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Pharmacoeconomics > Health - Related Quality of Life > Flashcards

Health - Related Quality of Life Flashcards

1
Q

What is QoL?

A

General concept focused on measuring people’s overall perception of their lives

Both health and non health related

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2
Q

What is HRQoL?

A

“Represents the functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient”

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3
Q

What are the 3 methods for measuring health states?

A
  1. Utility measures
  2. HRQoL measures
  3. Preference based classification systems
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4
Q

What is a utility measures?

A
  1. Estimates utility or value an individual assigns to different health states
  2. Preference based method that estimates a number between 0-1 to calculate a QALY

Examples: Rating scale, standard gamble, time trade off

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5
Q

What does a HRQoL measure?

A

Non-utility or non-preference measures
1. Describes a patient’s estimation of his/her own health at a certain point in time
2. Assesses patient perspective by relatives, caregivers, HCP, and patient
3. Multi-dimensional assesssment (multiple scores for each patient)

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6
Q

What are the types of HRQoL?

A
  1. Generic measures
  2. Dx-specific measures
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7
Q

What are example of generic measures?

A
  1. MOS-SF
  2. QWB scale
  3. SIP
  4. Dartmouth COOP
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8
Q

What is the function of SF36?

A
  1. Contains 36 survey items
  2. Multipurpose survey that assesses generic health status
  3. Useful in comparing relative burdens of different disease states
  4. Useful in estimating relative benefits of different treatments
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9
Q

What are the advantages of generic?

A
  1. Broadly applicable
  2. Summarizes range of concepts
  3. May detect unanticipated effects
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10
Q

What are the disadvantages of generic?

A
  1. May not be responsive to changes in health
  2. May not be relevant for specific populations
  3. Results may be difficult to interpret
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11
Q

What are the advantages of disease specific?

A
  1. More relevant for specific populations
  2. More responsive to changes in health
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12
Q

What are the disadvantages of disease-specific?

A
  1. Can’t compare across populations
  2. Less likely to detect unanticipated effects
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13
Q

What are the domains of healh status?

A
  1. Physical functioning
  2. Psychological functioning
  3. Social and role functioning
  4. General health perceptions

Others:
1. Economic or vocational status
2. Religious or spiritual status

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14
Q

What are physical functioning?

A

Assesses the patient’s observable limitations or disability over a specific time period

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15
Q

What are the psychological functioning?

A

Assesses the psychological distress caused by a disease or treatment side effect

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16
Q

What is a social functioning?

A

participation in social interactions & the satisfaction from interacting

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17
Q

What is role functioning?

A

ability to work, perform household duties, or complete schoolwork

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18
Q

What is general health perception?

A

Focuses on patients’ overall beliefs/evaluations about their health

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19
Q

Reliability in relation to HRQoL?

A

Describes how consistent the results of a HRQoL instrument is

20
Q

Validity in relation to HRQoL?

A

Describes how precise the results of a HRQoL instrument is

21
Q

Responsiveness in relation to HRQoL?

A

Describes the ability of a HRQoL instrument to measure meaningful clinical changes

22
Q

What are the types of reliability measures?

A
  1. Test-retest reliability
  2. Internal consistency
  3. Interrater reliability
23
Q

What does test-retest reliability evaluate?

A

The similarity of health status scores over time when no health changes have occurre

24
Q

What does internal consistency evaluate?

A

The correlation between responses for questions in a specific domain

25
Q

What does interrater reliability evaluate?

A

Aggreement between two individuals who are assessing the health status of the same patient

26
Q

HRQoL instruments can be ___ but not ___?

A

Reliable (consisten) but not valid (imprecise)

27
Q

What is the purpose of validity assessments?

A

if scores from HRQoL instruments truly represent the aspects of HRQoL

28
Q

What are the validity assessments?

A
  1. Content
  2. Criterion
  3. Construct
29
Q

What does content validity evaluate?

A

Evaluates if the HRQoL instrument provides an adequate representation of relevant variable of interest

Requires the existence of a stadard for comparison of concepts

30
Q

What is criterion validity?

A

Predictive validity: HRQoL scores are related to external outcome criteria

High HRQoL score (good health) -> low use of medical services
Low HRQoL score (poor health) -> higher rates of mortality in the following year

31
Q

What is construct validity?

A

Abstract and complex method for determinign validity:
1. Convergent validity
2. Discriminant validity
3. Known-groups validity

32
Q

What does convergent validity evaluate?

A

If use of different measures of the same construct provide similar results

33
Q

What does discriminant validity evaluate?

A

If different measures and their underlying construct can be differentiated from other constructs

34
Q

What does known-groups validity evaluate?

A

The differences between two patient groups known or theorized to differ

35
Q

What does validated mean?

A
  1. Sufficient evidence that the HRQoL instrument reflects the health concepts intended for measurement
  2. Sufficient evidence that the HRQoL instrument does not measure any unintended concepts
36
Q

What does ongoing mean?

A

As long as new info is available regarding the interpretation and meaning of scores

37
Q

What is minimally important difference?

A

The change in score that constitutes a clinical difference

38
Q

Using a HRQoL scenario, when is it considered cost effective?

A

If treatment costs are the same or lower (vs. alternative treatment) AND shows superior improvement in at least one (1) domain AND is no worse in any other domains

39
Q

What is Preference-based classification systems?

A
  1. Hybrid of utility and HRQoL methods for assessing health
  2. Indirect measures from a multi-attribute approach
  3. Scores are based on self-assessed health status but valued using weights from the general population
40
Q

What are examples of Preference-based classification systems?

A
  1. EuroQol 5D (EQ-5D)
  2. Short-Form 6D (SF-6D)
  3. Health Utilities Index 3 (HUI-3)
41
Q

What are the domains of EuroQol 5D?

A
  1. Mobility
  2. Self care
  3. Usual activity
  4. Pain/discomfort
  5. Anxiety/depression

5 domains
3 levels of functioning
243 possible health states

42
Q

What are the domains of SF-6D?

A

Indirect utility measure that uses response from SF-36 and SF-12 HRQoL instruments:
1. Physical functioning
2. Role limitations
3. Social functioning
4. Pain
5. Mental health
6. Vitality

6 domains
4-6 levels of functioning
18,000 possible health states

43
Q

What are the Health Utilities Index-3 (HUI-3) domains, levels, and total health status?

A

6 domains
5-6 levels of functioning
972,000 possible health states

44
Q

What is the ceiling effect?

A

Percent of respondents with a score of 1.0

Decreases differentiation between respondents in good (but not perfect) health

45
Q

What is EQ-5D-5L?

A

New version of EQ-5D:
* Five (5) levels of functioning
1 – none, 2 – slight, 3 – moderate, 4 – severe, 5 – extreme
* Improves sensitivity of instrument to detect differences in health states

46
Q

Rank the classifications based on ceiling effect

A

EQ-5D (HIGHEST) > HUI3 > SF-6D (LOWEST)

47
Q

What is Patient-reports outcomes (PROs)?

A

Measurement of any aspect of a patient’s health status that comes directly from the patient

Pharmacoeconomics (9 decks)

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