Montserrat Roset

A Comparison of United Kingdom and Spanish General Population Time Trade-off Values for EQ-5D Health States:

Few studies have compared preference values for health states obtained in different countries. The present study compared Spanish and United Kingdom (UK) time trade-off values for EuroQol-5D health states. The same preference elicitation protocol was followed in both countries. Differences in values for 43 health states rated directly were analyzed using t tests, and regression coefficients generated by random effects modeling were compared by aggregating the 2 value sets and using dummy variables to analyze country effect by dimension and level of severity. For the milder health states, Spanish and UK value assignation was similar; for intermediate health states, Spanish values were both higher and lower than UK values, whereas for health states worse than death, UK values were generally higher than Spanish values. There were statistically significant differences (P < 0.01) in values for 34.9% of health states rated directly, and some preference reversals between countries. UK raters ascribed greater importance to dimensions of pain/discomfort and anxiety/depression, whereas Spanish raters placed more importance on functional dimensions of mobility and self-care. Further analysis is required to determine how these differences affect cost-effectiveness and cost-utility analyses.

Relation between clinical and therapeutic variables and quality of life in hypertension.

Objective Study the relation between quality of life (QoL) and various clinical, therapeutic and sociodemographic variables in treated hypertensive patients. Material and methods A prospective study was carried out in 92 primary care centres in Spain. A total of 269 hypertensive patients were selected and 106 healthy normotensive individuals were included as controls. At the time of inclusion a wide range of clinical variables was documented. QoL was assessed at baseline and 1 month after the intensification of antihypertensive therapy, using a self-administered, specific hypertension, 56-item questionnaire in addition to the generic EuroQoL-5D. Results QoL was poorer among the hypertensive subjects than among the normotensive individuals, even adjusting for the differences observed between the groups (age, sex, education and working status). The same was found with the EuroQol-5D. In the hypertensive subjects, after applying a multiple regression equation, only four variables significantly retained their negative impact on QoL: sex (female), greater organ damage and higher heart rate and weight. After the intensification of antihypertensive therapy with irbesartan, QoL improved significantly. Neither the presence of side-effects during the month of follow-up, nor the degree of BP reduction showed a significant impact on QoL, although the latter came close to statistical significance. Conclusions Hypertensive patients have significantly poorer QoL than normotensive subjects, even with adjustment for differences. In hypertensives, QoL is affected by some clinical variables that might help us to identify those with worse QoL. Intensification of antihypertensive therapy produced a positive impact on QoL.

Is The CAT Questionnaire Sensitive To Changes In Health Status In Patients With Severe COPD Exacerbations

Abstract The COPD Assessment Test (CAT) was validated in English showing good psychometric properties. The objective of this study is to assess the capacity of the CAT to detect changes in health status in patients experiencing COPD exacerbations (ECOPD) and to further explore the validity of the Spanish version. An observational study was conducted in 49 Spanish centres. Patients hospitalised because of ECOPD (n = 224) completed the CAT, the St. Georges Respiratory Questionnaire-adapted for COPD (SGRQ-C) and the London Chest Activities of Daily Living (LCADL) questionnaire during the first 48 hours of admission and 4 ± 1 weeks after discharge. Stable patients (n = 153) also completed these at recruitment and 4 ± 1 weeks later. Over 90% of patients were male. The CAT discriminated between stable and ECOPD patients (15.8 vs 22.4, p < 0.01), as well as between patients with different levels of airflow limitation and dyspnea (MRC scale). The CAT proved sensitive to change; change in mean score was 8.9 points (effect size (ES), 0.90) in ECOPD patients reporting their health state as “much better” after discharge, 4.8 points in those reporting “quite a lot better” (ES = 0.63), and 4.6 points in those reporting “slightly better” (ES = 0.59). Cronbachs alpha and Intraclass Correlation Coefficient were 0.86 and 0.83, respectively. It correlated with both the SGRQ (r = 0.82; p < 0.01) and the LCADL (r = 0.63; p < 0.01). Change in CAT correlated well with Δ SGRQ (r = 0.63; p < 0.01). The CAT showed to be sensitive to the change in health status associated with ECOPD. We also provide evidence of the validity of the Spanish version.

The TETRA Study: A prospective evaluation of Helicobacter pylori‘Test‐and‐Treat’ Strategy on 736 Patients in Clinical Practice

Aims.  To prospectively evaluate the effectiveness of the test‐and‐treat strategy in a large group of dyspeptic patients in clinical practice.

A comparison of EQ-5D time trade-off values obtained in Germany, The United Kingdom and Spain

EQ-5D has been valued using a standardised TTO by general population samples in 3 different European countries: Spain, Germany and the United Kingdom (Badia et al, 2001; Claes et al,1999; Dolan, 1997). This has created an opportunity to compare TTO values for health states between countries. These types of comparisons are rare and those submitted or publicised are bilateral (Badia et al, 2001; Claes et al, 1999). Moreover, such comparisons do not usually involve the general public (Bleichrodt & Johannesson 1997) and tend to use VAS instead of TTO. For this reason, little is known about variations in health state valuations between countries using TTO. Hence it is not known if the results of decision analyses and cost-effectiveness analyses involving utility measurement in 1 country can be generalised to other countries. It would thus be helpful if more were known about international differences in TTO values. In this chapter, we report on the mutual efforts of several research groups within the EuroQol Group to make an international comparison of TTO values. On the basis of this comparison, general guidelines are formulated for the exchangeability of TTO value sets between different countries.

