EQ-VT protocol: one-size-fits-all? Challenges and innovative adaptations used in Egypt: a cross-sectional study

ObjectivesTo present the challenges and adaptations done to the EuroQol Valuation Technology (EQ-VT) protocol to fit the Egyptian culture during the extensive pilot phase of the Egyptian EuroQol 5 Dimension five level (EQ-5D-5L) valuation studyDesignThis study was a cross-sectional, interviewer-administered face-to-face survey of representative Egyptians using the Arabic version of the EuroQol Group Valuation Technology (EQ-VT-2.1) and a country specific questionnaire pertaining to participants’ demographics and opinions about health, life and deathSettingParticipants were recruited from workplaces, university campuses, sporting clubs, shopping malls and other public areas from different Egyptian governorates representing all geographical areas of the country.ParticipantsA total of 1378 participants were interviewed from July 2019 to March 2020 by 12 interviewers to select a representative sample in terms of: geographical distribution, age and gender, of which 75 participants did not complete the interview, 298 interviews were pilot and 1005 interviews were real of which 974 interviews were used for the valuation study. Two participants did not complete the country-specific questionnaire but completed the valuation protocol; therefore, 1301 interviews were included in the final analysis of country specific questions.ResultsSome modifications were applied to the protocol. The ‘wheelchair example’ was modified to ‘migraine example’ since most of the participants in the pilot interviews considered being in a wheelchair ‘worse than dead’. There was some ambiguity in the Egyptian translated version for the EQ-5D-5L between levels 4 and 5 of the pain and depression dimensions. This was overcome by using colour coding to express the different levels of severity. A pictorial representation for the EQ-5D-5L health states was used to interview illiterate and less educated participants.ConclusionIn the Egyptian valuation study, the modifications made to the EQ-VT protocol made it feasible and culturally acceptable to the Egyptian participants.

Do health preferences differ among Asian populations? A comparison of EQ-5D-5L Discrete Choice Experiments data from 11 Asian studies

Introduction For establishing EQ-5D-5L value set, the EuroQol Group developed a standardized EQ-VT protocol. Both time-trade off (TTO) method and discrete choice experiment (DCE) method are used in the EQ-VT protocol. Published studies did not make use of the DCE data for comparison purpose. This study aims to compare the health preferences among 11 Asian studies using the DCE data collected in their EQ-5D-5L valuation studies. Methods In the EQ-VT protocol, 196 pairs of EQ-5D-5L health states were valued by a general population sample using DCE method for all 11 studies. DCE data was obtained from the study PI. Three different main-effects models were fitted for each study. Coefficients were first tested between studies. Next, the relative importance of dimensions and levels was calculated and compared. Results The number of statistically differed coefficients ranged from 5 to 16, out of 20 main-effects coefficients. For the relative importance, there is not a universal preference pattern that fits all studies, but with some common characteristics e.g. mobility is the most weighted dimension except for Vietnam; the relative importance of levels were approximately 20% for level 2, 30% for level 3, 70% for level 4 across all studies. Discussion This study confirmed that health preferences heterogeneity among Asian populations. It is therefore justifiable to announce that national/regional value sets should be used for calculating health utility.

Nerve root sedimentation sign on MRI: A triage screen for leg dominant symptoms?

Purpose Surgical indications for lumbar spinal stenosis are controversial, but most agree that leg dominant pain is a better predictor of success after decompression surgery. The objective of this study is to analyze the ability of the Nerve Root Sedimentation Sign (SedSign) on MRI to differentiate leg dominant symptoms from non-specific low back pain. Methods This was a retrospective review of 367 consecutive patients presenting with back and/or leg pain. Baseline clinical characteristics included Oswestry disability index (ODI), visual analog pain scores, EuroQol Group 5-Dimension Self-Report (EQ5D) and Saskatchewan Spine Pathway Classification (SSPc). Inter- and intra-rater reliability for SedSign was 73% and 91%, respectively (3 examiners). Results SedSign was positive in 111 (30.2%) and negative in 256 (69.8%) patients. On univariate analysis, a positive SedSign was correlated with age, male sex, several ODI components, EQ5D mobility, cross-sectional area (CSA) of stenosis, antero-posterior diameter of stenosis, and SSPc pattern 4 (intermittent leg dominant pain). On multivariate analysis, SedSign was associated with age, male sex, CSA stenosis and ODI walking distance. Patients with a positive SedSign were more likely to be offered surgery after referral (OR 2.65). The sensitivity and specificity for detecting all types of leg dominant pain were 37.4 and 82.8, respectively (ppv 77.5%, npv 43.8%). Conclusions Patients with a positive SedSign were more likely to be offered surgery, in particular non-instrumented decompression. The SedSign has high specificity for leg dominant pain, but the sensitivity is poor. As such, its use in triaging appropriate surgical referrals is limited.

