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The concurrent validity and responsiveness of the health utilities index (HUI 3) among patients with advanced HIV/AIDS

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Abstract

Objectives

To assess the concurrent validity and responsiveness of the Health Utility Index 3 (HUI3) in patients with advanced HIV/AIDS, and to determine the responsiveness of this measure, the MOS-HIV and EQ-5D to HIV-related clinical events.

Methods

Data from the OPTIMA (OPTions In Management with Antiretrovirals) trial was analyzed. Two aspects of the validity of the HUI3 were considered: concurrent validity was evaluated using Spearman correlations with MOS-HIV component and summary scores. Responsiveness to AIDS-defining events (ADE) and all adverse events (our external change criterion) was assessed using area under the receiver operating characteristic (AUROC) curves.

Results

The study enrolled 368 patients (mean follow-up: 3.66 years); 82% had at least one severe adverse event and 27% had at least one ADE. The HUI3 scale and items showed good concurrent validity, with 85% of the expected relationships with the MOS-HIV subscales verified. The HUI3 was responsive to both adverse events (AUROC [95%CI]: 0.68 [0.57, 0.80]) and ADEs (0.62 [0.51, 0.74]). The EQ-5D was responsive to ADEs (0.66 [0.56, 0.76]), but not responsive to adverse events (0.56 [0.46, 0.68]).

Conclusion

The HUI3 is a valid and responsive measure of the change in HRQoL associated with clinical events in an advanced HIV/AIDS population.

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Abbreviations

ARV:

Antiretroviral

AE:

Adverse events

HIV:

Human immunodeficiency virus

AIDS:

Acquired immune deficiency syndrome

AUROC:

Area under the receiver operating characteristic curve

MHS:

Mental health score

PHS:

Physical health score

References

  1. Torres, R. A., & Barr, M. (1997). Impact of combination therapy for HIV infection on inpatient census. New England Journal of Medicine, 336, 1531–1532.

    Article  PubMed  CAS  Google Scholar 

  2. Hirschel, B., & Francioli, P. (1998). Progress and problems in the fight against AIDS. New England Journal of Medicine, 338, 906–908.

    Article  PubMed  CAS  Google Scholar 

  3. Crothers, K., Butt, A. A., Gilbert, C. L., Rodriguez-Barradas, M. C., Crystal, S., Justice, A. C., et al. (2006). Increased COPD among HIV-positive compared to HIV-negative veterans. Chest, 130(5), 1326–1333.

    Article  PubMed  Google Scholar 

  4. Tsiodras, S., Mantzoros, C., Hammer, S., & Samore, M. (2000). Effects of protease inhibitors on hyperglycemia, hyperlipidemia, and lipodystrophy: a 5-year cohort study. Archives of Internal Medicine, 160, 2050–2056.

    Article  PubMed  CAS  Google Scholar 

  5. Kamin, D. S., & Grinspoon, S. K. (2005). Cardiovascular disease in HIV-positive patients. AIDS, 19, 641–652.

    Article  PubMed  Google Scholar 

  6. Tsasis, P. (2000). Health-related quality of life measurements in HIV/AIDS care. AIDS Patient Care STDs, 14(8), 427–438.

    Article  PubMed  CAS  Google Scholar 

  7. Kyriakides, T. C., Babiker, A., Singer, J., Cameron, W., Schechter, M. T., Holodniy, M., et al. (2003). An open-label randomized clinical trial of novel therapeutic strategies for HIV-infected patients in whom antiretroviral therapy has failed: Rationale and design of the OPTIMA trial. Controlled Clinical Trials, 24, 481–500.

    Article  PubMed  Google Scholar 

  8. Neumann, P. J., Goldie, S. J., & Weinstein, M. C. (2000). Preference-based measures in economic evaluation in health care. Annual Review of Public Health, 21, 587–611.

    Article  PubMed  CAS  Google Scholar 

  9. Guyatt, G. H., King, D. R., Feeny, D. H., Stubbing, D., & Goldstein, R. S. (1999). Generic and specific measurement of health related quality of life in a clinical trial of respiratory rehabilitation. Journal of Clinical Epidemiology, 52(3), 187–192.

    Article  PubMed  CAS  Google Scholar 

  10. Wu, A. W., Jacobson, D. L., Frick, K. D., Clark, R., Revicki, D. A., Freedberg, K. A., et al. (2002). Validity and responsiveness of the EuroQol as a measure of health-related quality of life in people enrolled in an AIDS clinical trial. Quality of Life Research, 11, 273–282.

    Article  PubMed  CAS  Google Scholar 

  11. Anis, A. H., Nosyk, B., Sun, H., Guh, D. P., Bansback, N., Li, X., & Optima Team (2009). Quality of life of patients with advanced HIV/AIDS: Measuring the impact of both AIDS defining events and non-AIDS serious adverse events. Journal of Acquired Immune Deficiency Syndrome (in press).

