EQ-5D typically yielded higher values than the SF-6D , but also showed more sensitivity to differences in health states .
  When selecting CVD utility values for an economic model , consideration of the utility elicitation method is important , as this review demonstrates that methodology of choice impacts utility values in CVD
background: AIMS Utility values inform estimates of the cost-effectiveness of treatment for cardiovascular disease ( CVD ) , but values can vary depending on the method used .
  The aim of this systematic literature review ( SLR ) was to explore how methods of elicitation impact utility values for CVD .