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Measurement of utility in asthma: evidence indicating that generic instruments may miss clinically important changes

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Abstract

Background

Accurate assessment of preference-based health-related quality of life is important in determining the value of asthma interventions.

Objective

To examine the sensitivity and responsiveness of the EQ-5D and the AQL-5D to differences in asthma control measured by the Asthma Control Questionnaire (ACQ-5).

Methods

The Observational Study of Asthma Control and Outcomes was a prospective survey of persistent asthma patients ≥12 years old in Kaiser Colorado. Patients received a survey three times in 1 year, including the ACQ-5, AQL-5D and EQ-5D-3L (including VAS). Censored Least Absolute Deviations (CLAD) and logistic regression were used, controlling for sociodemographics and smoking.

Results

There were 6666 completed surveys (1799 individuals completed all three survey waves). After controlling for covariates, each one-point increase in ACQ-5 was associated with a decrease of 0.066, 0.058, 0.074 and 6.12 in EQ-5D(US), EQ-5D(UK), AQL-5D and VAS scores. Uncontrolled asthma (ACQ-5 > 1.5) was associated with a decrease of 0.15, 0.17, 0.11 and 10, respectively (vs. ACQ ≤ 1.5). AQL-5D scores were statistically significantly different across categories of ACQ-5 scores of 0.5 (the minimum clinically important difference [MCID]), while EQ-5D scores were not significant across most categories. The AQL-5D appeared more robust to changes in control over time (responsiveness) compared to EQ-5D-3L.

Conclusion

The AQL-5D appears more responsive to changes in asthma control over time and more sensitive to detecting differences corresponding to the ACQ-5 MCID than the EQ-5D-3L. Using the EQ-5D-3L without an asthma-specific measure such as the AQL-5D may miss clinically important changes in asthma control.

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Acknowledgments

The authors thank Denise Globe, PhD for her valuable contribution to the conception and design of the study. Funding source: This study was funded by Amgen Inc.

Author information

Authors and Affiliations

  1. Regis University School of Pharmacy, Denver, CO, USA

    Patrick W. Sullivan

  2. Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA

    David J. Magid

  3. Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, University of Colorado, Aurora, CO, USA

    Vahram H. Ghushchyan & Jonathan D. Campbell

  4. American University of Armenia, Yerevan, Armenia

    Vahram H. Ghushchyan

  5. Amgen, Inc., Thousand Oaks, CA, USA

    Gary Globe

  6. Department of Pediatrics, National Jewish Health, Denver, CO, USA

    Bruce Bender

Authors
  1. Patrick W. Sullivan
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  2. Vahram H. Ghushchyan
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  3. Jonathan D. Campbell
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  4. Gary Globe
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  5. Bruce Bender
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  6. David J. Magid
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Corresponding author

Correspondence to Patrick W. Sullivan.

Appendix

Appendix

See Table 5.

Table 5 Number of individuals with changes in ACQ-5 scores over time by MCID
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Sullivan, P.W., Ghushchyan, V.H., Campbell, J.D. et al. Measurement of utility in asthma: evidence indicating that generic instruments may miss clinically important changes. Qual Life Res 25, 3017–3026 (2016). https://doi.org/10.1007/s11136-016-1357-8

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  • DOI: https://doi.org/10.1007/s11136-016-1357-8

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