B Khoshaba

Limited correlation between the Health Assessment Questionnaire (HAQ) and EuroQol in rheumatoid arthritis: questionable validity of deriving quality adjusted life years from HAQ

Objectives: There is growing emphasis on the cost-effectiveness of treating rheumatoid arthritis. Few trials directly record the health utility measures, like EuroQol, needed for economic analyses. Consequently linear regression methods have been used to transform Health Assessment Questionnaire (HAQ) scores into utility measures. The authors examined whether this is justified. Methods: The authors compared HAQ and EuroQol in cross-sectional and treatment change observational studies of rheumatoid arthritis patients; they also measured SF-36 and Nottingham Health Profiles. Results: In the cross-sectional study, HAQ and EuroQol scores were moderately inversely correlated (Spearman rank correlation, r = 0.76). HAQ showed a Gaussian distribution whereas EuroQol was bimodal. In the treatment change study, changes in HAQ and EuroQol were unrelated (r = 0.08); the changes showed similar Gaussian and bimodal distributions. Conclusions: Not all patient-based measures are analogous, and evidence of clinical equivalence, especially in treatment response, is needed before data transformation is considered. Specifically, as HAQ and EuroQol are demonstrably not equivalent, economic evaluations of treatment cost effectiveness should not be based on EuroQol data transformed from HAQ. The use of such transformed data by regulatory bodies which determine drug availability means that the issue is no longer only of academic interest but a real clinical concern.

Cardiovascular risk at health checks performed opportunistically or following an invitation letter. Cohort study

Abstract Background A population-based programme of health checks has been established in England. Participants receive postal invitations through a population-based call–recall system but health check providers may also offer health checks opportunistically. We compared cardiovascular risk scores for ‘invited’ and ‘opportunistic’ health checks. Methods Cohort study of all health checks completed at 18 general practices from July 2013 to June 2015. For each general practice, cardiovascular (CVD) risk scores were compared by source of check and pooled using meta-analysis. Effect estimates were compared by gender, age-group, ethnicity and fifths of deprivation. Results There were 6184 health checks recorded (2280 invited and 3904 opportunistic) with CVD risk scores recorded for 5359 (87%) participants. There were 17.0% of invited checks and 22.2% of opportunistic health checks with CVD risk score ≥10%; a relative increment of 28% (95% confidence interval: 14–44%, P < 0.001). In the most deprived quintile, 15.3% of invited checks and 22.4% of opportunistic checks were associated with elevated CVD risk (adjusted odds ratio: 1.94, 1.37–2.74, P < 0.001). Conclusions Respondents at health checks performed opportunistically are at higher risk of cardiovascular disease than those participating in response to a standard invitation letter, potentially reducing the effect of uptake inequalities.

Enhanced Invitations Using the Question-Behavior Effect and Financial Incentives to Promote Health Check Uptake in Primary Care

Abstract Background Uptake of health checks for cardiovascular risk assessment in primary care in England is lower than anticipated. The question-behavior effect (QBE) may offer a simple, scalable intervention to increase health check uptake. Purpose The present study aimed to evaluate the effectiveness of enhanced invitation methods employing the QBE, with or without a financial incentive to return the questionnaire, at increasing uptake of health checks. Methods We conducted a three-arm randomized trial including all patients at 18 general practices in two London boroughs, who were invited for health checks from July 2013 to December 2014. Participants were randomized to three trial arms: (i) Standard health check invitation letter only; (ii) QBE questionnaire followed by standard invitation letter; or (iii) QBE questionnaire with offer of a financial incentive to return the questionnaire, followed by standard invitation letter. In intention to treat analysis, the primary outcome of completion of health check within 6 months of invitation, was evaluated using a p value of .0167 for significance. Results 12,459 participants were randomized. Health check uptake was evaluated for 12,052 (97%) with outcome data collected. Health check uptake within 6 months of invitation was: standard invitation, 590 / 4,095 (14.41%); QBE questionnaire, 630 / 3,988 (15.80%); QBE questionnaire and financial incentive, 629 / 3,969 (15.85%). Difference following QBE questionnaire, 1.43% (95% confidence interval −0.12 to 2.97%, p = .070); following QBE questionnaire and financial incentive, 1.52% (−0.03 to 3.07%, p = .054). Conclusions Uptake of health checks following a standard invitation was low and not significantly increased through enhanced invitation methods using the QBE.