EQ-5D和SF-6D测量脑卒中患者健康效用值的比较
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摘要
目的采用6维健康调查简表(SF-6D)和欧洲5维健康量表(EQ-5D)测量我国脑卒中患者健康效用值,并对两种方法进行比较,为今后开展相关成本效用分析提供支持。方法对596例在2010年1月至2016年6月入住四川大学华西医院的首发卒中患者进行前瞻性随访调查,在患者住院期间进行面对面问卷调查,并在出院后每3个月进行一次电话随访。每次调查采用EQ-5D和SF-6D量表评估患者健康效用值。采用Bland-Altman plot分析和组内相关系数(intraclass correlation coefficient,ICC)评价两量表的一致性;采用logistic回归分析健康效用值的影响因素。结果 EQ-5D和SF-6D测量脑卒中患者的平均健康效用值及其95%可信区间分别为0.78(0.76,0.80)和0.74(0.73,0.76),中位数及四分位数间距分别为0.86(0.68,1.00)和0.73(0.62,0.86);ICC为0.67(95%可信区间:0.62,0.71),Bland-Altman plot分析示95%一致性区间为-0.28~0.35,两量表测量结果不一致;EQ-5D具有较强的天花板效应;脑卒中患者发病后效用值在急性期内(<3月)变化明显,急性期后几无变化。无论是EQ-5D还是SF-6D,疾病严重程度都是健康效用值的主要影响因素。结论 SF-6D是较为合适的我国脑卒中患者健康效用值测量工具。
Objective To compare EQ-5 Dand SF-6 Dfor measuring health utility of stroke patients in health economic evaluation studies.Methods A prospective cohort study was conducted on 596 stroke patients in the West China Hospital of Sichuan University from 2010 to 2016.Data were collected at baseline through face to face interviews and at the follow-up stages through telephone interviews with a three-month interval.EQ-5 Dand SF-6 D were used for measuring health utility scores of the participants.The consistency of the two instruments was assessed using Bland-Altman plot and Intraclass correlation coefficient(ICC).Logistic regression models were established to identify predictors of health utility.Results The participants had a mean utility score of 0.78(95%confidence interval:0.76,0.80)in EQ-5 D,compared with 0.74(95% confidence interval:0.73,0.76)in SF-6 D,and a median(interquartile range)of 0.86(0.68,1.00)in EQ-5 Dand 0.73(0.62,0.86)in SF-6 D.The 95%limits of agreement between the two instruments ranged from-0.28 to 0.35,with an ICC of 0.67(95% confidence interval:0.62,0.71).EQ-5 Dhad a higher ceiling effect.The health utility score of stroke patients changed there rapidly in acute phase(less than 3 months)but barely changed there after.Severity of stroke was a major predictor of health utility scores.Conclusion The two instruments generate inconsistent results in health utility.SF-6 Dis better for measuring health utility in patients with stroke in China.
Objective To compare EQ-5 Dand SF-6 Dfor measuring health utility of stroke patients in health economic evaluation studies.Methods A prospective cohort study was conducted on 596 stroke patients in the West China Hospital of Sichuan University from 2010 to 2016.Data were collected at baseline through face to face interviews and at the follow-up stages through telephone interviews with a three-month interval.EQ-5 Dand SF-6 D were used for measuring health utility scores of the participants.The consistency of the two instruments was assessed using Bland-Altman plot and Intraclass correlation coefficient(ICC).Logistic regression models were established to identify predictors of health utility.Results The participants had a mean utility score of 0.78(95%confidence interval:0.76,0.80)in EQ-5 D,compared with 0.74(95% confidence interval:0.73,0.76)in SF-6 D,and a median(interquartile range)of 0.86(0.68,1.00)in EQ-5 Dand 0.73(0.62,0.86)in SF-6 D.The 95%limits of agreement between the two instruments ranged from-0.28 to 0.35,with an ICC of 0.67(95% confidence interval:0.62,0.71).EQ-5 Dhad a higher ceiling effect.The health utility score of stroke patients changed there rapidly in acute phase(less than 3 months)but barely changed there after.Severity of stroke was a major predictor of health utility scores.Conclusion The two instruments generate inconsistent results in health utility.SF-6 Dis better for measuring health utility in patients with stroke in China.
