Adrienn Katalin Poór

A detailed analysis of ‘not relevant’ responses on the DLQI in psoriasis: potential biases in treatment decisions

Dermatology Life Quality Index (DLQI) is the most common health‐related quality of life measure in dermatology that is widely used in treatment guidelines for psoriasis. Eight of the 10 questions of the DLQI offer a ‘not relevant’ response (NRR) option that is scored as the item had no impact on patients’ life at all.

Is the DLQI appropriate for medical decision-making in psoriasis patients?

Dermatology Life Quality Index (DLQI) is the most commonly applied measure of health-related quality of life (HRQoL) in psoriasis patients. It is among defining criteria of moderate-to-severe psoriasis and present in treatment guidelines. Our objective was to estimate preference-based HRQoL values (i.e., utilities) for hypothetical health states described by the 10 items of the DLQI in psoriasis patients. Moreover, we compare results to findings of a similar study previously conducted among the general public. A cross-sectional survey was carried out among 238 psoriasis patients. Seven hypothetical DLQI-defined health states with total scores of 6, 11, and 16 (3–3 and 1 states, respectively) were evaluated by time trade-off method. The difference in DLQI scores between hypothetical health states was set at 5 points, as it exceeds the minimal clinically important difference (MCID). Utility scores were found to be homogenous across the seven hypothetical health states (range of means for the 6-point states 0.85–0.91, range of means for the 11-point states 0.83–0.85, and mean of 0.84 for the 16-point state). Overall, mean utilities assessed by psoriasis patients were higher for all seven states compared with the general public (mean difference 0.16–0.28; p < 0.001). In 11 out of the 15 comparisons between health states with DLQI scores differing larger than the MCID, there was no statistically significant difference in utility. Thus, in clinical settings, patients with DLQI scores differing more than the MCID may have identical HRQoL. Improving the definition of moderate-to-severe disease and reconsideration of the DLQI in clinical assessment of psoriasis patients are suggested.

Psoriasisban szenvedő betegek életminőségének vizsgálata Magyarországon

Absztrakt: Bevezetes: Magyarorszagon a psoriasisos betegpopulacio egeszsegi allapota es eletminősege kevesse ismert. Celkitűzes: Kutatasunk celja a hazai psoriasisos betegek eletminősegenek vizsgalata es osszehasonlitasa az altalanos populacioval, illetve az eletminőseget befolyasolo tenyezők azonositasa. Modszer: 2012 es 2016 kozott ket keresztmetszeti kerdőives felmerest vegeztunk ket hazai egyetemi klinika psoriasisos betegeinek bevonasaval. Az eletminőseget az EQ-5D-3L es a hozza tartozo Vizualis Analog Skala (EQ VAS), valamint a Bőrgyogyaszati Eletminőseg Index (DLQI) segitsegevel vizsgaltuk. Az eletminőseget befolyasolo tenyezőket tobbvaltozos linearis regresszioval elemeztuk. Eredmenyek: A kerdőivet 434 psoriasisos beteg toltotte ki (atlageletkor 49 ev, 65% ferfi, 81% kozepsulyos vagy sulyos psoriasis). A felmeres időpontjaban a betegek 43%-a biologiai terapiaban reszesult. A mintaban az EQ-5D-3L, az EQ VAS es a DLQI atlaga 0,74 ± 0,28, 69,06 ± 20,98, illetve 6,78 ± 7,38 volt. A fajdalom/rossz koze...INTRODUCTION The health status and health-related quality of life (HRQoL) of patients with psoriasis in Hungary are understudied. AIM To assess HRQoL in psoriasis patients, to compare HRQoL of psoriasis patients to that of the general public in Hungary and to identify predictors of HRQoL. METHOD Between 2012 and 2016, two cross-sectional surveys were carried out among psoriasis patients at two academic dermatology departments. HRQoL was assessed by EQ-5D-3L, EQ Visual Analogue Scale (EQ VAS) and Dermatology Life Quality Index (DLQI). Predictors of HRQoL were analysed by multivariate linear regression. RESULTS 434 patients were enrolled (mean age 49 years, 65% male, 81% moderate-to-severe psoriasis, 43% treated with biologics). Mean EQ-5D-3L, EQ VAS and DLQI scores were 0.74 ± 0.28, 69.06 ± 20.98 and 6.78 ± 7.38, respectively. Overall, 54%, 43%, 40%, 32% and 15% of patients indicated at least some problems in pain/discomfort, anxiety/depression, mobility, usual activities and self-care. EQ-5D-3L index scores in patients were lower compared to the age- and gender-matched general population in Hungary. The difference was statistically significant for the age groups 25-34 and 45-64 in males, and 18-64 in females (p<0.05). Female gender (p = 0.042), psoriatic arthritis (p<0.001) and palmoplantar psoriasis (p = 0.031) were associated with lower EQ-5D-3L index scores. On the contrary, employed and highly educated patients reported higher EQ-5D-3L index scores (p<0.001). CONCLUSIONS We were the first to assess HRQoL in psoriasis patients by using EQ-5D questionnaire in Hungary, and more broadly in Central and Eastern Europe. Our findings are useful for cost-effectiveness modelling of psoriasis treatments and decision-making in healthcare. Orv Hetil. 2018; 159(21): 837-846.

Proposal of a new scoring formula for the Dermatology Life Quality Index in psoriasis

‘Not relevant’ responses (NRRs) on the Dermatology Life Quality Index (DLQI) may occur in up to 40% of patients with psoriasis. As these responses are scored as the item of the questionnaire having no impact on the patients’ lives at all, it is more difficult for these patients to fulfil the DLQI > 10 criterion required by clinical guidelines to become candidates for systemic treatment including biologics.