Measuring the impact of COVID-19 on the quality of life of the survivors, partners and family members: a cross-sectional international online survey

ObjectiveThis study aimed to measure the impact of COVID-19 on the quality of life (QoL) of survivors and their partners and family members.Design and settingA prospective cross-sectional global online survey using social media.ParticipantsPatients with COVID-19 and partners or family members (age ≥18 years).InterventionOnline survey from June to August 2020.Main outcome measureThe EuroQol group five dimensions three level (EQ-5D-3L) to measure the QoL of survivors of COVID-19, and the Family Reported Outcome Measure (FROM-16) to assess the impact on their partner/family member’s QoL.ResultsThe survey was completed by 735 COVID-19 survivors (mean age=48 years; females=563) at a mean of 12.8 weeks after diagnosis and by 571 partners and 164 family members (n=735; mean age=47 years; females=246) from Europe (50.6%), North America (38.5%) and rest of the world (10.9%). The EQ-5D mean score for COVID-19 survivors was 8.65 (SD=1.9, median=9; range=6–14). 81.1% (596/735) reported pain and discomfort, 79.5% (584/735) problems with usual activities, 68.7% (505/735) anxiety and depression and 56.2% (413/735) problems with mobility. Hospitalised survivors (20.1%, n=148) and survivors with existing health conditions (30.9%, n=227) reported significantly more problems with mobility and usual activities (p<0.05), with hospitalised also experiencing more impact on self-care (p≤0.001). Among 735 partners and family members, the mean FROM-16 score (maximum score=highest impact =32) was 15 (median=15, range=0-32). 93.6% (688/735) reported being worried, 81.7% (601/735) frustrated, 78.4% (676/735) sad, 83.3% (612/735) reported impact on their family activities, 68.9% (507/735) on sleep and 68.1% (500/735) on their sex life.ConclusionCOVID-19 survivors reported a major persisting impact on their physical and psychosocial health. The lives of their partners and other family members were also severely affected. There is a need for a holistic support system sensitive to the needs of COVID-19 survivors and their family members who experience a major ‘secondary burden’.

Gambaran Kualitas Hidup Pasien Pasca Trauma Kepala Sedang dan Berat dengan Lesi Intrakranial Menggunakan Parameter EUROQOL Group EQ-5D-5L di Departemen Bedah Saraf Rumah Sakit Hasan Sadikin Bandung

Latar Belakang : Trauma kepala merupakan salah satu penyebab utama kematian pada pengguna kendaraan bermotor di negara berkembang. Angka kematian pasien pasca trauma kepala saat perawatan di rumah sakit cukup tinggi. Literatur tentang kualitas hidup pasien pasca trauma kepala atau pasien neurologis di negara berkembang sangat terbatas. Tujuan: Menilai kualitas hidup pasien trauma kepala sedang dan berat dengan lesi intrakranial di bagian Bedah Saraf RS. Hasan Sadikin Bandung menggunakan kuisioner EQ-5D-5L. Metode : Penelitian ini menggunakan desain penelitian observasional deksriptif prospektif, dengan subjek penelitian pasien bedah saraf yang masuk ke ruang gawat darurat RS. Hasan Sadikin dan memenuhi kriteria inklusi. Dilakukan pemeriksaan awal oleh dokter bedah saraf dan dilakukan pemeriksaan CT-Scan, kemudian dilanjutkan dengan mengisi kuisioner F1, selama perawatan akan mengisi F2, dan sebelum pulang mengisi F3, selanjutnya follow-up selama bulan 1, 2, dan 3 akan mengisi format F4.1, F4.2 dan F4.3. Sampel diambil dengan cara Consecutive Sampling. Hasil : Dari 721 pasien trauma kepala yang masuk ke Instalasi Gawat Darurat (IGD) bagian bedah saraf Rumah Sakit Hasan Sadikin (RSHS) selama periode 1 Agustus 2018 sampai dengan 31 Januari 2019, didapatkan 22 (3,05 %) orang meninggal di IGD, 23 orang (3,2 %) pulang paksa sebelum dilakukan interview, dan diperoleh 36 pasien (4,5 %) yang masuk kriteria inklusi dan ikut dalam penelitian ini. Berdasarkan skala dimensi Euroqol EQ-5D mobilisasi saat pulang tidak ada masalah sebanyak 35%, sedikit masalah 62 %, dan masalah sedang 3 %. Skala perawatan diri didapatkan pasien yang saat pulang tidak ada masalah sebanyak 10%, sedikit masalah 87 %, dan masalah sedang 3 %. Skala aktifitas biasa didapatkan pada saat pulang tidak ada masalah sebanyak 3%, sedikit masalah 87 %, dan masalah sedang 10 %. Skala nyeri didapatkan pada saat pulang tidak ada masalah sebanyak 10%, masalah sedikit 83%, dan masalah sedang 7%. Skala kecemasan / depresi didapatkan pada saat pulang tidak ada masalah sebanyak 52%, sedikit masalah 45%, dan masalah sedang 3%. Skala intelektual didapatkan pada saat pulang tidak ada masalah sebanyak 74%, sedikit masalah 23%, dan masalah sedang 3%. Kesimpulan : Kuesioner Euroqol EQ-5D merupakan instrumen yang mudah dimengerti, tidak membutuhkan biaya banyak serta dapat diterapkan di berbagai bidang ilmu. Terdapat perbaikan pada semua skala dimensi Euroqol EQ-5D pada akhir pemantauan.

