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PharmacoEconomics
Published in: PharmacoEconomics 11/2011

01-11-2011 | Current Opinion

Utility Estimation in Chronic Obstructive Pulmonary Disease

A Preference for Change?

Authors: Dr Jennifer Petrillo, Floortje van Nooten, Paul Jones, Maureen Rutten-van MÖlken

Published in: PharmacoEconomics | Issue 11/2011

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Abstract

Economic evaluations of chronic obstructive pulmonary disease (COPD) incorporate utilities through multi-attribute utility (MAU) measures, most commonly the EQ-5D, to report health-related quality-of-life (HR-QOL) changes or differences. Questions have been raised about the sensitivity of these measures in COPD. Limitations in detecting adequate patient-level changes inHR-QOL over time in stable and exacerbation states compared with disease-specific instruments could also result in underestimation of known treatment benefits.
The purpose of this article was to present and discuss the empirical evidence on the validity of genericMAUmeasures within the COPD population. We built upon a previously conducted validation review for the period 1997–2007 that used ‘respiratory disease’ and ‘EQ-5D’ as keywords. For this discussion, PubMed and EMBASE databases were searched for articles in English from 1988 to August 2009, using similar search words.
Based on the performance ofMAUmeasures in COPD and exacerbations, they appear to have limited discriminatory ability, particularly between moderate and severe COPD, despite known differences in HR-QOL. Sensitivity to clinically relevant change in stable COPD over time due to treatment also appears limited. Current research suggests adequate sensitivity regarding detecting the onset and resolution of an exacerbation; however, sensitivity is limited in the short term, such as daily changes in health status. The evidence suggests responsiveness of MAU measures may be restricted to large withinpatient change, which leads to difficulties in evaluating the subtle but important impact of exacerbations. Studies presenting alternative methods of deriving COPD-related utilities are also discussed.
Overall, the insensitivities of generic MAU measures in COPD can lead to biased cost-effectiveness analyses and ill-informed economic decisions. Alternative measures such as condition-specific preference-based measures may be used in circumstances where more sensitivity is needed. The trade-off allows relevant and sensitive matters most important to patients to be evaluated; however inevitable gaps such as those related to adverse events are not considered.
Literature
1.
2.
Halbert RJ, Natoli JL, Gano A, et al. Global burden of COPD: systematic review and meta-analysis. Eur Respir J 2006 Sep; 28 (3): 523–32PubMedCrossRef
3.
Celli BR, MacNee W. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004 Jun; 23 (6): 932–46PubMedCrossRef
4.
5.
Rodriguez-Roisin R. Toward a consensus definition for COPD exacerbations. Chest 2000 May; 117 (5 Suppl. 2): 398–401SCrossRef
6.
7.
Jones PW. Health status: what does it mean for payers and patients? Proc Am Thorac Soc 2006 May; 3 (3): 222–6PubMedCrossRef
8.
Miravitlles M, Anzueto A, Legnani D, et al. Patient’s perception of exacerbations of COPD: the PERCEIVE study. Respir Med 2007 Mar; 101 (3): 453–60PubMedCrossRef
9.
Russell LB, Gold MR, Siegel JE, et al. The role of cost-effectiveness analysis in health and medicine. Panel on Cost-Effectiveness in Health and Medicine. JAMA 1996 Oct 9; 276 (14): 1172–7
10.
Prieto L, Sacristan JA. What is the value of social values? The uselessness of assessing health-related quality of life through preference measures. BMC Med Res Methodol 2004 Apr 29; 4: 10
11.
Feeny D. Commentary on Jack Dowie, “Decision validity should determine whether a generic or condition-specific HRQOL measure is used in health care decisions”. Health Econ 2002 Jan; 11 (1): 13–6; discussion 21-2PubMedCrossRef
12.
Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med 2001 Jul; 33 (5): 337–43PubMedCrossRef
13.
