Quality of Life Research

, Volume 12, Issue 6, pp 611–619

Understanding differences between self-ratings and population ratings for health in the EuroQOL

  • Ralph P. Insinga
  • Dennis G. Fryback
Article

Abstract

Objective: To examine the source and magnitude of differences between self-ratings for health and ratings of corresponding health state profiles by the general population in the EuroQOL. Data and methods: EuroQOL data were analysed from the 1993 measurement and valuation of health study (MVH), a sample of 2997 members of the UK adult population, nationally representative by age, gender and social class. Multivariate regression analyses were used to examine the source of differences in visual analogue scores (VAS) between self-ratings and general population ratings. The source of observed differences were investigated with respect to four hypothesized factors: (1) Socio-demographics (age, gender, education, social class); (2) The level of respondent difficulty in completing the rating task; (3) Values for particular EQ-5D health profile attributes; and (4) Differences in the scope of health attributes and levels considered in the rating task (e.g., self-ratings may reflect preferences for attributes not captured by EQ-5D profiles). Results: Overall, mildly ill individuals provided lower self-ratings (3–4 points), and moderately ill individuals higher self-ratings (7 points), than ratings for these states provided by the general population. Socio-demographic characteristics and difficulties in rating task completion did not explain differences between self and general population VAS ratings, contributing differences of 1 point or less in all 15 rating comparisons examined. Rating differences related more closely to a lack of correspondence between health state descriptions and self-raters' actual health experiences (differences in scope) than differences in values for health profile attributes between self-raters and the general population. Conclusions: EQ-5D health state descriptions may be too sparse to comprehensively describe certain health states. Adding new health state levels or dimensions, or changing the nature and tone of health state descriptions, may be useful steps for improvement.

