Quality of life after hip, vertebral, and distal forearm fragility fractures measured using the EQ-5D-3L, EQ-VAS, and time-trade-off: results from the ICUROS
The International Costs and Utilities Related to Osteoporotic fractures Study is a multinational observational study set up to describe the costs and quality of life (QoL) consequences of fragility fracture. This paper aims to estimate and compare QoL after hip, vertebral, and distal forearm fracture using time-trade-off (TTO), the EuroQol (EQ) Visual Analogue Scale (EQ-VAS), and the EQ-5D-3L valued using the hypothetical UK value set.
Data were collected at four time-points for five QoL point estimates: within 2 weeks after fracture (including pre-fracture recall), and at 4, 12, and 18 months after fracture. Health state utility values (HSUVs) were derived for each fracture type and time-point using the three approaches (TTO, EQ-VAS, EQ-5D-3L). HSUV were used to estimate accumulated QoL loss and QoL multipliers.
In total, 1410 patients (505 with hip, 316 with vertebral, and 589 with distal forearm fracture) were eligible for analysis. Across all time-points for the three fracture types, TTO provided the highest HSUVs, whereas EQ-5D-3L consistently provided the lowest HSUVs directly after fracture. Except for 13–18 months after distal forearm fracture, EQ-5D-3L generated lower QoL multipliers than the other two methods, whereas no equally clear pattern was observed between EQ-VAS and TTO. On average, the most marked differences between the three approaches were observed immediately after the fracture.
The approach to derive QoL markedly influences the estimated QoL impact of fracture. Therefore the choice of approach may be important for the outcome and interpretation of cost-effectiveness analysis of fracture prevention.
KeywordsOsteoporosis Fracture Health-related quality of life Health utility
We are grateful to the quality of life and Epidemiology Working Group of the Committee of Scientific Advisors for the International Osteoporosis Foundation under whose supervision this study was undertaken. The Mexican substudy are grateful to Danai Curiel, and Fernando Carlos MHE Mexico City. In Lithuania, gratitude is extended to Violeta Sinkeviciene and Inga Tamulaityte-Morozoviene for skilful technical assistance. In Russia, the following team members provided valuable contributions to the study: Dr. Natalia Toroptsova, Dr. Oxana Nikitinskaya, Dr. Olga Dobrovolskaya (Institute of Rheumatology, RAS, Moscow), Prof. Larissa Menshikova, Dr. Julia Varavko (Medical Institute of Postgraduate Training, Irkutsk), Dr. Ksenia Belova (Yaroslavl State Medical University, Yaroslavl), Dr. Alexander Solodovnikov, Dr. Ksenia Usenko (Ural State Medical University, Yekaterinburg), Prof. Georgij Golubev, Dr. Vyacheslav Grebenshikov (Rostov-on-Don State Medical University, Rostov-on-Don), Prof. Eugenij Zotkin, Dr. Irina Zubkova (North-West Mechnikov State Medical University, Saint-Petersburg), Prof. Alexander Kochish, Dr. Sergej Ivanov (Vreden Institute of Traumatology and Orthopedics, Saint-Petersburg), and Dr. Radik Nurligayanov (City Clinical Hospital # 21, Ufa). The following investigators provided valuable contributions to the Australian substudy: Prof JJ Watts and Professors GC Nicholson, E Seeman, R Prince, G Duque, T Winzenberg, L March, and PR Ebeling. In France, the following gratitude is extended to the following professors Bernard Cortet, Roland Chapurlat, Patrice Fardellone, Philippe Orcel, and Christian Roux. The global study team would like to thank Ingrid Lekander, Erik Landfeldt, Martin Kleman, Moa Ivergård, and Viktor Wintzell for contributing to the study.
FB, AT, BJ, and JAK designed the study. VA, MLB, PC, MDC, HPD, MJ, AU, ML, RK, OL, OM, OE, KMS, SS, MT, and TT led the data collection. AS and EH designed and executed the statistical analyses. AS led the interpretation of findings with inputs from the other authors. AS drafted the manuscript. All authors reviewed the manuscript and approved the submission for publication.
Compliance with ethical standards
Conflict of interest
AS and EH are employees of Mapi, a contract research organization. FB and OS are employed by and own equity in Quantify Research, a contract research organization. JAK received consultancies/speaking fees from AgNovos healthcare, Amgen, D3A, Lilly, Medimaps, Unigene, Radius Health, Pfizer, Servier, and Takeda; and research support from Asahi, Amgen, GSK, Lilly, Medtronic, Novartis, Pfizer, Sanofi-Aventis, Servier, and Warner Chilcott. EM received consultancies, honoraria and speaking fees from ActiveSignal, Alliance for Better Bone Health, Amgen, Bayer, Boehringer Ingelheim, Consilient Healthcare, Eli Lilly, GE Lunar, GSK, Hologic, Internis, Medtronic, Merck, Novartis, Pfizer, Roche, Servier, Synexus, Tethys, and UCB; and research funding from the Alliance for Better Bone Health, Amgen, Arthritis Research UK, EPSRC, Internis, Medical Research Council, and NIHR. HPD reports consultancies, honoraria and speaking fees from Amgen, BRAINCON, Daiichi-Sankyo, Eli Lilly, Merck Sharp & Dohme, Novartis, Nycomed, Servier, Sinapharm, Alexion, Daiichi-Sankyo, Genericon, Kyphon, and Genericon. TT reports consultancies, honoraria and speaking fees, and grants from Abbvie, Amgen, BMS, Chugai/Roche, Eli Lilly, Expanscience, Gilead, Merck Sharp & Dohme, Medac, Thuasne, UCB, HAC-Pharma, LCA, Novartis, Pfizer, Servier, and TEVA. The remaining authors report no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study and all study participants could withdraw from the study at any time at their own request.
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