A Head-to-Head Comparison of the EQ-5D-5L and AQoL-8D Multi-Attribute Utility Instruments in Patients Who Have Previously Undergone Bariatric Surgery
- 162 Downloads
Psychosocial health status is an important and dynamic outcome for bariatric/metabolic surgery patients, as acknowledged in recent international standardised outcomes reporting guidelines. Multi-attribute utility-instruments (MAUIs) capture and assess an individual’s health-related quality-of-life (HRQoL) within a single valuation, their utility. Neither MAUIs nor utilities were discussed in the guidelines. Many MAUIs (e.g. EQ-5D) target physical health. Not so the AQoL-8D.
Our objective was to explore agreement between, and suitability of, the EQ-5D-5L and AQoL-8D for assessing health state utility, and to determine whether either MAUI could be preferentially recommended for metabolic/bariatric surgery patients.
Utilities for post-surgical private-sector patients (n = 33) were assessed using both instruments and summary statistics expressed as mean [standard deviation (SD)] and median [interquartile range (IQR)]. Interchangeability of the MAUIs was assessed with Bland–Altman analysis. Discriminatory attributes were investigated through floor/ceiling effects and dimension-to-dimension comparisons. Spearman’s rank measured associations between the instruments’ utility values and with the body mass index (BMI).
Mean (SD) EQ-5D-5L utility value was 0.84 (0.15) and median 0.84 (IQR 0.75–1.00). Mean (SD) AQoL-8D utility value was 0.76 (0.17) and median 0.81 (IQR 0.63–0.88). Spearman’s rank was r = 0.68; (p < 0.001); however, Bland–Altman analysis revealed fundamental differences. Neither instrument gave rise to floor effects. A ceiling effect was observed with the EQ-5D-5L, with 36 % of participants obtaining a utility value of 1.00 (perfect health). These same participants obtained a mean utility of 0.87 on the AQoL-8D, primarily driven by the mental-super-dimension score (0.52).
The AQoL-8D preferentially captures psychosocial aspects of metabolic/bariatric surgery patients’ HRQoL. We recommend the AQoL-8D as a preferred MAUI for these patients given their complex physical/psychosocial needs.
KeywordsCeiling Effect Laparoscopic Adjustable Gastric Band Perfect Health Psychosocial Health HRQoL Instrument
Julie Campbell contributed to study design, data verification and analysis, manuscript preparation and final approval. Andrew Palmer contributed to study design, manuscript review and final approval. Alison Venn contributed to study design, manuscript review and final approval. Melanie Sharman contributed to data collection and verification, manuscript review and final approval. Petr Otahal contributed to statistical analysis, manuscript review and final approval. Amanda Neil contributed to study design, data analysis, manuscript preparation and final approval. Amanda Neil is the overall guarantor of the submission.
Compliance with Ethical Standards
Disclosure of potential conflicts of interest
This work was supported by a National Health and Medical Research Council (NHMRC) Partnership Project Grant (APP1076899). AV is supported by a NHMRC Research Fellowship. AN is supported by a Select Foundation Research Fellowship.
Research involving human participants
Ethics approval was granted by the University of Tasmania’s Health and Medical Human Research Ethics Committees.
Informed consent was obtained from all individual participants included in the study.
Conflict of interest
The authors Julie A. Campbell, Andrew J. Palmer, Alison Venn, Melanie Sharman, Petr Otahal and Amanda Neil declare that they have no conflicts of interest.
- 11.Drummond MF, Sculpher M, Torrance G, O’Brien B, Stoddart G. Methods for the economic evaluation of health care programmes. 3rd ed. New York: Oxford University Press; 2005.Google Scholar
- 13.Skinner EH, Denehy L, Warrillow S, Hawthorne G. Comparison of the measurement properties of the AQoL and SF-6D in critical illness. Critic Care Resusc. 2013;15(3):205.Google Scholar
- 18.National Institute for Health and Care Excellence. Process and methods guides: guide to the methods for technology appraisal 2013. London: NICE; 2013. https://www.nice.org.uk/article/pmg9/resources/non-guidance-guide-to-the-methods-of-technology-appraisal-2013-pdf. Accessed 15 June 2015.
- 19.Richardson J, McKie J, Bariola E. Review and critique of health related multi attribute utility instruments. Melbourne: Monash University, Business and Economics, Centre for Health Economics; 2011.Google Scholar
- 24.Richardson. J. Increasing the sensitivity of the AQoL inventory for the evaluation of interventions affecting mental health. Melbourne: Monash University, Centre for Health Economics; 2011.Google Scholar
- 28.Richardson J, Atherton Day N, Peacock S, Iezzi A. Measurement of the quality of life for economic evaluation and the Assessment of Quality of Life (AQoL) Mark 2 instrument. Aust. Econ Rev. 2004;37(1):62–88.Google Scholar
- 32.Culyer AJ. Encyclopaedia of Health Economics. 1st ed. : vol. 2. 1st ed. Oxford: Elsevier Science; 2014. p. 353.Google Scholar
- 35.Marra CA, Woolcott JC, Kopec JA, Shojania K, Offer R, Brazier JE, et al. 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. Soc Sci Med. 2005;60(7):1571–82.CrossRefPubMedGoogle Scholar
- 49.Scalone L, Cortesi PA, Ciampichini R, Cesana G, Mantovani LG. Health related quality of life norm data of the Italian general population: results using the EQ-5D-3L and EQ-5D-5L instruments. Epidemiol Biostat Public Health. 2015;12(3):e11457-1-15.Google Scholar