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Quality of life among hazardous and harmful drinkers: EQ-5D over a 1-year follow-up period

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Abstract

Purpose

To investigate the ability of the EQ-5D to discriminate between levels of alcohol risk in a large sample of hazardous and harmful drinkers, and to explore the relationship between transitions between alcohol risk levels and changes in EQ-5D up to 12 months.

Methods

This is a web-based randomised controlled trial evaluating a novel intervention for hazardous and harmful alcohol consumption. EQ-5D scores were compared among groups of drinkers at baseline (low/medium/high risk according to self-reported past week alcohol consumption), and changes in EQ-5D scores were estimated as a function of changes in alcohol consumption level.

Results

Baseline EQ-5D scores were dominated by problems with anxiety/depression, which increased with alcohol risk level, whilst high-risk drinkers also experienced more problems with physical HRQoL dimensions. However, the tool demonstrated a considerable ceiling effect. At follow-up, despite considerable reductions in alcohol consumption across the sample, significant changes in aggregated EQ-5D index scores were only observed for high-risk drinkers at baseline who reduced their drinking, with small improvements (0.04–0.06) compared to those who did not reduce.

Conclusions

Our results suggest that the three-option EQ-5D may not be an optimal primary end point for measuring clinical and cost-effectiveness in randomised controlled trials of interventions among hazardous and harmful alcohol users, although further testing of the sensitivity of the tool in these populations is needed.

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References

  1. Rehm, J., Mathers, C., Popova, S., Thavorncharoensap, M., Teerawattananon, Y., & Patra, J. (2009). Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders [Review]. Lancet, 373(9682), 2223–2233. doi:10.1016/S0140-6736%2809%2960746-7.

    Article  PubMed  Google Scholar 

  2. Room, R., Babor, T., & Rehm, J. (2005). Alcohol and public health. Lancet, 365(9458), 519–530. doi:10.1016/S0140-6736(05)17870-2.

    Article  PubMed  Google Scholar 

  3. Heather, N., Raistrick, D., & Godfrey, C. (2006). Review of the effectiveness of treatment for alcohol problems. London: National Treatment Agency for Substance Misuse.

    Google Scholar 

  4. McCollister, K. E., & French, M. T. (2003). The relative contribution of outcome domains in the total economic benefit of addiction interventions: A review of first findings. Addiction, 98(12), 1647–1659. doi:10.1111/j.1360-0443.2003.00541.x.

    Article  PubMed  Google Scholar 

  5. Khadjesari, Z., Murray, E., Hewitt, C., Hartley, S., & Godfrey, C. (2011). Can stand-alone computer-based interventions reduce alcohol consumption? A systematic review. Addiction, 106(2), 267–282. doi:10.1111/j.1360-0443.2010.03214.x.

    Article  PubMed  Google Scholar 

  6. Barbosa, C., Godfrey, C., & Parrott, S. (2010). Methodological assessment of economic evaluations of alcohol treatment: What is missing? [Review]. Alcohol and Alcoholism, 45(1), 53–63. doi:10.1093/alcalc/agp067.

    Article  PubMed  Google Scholar 

  7. French, M. (2000). Economic evaluation of alcohol treatment services. Evaluation and Program Planning, 23, 27–39. doi:10.1016/S0149-7189(99)00035-X.

    Article  Google Scholar 

  8. NICE. (2008). Guide to the methods of technology appraisal. London: National Institute for Health and Clinical Excellence.

    Google Scholar 

  9. Pyne, J. M., French, M., McCollister, K., Tripathi, S., Rapp, R., & Booth, B. (2008). Preference-weighted health-related quality of life measures and substance use disorder severity. Addiction, 103(8), 1320–1329. doi:10.1111/j.1360-0443.2008.02153.x.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Parrott, S., Godfrey, C., Heather, N., Clark, J., & Ryan, T. (2006). Cost and outcome analysis of two alcohol detoxification services. Alcohol and Alcoholism, 41(1), 84–91. doi:10.1093/alcalc/agh236.

    Article  PubMed  Google Scholar 

  11. UKATT Research Team. (2005). Cost effectiveness of treatment for alcohol problems: Findings of the randomised UK alcohol treatment trial (UKATT). British Medical Journal, 331(7516), 544–548. doi:10.1136/bmj.331.7516.544.

    Article  Google Scholar 

  12. EuroQol Group. (1990). EuroQol—A new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy, 16(3), 199–208. doi:10.1016/0168-8510(90)90421-9.

    Article  Google Scholar 

  13. Dolan, P. (1997). Modeling valuations for EuroQol health states. Medical Care, 35(11), 1095–1108. Retrieved from http://www.jstor.org/stable/3767472.

