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Association between knee symptoms, change in knee symptoms over 6–9 years, and SF-6D health state utility among middle-aged Australians

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Abstract

Objectives

Health state utilities (HSUs) are an input metric for estimating quality-adjusted life-years (QALY) in cost–utility analyses. Currently, there is a paucity of data on association of knee symptoms with HSUs for middle-aged populations. We aimed to describe the association of knee symptoms and change in knee symptoms with SF-6D HSUs and described the distribution of HSUs against knee symptoms’ severity.

Methods

Participants (36–49-years) were selected from the third follow-up (completed 2019) of Australian Childhood Determinants of Adult Health study. SF-6D HSUs were generated from the participant-reported SF-12. Association between participant-reported WOMAC knee symptoms’ severity, change in knee symptoms over 6–9 years, and HSUs were evaluated using linear regression models.

Results

For the cross-sectional analysis, 1,567 participants were included; mean age 43.5 years, female 54%, BMI ± SD 27.18 ± 5.31 kg/m2. Mean ± SD HSUs for normal, moderate, and severe WOMAC scores were 0.820 ± 0.120, 0.800 ± 0.120, and 0.740 ± 0.130, respectively. A significant association was observed between worsening knee symptoms and HSUs in univariable and multivariable analyses after adjustment (age and sex). HSU decrement for normal-to-severe total-WOMAC and WOMAC-pain was − 0.080 (95% CI − 0.100 to − 0.060, p < 0.01) and − 0.067 (− 0.085 to − 0.048, p < 0.01), exceeding the mean minimal clinically important difference (0.04). Increase in knee pain over 6–9 years was associated with a significant reduction in HSU.

Conclusion

In a middle-aged population-based sample, there was an independent negative association between worse knee symptoms and SF-6D HSUs. Our findings may be used by decision-makers to define more realistic and conservative baseline and ongoing HSU values when assessing QALY changes associated with osteoarthritis interventions.

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Acknowledgements

The authors would like to acknowledge the contributions of the CDAH project manager, Marita Dalton, CDAH participants, funders, and all other project staff.

Funding

AS is supported by the International Graduate Research Scholarship, University of Tasmania. BA is supported by the National Health and Medical Research Council of Australia Fellowship. The CDAH study was supported by the National Health and Medical Research Council Project Grant 211316. CDAH-knee sub-study was supported by the Royal Hobart Hospital Research Foundation (RHHRF) Grant 18-202 RHHRF.

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Authors and Affiliations

  1. Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia

    Ambrish Singh, Julie A. Campbell, Alison Venn, Graeme Jones, Leigh Blizzard, Andrew J. Palmer, Terence Dwyer, Changhai Ding & Benny Antony

  2. Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Australia

    Andrew J. Palmer

  3. Nuffield Department of Obstetrics & Gynaecology, The George Institute for Global Health, University of Oxford, Oxford, UK

    Terence Dwyer

  4. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

    Flavia Cicuttini & Changhai Ding

  5. Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China

    Changhai Ding

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  1. Ambrish Singh
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  2. Julie A. Campbell
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  10. Benny Antony
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Contributions

AS, BA, and AP conceived the Study. AS, JC, and LB conceived the present analysis. AS and LB cleaned and prepared the data and performed the analysis. AS and JC undertook HSU estimation using the algorithm. AS drafted the first draft of the manuscript, and JC, AV, GJ, LB, AP TD, FC, CD, and BA edited the manuscript. All authors commented on and approved the final version of the manuscript.

Corresponding author

Correspondence to Benny Antony.

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Conflict of interest

All authors declare that there is no conflict of interest.

Ethical approval

The Southern Tasmania Health and Medical Human Research Ethics Committee, Monash University Human Research Ethics Committee, and the Northern Sydney and Central Coast Area Human Research Ethics Committee provided ethical approval for the study (Ethics ID: H0018491).

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Participants were asked to read the participant information and to consent before entering the study.

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Singh, A., Campbell, J.A., Venn, A. et al. Association between knee symptoms, change in knee symptoms over 6–9 years, and SF-6D health state utility among middle-aged Australians. Qual Life Res 30, 2601–2613 (2021). https://doi.org/10.1007/s11136-021-02859-5

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  • DOI: https://doi.org/10.1007/s11136-021-02859-5

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