https://bura.brunel.ac.uk/bitstream/2438/10265/1/Fulltext.pdf

An Exploratory Study to Test the Impact on Three “Bolt-On” Items to the EQ-5D

Health-Related Quality of Life of Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes—Results from the PLATO Trial

Purpose
In multiple sclerosis (MS), the use of preference-based measures is limited to generic measures such as Health Utilities Index Mark 2 and 3, the EQ-5D and the SF-6D. However, the challenge of using such generic preference-based measures in people with MS is that they may not capture all domains of health relevant to the disease. Therefore, the main aim of this paper is to describe the development of a health state classification system for MS patients. The specific objectives are: (1) to identify items best reflecting the domains of quality of life important to people with MS and (2) to provide evidence for the discriminative capacity of the response options by cross-walking onto a visual analog scale of health rating.

Using existing data to identify candidate items for a health state classification system in multiple sclerosis.

Decision analytic modeling in spinal surgery: a methodologic overview with review of current published literature

Background: Generic preference-based measures (PBMs), such as the EQ-5D and SF-6D, are widely used for the estimation of Quality Adjusted Life Years in cost-utility analyses of healthcare interventions. However, their relevance in some disease areas, including mental health, has been questioned.
Objective of the thesis: To derive a PBM specific to mental health problems from an existing condition-specific measure (CSM)
Methods: A systematic literature review was conducted to identify an appropriate CSM for the derivation of a health state classification. Derivation of the new measure was achieved using novel methodology developed for this purpose, due to the high correlation across the items of the original CSM. Selected health states were valued by members of the public. Regression analysis was employed to predict utility values for all states of the health state classification. Psychometric and qualitative assessments evaluated the performance of the new PBM compared with generic PBMs and the original CSM. 
Results: The Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM) was selected as the basis for the derivation of the new PBM. Application of novel methodology based primarily on Rasch analysis resulted in the development of CORE-6D, a health state classification that consists of a 5-item emotional component and a physical item. Rasch analysis was used to select plausible health states for valuation. A highly predictive regression model was used to attach utility values to all CORE-6D health states. The new PBM has shown promising results regarding its psychometric properties compared with generic PBMs and suffers from little loss of information relative to the original measure, CORE-OM. Further research needs to validate these findings.
Conclusion: The CORE-6D preference-based index will enable cost-utility analysis of mental health interventions using existing and prospective CORE-OM datasets. The new methodology for deriving PBMs from existing instruments can be useful for the derivation of PBMs from other instruments with highly correlated dimensions.

The derivation of a preference-based measure for people with common mental health problems from the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM)

Professor Dowie has written an interesting and thought provoking paper on a long lasting debate in the literature on measuring health related quality of life. The debate between generic and condition specific measures (CSMs) has not progressed a great deal with time and he is right to question a purely psychometric approach that currently tends to focuses on effect sizes. He has also presented an interesting challenge to the compromise solution suggested by anumber of psychometricians to adopt both types of measure. The paper is predicated on the apparently useful distinction between knowledge- versus decision- validity, but this is something of a straw man argument. Advocates of CMSs are not interested in knowledge-validity but are concerned with different types of decisions. Furthermore, produ- cers of criteriafor judging the merits of mea sures (including ourselves (1,2)) do not presume it to be an absolute question of whether a measure is 'valid' but hope such lists assist researchers and other users to find the best measure for their purpose, such as informing clinical or resource allocation decisions. For patients and clinicians important informa- tion is provided by atria l through the use of CSMs in terms of the impact on the problem that they bring to the doctor - i.e. proximal concerns. Neither the patient nor the doctor are necessarily anticipating an impact on the more distal dimen- sions typically covered by generic measures. Professor Dowie's response to this narrow view is that there may be important consequences of the treatment that are not covered by the CSM and consequences for co-morbidities. This is the basis of the usual argument for using both types of measure in trials. Professor Dowie goes on to argue that a generic measure 'is intended to cover the full range of health outcomes' whereas the condition specific is by definition intended to cover an a rrower range. On the basis of this distinction of intention he argues that in most cases the GEN should be used alone, but he accepts that there may be circumstances where a CSM is preferable, but that it is never preferable to use both (for decision-making purposes). We would just like to make a few comments about this distinction of intention. CSMs typically focus on fewer domain of interest and hence may be able to ask more questions about each domain and thereby achieve a greater degree of refinement. For example, the EQ-5D has a large jump in scores between perfect health and any level of illness of 1.0-0.88 and has only two levels of imperfect health for each dimension. However, Professor Dowie seems sceptical as to the empirical evidence regarding the sensitivity of CSMs over generics. We agree there are cases that do not support this common claim in the psychometric literature (3), but equally there are many where this has been found including: EQ-5D in chronic pulmonary disease (4) and in cosmetic surgery (5), the SF-36 in urinary incontinence (6) and the example of urinary incontinence that he provides (7).

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Measures of health-related qualityof lifein animperfect world: a comment on Dowie

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Measures of health-related qualityof lifein animperfect world: a comment on Dowie