  14. Dolan, P., Gudex, C., Kind, P., & Williams, A. (1996). The time trade-off method: Results from a general population study (research support, Non-US Gov’t). Health Economics, 5(2), 141–154. doi:10.1002/(SICI)1099-1050(199603)5:2<141:AID-HEC189>3.0.CO;2-N.

    Article  PubMed  CAS  Google Scholar 

  15. Richardson, G., & Manca, A. (2004). Calculation of quality adjusted life years in the published literature: A review of methodology and transparency. Health Economics, 13(12), 1203–1210. doi:10.1002/hec.901.

    Article  PubMed  Google Scholar 

  16. Gunther, O., Roick, C., Angermeyer, M. C., & Konig, H. (2007). The EQ-5D in alcohol dependent patients: Relationships among health-related quality of life, psychopathology and social functioning. Drug and Alcohol Dependence, 86(2–3), 253–264. doi:10.1016/j.drugalcdep.2006.07.001.

    Article  PubMed  Google Scholar 

  17. Konig, H. H., Gunther, O. H., Angermeyer, M. C., & Roick, C. (2009). Utility assessment in patients with mental disorders: Validity and discriminative ability of the time trade-off method. Pharmacoeconomics, 27(5), 405–419. doi:10.2165/00019053-200927050-00005.

    Article  PubMed  Google Scholar 

  18. Dorney-Smith, S. (2007). Piloting the community matron model with alcoholic homeless clients. British Journal of Community Nursing, 12(12), 546, 548–551.

    Google Scholar 

  19. Foster, J. H., Peters, T. J., & Kind, P. (2002). Quality of life, sleep, mood and alcohol consumption: A complex interaction. Addiction Biology, 7(1), 55–65. doi:10.1080/135562101200100616.

    Article  PubMed  CAS  Google Scholar 

  20. Gunther, O., Roick, C., Angermeyer, M. C., & Konig, H. H. (2008). Responsiveness of EQ-5D utility indices in alcohol-dependent patients. Drug and Alcohol Dependence, 92(1–3), 291–295. doi:10.1016/j.drugalcdep.2007.07.016.

    Article  PubMed  Google Scholar 

  21. UKATT Research Team. (2005). Effectiveness of treatment for alcohol problems: Findings of the randomised UK alcohol treatment trial (UKATT). British Medical Journal, 331(7516), 541. doi:10.1136/bmj.331.7516.541.

    Article  Google Scholar 

  22. Livingston, M., Wilkinson, C., & Laslett, A.-M. (2010). Impact of heavy drinkers on others’ health and well-being. Journal of Studies on Alcohol and Drugs, 71(5), 778–785.

    PubMed  Google Scholar 

  23. Molarius, A., Berglund, K., Eriksson, C., Eriksson, H. G., Linden-Bostrom, M., Nordstrom, E., et al. (2009). Mental health symptoms in relation to socio-economic conditions and lifestyle factors—A population-based study in Sweden. BMC Public Health, 9, 302. doi:10.1186/1471-2458-9-302.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Petrie, D., Doran, C., Shakeshaft, A., & Sanson-Fisher, R. (2008). The relationship between alcohol consumption and self-reported health status using the EQ5D: Evidence from rural Australia. Social Science and Medicine, 67(11), 1717–1726. doi:10.1016/j.socscimed.2008.09.017.

    Article  PubMed  Google Scholar 

  25. Saarni, S. I., Joutsenniemi, K., Koskinen, S., Suvisaari, J., Pirkola, S., Sintonen, H., et al. (2008). Alcohol consumption, abstaining, health utility, and quality of life: A general population survey in Finland. Alcohol and Alcoholism, 43(3), 376–386. doi:10.1093/alcalc/agn003.

    Article  PubMed  Google Scholar 

  26. Drummond, C., Oyefeso, A., Phillips, T., Cheeta, S., Deluca, P., Perryman, K., et al. (2004). Alcohol needs assessment research project (ANARP): The 2004 national alcohol needs assessment for England. London: Department of Health.

    Google Scholar 

  27. Wallace, P., Murray, E., McCambridge, J., Khadjesari, Z., White, I. R., Thompson, S. G., et al. (2011). On-line randomized controlled trial of an internet based psychologically enhanced intervention for people with hazardous alcohol consumption. PLoS One, 6(3), e14740. doi:10.1371/journal.pone.0014740.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  28. Murray, E., McCambridge, J., Khadjesari, Z., White, I. R., Thompson, S. G., Godfrey, C., et al. (2007). The DYD-RCT protocol: An on-line randomised controlled trial of an interactive computer-based intervention compared with a standard information website to reduce alcohol consumption among hazardous drinkers. BMC Public Health, 7, 306. doi:10.1186/1471-2458-7-306.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). AUDIT, the alcohol use disorders identification test, guidelines for use in primary care (2nd ed.). Geneva: World Health Organization.

