Quality of Life Research

, Volume 22, Issue 10, pp 2973–2981 | Cite as

Comparison of direct-measured and derived short form six dimensions (SF-6D) health preference values among chronic hepatitis B patients

  • Carlos K. H. Wong
  • Elegance T. P. Lam
  • Cindy L. K. Lam



The short form six dimensions (SF-6D) are derived from the SF-36 Health Survey with the intention that item data of the latter are often converted to a preference value, which was subsequently used in economic evaluations of interventions. The aim was to compare the equivalence and sensitivity of health preference values derived from the SF-36/SF-12 Health Surveys to that measured directly by the SF-6D for chronic hepatitis B (CHB) patients.


This was a secondary analysis of the SF-6D and SF-36 data from a baseline sample of 589 patients with CHB infection with different stages of liver diseases. Degree of agreement (equivalence) between direct-measured and derived SF-6D values was determined using spearman correlation and intra-class correlation. Sensitivity and discriminative power of different SF-6D values were compared by standardized effect size and relative efficiency (RE) statistics.


Significant differences in the direct-measured or derived SF-6D preference values were found between CHB groups. Degree of agreement between SF-6D values was satisfactory. Direct-measured SF-6D was the most efficient, followed by SF-12-derived and the SF-36-derived was the least, based on the standardized effect size and the RE statistics. Sensitivity and discriminative power of direct-measured SF-6D were superior to derived SF-6D among people with different CHB health states.


Although direct-measured and derived SF-6D preference values had satisfactory sensitivity in discriminating between CHB groups, direct-measured SF-6D is the most sensitive and preferable method of obtaining health preference.


Chronic hepatitis B Health preference SF-6D SF-36 Sensitivity Discriminative power 