引文
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[4]王方舟,李洪超,马爱霞.效用量表在中国人群中的应用研究综述.中国药物评价,2015,32(4):244-247.
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[7]张崖冰,胡善联.用不同测量方法得到的效用值的比较.中国卫生经济,2014,33(3):5-8.
[8]詹凤羽,闫沛静,张娟,等.竞争风险模型在吸烟与缺血性脑卒中复发关系研究中的应用.四川大学学报(医学版),2015,46(5):736-739.
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[12]HAACKE C,ALTHAUS A,SPOTTKE A,et al.Longterm outcome after stroke.Stroke,2006,37(1):193-198.
[13]徐涵,黄卫东,刘国祥,等.成本-效用分析中效用值的测量方法.中国卫生经济,2016,35(1):28-30.
[14]YANG F,LAU T,LEE E,et al.Comparison of the preference-based EQ-5D-5Land SF-6Din patients with endstage renal disease(ESRD).Eur J Health Econ,2015,16(9):1019-1026.
[15]CHANG TJ,TARN YH,HSIEH CL,et al.Taiwanese version of the EQ-5D:validation in a representative sample of the Taiwanese population.J Formos Med Assoc,2007,106(12):1023-1031.
[16]张方,傅书勇,王曼,等.采用EQ-5D测量中国急性缺血性脑卒中患者生存质量的相关性实证研究.中国药物经济学,2009,4(6):5-12.
[17]LAM CL,TSE EY,GANDEK B.Is the standard SF-12health survey valid and equivalent for a Chinese population?Qual Life Res,2005,14(2):539-547.
[18]ELLIS C,GRUBAUGH AL,EGEDE LE.Factors associated with SF-12physical and mental health quality of life scores in adults with stroke.J Stroke Cerebrovasc Dis,2013,22(4):309-317.
[19]CHEN J,WONG CKH,MCGHEE SM,et al.A comparison between the EQ-5D and the SF-6Din patients with chronic obstructive pulmonary disease(COPD).PLoS One,2014,9(11):e112389[2017-04-18].https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4224433/.doi:10.1371/journal.pone.0112389.
[20]曹卫华,李俊,郭春晖.脑卒中患者生活质量的影响因素分析.中华物理医学与康复杂志,2005,27(5):308-311.
[21]CUNILLERA O,TRESSERRAS R,RAJMIL L,et al.Discriminative capacity of the EQ-5D,SF-6D,and SF-12as measures of health status in population health survey.Qual Life Res,2010,19(6):853-864.
[22]FERREIRA PL,FERREIRA LN,PEREIRA LN.How consistent are health utility values?Qual Life Res,2008,17(7):1031-1042.
[23]徐喜卿,王珉,李顺平,等.乳腺癌患者健康效用值测量研究.中国卫生经济,2016,35(3):21-24.
[24]ALGUREN B,FRIDLUND B,CIEZA A,et al.Factors associated with health-related quality of life after stroke.Neurorehabil Neural Repair,2011,26(3):266-274.
[25]WANG Q,FURLONG W,FEENY D,et al.How robust is the Health Utilities Index Mark 2utility function?Med Decis Making,2002,22(4):350-358.
[2]KERNAN WN,OVBIAGELE B,BLACK HR,et al.Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack:a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke,2014,45(7):2160-2236.
[3]LIU GG,WU H,LI M,et al.Chinese time trade-off values for EQ-5D health states.Value Health,2014,17(5):597-604.