    Google Scholar 

  30. Bradley, K. A., DeBenedetti, A. F., Volk, R. J., Williams, E. C., Frank, D., & Kivlahan, D. R. (2007). AUDIT-C as a brief screen for alcohol misuse in primary care. Alcoholism, Clinical and Experimental Research, 31(7), 1208–1217. doi:10.1111/j.1530-0277.2007.00403.x.

    Article  PubMed  Google Scholar 

  31. Khadjesari, Z., Murray, E., Kalaitzaki, E., White, I. R., McCambridge, J., Godfrey, C., et al. (2009). Test-retest reliability of an online measure of past week alcohol consumption (the TOT-AL), and comparison with face-to-face interview. Addictive Behaviors, 34(4), 337–342. doi:10.1016/j.addbeh.2008.11.010.

    Article  PubMed  Google Scholar 

  32. Rehm, J., Room, R., Monteiro, M., Gmel, G., Graham, K. R., Sempos, C. T., et al. (2004). Alcohol use. In M. Ezzati, A. D. Lopez, A. Rodgers, & C. J. L. Murray (Eds.), Comparative quantification of health risks: Global and regional burden of disease due to selected major risk factors (Vol. 1). Geneva: World Health Organization.

    Google Scholar 

  33. Jenkins, R. J., McAlaney, J., & McCambridge, J. (2009). Change over time in alcohol consumption in control groups in brief intervention studies: Systematic review and meta-regression study. Drug and Alcohol Dependence, 100(1–2), 107–114. doi:10.1016/j.drugalcdep.2008.09.016.

    Article  PubMed  CAS  Google Scholar 

  34. Moyer, A., & Finney, J. W. (2002). Outcomes for untreated individuals involved in randomized trials of alcohol treatment. Journal of Substance Abuse Treatment, 23(3), 247–252.

    Article  PubMed  Google Scholar 

  35. McCambridge, J. (2009). Research assessments: Instruments of bias and brief interventions of the future? [Commentary]. Addiction, 104(8), 1311–1312. doi:10.1111/j.1360-0443.2009.02684.x.

    Article  PubMed  Google Scholar 

  36. McCambridge, J., & Kypri, K. (2011). Can simply answering research questions change behaviour? Systematic review and meta analyses of brief alcohol intervention trials. PLoS One, 6(10), e23748. doi:10.1371/journal.pone.0023748.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  37. Kind, P., Dolan, P., Gudex, C., & Williams, A. (1998). Variations in population health status: Results from a United Kingdom national questionnaire survey. British Medical Journal, 316(7133), 736–741. doi:10.1136/bmj.316.7133.736.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  38. Dawson, D. A., Li, T. K., Chou, S. P., & Grant, B. F. (2009). Transitions in and out of alcohol use disorders: Their associations with conditional changes in quality of life over a 3-year follow-up interval. Alcohol and Alcoholism, 44(1), 84–92. doi:10.1093/alcalc/agn094.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Sullivan, P. W., & Ghushchyan, V. (2006). Mapping the EQ-5D index from the SF-12: US general population preferences in a nationally representative sample. Medical Decision Making, 26(4), 401–409. doi:10.1177/0272989X06290496.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Efron, B., & Tibshirani, R. (1993). An introduction to the bootstrap. New York: Chapman & Hall.

    Book  Google Scholar 

  41. Drummond, M., Sculpher, M., Torrance, G. W., O’Brien, B. J., & Stoddart, G. L. (2005). Methods for the economic evaluation of health care programmes (3rd ed.). Oxford: Oxford University Press.

    Google Scholar 

  42. Foster, J. H., Peters, T. J., & Marshall, E. J. (2000). Quality of life measures and outcome in alcohol-dependent men and women. Alcohol, 22(1), 45–52. doi:10.1016/S0741-8329(00)00102-6.

    Article  PubMed  CAS  Google Scholar 

  43. Lock, C. A., Kaner, E., Heather, N., Doughty, J., Crawshaw, A., McNamee, P., et al. (2006). Effectiveness of nurse-led brief alcohol intervention: A cluster randomized controlled trial. Journal of Advanced Nursing, 54(4), 426–439. doi:10.1111/j.1365-2648.2006.03836.x.

