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Health-related quality of life profiles of patients with diabetic retinopathy
Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Ophthalmology UHL/MH.
Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Medical Specialist.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Purpose: There are various instruments for estimating health-related quality of life (HRQoL) in patients with diabetic retinopathy (DR). However, if the results are to be compared with those for other diseases, it is essential to use measures that are applicable to all disease areas. The aim of this study was to explore the HRQoL profiles of patients with DR using two generic multi-attribute instruments, the Health State Utilities Index Mark 3 (HUI-3) and the EQ-5D questionnaire, and to investigate these questionnaires’ sensitivity to differences in HRQoL due to DR.

Methods: The study population comprised 166 Swedish diabetes patients diagnosed with DR at different severities. Patients were interviewed over the telephone using HUI-3 and EQ-5D. The vision-specific National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25) was also included, to give an empirical framework for the results of the generic instruments. Linear and logistic regression models were used to adjust for possible confounders.

Results: Patients with vision impairment (VI) reported lower scores in Vision, Ambulation, and Pain in HUI-3 and more problems with Usual activities and Anxiety/depression in EQ-5D. However, even though NEI VFQ-25 showed a negative association between DR severity and Mental health and Near activities, neither EQ-5D nor HUI-3 identified a negative relationship between DR severity and HRQoL.

Conclusion: The generic instruments show lowered HRQoL for patients with VI in various dimensions but were not sensitive to decrements related to the diagnosis of DR alone. The questionnaire of HUI-3 was more sensitive than EQ-5D to differences in HRQoL due to DR-related VI.

Keyword [en]
diabetes, diabetic retinopathy, health-related quality of life, health profile, EQ-5D, Health Utilities Index, HUI-3, National Eye Institute Visual Functioning Questionnaire 25, NEI VFQ-25
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:liu:diva-76281OAI: oai:DiVA.org:liu-76281DiVA: diva2:513374
Available from: 2012-04-02 Created: 2012-04-02 Last updated: 2012-04-10Bibliographically approved
In thesis
1. Health economic aspects of diabetic retinopathy
Open this publication in new window or tab >>Health economic aspects of diabetic retinopathy
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

To ensure that the resources of the health care sector are used effectively, new technologies need to be evaluated before implementation to examine if they generate health outcomes at an acceptable cost. This information can be collected by performing health economic evaluations in which the costs and health outcomes of different technologies are compared. To estimate the effect on health care budgets, there is also a need for information about the prevalence of the specific disease. Health outcomes in health economic evaluations are often measured in quality-adjusted life years (QALYs), which are calculated by multiplying the remaining life years after an intervention by a weight representing the health-related quality of life (HRQoL) during those years.

This thesis aims to provide deeper knowledge of the health economic aspects of diabetic retinopathy (DR), an eye complication that affects patients with diabetes and may in the worst case lead to blindness. The focus is on three empirical and two methodological health economic research questions. The empirical research areas cover prevalence, costs, and HRQoL related to patients with DR. The methodological research questions explore the performance of different methods for estimation of QALY weights. This is of interest since it has been argued that the most common methods for estimating QALY weights may not capture all relevant vision-related aspects of quality of life. The analyses comprehend the validity of different methods for estimating QALY weights among patients with DR and if the results of one of the specific methods for estimating QALY weights, the time trade-off (TTO) exercise, are affected by patients’ subjective life expectancy (SLE).

The empirical results demonstrate that DR is seen in approximately 40% and 30% of patients with type I and type II diabetes respectively, indicating that the prevalence of DR has decreased in both of these patient groups. Healthcare costs vary considerably between different severity levels of the disease, being estimated at €26, €257, €216, and €433 per patient per year for background retinopathy, proliferative diabetic retinopathy (PDR), diabetic macular oedema (DMO), and PDR combined with DMO respectively. Blindness due to DR is associated with an increased use of transportation services, caregiving services, and assistive technologies as well as productivity losses. This suggests that preventing the progression of DR may lower healthcare costs. Patients with vision impairment due to DR have lowered HRQoL in various dimensions, but the diagnosis of DR in itself has only a limited effect on HRQoL.

The results on the methodological research questions show that different methods for estimating QALY weights seem to give different results. In comparison to EQ-5D, the Health Utilities Index Mark 3 (HUI-3) is the most sensitive method for detecting differences in QALY weights due to DR, and if decisions are to be made based on values from the general public, it can be recommended for use in cost-utility analyses of interventions directed at DR. Neither of the direct methods, TTO and the visual analogue scale, seems to be sensitive to differences in visual function, and more research is needed concerning the role of vision in people’s responses to the TTO exercises. In TTO exercises with time frames based on actuarial life expectancy, the patients’ SLE has an effect on their willingness to trade off years for full health. Thus, applying time frames deviating from patients’ SLE may result in biased QALY weights. Such bias may appear stronger within patient populations than within the general public.

In conclusion, this thesis offers estimates for prevalence, costs, and QALY weights that can be used in economic evaluations of interventions directed at DR and as benchmarks for future DR research in order to follow up consequences of changes in diabetes care. In addition, it demonstrates that the choice of method for estimating QALY weights may have an impact on whether an intervention is considered cost-effective.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. 137 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1293
Keyword
diabetes, diabetic retinopathy, health economic evaluations, quality-adjusted life years, costs, quality of life, prevalence
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-76283 (URN)978-91-7519-964-1 (ISBN)
Public defence
2012-05-04, Eken, Entrance 65, Campus US, Linköping University, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2012-04-03 Created: 2012-04-02 Last updated: 2012-04-12Bibliographically approved

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Heintz, EmelieBourghardt Peebo, BeatriceWiréhn, Ann-BrittLevin, Lars-Åke

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Health Technology Assessment and Health EconomicsFaculty of Health SciencesDepartment of Clinical and Experimental MedicineDepartment of Ophthalmology UHL/MHHealth and SocietyDepartment of Medical Specialist
Health Care Service and Management, Health Policy and Services and Health Economy

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