Asymptomatic hepatitis B carrier


Chronic hepatitis B


Hepatocellular carcinoma


Health-related qualify of life


Health utilities index


Intra-class correlation


CHB with impaired liver function


Relative efficiency


Short form six dimensions


  1. 1.
    World Health Organization. (1996). World health report 1996: Fighting disease, fostering development. Geneva: World Health Organization.CrossRefGoogle Scholar
  2. 2.
    Lam, E. T. P., Lam, C. L. K., Lai, C. L., Yuen, M. F., Fong, D. Y. T., & So, T. (2009). Health-related quality of life of southern Chinese with chronic hepatitis B infection. Health and Quality of Life Outcomes, 7(1), 52.PubMedCrossRefGoogle Scholar
  3. 3.
    Levy, A. R., Kowdley, K. V., Iloeje, U., Tafesse, E., Mukherjee, J., Gish, R., et al. (2008). The impact of chronic hepatitis B on quality of life: A multinational study of utilities from infected and uninfected persons. Value in Health, 11(3), 527–538.PubMedCrossRefGoogle Scholar
  4. 4.
    Dan, A. A., Kallman, J. B., Srivastava, R., Younoszai, Z., Kim, A., & Younossi, Z. M. (2008). Impact of chronic liver disease and cirrhosis on health utilities using SF-6D and the health utility index. Liver Transplantation, 14(3), 321–326.PubMedCrossRefGoogle Scholar
  5. 5.
    Ong, S. C., Mak, B., Aung, M. O., Li, S. C., & Lim, S. G. (2008). Health-related quality of life in chronic hepatitis B patients. Hepatology, 47(4), 1108–1117.PubMedCrossRefGoogle Scholar
  6. 6.
    Bondini, S., Kallman, J., Dan, A., Younoszai, Z., Ramsey, L., Nader, F., et al. (2007). Health-related quality of life in patients with chronic hepatitis B. Liver International, 27(8), 1119–1125.PubMedCrossRefGoogle Scholar
  7. 7.
    Saab, S., Ibrahim, A. B., Surti, B., Durazo, F., Han, S., Yersiz, H., et al. (2008). Pretransplant variables associated with quality of life in liver transplant recipients. Liver International, 28(8), 1087–1094.PubMedCrossRefGoogle Scholar
  8. 8.
    EuroQol Group. (1990). EuroQol—a new facility for the measurement of health-related quality of life. Health Policy, 16(3), 199–208.CrossRefGoogle Scholar
  9. 9.
    Torrance, G., Feeny, D., Furlong, W., Barr, R., Zhang, Y., & Wang, Q. (1996). Multiattribute utility function for a comprehensive health status classification system: Health utilities index mark 2. Medical Care, 34(7), 702–722.PubMedCrossRefGoogle Scholar
  10. 10.
    Feeny, D., Furlong, W., Torrance, G., Goldsmith, C., Zhu, Z., DePauw, S., et al. (2002). Multi-attribute and single-attribute utility functions for the health utilities index mark 3 system. Medical Care, 40(2), 113–128.PubMedCrossRefGoogle Scholar
  11. 11.
    Brazier, J., Usherwood, T., Harper, R., & Thomas, K. (1998). Deriving a preference-based single index from the UK SF-36 health survey. Journal of Clinical Epidemiology, 51(11), 1115–1128.PubMedCrossRefGoogle Scholar
  12. 12.
    Longworth, L., & Bryan, S. (2003). An empirical comparison of EQ-5D and SF-6D in liver transplant patients. Health Economics, 12(12), 1061–1067.PubMedCrossRefGoogle Scholar
  13. 13.
    Bryce, C. L., Angus, D. C., Switala, J., Roberts, M. S., & Tsevat, J. (2004). Health status versus utilities of patients with end-stage liver disease. Quality of Life Research, 13(4), 773–782.PubMedCrossRefGoogle Scholar
  14. 14.
    Thein, H. H., Krahn, M., Kaldor, J. M., & Dore, G. J. (2005). Estimation of utilities for chronic hepatitis C from SF-36 scores. The American Journal of Gastroenterology, 100(3), 643–651.PubMedCrossRefGoogle Scholar
  15. 15.
    Björnsson, E., Verbaan, H., Oksanen, A., Frydén, A., Johansson, J., Friberg, S., et al. (2009). Health-related quality of life in patients with different stages of liver disease induced by hepatitis C. Scandinavian Journal of Gastroenterology, 44(7), 878–887.PubMedCrossRefGoogle Scholar
  16. 16.