Ringbaek T, Brondum E, Martinez G, et al. EuroQoL in assessment of the effect of pulmonary rehabilitation COPD patients. Respir Med 2008 Nov; 102 (11): 1563–7PubMedCrossRef
14.
Jones PW, Quirk FH, Baveystock CM. The St. George’s Respiratory Questionnaire. Respir Med 1991 Sep; 85 Suppl. B: 25–31; discussion 3-7CrossRef
15.
Jones PW, Quirk FH, Baveystock CM, et al. A self-complete measure of health status for chronic airflow limitation. The St. George’s Respiratory Questionnaire. Am Rev Respir Dis 1992 Jun; 145 (6): 1321–7
16.
Hesselink AE, van der Windt DA, Penninx BW, et al. What predicts change in pulmonary function and quality of life in asthma or COPD? J Asthma 2006 Sep; 43 (7): 513–9PubMedCrossRef
17.
Jenkins C, Rodriguez-Roisin R. Quality of life, stage severity and COPD. Eur Respir J 2009 May; 33 (5): 953–5PubMedCrossRef
18.
Jones PW, Bosh TK. Quality of life changes in COPD patients treated with salmeterol. Am J Respir Crit Care Med 1997 Apr; 155 (4): 1283–9PubMed
19.
Verhage TL, Heijdra YF, Molema J, et al. Adequate patient characterization in COPD: reasons to go beyond GOLD classification. Open Respir Med J 2009; 3: 1–9PubMedCrossRef
20.
Wijnhoven HA, Kriegsman DM, Hesselink AE, et al. Determinants of different dimensions of disease severity in asthma and COPD: pulmonary function and health-related quality of life. Chest 2001 Apr; 119 (4): 1034–42PubMedCrossRef
21.
Brazier J, Tsuchiya A. Preference-based condition-specific measures of health: what happens to cross programme comparability? Health Econ 2010 Feb; 19 (2): 125–9PubMedCrossRef
22.
Pickard AS, Wilke C, Jung E, et al. Use of a preferencebased measure of health (EQ-5D) in COPD and asthma. Respir Med 2008 Apr; 102 (4): 519–36PubMedCrossRef
23.
Brown G, Austin J, McGowan I, et al. Is the EuroQol generic health status questionnaire sensitive to the impact of pulmonary rehabilitation in COPD? [abstract]. Am J Respir Crit Care Med 2009; 179: A3852
24.
Harper R, Brazier JE, Waterhouse JC, et al. Comparison of outcome measures for patients with chronic obstructive pulmonary disease (COPD) in an outpatient setting. Thorax 1997 Oct; 52 (10): 879–87PubMedCrossRef
25.
Hazell M, Frank T, Frank P. Health related quality of life in individuals with asthma related symptoms. Respir Med 2003 Nov; 97 (11): 1211–8PubMedCrossRef
26.
Punekar YS, Rodriguez-Roisin R, Sculpher M, et al. Implications of chronic obstructive pulmonary disease (COPD) on patients’ health status: a western view. Respir Med 2007 Mar; 101 (3): 661–9PubMedCrossRef
27.
Rutten-van MÖlken MP, Oostenbrink JB, Miravitlles M, et al. Modelling the 5-year cost effectiveness of tiotropium, salmeterol and ipratropium for the treatment of chronic obstructive pulmonary disease in Spain. Eur J Health Econ 2007; 8 (2): 123–35PubMedCrossRef
28.
Ståhl E, Lindberg A, Jansson SA, et al. Health-related quality of life is related to COPD disease severity. Health Qual Life Outcomes 2005; 3: 56PubMedCrossRef
29.
Ståhl E, Lindberg A, Rönmark E, et al. The level of healthrelated quality of life in patients with COPD and its dependence on age, gender and disease severity. Eur Respir J 2001; 18 Suppl. 33: S184
30.
Stavem K. Association of willingness to pay with severity of chronic obstructive pulmonary disease, health status and other preference measures. Int J Tuberc Lung Dis 2002 Jun; 6 (6): 542–9PubMed
31.
Stavem K.Reliability, validity and responsiveness of two multiattribute utility measures in patients with chronic obstructive pulmonary disease. Qual Life Res 1999; 8 (1-2): 45–54PubMedCrossRef
32.
Sullivan PW, Lawrence WF, Ghushchyan V. A national catalog of preference-based scores for chronic conditions in the United States. Medical Care 2005; 43 (7): 736–49PubMedCrossRef
33.
Szende A, Leidy NK, Stahl E, et al. Estimating health utilities in patients with asthma and COPD: evidence on the performance of EQ-5D and SF-6D. Qual Life Res 2009 Mar; 18 (2): 267–72PubMedCrossRef
34.
Goossens L, Rutten-van Mölken M, Nivens C. Is the EQ-5D responsive to recovery from a moderate COPD exacerbation? ISPOR 11th Annual European Congress; 2008 Nov 8–11; Athens
