IHE Report - Institute of Health Economics

Barriers related to the properties of the HRQL measures: Poor reliabilityand ceiling effects were identified as barriers to the use of HRQL measuresin clinical care by McHorney et al (2002).SUMMARYIn summary, HRQL instruments should be easy to administer, score andinterpret. These instruments should be able to cover a range of age, severity,diagnoses, co-morbidities and assess a full range of health among diversepatient groups at a single point in time and overtime. HRQL measures shouldexhibit minimal floor and ceiling effects and should be highly reproducibleovertime and have a small standard error of measurement for use inlongitudinal monitoring. They should also yield highly accurate and precisescores that have a small standard error of measurement for use in clinicaldecision making. HRQL should be valid indicators of the constructs they arehypothesized to represent, be responsive to clinical change and have evidenceof validity for individual patient applications when used for that purpose(McHorney and Tarlov, 1995).The choice of clinical area in which to assess the routine use of a HRQLinstrument should be made on the basis of type of patients, characteristics ofthe disease and its management. Previous studies described the usefulness ofHRQL measures when applied to chronically ill populations (palliative care,oncology, AIDS) in specialist centres (Morris et al. 1998). In this scenario,the use of HRQL instruments is recommended to record the patient’sperceptions about his/her condition. The inclusion of these measures inroutine clinical care has the potential to add valuable information to thepatient’s medical history. HRQL measures provide a comprehensive pictureof the patient’s condition. Information on the patient’s emotional status(anxiety and depression) complements physiological and pathologicalinformation and has the potential to improve patient clinical care.HRQL STUDIES CONDUCTED AT THEINSTITUTE OF HEALTH ECONOMICSInvestigators at the Institute of Health Economics (IHE) have been active indeveloping, applying, and evaluating measures of HRQL. Several studies havebeen conducted at the IHE examining the importance of HRQL measures inpatient’s care, economic evaluations and decision making.The following IHE Working papers from 1997 to 2006 were reviewed:Johnson et al. (1997) conducted a study to derive a set of US-basedpopulation weights for the standard set of health states described inthe EQ-5D health questionnaire. The results showed that the valuations11The Importance of Measuring Health-related Quality of Life