    Younossi, Z. M., Boparai, N., McCormick, M., Price, L. L., & Guyatt, G. (2001). Assessment of utilities and health-related quality of life in patients with chronic liver disease. The American Journal of Gastroenterology, 96(2), 579–583.PubMedCrossRefGoogle Scholar
  17. 17.
    Hsu, P. C., Federico, C. A., Krajden, M., Yoshida, E. M., Bremner, K. E., Anderson, F. H., et al. (2012). Health utilities and psychometric quality of life in patients with early- and late-stage hepatitis C virus infection. Journal of Gastroenterology and Hepatology, 27(1), 149–157.PubMedCrossRefGoogle Scholar
  18. 18.
    Chong, C. A. K. Y., Gulamhussein, A., Heathcote, E. J., Lilly, L., Sherman, M., Naglie, G., et al. (2003). Health-state utilities and quality of life in hepatitis C patients. The American Journal of Gastroenterology, 98(3), 630–638.PubMedCrossRefGoogle Scholar
  19. 19.
    Gutteling, J. J., De Man, R. A., Van Der Plas, S. M., Schalm, S. W., Busschbach, J. J. V., & Darlington, A. S. E. (2006). Determinants of quality of life in chronic liver patients. Alimentary Pharmacology & Therapeutics, 23(11), 1629–1635.CrossRefGoogle Scholar
  20. 20.
    Russell, R. T., Feurer, I. D., Wisawatapnimit, P., & Pinson, C. W. (2009). The validity of EQ-5D US preference weights in liver transplant candidates and recipients. Liver Transplantation, 15(1), 88–95.PubMedCrossRefGoogle Scholar
  21. 21.
    Ratcliffe, J., Longworth, L., Young, T., Bryan, S., Burroughs, A., & Buxton, M. (2002). Assessing health-related quality of life pre- and post-liver transplantation: A prospective multicenter study. Liver Transplantation, 8(3), 263–270.PubMedCrossRefGoogle Scholar
  22. 22.
    Brazier, J., Roberts, J., & Deverill, M. (2002). The estimation of a preference-based measure of health from the SF-36. Journal of Health Economics, 21(2), 271–292.PubMedCrossRefGoogle Scholar
  23. 23.
    Brazier, J., Roberts, J., Tsuchiya, A., & Busschbach, J. (2004). A comparison of the EQ-5D and SF-6D across seven patient groups. Health Economics, 13(9), 873–884.PubMedCrossRefGoogle Scholar
  24. 24.
    McDonough, C. M., Grove, M. R., Tosteson, T. D., Jon, D. L., Hilibrand, A. S., & Tosteson, A. N. A. (2005). Comparison of EQ-5D, HUI, and SF-36-derived societal health state values among spine patient outcomes research trial (SPORT) Participants. Quality of Life Research, 14(5), 1321–1332.PubMedCrossRefGoogle Scholar
  25. 25.
    Petrou, S., & Hockley, C. (2005). An investigation into the empirical validity of the EQ-5D and SF-6D based on hypothetical preferences in a general population. Health Economics, 14(11), 1169–1189.PubMedCrossRefGoogle Scholar
  26. 26.
    Lamers, L. M., Bouwmans, C. A. M., Straten, Av, Donker, M. C. H., & Hakkaart, L. (2006). Comparison of EQ-5D and SF-6D utilities in mental health patients. Health Economics, 15(11), 1229–1236.PubMedCrossRefGoogle Scholar
  27. 27.
    Barton, G. R., Sach, T. H., Avery, A. J., Jenkinson, C., Doherty, M., Whynes, D. K., et al. (2008). A comparison of the performance of the EQ-5D and SF-6D for individuals aged ge 45 years. Health Economics, 17(7), 815–832.PubMedCrossRefGoogle Scholar
  28. 28.
    Konerding, U., Moock, J., & Kohlmann, T. (2009). The classification systems of the EQ-5D, the HUI II and the SF-6D: What do they have in common? Quality of Life Research, 18(9), 1249–1261.PubMedCrossRefGoogle Scholar
  29. 29.
    Lam, E. T. P., Lam, C. L. K., Lai, C. L., Yuen, M. F., & Fong, D. Y. T. (2009). Psychometrics of the chronic liver disease questionnaire for southern Chinese patients with chronic hepatitis B virus infection. World Journal of Gastroenterology, 15(26), 3288–3297.PubMedCrossRefGoogle Scholar
  30. 30.
    Ware, J. E, Jr, & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30(6), 473–483.PubMedCrossRefGoogle Scholar
  31. 31.
    Ware, J. E., Snow, K., Kosinski, J. M., & Gandek, B. (1993). SF-36 health survey manual and interpretation guide. Boston: The Health Institute, New English Medical Centre.Google Scholar
  32. 32.