    Article  PubMed  Google Scholar 

  44. Malet, L., Llorca, P. M., Beringuier, B., Lehert, P., & Falissard, B. (2006). AlQoL 9 for measuring quality of life in alcohol dependence. Alcohol and Alcoholism, 41(2), 181–187. doi:10.1093/alcalc/agl001.

    Article  PubMed  Google Scholar 

  45. Morgan, M. Y., Landron, F., & Lehert, P. (2004). Improvement in quality of life after treatment for alcohol dependence with acamprosate and psychosocial support. Alcoholism, Clinical and Experimental Research, 28(1), 64–77. doi:10.1097/01.ALC.0000108652.73143.4B.

    Article  PubMed  CAS  Google Scholar 

  46. Volk, R. J., Cantor, S. B., Steinbauer, J. R., & Cass, A. R. (1997). Alcohol use disorders, consumption patterns, and health-related quality of life of primary care patients. Alcoholism, Clinical and Experimental Research, 21(5), 899–905. doi:10.1111/j.1530-0277.1997.tb03855.x.

    Article  PubMed  CAS  Google Scholar 

  47. Okoro, C. A., Brewer, R. D., Naimi, T. S., Moriarty, D. G., Giles, W. H., & Mokdad, A. H. (2004). Binge drinking and health-related quality of life: Do popular perceptions match reality? American Journal of Preventive Medicine, 26(3), 230–233. doi:10.1016/j.amepre.2003.10.022.

    Article  PubMed  Google Scholar 

  48. Marra, C. A., Woolcott, J. C., Kopec, J. A., Shojania, K., Offer, R., Brazier, J. E., et al. (2005). A comparison of generic, indirect utility measures (the HUI2, HUI3, SF-6D, and the EQ-5D) and disease-specific instruments (the RAQoL and the HAQ) in rheumatoid arthritis. Social Science and Medicine, 60(7), 1571–1582. doi:10.1016/j.socscimed.2004.08.034.

    Article  PubMed  Google Scholar 

  49. Walters, S. J., & Brazier, J. E. (2005). Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Quality of Life Research, 14(6), 1523–1532. doi:10.1007/s11136-004-7713-0.

    Article  PubMed  Google Scholar 

  50. Brusselle, G., Michils, A., Louis, R., Dupont, L., Van de Maele, B., Delobbe, A., et al. (2009). “Real-life” effectiveness of omalizumab in patients with severe persistent allergic asthma: The PERSIST study. Respiratory Medicine, 103(11), 1633–1642. doi:10.1016/j.rmed.2009.06.014.

    Article  PubMed  CAS  Google Scholar 

  51. Cleland, J. G. F., Calvert, M. J., Verboven, Y., & Freemantle, N. (2009). Effects of cardiac resynchronization therapy on long-term quality of life: An analysis from the cardiac resynchronisation-heart failure (CARE-HF) study. American Heart Journal, 157(3), 457–466. doi:10.1016/j.ahj.2008.11.006.

    Article  PubMed  Google Scholar 

  52. Minet Kinge, J., & Morris, S. (2010). Socioeconomic variation in the impact of obesity on health-related quality of life. Social Science and Medicine, 71(10), 1864–1871. doi:10.1016/j.socscimed.2010.09.001.

    Article  PubMed  Google Scholar 

  53. Peltzer, K., & Pengpid, S. (2012). Alcohol use and health-related quality of life among hospital outpatients in South Africa. Alcohol and Alcoholism, 47(3), 291–295. doi:10.1093/alcalc/ags001.

    Article  PubMed  Google Scholar 

  54. Herdman, M., Gudex, C., Lloyd, A., Janssen, M., Kind, P., Parkin, D., et al. (2011). Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Quality of Life Research,. doi:10.1007/s11136-011-9903-x.

    PubMed Central  Google Scholar 

  55. Reaney, M. D., Martin, C., & Speight, J. (2008). Understanding and assessing the impact of alcoholism on quality of life: A systematic review of the content validity of instruments used to assess health-related quality of life in alcoholism. Patient, 1(3), 151–163. doi:10.2165/1312067-200801030-00002.

    Article  PubMed  Google Scholar 

  56. Foster, J. H. (2006). Quality of life measurement and alcoholism: Another arm to nursing practice? Clinical Effectiveness in Nursing, 9S3, e295–e301. doi:10.1016/j.cein.2006.07.002.

    Article  Google Scholar 

  57. Sindelar, J. L., Jofre-Bonet, M., French, M. T., & McLellan, A. T. (2004). Cost-effectiveness analysis of addiction treatment: Paradoxes of multiple outcomes. Drug and Alcohol Dependence, 73(1), 41–50.