Crosswalk EQ-5D-5L Value Set for Slovenia

IntroductionDue to the availability of the EQ-5D-5L instrument official translation into Slovenian its use is widespread in Slovenia. However, the health profiles obtained in many studies cannot be ascribed their appropriate values as the EQ-5D-5L value set does not yet exist in Slovenia. Our aim was to estimate an interim EQ-5D-5L value set for Slovenia using the crosswalk methodology developed by the EuroQol Group on the basis of the EQ-5D-3L Slovenian TTO value set. Our secondary aim was to compare the interim values obtained with the EQ-5D-3L Slovenian values.MethodsTo obtain a Slovenian interim EQ-5D-5L value set, we applied the crosswalk methodology developed by the EuroQol Group to the Slovenian EQ-5D-3L TTO value set. We examined the differences between values by comparing the mean 3L and 5L value scores and the distribution of values across all respondents.ResultsBy definition, 3-level and 5-level versions have the same range (from 1 to −0.495) and a health state coded 22222 in the 3-level version corresponds to 33333 in the 5-level version. While the addition of a “slight” severity level (22222) in the 5-level version has a low informational value, the addition of a “severe” health state (44444) covers larger range of the scale. The 5-level version results in fewer health states being valued below 0 and above 0.8.ConclusionThe EQ-5D-5L value set, based on the crosswalk methodology, should be used until a value set for the EQ-5D-5L is derived from preferences elicited directly from a representative sample of the Slovenian general population.

Impact of flooding on health-related quality of life in England: results from the National Study of Flooding and Health

Background Flooding can have extensive effects on the health and wellbeing of affected communities. The impact of flooding on psychological morbidity has been established; however, the wider impacts of flooding exposure, including on health-related quality of life (HRQoL), have not been described. Methods Using data from the English National Study of Flooding and Health cohort, HRQoL 2 and 3 years post-flooding was assessed with the EuroQol Group EQ-5D-5L tool. Associations between exposure groups (flooding and disruption from flooding) and HRQoL were assessed, using ordinal and linear regression, adjusting for a priori confounders. Results For both 2 and 3 years post-flooding, the median HRQoL scores were lower in the flooded and disrupted groups, compared with unaffected respondents. A higher proportion of flooded and disrupted respondents reported HRQoL problems in most dimensions of the EQ-5D-5L, compared with unaffected respondents. In year 2, independent associations between exposure to flooding and experiencing anxiety/depression [adjusted odds ratio (aOR) 7.7; 95% CI 4.6–13.5], problems with usual activities (aOR 5.3; 95% CI 2.5–11.9) and pain/discomfort (aOR 2.4; 95% CI 1.5–3.9) were identified. These problems persisted 3 years post-flooding; associations between exposure to flooding and experiencing anxiety/depression (aOR 4.3; 95% CI 2.5–7.7), problems with usual activities (aOR 2.9; 95% CI 1.5–6.1) and pain/discomfort (aOR 2.5; 95% CI 1.5–4.2) were identified. Conclusions Exposure to flooding and disruption from flooding significantly reduces HRQoL. These findings extend our knowledge of the impacts of flooding on health, with implications for multi-agency emergency response and recovery plans.