Using HAQ-DI to estimate HUI-3 and EQ-5D utility values for patients with rheumatoid arthritis in Spain

BACKGROUND/OBJECTIVE Utility values are not usually assessed in clinical trials and do not allow cost-utility analysis to be performed with the data collected. The aim of this study was to derive relation functions so that Health Assessment Questionnaire - Disability Index (HAQ-DI) scores could be used to estimate Health Utilities Index - 3 (HUI-3) and EQ-5D utility values for patients with rheumatoid arthritis (RA). METHODS An observational, cross-sectional, naturalistic, multicentre study was conducted. A total of 244 patients aged 18 years or older, with RA according to American College of Rheumatology diagnostic criteria, were recruited. Sociodemographic and clinical variables were recorded and patients completed three generic HRQoL questionnaires: the HAQ-DI, the HUI-3, and the EQ-5D. Two linear regression models were used to predict HUI-3 and EQ-5D utility values as functions of HAQ-DI scores, age, and gender. RESULTS Patient mean age was 57.8 years old (standard deviation [SD], 13.3 years); 75.8% of the patients were women and 95.9% were white. Mean disease duration was 10.8 years (SD, 9 years). Patient distribution according to HAQ-DI severity was as follows: HAQ-DI < 0.5, 29%; 0.5 ≤ HAQ-DI < 1.1, 28%; 1.1 ≤ HAQ-DI < 1.6, 16%,1.6 ≤ HAQ-DI < 2.1, 15%; and HAQ-DI ≥ 2.1, 12%. HAQ-DI and EQ-5D mean scores were 1.02 (SD, 0.78) and 63.1 (SD, 20.3), respectively. Mean utility values for HUI-3 and time trade-off (TTO) were 0.75 (SD, 0.21) and 0.65 (SD, 0.3), respectively. The equations converting HAQ-DI scores to utilities were HUI-3 = 0.9527 - (0.2018 × HAQ-DI) +ε (R(2)=0.56), and TTO = 0.9567 - (0.309 × HAQ-DI) + ε (R(2)=0.54). Error distribution was non-normal. Age and gender were found to have no bearing on the utility functions. CONCLUSIONS HAQ-DI scores can be used to estimate HUI-3 and EQ-5D utility values for patients with RA in data obtained from studies where utility values have not been collected.

Comparison of EQ-5D VAS valuations: analysis of background variables

Preference-based instruments for measuring HRQoL of life have been developed in different countries and applied in empirical research in a much wider range of countries. A major concern in this context has been whether the valuations (values or utility weights) elicited for the instrument in 1 country are applicable in another, that is, whether the valuations in terms of the relative values/utilities of different health states are similar or not. If they are, an instrument that has been valued in country A can be applied in country B without having to carry out a very cumbersome and expensive process of eliciting the valuations in country B. However, if the valuations differ, the use of an instrument with valuations from country A in country B, for example in the evaluation of health interventions, may lead to different results and a different order of preference among the interventions from those should valuations from country B have been available.

Validación de la versión española de la escala de intensidad del picor (Cuestionario Itch Severity Scale, ISS). Estudio PSEDA

BACKGROUND AND OBJECTIVES The Itch Severity Scale (ISS) facilitates objective assessment of the intensity of pruritus. The aim of this study was to validate a Spanish version of the ISS in patients with atopic dermatitis. MATERIAL AND METHODS A prospective epidemiological study was undertaken in patients diagnosed with atopic dermatitis at least 1 year previously and a control group without the disease. Patients with atopic dermatitis were stratified according to the status of the lesions (active or inactive) and questionnaires were completed at baseline and 3-month and 6-month follow-up. Data were collected on sociodemographic variables relating to atopic dermatitis (including the modified Eczema Area and Severity Index [mEASI]), concomitant disease, and patient measures such as ISS, Dermatology Life Quality Index (DLQI), and Childrens DLQI (cDLQI). RESULTS A total of 207 children (2-17 years) were included: 56 control subjects, 103 patients with active lesions, and 48 with inactive lesions. The mean (SD) age of the participants in this age group was 8.1 (4.0) years. A total of 261 adults (≥ 18 years) were included: 89 control subjects, 124 patients with active lesions, and 48 with inactive lesions. The mean age of the adult participants was 32.3 (13.4) years. A response rate of > 80% was obtained on the pediatric ISS (feasibility) and the responses correlated with the mEASI and cDLQI at baseline (P<.001) as an indicator of validity. An effect size of 0.988 was observed (sensitivity to change) along with a Chronbach α of 0.840 (internal consistency). A response rate of >95% was obtained on the adult ISS (feasibility) and the responses correlated with the mEASI and DLQI at baseline (P<.001) as an indicator of validity. An effect size of 1.0 was observed (sensitivity to change) along with a Chronbach α of 0.825 (internal consistency). CONCLUSIONS The Spanish version of the ISS is feasible, valid, sensitive to change, and displays good reliability based on internal consistency in both children and adults.

Clinical characteristics, beliefs, and coping strategies among older patients with overactive bladder

To describe clinical characteristics and assess beliefs and coping strategies in older patients with overactive bladder (OAB) attending urology and gynecology clinics in Spain.

Estimating the burden of genital warts in Taiwan

Background This study aimed to estimate the prevalence of genital warts in Taiwan among those seeking healthcare, as well as genital-warts-related healthcare resource use and costs, and self-reported genital-warts-related psychosocial impact. METHODS Genital warts prevalence estimates were extracted from a daily record of patients examined from 31 October 2011 to 4 May 2012 by 67 physicians in Taiwan. Physicians recorded the total number of patients and genital warts patients seen daily for 2 weeks. These physicians also completed a survey regarding healthcare resource use, treatment, follow-up care, and referral patterns. Patient psychosocial impact was estimated using a self-administered survey. RESULTS The overall prevalence of genital warts in Taiwan was estimated at 1.1%, with a higher prevalence among men. A total of 146 genital warts case patients were included in the study (76 men, 70 women). Median costs for diagnosis and treatment were US