EQ-5D Health status Patient preferences Self-rated health Visual analogue scales 

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References

  1. 1.
    Gold M, Siegel J, Russell L, Weinstein M. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press, 1996.Google Scholar
  2. 2.
    Nord E. Cost-Value Analysis in Health Care. In: MacLean D (ed), Cambridge Studies in Philosophy and Public Policy. Cambridge, UK: Cambridge University Press, 1999.Google Scholar
  3. 3.
    Tengs TO, Wallace A. One thousand health-related quality-of-life estimates. Med Care 2000; 38: 583–637.Google Scholar
  4. 4.
    De Wit GA, Busschbach JJ, De Charro FT. Sensitivity and perspective in the valuation of health status: Whose values count? Health Econ 2000; 9: 109–126.Google Scholar
  5. 5.
    Jansen SJ, Stiggelbout AM, Wakker PP, Nooij MA, Noordijk EM, Kievit J. Unstable preferences: A shift in valuation or an effect of the elicitation procedure? Med Decis Making 2000; 20: 62–71.Google Scholar
  6. 6.
    Jansen SJ, Kievit J, Nooij MA, Stiggelbout AM. Stability of patients' preferences for chemotherapy: The impact of experience. Med Decis Making 2001; 21: 295–306.Google Scholar
  7. 7.
    Kind P, Dolan P. The effect of past and present illness experience on the valuations of health states. Med Care 1995; 33: AS255–AS263.Google Scholar
  8. 8.
    Dolan P. The effect of experience of illness on health state valuations. J Clin Epidemiol 1996; 49: 551–564.Google Scholar
  9. 9.
    EuroQOL-a new facility for the measurement of health-related quality of life. The EuroQOL Group [see comments]. Health Policy 1990; 16: 199–208.Google Scholar
  10. 10.
    Kind P. The EuroQOL Instrument: An Index of Health-Related Quality of Life. 2nd ed. in: Spilker B (ed), Quality of Life and Pharmacoeconomics in Clinical Trials. Philadelphia, PA: Lippincott-Raven Publishers, 1996.Google Scholar
  11. 11.
    Brazier J, Jones N, Kind P. Testing the validity of the Euroqol and comparing it with the SF-36 health survey questionnaire [see comments]. Qual Life Res 1993; 2: 169–180.Google Scholar
  12. 12.
    Bjork S, Norinder A. The weighting exercise for the Swedish version of the EuroQOL. Health Econ 1999; 8: 117–126.Google Scholar
  13. 13.
    Zethraeus N, Johannesson M. A comparison of patient and social tariff values derived from the time trade-off method. Health Econ 1999; 8: 541–545.Google Scholar
  14. 14.
    Bosch JL, Hunink MG. Comparison of the Health Utilities Index Mark 3 (HUI3) and the EuroQOL EQ-5D in patients treated for intermittent claudication. Qual Life Res 2000; 9: 591–601.Google Scholar
  15. 15.
    Kind P, Dolan P, Gudex C, Williams A. Variations in population health status: Results from a United Kingdom national questionnaire survey [see comments]. Br Med J 1998; 316: 736–741.Google Scholar
  16. 16.
    Gudex C, Dolan P, Kind P. Health state valuations from the general public using the visual analogue scale. Qual Life Res 1996; 5: 521–531.Google Scholar
  17. 17.
    Woloshin S, Schwartz L, Moncur M, Gabriel S, Tosteson A. Assessing values for health: Numeracy matters. Med Decis Making 2001; 21: 382–390.Google Scholar
  18. 18.
    Dolan P, Gudex C, Kind P, Williams A. The time trade-off method: Results from a general population study. Health Econ 1996; 5: 141–154.Google Scholar
  19. 19.
    Torrance GW, Thomas WH, Sackett DL. A utility maximization model for evaluation of health care programs. Health Serv Res 1972; 7: 118–133.Google Scholar
  20. 20.
    Torrance G. Social preferences for health states: An empirical evaluation of three measurement techniques. Socio-Econ Plan Sci 1976; 10: 129–136.Google Scholar
  21. 21.
    Badia X, Herdman M, Dipstat M, Ohinmaa A. Feasibility and validity of the VAS and TTO for eliciting general population values for temporary health states: A comparative study. Health Serv Res Outcome Res Meth 2001; 2: 51–65.Google Scholar
  22. 22.
    Polsky D, Willke RJ, Scott K, Schulman KA, Glick HA. A comparison of scoring weights for the EuroQOL derived from patients and the general public. Health Econ 2001; 10: 27–37.Google Scholar
  23. 23.
    Essink-Bot ML, Krabbe PF, Bonsel GJ, Aaronson NK. An empirical comparison of four generic health status measures. The Nottingham Health Profile, the Medical Outcomes Study 36-item Short-Form Health Survey, the COOP/WONCA charts, and the EuroQOL instrument. Med Care 1997; 35: 522–537.Google Scholar
  24. 24.
    Johnson JA, Coons SJ. Comparison of the EQ-5D and SF-12 in an adult US sample. Qual Life Res 1998; 7: 155–166.Google Scholar
  25. 25.
    Johnson JA, Pickard AS. Comparison of the EQ-5D and SF-12 health surveys in a general population survey in Alberta, Canada. Med Care 2000; 38: 115–121.Google Scholar
  26. 26.
    Postulart D, Adang EM. Response shift and adaptation in chronically ill patients. Med Decis Making 2000; 20: 186–193.Google Scholar
  27. 27.
    Torrance G, Boyle MH, Horwood SP. Application of multi-attribute health utility theory to measure social preferences of health states. Oper Res 1982; 30: 1043–1049.Google Scholar
  28. 28.
    Torrance GW, Feeny DH, Furlong WJ. Visual analog scales: Do they have a role in the measurement of preferences for health states? Med Dec Making 2001; 21: 329–334.Google Scholar
  29. 29.
    Krabbe PF, Stouthard ME, Essink-Bot ML, Bonsel GJ. The effect of adding a cognitive dimension to the EuroQOL multiattribute health-status classification system. J Clin Epidemiol 1999; 52: 293–301.Google Scholar

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • Ralph P. Insinga
    • 1
  • Dennis G. Fryback
    • 1
  1. 1.Department of Population Health SciencesUniversity of Wisconsin-MadisonMadisonUSA

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