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Separating gains and losses in health when calculating the minimum important difference for mapped utility measures

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Abstract

Objective

To estimate the minimum important difference (MID) for a variety of mapped utility measures and to determine whether patients perceiving gains and losses in health status should be treated equally when calculating the MID.

Methods

A longitudinal study within a California managed care population of 6,932 patients was retrospectively analyzed. Utilities were derived from the SF-36 short-form health survey using multiple validated mapping methods. Absolute utility changes for patients who considered their current health as ‘somewhat better’ or ‘somewhat worse’ in the prior year were compared to determine if gains and losses in utility values could be combined. The MIDs were calculated and compared using anchor- and distribution-based methods.

Results

Two thousand one hundred patients reported ‘somewhat better’ or ‘somewhat worse’ health in the first year. When combining these patients, the average MID for all mapped utility measures was 0.03 (SD = 0.1), a magnitude similar to that identified by Walters. However, when separated, the mean MID utility change for those reporting ‘somewhat better’ and ‘somewhat worse’ health was 0.02 (SD = 0.1) and −0.06 (SD = 0.1), respectively (P < 0.0001).

Conclusions

Researchers should consider the effects of combining gains and losses when determining utility MID values.

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Abbreviations

CDS:

Chronic Disease Score

CEA:

Cost-effectiveness analysis

ES:

Effect size

FACT:

Functional Assessment of Cancer Therapy

FDA:

Food and Drug Administration

HrQoL:

Health-related quality of life

HUI2:

Health Utilities Index Mark 2

MID:

Minimum important difference

PRO:

Patient-reported outcome

QALY:

Quality-adjusted life year

SEM:

Standard error of measurement

SD:

Standard deviation

SG:

Standard gamble

VAS:

Visual analog scale

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Authors and Affiliations

  1. University of Southern California, Los Angeles, CA, USA

    Michael B. Nichol & Joshua D. Epstein

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  1. Michael B. Nichol
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  2. Joshua D. Epstein
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Correspondence to Michael B. Nichol.

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Nichol, M.B., Epstein, J.D. Separating gains and losses in health when calculating the minimum important difference for mapped utility measures. Qual Life Res 17, 955–961 (2008). https://doi.org/10.1007/s11136-008-9369-7

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