Measures Preference-Based Measures Ron D. Hays, Ph.D. February 9, 2004.

Slides:



Advertisements
Similar presentations
Measuring outcomes Emma Frew October Measuring outcomes Learning objectives By the end of the session students should be able to – Explain how different.
Advertisements

Scaling Session Measurement implies “assigning numbers to objects or events…” Distinguish two levels: we can assign numbers to the response levels for.
Why Patient-Reported Outcomes Are Important: Growing Implications and Applications for Rheumatologists Ron D. Hays, Ph.D. UCLA Department of Medicine RAND.
Big Q and Little Q revisited Christopher McCabe PhD Capital Health Endowed Research Chair in Emergency Medicine Research.
Using a discrete choice experiment with duration to estimate values for health states on the QALY scale Nick Bansback Assistant Professor School of Population.
Utility Assessment HINF Medical Methodologies Session 4.
1 Interactive Introduction cost effectiveness Jan J. v. Busschbach, Ph.D. Psychotherapeutic Centrum ‘De Viersprong’, Halsteren
Two ways to skin a cat: a comparison of two variants of standard gamble John Brazier and Paul Dolan Prepared for the CHEBS workshop on Elicitation, 9 October.
The Influence of Transportation and Access on the Well-Being of Older Adults William A. Satariano, Ph.D., MPH School of Public Health University of California,
Schneider Institute for Health Policy Heller Graduate School Brandeis University September by Donald S. Shepard, Ph.D. Schneider Institute for Health.
QUALITY OF LIFE ASSESSMENT IN PEOPLE LIVING WITH HIV/AIDS Antonieta Medina Lara HIV/AIDS and STI Knowledge Programme Liverpool School of Tropical Medicine.
1 8/14/2015 Evaluating the Significance of Health-Related Quality of Life Change in Individual Patients Ron Hays October 8, 2004 UCLA GIM/HSR.
1 EuroQol EQ-5D Jan J. V. Busschbach, Ph.D Psychotherapeutic Centrum ‘De Viersprong’, Halsteren Department of Medical.
1 Health-Related Quality of Life Ron D. Hays, Ph.D. - UCLA Department of Medicine: Division of General Internal Medicine.
Measuring and valuing health outcome Montarat Thavorncharoensap, Ph.D. 1: Faculty of Pharmacy, Mahidol University 2. HITAP, Thailand.
1 EQ-5D, HUI and SF-36 Of the shelf instruments…..
Introduction to Effectiveness, Patient Preferences and Utilities Patsi Sinnott, PT, PhD, MPH HERC Economics Course May 6, 2009.
1 Health Economics  Comparing different allocations  Should we spent our money on Wheel chairs Screening for cancer  Comparing costs  Comparing outcome.
 Course materials copyrighted 2004 by Ron D. Hays Health-Related Quality of Life Ron D. Hays, Ph.D. February 4, 2004 (3:00-6:00 pm) Main.
Basic Methods for Measurement of Patient-Reported Outcome Measures Ron D. Hays, Ph.D. UCLA/RAND ISOQOL Conference on.
Overview of the EQ-5D Purpose and origins of the descriptive system.
1 9/8/2015 Health-Related Quality of Life Assessment in Outcome Studies Ron D. Hays, Ph.D. UCLA GIM & HSR July 17, 2006 (8:00-9:30 am) Gonda Building Conference.
1 Health-Related Quality of Life as an Indicator of Quality of Care Ron D. Hays, Ph.D. HS216—Quality Assessment: Making the Business Case.
 Course materials copyrighted 2003 by Ron D. Hays Measurement of Health-Related Quality of Life Outcomes Ron D. Hays, Ph.D. January 29,
1 9/14/2015 Options for Summarizing the SF-36 Health Survey in Health-Related Quality of Life Research Ron D. Hays, Ph.D. NCI, March 29, 2007 (11:00-11:59.
Economic evaluation of health programmes Department of Epidemiology, Biostatistics and Occupational Health Class no. 11: Cost-utility analysis – Part 4.
Ron D. Hays, Ph.D. Use of Preference-Based Health-Related Quality of Life Measures in Cost-Effectiveness Studies (HLT POL 239B) February.
Measuring Health Outcomes
Why use the EQ-5D? What are the alternatives?. What are the alternatives for Direct valuation? Other VAS Time Trade-Off Standard Gamble Willingness to.
Profile Health-Related Quality of Life Measures
University of Minnesota Medical Technology Evaluation and Market Research Department of Healthcare Management Course: MILI/PUBH 6589 Spring Semester, 2013.
Patient-Centered Outcomes of Health Care Comparative Effectiveness Research February 3, :00am – 12:00pm CHS 1 Ron D.Hays, Ph.D.
Health-Related Quality of Life as an Indicator of Quality of Care May 4, 2014 (8:30 – 11:30 PDT) HPM216: Quality Assessment/ Making the Business Case for.