Patient-reported outcome measures in the management of neovascular age-related macular degeneration: a 1-year prospective study

ObjectiveTo prospectively explore the following patient-reported outcome measures (PROMs) in the management of neovascular age-related macular degeneration (nAMD): (1) self-reported visual function, (2) symptom-state, (3) general-health and (4) satisfaction of treatment.Methods and analysisCorresponding to the four PROMs, participants responded to the following questionnaires: (1) National Eye Institute Visual-Functioning-Questionnaire (NEI-VFQ-25), (2) Patient-Acceptable-Symptom-Status (PASS 5), (3) EuroQol-Group-Questionnaire (EQ-5D-3L) and (4) Dimensions of Importance in Treatment of nAMD (DITAMD). Data were collected at baseline and after 3, 6 and 12 months of intravitreal antivascular endothelial growth factor treatment. Results were evaluated with t-tests and mixed linear regression analyses.ResultsThe study included 197 patients. At baseline NEI-VFQ-25 (79.53±14.52) and EQ-5D (0.74±0.28) had relatively high scores, whereas PASS 5 was below ‘acceptable’ (3.30±0.80). At 12 months NEI-VFQ-25 and PASS 5 showed significant improvement, whereas EQ-5D and DITAMD remained unchanged. At baseline patients receiving treatment of the better-seeing eye (BSE) (n=52) reported significantly worse NEI-VFQ-25 and PASS 5 than patients for whom treatment only involved the worse-seeing eye (WSE), (n=145). In contrast to BSE patients, there was no improvement of NEI-VFQ-25 for WSE patients at 12 months, despite a significant improvement in best-corrected visual acuity (BCVA). Two independent variables, treatment including the BSE and BCVA for the treated eye, were found to predict both NEI-VFQ-25 and PASS 5.ConclusionAfter 12 months of nAMD treatment, there was a significant improvement in PASS 5 and NEI-VFQ-25, the latter depending on whether therapy included BSE. EQ-5D and DITAMD remained unaltered.

P.131 Does a multidisciplinary triage pathway facilitate better outcomes after spine surgery?

Background: The Saskatchewan Spine Pathway (SSP) facilitates timelier imaging and more appropriate surgical referrals. In this prospective study, pre- and post-operative wait times, satisfaction, and outcomes were compared between SSP and conventionally referred surgical patients. Methods: A prospective matched cohort comparison of 150 patients (SSP group n=75; conventional group n=75) undergoing elective lumbar surgery for mechanical back and leg pain between 2011 and 2016 was performed with 1 year follow-up. Outcomes were measured with patient questionnaires, Oswestry disability index (ODI), visual analogue back and leg pain scores (VAS), and EuroQol Group 5 –Dimension self-report (EQ5D). Results: Baseline measures were the same in both groups. Wait times to see the surgeon and for surgery were the same, and wait time for MRI was significantly shorter for the SSP group (p&lt;0.001). SSP patients utilized more non-operative treatment strategies such as physiotherapy (p&lt;0.04), and had higher satisfaction with pre-surgical care (p=0.03). Good surgical outcomes were obtained in both groups with no significant differences. Conclusions: There are minimal differences in post-surgical outcomes for SSP patients versus conventionally referred patients; however, the SSP facilitates significantly shorter wait times for MRI and non-operative treatment strategies. Pre-surgical patient satisfaction is significantly higher among SSP patients.

Exploring the Impact of Adding a Respiratory Dimension to the EQ-5D-5L

Objectives. To evaluate the impact of adding a respiratory dimension (a bolt-on dimension) to the EQ-5D-5L health state valuations. Methods. Based on extensive regression and principal component analyses, 2 respiratory bolt-on candidates were formulated: R1, limitations in physical activities due to shortness of breath, and R2, breathing problems. Valuation interviews for the selected bolt-ons were performed with a representative sample from the Dutch general public using the standardized interview protocol and software of the EuroQol group. Hybrid models based on the combined time-tradeoff (TTO) and discrete choice experiment (DCE) data were estimated to assess whether the 5 levels of the respiratory bolt-on led to significant changes in utility values. Results. For each bolt-on candidate, slightly more than 200 valuation interviews were conducted. Mean TTO values and DCE choice probabilities for health states with a level 4 or 5 for the respiratory dimension were significantly lower compared with the same health states in the Dutch EQ-5D-5L valuation study without the respiratory dimension. Results of hybrid models showed that for the bolt-on “limitations in physical activities,” the utility decrements were significant for level 3 (–0.055), level 4 (–0.087), and level 5 (–0.135). For “breathing problems,” the utility decrements for the same levels were greater (–0.086, –0.219, and –0.327, respectively). Conclusions. The addition of each of the 2 respiratory bolt-ons to the EQ-5D-5L had a significant effect on the valuation of health states with severe levels for the bolt-on. The bolt-on dimension “breathing problems” showed the greatest utility decrements and therefore seems the most appropriate respiratory bolt-on dimension.