    Article  PubMed  Google Scholar 

  58. Jarl, J., & Gerdtham, U. G. (2012). Time pattern of reduction in risk of oesophageal cancer following alcohol cessation—A meta-analysis. Addiction, 107(7), 1234–1243. doi:10.1111/j.1360-0443.2011.03772.x.

    Article  PubMed  Google Scholar 

  59. Holmes, J., Meier, P. S., Booth, A., Guo, Y., & Brennan, A. (2012). The temporal relationship between per capita alcohol consumption and harm: A systematic review of time lag specifications in aggregate time series analyses. Drug and Alcohol Dependence, 123(1–3), 7–14. doi:10.1016/j.drugalcdep.2011.12.005.

    Article  PubMed  Google Scholar 

  60. Wannamethee, G., & Shaper, A. G. (1988). Men who do not drink: A report from the British Regional Heart Study. International Journal of Epidemiology, 17(2), 307–316.

    Article  PubMed  CAS  Google Scholar 

  61. Murray, E., Khadjesari, Z., White, I. R., Kalaitzaki, E., Godfrey, C., McCambridge, J., et al. (2009). Methodological challenges in online trials. Journal of Medical Internet Research, 11(2), e9. doi:10.2196/jmir.1052.

    Article  PubMed  PubMed Central  Google Scholar 

  62. McCambridge, J., Kalaitzaki, E., White, I. R., Khadjesari, Z., Murray, E., Linke, S., et al. (2011). Impact of length or relevance of questionnaires on attrition in online trials: Randomized controlled trial. Journal of Medical Internet Research, 13(4), e96. doi:10.2196/jmir.1733.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Khadjesari, Z., Murray, E., Kalaitzaki, E., White, I. R., McCambridge, J., Thompson, S. G., et al. (2011). Impact and costs of incentives to reduce attrition in online trials: Two randomized controlled trials. Journal of Medical Internet Research, 13(1), e26. doi:10.2196/jmir.1523.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Sterne, J. A., White, I. R., Carlin, J. B., Spratt, M., Royston, P., Kenward, M. G., et al. (2009). Multiple imputation for missing data in epidemiological and clinical research: Potential and pitfalls. British Medical Journal, 338, b2393. doi:10.1136/bmj.b2393.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Del Boca, F. K., & Darkes, J. (2003). The validity of self-reports of alcohol consumption: State of the science and challenges for research. Addiction, 98(Suppl 2), 1–12. doi:10.1046/j.1359-6357.2003.00586.x.

    Article  PubMed  Google Scholar 

  66. Noknoy, S., Rangsin, R., Saengcharnchai, P., Tantibhaedhyangkul, U., & McCambridge, J. (2010). RCT of effectiveness of motivational enhancement therapy delivered by nurses for hazardous drinkers in primary care units in Thailand. Alcohol and Alcoholism, 45(3), 263–270. doi:10.1093/alcalc/agq013.

    Article  PubMed  Google Scholar 

  67. Barbosa, C., Taylor, B., Godfrey, C., Rehm, J., Parrott, S., & Drummond, C. (2010). Modelling lifetime QALYs and health care costs from different drinking patterns over time: A Markov model. International Journal of Methods in Psychiatric Research, 19(2), 97–109. doi:10.1002/mpr.306.

    PubMed  Google Scholar 

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Acknowledgments

This study was funded by the National Prevention Research Initiative, which includes the following funding partners: British Heart Foundation; Cancer Research UK; Department of Health; Diabetes UK; Economic and Social Research Council; Medical Research Council; Research and Development Office for the Northern Ireland Health and Social Services; Chief Scientist Office, Scottish Executive Health Department; and the Welsh Assembly Government. IRW was supported by the Medical Research Council (Unit Programme Number U105260558). J.M. was supported by a Wellcome Trust award in Basic Biomedical Science (WT086516MA).

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Authors and Affiliations

  1. Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK

    Holly N. Essex, Steve Parrott & Christine Godfrey

  2. MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK

    Ian R. White

  3. Research Department of Primary Care and Population Health, e-Health Unit, Royal Free Hospital, University College London, Upper 3rd Floor, Rowland Hill Street, London, NW3 2PF, UK

    Zarnie Khadjesari, Stuart Linke & Elizabeth Murray

  4. Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK

    Jim McCambridge

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  1. Holly N. Essex
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Correspondence to Holly N. Essex.

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Essex, H.N., White, I.R., Khadjesari, Z. et al. Quality of life among hazardous and harmful drinkers: EQ-5D over a 1-year follow-up period. Qual Life Res 23, 733–743 (2014). https://doi.org/10.1007/s11136-013-0521-7

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