  12. Clayson, D. J., Wild, D. J., Quarterman, P., Duprat-Lomon, I., Kubin, M., & Coons, S. J. (2006). A comparative review of health-related quality of life measures for use in HIV/AIDS clinical trials. Pharmacoeconomics, 24(8), 751–765.

    Article  PubMed  Google Scholar 

  13. Chan, K. S., & Revicki, D. A. (1998). Changes in surrogate laboratory markers, clinical endpoints, and health-related quality of life in patients with the human immunodeficiency virus. Evaluation & Health Professions, 21(2), 265–281.

    Article  CAS  Google Scholar 

  14. Lubeck, D. P., & Fries, J. F. (1992). Changes in quality of life among persons with HIV infection. Quality of Life Research, 1(6), 359–366.

    Article  PubMed  CAS  Google Scholar 

  15. Carretero, M. D., Burgess, A. P., Soler, P., Soler, M., & Catalan, J. (1996). Reliability and validity of an HIV-specific health-related quality of life measure for use with injection drug users. AIDS, 10, 1699–1705.

    PubMed  CAS  Google Scholar 

  16. Paton, N. I., Chapman, C. A., Chan, S. P., Tan, K. M., Leo, Y. S., Aboulhad, J., et al. (2002). Validation of the medical outcomes study HIV health survey as a measure of quality of life in HIV-infected patients in Singapore. International Journal of STDs and AIDS, 13, 456–461.

    Article  Google Scholar 

  17. Wu, A. W., Revicki, D. A., Jacobson, D., & Malitz, F. E. (1997). Evidence for reliability, validity and usefulness of the medical outcomes study HIV health survey (MOS-HIV). Quality of Life Research, 6, 481–493.

    Article  PubMed  CAS  Google Scholar 

  18. Brooks, R. (1996). EuroQol: The current state of play. Health Policy, 37(1), 53–72.

    Article  PubMed  CAS  Google Scholar 

  19. Coons, S. J., Rao, S., Keininger, D. L., & Hays, R. D. (2000). A comparative review of generic quality-of-life instruments. Pharmacoeconomics, 17, 13–35.

    Article  PubMed  CAS  Google Scholar 

  20. Shaw, J. W., Johnson, J. A., & Coons, S. J. (2005). US valuation of the EQ-5D health states: Development and testing of the D1 valuation model. Medical Care, 43(3), 203–220.

    Article  PubMed  Google Scholar 

  21. Torrance, G. W., Furlong, W., Feeny, D., & Boyle, M. (1995). Multi-attribute preference functions. Health Utilities Index. Pharmacoeconomics, 7(6), 503–520.

    Article  PubMed  CAS  Google Scholar 

  22. Feeny, D., Furlong, W., Torrance, G. W., Goldsmith, C. H., Zhu, Z., DePauw, S., et al. (2002). Multiattribute and single-attribute utility functions for the health utilities index mark 3 system. Medical Care, 40(2), 113–128.

    Article  PubMed  Google Scholar 

  23. Boyle, M. H., Furlong, W., Feeny, D., Torrance, G. W., & Hatcher, J. (1995). Reliability of the Health Utilities Index—mark III used in the 1991 cycle 6 Canadian General Social Survey Health Questionnaire. Quality of Life Research, 4(3), 249–257.

    Article  PubMed  CAS  Google Scholar 

  24. Horsman, J., Furlong, W., Feeny, D., & Torrance, G. (2003). The Health Utilities Index (HUI®): Concepts, measurement properties and applications. Health & Quality of Life Outcomes, 1, 54.

    Article  Google Scholar 

  25. Bayoumi, A. M., & Redelmeier, D. A. (1999). Economic methods for measuring the quality of life associated with HIV infection. Quality of Life Research, 8, 471–480.

    Article  PubMed  CAS  Google Scholar 

  26. Fayers, P. M., & Machin, D. (2006). Quality of life. The assessment, analysis and interpretation of patient-reported outcomes (2nd ed.). West Sussex: Wiley.

    Google Scholar 

  27. Common Terminology Criteria for Adverse Events, Version 3.0. https://webapps.ctep.nci.nih.gov/webobjs/ctc/webhelp/welcome_to_ctcae.htm. Accessed Jan 2009.

  28. Sackett, D. L., Haynes, R. B., Tugwell, P. (1985). The interpretation of diagnostic data. In Clinical epidemiology: A basic science for clinical medicine (pp. 59–138). Boston: Little, Brown.

  29. DeLong, E. R. (1988). Comparing the areas under tow or more correlated receiver operating characteristic curves: A nonparametric approach. Biometrics, 44, 837–845.

