2010 review - Patient-Reported Outcomes Measurement - University ...

Response rates of 93% and above were reported for in-hospital administration of a battery of
instruments including the EQ-5D in the RITA-3 trial (Kim et al., 2005, UK), indicating good
acceptability to patients. A return rate of 87% for postal administration of a battery of
instruments including the EQ-5D was reported by the BHACAS trial comparing OPCAB and
CABG-CPB (Ascione et al., 2004, UK). However, there were low rates of return for postal
administration in three other studies – 64%, 52%, and 68%, respectively (Sollano et al., 1998;
Denvir et al., 2006, UK; Dunning et al., 2008, UK).
Interpretability of the EQ-VAS and EQ-5D global utility score was supported in the RITA-3
trial (Kim et al., 2005, UK), with a 5-unit decline in VAS and a 0.068 decline in global utility
score, respectively, corresponding to a 1-unit increase in angina grade, according to the CCS
classification.
c. Health Utilities Index (Feeny et al., 1995)
The Health Utilities Index (HUI) was designed as a comprehensive framework for describing
health status and health-related quality of life for use in clinical studies, population health
surveys, and economic evaluations; the original HUI has been largely superseded by HUI2
and HUI3 (Feeny et al., 1995). The Health Utilities Index Mark 3 (HUI3) consists of eight
dimensions, rated by members of the general population as the most important attributes or
dimensions of health status. For each attribute, there are five or six levels of functioning,
ranging from highly impaired to normal, defined in terms of capacity rather than
performance, to avoid confounding abilities with preferences. A combination of levels across
the attributes constitutes a health state; utility scores, based on community preferences, can
be obtained for each health state using an algorithm, with 0 representing death and 1 perfect
health.
Population norm data have been obtained from several large general population surveys.
Over 15 different language versions of the HUI are available, and it has been used in more
than 25 countries.
Two studies were identified using HUI3 with patients undergoing elective coronary
procedures, the most recent being from 2004; neither was conducted in the UK. One of the
studies examined outcomes of PCI, the other feasibility of outcome measurement in CABG
or PCI.
In a head-to-head comparison between the HUI3 and the SF-6D with a sample of patients
undergoing PCI (Hatoum et al., 2004; EXCITE study), both measures demonstrated
discriminative validity, with significant differences in score distribution compared with the
general population samples from whom preference weights were originally obtained, and
significant between-group differences according to severity of angina (Hatoum et al., 2004).
However, unlike the SF-6D, the HUI did not discriminate women and men, and patients
requiring a longer stay in CCU (Hatoum et al., 2004).
Concurrent validity was demonstrated by significant correlations between comparable
domains of the HUI3 and SF-6D (Hatoum et al., 2004).
Responsiveness of the HUI3 to change was also supported in the EXCITE study, with
significant score changes between baseline (pre-discharge) and six months (Hatoum et al.,
2004). However, HUI scores showed large ceiling effects, with 50% of the sample scoring at
the top level in five of the eight dimensions, suggesting that the measure may lack precision,
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