1 10/12/2015 Health-Related Quality of Life Assessment Health-Related Quality of Life Assessment Ron D. Hays, Ph.D. November 27, 2002 (8:30-9:30.
1 Assessing the Minimally Important Difference in Health-Related Quality of Life Scores Ron D. Hays, Ph.D. UCLA Department of Medicine October 25, 2006,
Health-Related Quality of Life Measures (HLT POL 239B)
1 10/19/2015  Course materials copyrighted 2003 by Ron D. Hays A Comprehensive Approach to the Measurement of Health Outcomes Ron D. Hays, Ph.D. UCLA.
1 10/20/2015 Quality of Life in Health Outcome Studies Ron D. Hays, Ph.D. UCLA GIM & HSR November 21, 2006 (9--10:20 am) Room
Measuring Health-Related Quality of Life Ron D. Hays, Ph.D. UCLA Department of Medicine RAND Health Program UCLA Fielding School of Public Health
Another Perspective on PRO Content in Clinical Practice Ron D. Hays, Ph.D. University of California, Los Angeles June 25, 2007.
Development of Physical and Mental Health Summary Scores from PROMIS Global Items Ron D. Hays ( ) UCLA Department of Medicine
A Comprehensive Approach to the Measurement of Health Outcomes Ron D. Hays, Ph.D. UCLA Division of General Internal Medicine.
Preference-Based Health-Related Quality of Life Measures Ron D. Hays, Ph.D. January 26, 2015 (9:00-11:50 am) HPM 214
Measuring Health-Related Quality of Life
1 EQ-5D, HUI and SF-36 Of the shelf instruments…..
Patsi Sinnott, PT, PhD, MPH HERC Economics Course April 7, 2010 Introduction to Effectiveness, Patient Preferences and Utilities.
RESCUE: Assessing Health and Economic Outcomes William C. Black, M.D. Dartmouth-Hitchcock Medical Center.
Overview of Health-Related Quality of Life Measures May 22, 2014 (1:00 – 2:00 PDT) Kaiser Methods Webinar Series 1 Ron D.Hays, Ph.D.
1 Health-Related Quality of Life Assessment as an Indicator of Quality of Care (HPM 216) Ron D. Hays April 11, 2013(8:30-11:30 am) Wilshire Blvd.
Health-Related Quality of Life Preference Measures for Vision Studies Ron D. Hays, Ph.D. UCLA GIM & HSR June 10, 2009 (2:30-4:00 pm) Irvine, CA.
1 Health outcome valuation study in Thailand Sirinart Tongsiri Research degree student Health Services Research Unit, Public Health & Policy Department.
1 Interactive Introduction Cost Effectiveness and Psychotherapy Jan J. v. Busschbach, Ph.D. Psychotherapeutic Centrum ‘De Viersprong’, Halsteren
1 12/3/2015 Measuring Self-Reported Health Ron D. Hays, Ph.D. UCLA GIM & HSR November 27, 2007 (9:00-10:00 am) Gonda Building (Room 1357)
Hermann P. G. Schneider, Alastair H. MacLennan and David Feeny
“Introduction to Patient Preference Methods used for QALYs” Presented by: Jan Busschbach, PhD, Chair Section Medical Psychology and Psychotherapy, Department.
1 12/18/2015 Comprehensive Approach to Measuring Health Outcomes Ron D. Hays, Ph.D. UCLA GIM & HSR October 23, 2006 (3:15-4:45 pm) MacDonald.
1 1/5/2016  Course materials copyrighted 2002 by Ron D. Hays Health-Related Quality of Life Assessment Ron D. Hays, Ph.D. February 13,
Overlap between Subjective Well-being and Health-related Quality of Life. 3 Ron D. Hays, Ph.D. (Alina Palimaru) November 18, 2015 (11:30-12:00 noon) Geriatric.
Measurement of Outcomes Ron D. Hays Accelerating eXcellence In translational Science (AXIS) January 17, 2013 (2:00-3:00 pm) 1720 E. 120 th Street, L.A.,
1 2/13/2016 Health-Related Quality of Life Assessment as an Indicator of Quality of Care Ron D. Hays, Ph.D. HS249F January 30, 2008 (3:30-6:30 pm) RAND.
 Course materials copyrighted 2005 by Ron D. Hays Health-Related Quality of Life Ron D. Hays, Ph.D. February 2, 2005 (3:00-6:00 pm) Room.
Health-Related Quality of Life in Outcome Studies Ron D. Hays, Ph.D UCLA Division of General Internal Medicine & Health Services Research GCRC Summer Session.
Health-Related Quality of Life (HRQOL) Assessment in Outcome Studies Ron D. Hays, Ph.D. UCLA/RAND GCRC Summer Course “The.
Table 1. Characteristics of generic HRQOL assessments in adult physical activity research Peter D. Hart et al. Systematic Review of Health-Related Quality.
1 9/29/2016  Course materials copyrighted 2002 by Ron D. Hays Measurement of Health-Related Quality of Life Outcomes Ron D. Hays, Ph.D.
Health-Related Quality of Life Assessment in Outcome Studies
Health-Related Quality of Life Measures (HS249T: Decision Analysis and Cost-Effectiveness Analysis) Ron D. Hays, Ph.D. UCLA Division.
Measuring outcomes Emma Frew October 2012.
Health-Related Quality of Life as an indicator of Quality of Care
How to Measure Quality of Life
Presentation transcript:

Measures Preference-Based Measures Ron D. Hays, Ph.D. February 9, 2004

ProfileProfile – Generic – Targeted Preference-basedPreference-based Types of HRQOL Measures

Physical Health Physical function Role function- physical Pain General Health Physical Health

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

SF-36 PCS and MCS PCS_z = (PF_z *.42402) + (RP_z *.35119) + (BP_z *.31754) + (GH_z *.24954) + (EF_z *.02877) + (SF_z * ) + (RE_z * ) + (EW_z * ) MCS_z = (PF_z * ) + (RP_z * ) + (BP_z * ) + (GH_z * ) + (EF_z *.23534) + (SF_z *.26876) + (RE_z *.43407) + (EW_z *.48581)

T-score Transformation PCS = (PCS_z*10) + 50 MCS = (MCS_z*10) + 50

Is New Treatment (X) Better Than Standard Care (O)? X 0 X 0 PhysicalHealth X > 0 MentalHealth 0 > X

35%84%at least 1 moderate symptom 7%70%at least 1 disability day 7%70%at least 1 disability day 1%11%hospital admission 1%11%hospital admission 2%14%performance of invasive 2%14%performance of invasive diagnostic procedure Perceived Health Index (n = 1,862; reliability = 0.94) Highest Lowest Quartile on Index Perceived Health Index = 0.20 Physical functioning Pain Energy Emotional well-being Social functioning Role functioning. Bozzette, S.A., Hays, R.D., Berry, S.H., & Kanouse, D.E. (1994). A perceived health index for use in persons with advanced HIV disease: Derivation, reliability, and validity. Medical Care, 32, Single Weighted Combination of Scores

Is Use of Medicine Related to Worse HRQOL? dead 1 Nodead dead 2 Nodead 3 No50 4 No75 5 No100 6 Yes0 7 Yes25 8 Yes50 9 Yes75 10 Yes100 Medication Person Use HRQOL (0-100 scale) No Medicine375 Yes Medicine550 Group nHRQOL

Marathoner 1.0 Person in coma 1.0 Survival Analysis

Profile + Mortality Outcomes for Acute MI (n = 133)

Tengs, T. Presented at Health Services Research Seminar, VA Hospital, San Diego, July, 2000

Overall Health Rating Item Overall, how would you rate your current health? (Circle One Number) Worst possible health (as bad or worse than being dead) Half-way between worst and best Best possible health

Summarize HRQOL in QALYs -- Physical activity (PAC) -- Physical activity (PAC) – Mobility (MOB) – Mobility (MOB) – Social activity (SAC) – Social activity (SAC) - Symptom/problem complexes (SPC) - Symptom/problem complexes (SPC) Well-Being Formula w = 1 + PAC + MOB + SAC + SPC Preference-Based Measure-- Quality of Well-Being Scale Dead Well-Being 01

Each page in this booklet tells how an imaginary person is affected by a health problem on one day of his or her life. I want you to look at each health situation and rate it on a ladder with steps numbered from zero to ten. The information on each page tells 1) the person's age group, 2) whether the person could drive or use public transportation, 3) how well the person could walk, 4) how well the person could perform the activities usual for his or her age, and 5) what symptom or problem was bothering the person. Example Case #1 Adult (18-65) Drove car or used public transportation without help Walked without physical problems Limited in amount or kind of work, school, or housework Problem with being overweight or underweight Quality of Well-Being Weighting Procedure Perfect Health Death