    Lam, C. L. K., Gandek, B., Ren, X. S., & Chan, M. S. (1998). Tests of scaling assumptions and construct validity of the Chinese (HK) version of the SF-36 health survey. Journal of Clinical Epidemiology, 51(11), 1139–1147.PubMedCrossRefGoogle Scholar
  33. 33.
    Lam, C. L. K., Tse, E. Y. Y., & Gandek, B. (2005). Is the standard SF-12 health survey valid and equivalent for a Chinese population? Quality of Life Research, 14(2), 539–547.PubMedCrossRefGoogle Scholar
  34. 34.
    Lam, C. L. K., Lauder, I., Lam, T. P., & Gandek, B. (1999). Population based norming of the Chinese (HK) version of the SF-36 health survey. Hong Kong Practitioner, 21(10), 460–470.Google Scholar
  35. 35.
    Lam, C. L. K., Wong, C. K. H., Lam, E. T. P., Lo, Y. Y. C., & Huang, W. W. (2010). Population norm of Chinese (HK) SF-12 health survey_version 2 of Chinese adults in Hong Kong. Hong Kong Practitioner, 32, 77–86.Google Scholar
  36. 36.
    McGhee, S. M., Brazier, J., Lam, C. L. K., Wong, L. C., Chau, J., Cheung, A., et al. (2011). Quality-adjusted life years: Population-specific measurement of the quality component. Hong Kong Medical Journal, 17(Suppl 6), 17–21.PubMedGoogle Scholar
  37. 37.
    Lam, C. L. K., Brazier, J., & McGhee, S. M. (2008). Valuation of the SF-6D health states is feasible, acceptable, reliable, and valid in a Chinese population. Value in Health, 11(2), 295–303.PubMedCrossRefGoogle Scholar
  38. 38.
    Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33(1), 159–174.PubMedCrossRefGoogle Scholar
  39. 39.
    Luo, N., Johnson, J. A., Shaw, J. W., & Coons, S. J. (2009). Relative efficiency of the EQ-5D, HUI2, and HUI3 index scores in measuring health burden of chronic medical conditions in a population health survey in the United States. Medical Care, 47(1), 53–60.PubMedCrossRefGoogle Scholar
  40. 40.
    Whitfield, K., Buchbinder, R., Segal, L., & Osborne, R. (2006). Parsimonious and efficient assessment of health-related quality of life in osteoarthritis research: Validation of the assessment of quality of life (AQoL) instrument. Health and Quality of Life Outcomes, 4(1), 19.PubMedCrossRefGoogle Scholar
  41. 41.
    Mutebi, A., Brazier, J., & Walters, S. (2011). A comparison of the discriminative and evaluative properties of the SF-36 and the SF-6D index. Quality of Life Research, 20(9), 1477–1486.PubMedCrossRefGoogle Scholar
  42. 42.
    Luo, N., Wang, P., Fu, A. Z., Johnson, J. A., & Coons, S. J. (2012). Preference-based SF-6D scores derived from the SF-36 and SF-12 have different discriminative power in a population health survey. Medical Care, 50(7), 627–632.PubMedCrossRefGoogle Scholar
  43. 43.
    Pickard, A. S., Yang, Y., & Lee, T. (2011). Comparison of health-related quality of life measures in chronic obstructive pulmonary disease. Health and Quality of Life Outcomes, 9(1), 26.PubMedCrossRefGoogle Scholar
  44. 44.
    Zhao, F. L., Yue, M., Yang, H., Wang, T., Wu, J. H., & Li, S. C. (2010). Validation and comparison of EuroQol and short form 6D in chronic prostatitis patients. Value in Health, 13(5), 649–656.PubMedCrossRefGoogle Scholar
  45. 45.
    Brazier, J. E., & Roberts, J. (2004). The estimation of a preference-based measure of health from the SF-12. Medical Care, 42(9), 851–859.PubMedCrossRefGoogle Scholar
  46. 46.
    Wong, C. K. H., Mulhern, B., Wan, Y. F., & Lam, C. (Under review). Responsiveness of preference-based quality of life measure was improved by mapping algorithm in colorectal cancer.Google Scholar
  47. 47.
    Cheung, Y. B., Wong, L. C., Tay, M. H., Toh, C. K., Koo, W. H., Epstein, R., et al. (2004). Order effects in the assessment of quality of life in cancer patients. Quality of Life Research, 13(7), 1217–1223.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Carlos K. H. Wong
    • 1
  • Elegance T. P. Lam
    • 1
  • Cindy L. K. Lam
    • 1
  1. 1.Department of Family Medicine and Primary CareThe University of Hong KongAp Lei Chau, Hong Kong IslandHong Kong

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