    Article  PubMed  CAS  Google Scholar 

  30. Terwee, C. B., Bot, S. D. M., de Boer, M. R., van der Windt, D. A. W. M., Knol, D. L., Dekker, J., et al. (2007). Quality criteria were proposed for measurement properties of heath status questionnaires. Journal of Clinical Epidemiology, 60, 34–42.

    Article  PubMed  Google Scholar 

  31. Revicki, D. A., Wu, A. W., & Murray, M. I. (1995). Change in clinical status, health status, and health utility outcomes in HIV-infected patients. Medical Care, 33, AS173–AS182.

    PubMed  CAS  Google Scholar 

  32. Hays, R. D., & Hadorn, D. (1992). Responsiveness to change: An aspect of validity, not a separate dimension. Quality of Life Research, 1(1), 73–75.

    Article  PubMed  CAS  Google Scholar 

  33. Patrick, D. L., & Chiang, Y. P. (2000). Measurement of health outcomes in treatment effectiveness evaluations: Conceptual and methodological challenges. Medical Care, 38(9 Suppl), II14–II25.

    PubMed  CAS  Google Scholar 

  34. Streiner, D. L., & Norman, G. R. (2008). Health measurement scales: A practical guide to their development and use (4th ed.). New York: Oxford University Press Inc.

    Google Scholar 

  35. Terwee, C. B., Dekker, F. W., Wiersinga, W. M., Prummel, M. F., & Bossuyt, P. M. M. (2003). On assessing responsiveness of health-related quality of life instruments: Guidelines for instrument evaluation. Quality of Life Research, 12, 349–362.

    Article  PubMed  CAS  Google Scholar 

  36. Revicki, D., Hays, R. D., Cella, D., & Sloan, J. (2008). Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. Journal of Clinical Epidemiology, 61, 102–109.

    Article  PubMed  Google Scholar 

  37. Aiken, L. R. (1977). Note on sensitivity: A neglected psychometric concept. Perceptual and motor skills, 45, 1330.

    Google Scholar 

  38. Krabbe, P. F. M., Peerenboom, L., Langenhoff, B. S., & Ruers, T. J. M. (2004). Responsiveness of the generic EQ-5D summary measure compared to the disease-specific EORTC QLQ C-30. Quality of Life Research, 13, 1247–1253.

    Article  PubMed  Google Scholar 

  39. Husted, J. A., Cook, R. J., Farewell, V. T., & Gladman, D. D. (2000). Methods for assessing responsiveness: A critical review and recommendations. Journal of Clinical Epidemiology, 53, 459–468.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The OPTIMA study was funded by the Canadian Institutes of Health Research (Canada), Cooperative Studies Program of the US Department of Veterans Affairs Veterans Health Administration (USA), and the Office of Research and Development, Cooperative Studies Program, United Kingdom Medical Research Council. BN was supported by doctoral research awards from the Michael Smith Foundation for Health Research, the Canadian Institutes of Health Research, and the Research in Addictions and Mental Health Policy & Services CIHR strategic training initiative.

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Authors and Affiliations

  1. Canadian HIV Trials Network, St. Paul’s Hospital, 620-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada

    Bohdan Nosyk, Huiying Sun, Nick Bansback, Daphne P. Guh, Xin Li & Aslam H. Anis

  2. Cooperative Studies Program of the US, Department of Veterans Affairs Office of Research and Development, VA Health Economics Resource Centre, Menlo Park, CA, USA

    Paul Barnett & Vilija Joyce

  3. Department of Health Policy, Management and Evaluation Faculty of Medicine, University of Toronto, Toronto, Canada

    Ahmed Bayoumi

  4. Centre for Health Economics, University of York, York, UK

    Susan Griffin

  5. VA Medical Centre, Palo Alto, CA, USA

    Mark Holodniy

  6. VA Center for Health Care Evaluation, Stanford, CA, USA

    Doug K. Owens

  7. Faculty of Medicine, School of Population and Public Health, Vancouver, BC, Canada

    Aslam H. Anis

Authors
  1. Bohdan Nosyk
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  2. Huiying Sun
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  5. Xin Li
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  7. Ahmed Bayoumi
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  9. Vilija Joyce
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  10. Mark Holodniy
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  12. Aslam H. Anis
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Correspondence to Aslam H. Anis.

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Nosyk, B., Sun, H., Bansback, N. et al. The concurrent validity and responsiveness of the health utilities index (HUI 3) among patients with advanced HIV/AIDS. Qual Life Res 18, 815–824 (2009). https://doi.org/10.1007/s11136-009-9504-0

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  • DOI: https://doi.org/10.1007/s11136-009-9504-0

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