[4]王方舟,李洪超,马爱霞.效用量表在中国人群中的应用研究综述.中国药物评价,2015,32(4):244-247.
[5]POST PN,STIGGELBOUT AM,WAKKER PP.The utility of health states after stroke.Stroke,2001,32(6):1425-1429.
[6]LUENGO-FERNANDEZ R,GRAY AM,BULL L,et al.Quality of life after TIA and stroke:ten-year results of the Oxford Vascular Study.Neurology,2013,81(18):1588-1595.
[7]张崖冰,胡善联.用不同测量方法得到的效用值的比较.中国卫生经济,2014,33(3):5-8.
[8]詹凤羽,闫沛静,张娟,等.竞争风险模型在吸烟与缺血性脑卒中复发关系研究中的应用.四川大学学报(医学版),2015,46(5):736-739.
[9]刘敏,方向华.脑卒中后残疾的研究进展.中华流行病学杂志,2013,34(11):1146-1150.
[10]BRAZIER JE,ROBERTS J.The estimation of a preferencebased measure of health from the SF-12.Med Care,2004,42(9):851-859.
[11]萨建,刘桂芬.定量测量结果的一致性评价及BlandAltman法的应用.中国卫生统计,2011,28(4):409-411.
[12]HAACKE C,ALTHAUS A,SPOTTKE A,et al.Longterm outcome after stroke.Stroke,2006,37(1):193-198.
[13]徐涵,黄卫东,刘国祥,等.成本-效用分析中效用值的测量方法.中国卫生经济,2016,35(1):28-30.
[14]YANG F,LAU T,LEE E,et al.Comparison of the preference-based EQ-5D-5Land SF-6Din patients with endstage renal disease(ESRD).Eur J Health Econ,2015,16(9):1019-1026.
[15]CHANG TJ,TARN YH,HSIEH CL,et al.Taiwanese version of the EQ-5D:validation in a representative sample of the Taiwanese population.J Formos Med Assoc,2007,106(12):1023-1031.
[16]张方,傅书勇,王曼,等.采用EQ-5D测量中国急性缺血性脑卒中患者生存质量的相关性实证研究.中国药物经济学,2009,4(6):5-12.
[17]LAM CL,TSE EY,GANDEK B.Is the standard SF-12health survey valid and equivalent for a Chinese population?Qual Life Res,2005,14(2):539-547.
[18]ELLIS C,GRUBAUGH AL,EGEDE LE.Factors associated with SF-12physical and mental health quality of life scores in adults with stroke.J Stroke Cerebrovasc Dis,2013,22(4):309-317.
[19]CHEN J,WONG CKH,MCGHEE SM,et al.A comparison between the EQ-5D and the SF-6Din patients with chronic obstructive pulmonary disease(COPD).PLoS One,2014,9(11):e112389[2017-04-18].https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4224433/.doi:10.1371/journal.pone.0112389.
[20]曹卫华,李俊,郭春晖.脑卒中患者生活质量的影响因素分析.中华物理医学与康复杂志,2005,27(5):308-311.
[21]CUNILLERA O,TRESSERRAS R,RAJMIL L,et al.Discriminative capacity of the EQ-5D,SF-6D,and SF-12as measures of health status in population health survey.Qual Life Res,2010,19(6):853-864.
[22]FERREIRA PL,FERREIRA LN,PEREIRA LN.How consistent are health utility values?Qual Life Res,2008,17(7):1031-1042.
[23]徐喜卿,王珉,李顺平,等.乳腺癌患者健康效用值测量研究.中国卫生经济,2016,35(3):21-24.
[24]ALGUREN B,FRIDLUND B,CIEZA A,et al.Factors associated with health-related quality of life after stroke.Neurorehabil Neural Repair,2011,26(3):266-274.
[25]WANG Q,FURLONG W,FEENY D,et al.How robust is the Health Utilities Index Mark 2utility function?Med Decis Making,2002,22(4):350-358.