1)In wheelchair and moved oneself or had difficulty: lifting stooping using stairs walking, etc. 2) In bed, chair, couch, or wheelchair and did not move oneself QWB Physical Activity Levels

1) Did not drive car or use public transportation 2) In hospital, nursing home, or hospice QWB Mobility Levels

1)Limited or did not perform role activities 2) Did not feed, bath, dress, or toilet oneself QWB Social Activity Levels

Worst Symptom/problem complex experienced Breathing smog  Loss of consciousness QWB Symptom/Problem Complexes

ComponentMeasuresStatesWeights Physical activityPhysical functionIn bed, chair, couch, or wheelchair*-.077 In wheelchair* or had difficulty lifting,-.060 stooping, using stairs, walking, etc. MobilityAbility to get around orIn hospital, nursing home, or hospice transport oneselfDid not drive car or use public transportation Social activityRole function and self-careDid not feed, bath, dress, or toilet Limited or did not perform role Symptom/problem Physical symptoms andWorst symptom from loss of complexes problems consciousness to breathing smog or unpleasant air * moved vs. did not move oneself in wheelchair Quality of Well-Being States and Weights

EQ-5D MobilitySelf-care Usual activities Pain/discomfortAnxiety/depression  243 states, 3 levels per attribute

HUI-3 VisionHearingSpeechAmbulationDexterityCognition Pain and discomfort Emotion  972,000 states, 5-6 levels per attribute

SF-6D Summary Measure  Brazier et al. (1998, 2002) —6-dimensional classification  Collapsed role scales, dropped general health  Uses 11 SF-36 items (8 SF-12 and 3 additional physical functioning items) —18,000 possible states —249 states rated by sample of 836 from UK general population

Health state (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 the time. You have a lot of energy all of the time

Cost/QALY (1993 US dollars) $0 Seat belt laws $2k Pneumonococcal vaccine $6k Smoking cessation counseling $12k Oral gold for rheumatoid arthritis $40k CABG, 2-vessel disease; hemodialysis $167k Mammography screening $293k Hip replacement $663k CABG, 1-vessel disease

Ad Hoc Preference Score Estimates Comprehensive Geriatric Assessment (n = 363 community-dwelling older persons) lead to improvements in SF-36 energy, social functioning, and  Physical functioning (4.69 points) in 64 weeks  Cost of $746 over 5 years beyond control group Keeler, E. B., et al. Cost-effectiveness of outpatient geriatric assessment with an intervention to increase adherence. Med Care, 1999, 37 (12),

Is CGA worth paying for? Change in QALYs associated with 4.69 change in SF- 36 physical functioning  r = > b =.003   QWB = 4.69 x.003 =.014 .014 x 5 yrs. = 0.07 QALYs  Cost/QALY: $10,600+ <$20,000 per QALY worthwhile

Limitations of Preference Measures Complexity of task Coarseness of health states Sensitivity to method of elicitation

Choice between two certain outcomes Years of life traded for quality of life Simple to administer alternative to SG Time Tradeoff (TTO)

Choice #1: Your present state (e.g., paralysis) Life Expectancy: 10 years Choice #2: Complete mobility How many years (x) would you give up in your current state to be able to have complete mobility? [ 1 - X = QALY ] 10 Time Tradeoff

How many years (x) would you give up in your current state to be able to have complete mobility? X = 0  QALY = 1 X = 1 -> QALY = 0.9 X = 5 -> QALY = 0.5 X = 10 -> QALY = 0 [ 1 - X = QALY ] 10 Time Tradeoff

Classical method of assessing preferences Choose between certain outcome and a gamble Conformity to axioms of expected utility theory Incorporates uncertainty (thus, more reflective of treatment decisions). Standard Gamble

Choice #1: Your present state (e.g., paralysis) Choice #2: X probability of complete mobility 1-X probability of death Preference Value:Point at which indifferent between choices, varying X [ X = QALY ] Standard Gamble (SG)

X probability of complete mobility X = 1.00  QALY = 1.00 X = 0.50  QALY = 0.50 X = 0.00  QALY = 0.00 Standard Gamble (SG)

Physical Health P30.00High P2-0.20Medium P1-0.50Low Mental Health M30.00High M2-0.30Medium M1-0.40Low Hypothetical Health States

Perfect QOL Dead ExistsMeasured P3, M3 P2, M3 P3, M2 P3, M1 P1, M2 P1, M1 P1, M3 P2, M2 P2, M1 Mapping Health States into Quality of Life