35.
Menn P, Weber N, Holle R. Health-related quality of life in patients with severe COPD hospitalized for exacerbations: comparing EQ-5D, SF-12 and SGRQ. Health Qual Life Outcomes 2010; 8 (1): 39PubMedCrossRef
36.
O’Reilly JF, Williams AE, Rice L. Health status impairment and costs associated with COPD exacerbation managed in hospital. Int J Clin Pract 2007 Jul; 61 (7): 1112–20PubMedCrossRef
37.
Paterson C, Langan CE, McKaig GA, et al. Assessing patient outcomes in acute exacerbations of chronic bronchitis: the Measure Your Medical Outcome Profile (MYMOP), Medical Outcomes Study 6-Item general health survey (MOS-6A) and EuroQol (EQ-5D). Qual Life Res 2000; 9 (5): 521–7PubMedCrossRef
38.
Torrance G, Walker V, Grossman R, et al. Economic evaluation of ciprofloxacin compared with usual antibacterial care for the treatment of acute exacerbations of chronic bronchitis in patients followed for 1 year. Pharmacoeconomics 1999; 16 (5 Pt 1): 499–520PubMedCrossRef
39.
Vardeva K, Spencer MD, Punekar Y. Development of preference-based EQ-5D utility values for the St George’s Respiratory Questionnaire: Chronic Obstructive Pulmonary Disease (SGRQ-COPD). 10th Annual ISPOR European Congress; 2007 Oct 20–23; Dublin
40.
Starkie H, Briggs A, Chambers M. Mapping the St George’s Respiratory Questionnaire to utility values using the EQ5D. 30th Annual Meeting of the Society for Medical Decision Making; 2008 Oct 19–22; Philadelphia (PA)
41.
Marra CA, Sullivan SD, Najafzadeh M, et al. Mapping the EQ-5D from the St. George’s Respiratory Questionnaire in a clinical trial of COPD treatments: results from the OPTIMAL trial. 10th Annual ISPOR European Congress; 2007 Oct 20–23; Dublin
42.
Meguro M, Jones PW. Item selection for COPD-specific utility instrument (abstract no. PCO2). Value Health 2004; 7 (6): 684CrossRef
43.
Meguro M, Jones PW. Elicitation of utility weights for a COPD specific preference measure [abstract]. Am J Resp Crit Care Med 2006; 3: A488
44.
Petrillo J, Cairns J. Development of the EXACT-U: a preference-based measure to report COPD exacerbation utilities. Value Health 2011; 14 (4): 546–54PubMedCrossRef
45.
Rutten-van MÖlken MP, Hoogendoorn M, Lamers LM. Holistic preferences for 1-year health profiles describing fluctuations in health: the case of chronic obstructive pulmonary disease. Pharmacoeconomics 2009; 27 (6): 465–77PubMedCrossRef
46.
Brazier J, Roberts J, Tsuchiya A, et al. A comparison of the EQ-5D and SF-6D across seven patient groups. Health Econ 2004 Sep; 13 (9): 873–84PubMedCrossRef
47.
48.
Feeny D, Furlong W, Boyle M, et al. Multi-attribute health status classification systems: Health Utilities Index. Pharmacoeconomics 1995; 7 (6): 490–502PubMedCrossRef
49.
Kaplan RM, Anderson JP. A general health policy model: update and applications. Health Serv Res 1988 Jun; 23 (2): 203–35PubMed
50.
Kaplan RM, Ganiats TG, Sieber WJ, et al. The Quality of Well-Being scale: critical similarities and differences with SF-36. Int J Qual Health Care 1998 Dec; 10 (6): 509–20PubMedCrossRef
51.
Rutten-van MÖlken M, Roos B, Van Noord JA. An empirical comparison of the St. George’s Respiratory Questionnaire (SGRQ) and the Chronic Respiratory Disease Questionnaire (CRQ) in a clinical trial setting. Thorax 1999 Nov; 54 (11): 995–1003
52.
Torrance GW, Furlong W, Feeny D, et al. Multi-attribute preference functions: Health Utilities Index. Pharmacoeconomics 1995; 7 (6): 503–20PubMedCrossRef
53.
National Institute for Health and Clinical Excellence. Technical guidance for manufacturers and sponsors on making a submission to a technology appraisal. London: NICE, 2008
54.
Cazzola M, MacNee W, Martinez FJ, et al. Outcomes for COPD pharmacological trials: from lung function to biomarkers. Eur Respir J 2008 Feb; 31 (2): 416–69PubMedCrossRef
55.
Borg S, Ericsson A, Wedzicha J, et al. A computer simulation model of the natural history and economic impact of chronic obstructive pulmonary disease. Value Health 2004 Mar-Apr; 7 (2): 153–67PubMedCrossRef
56.
Spencer M, Briggs AH, Grossman RF, et al. Development of an economic model to assess the cost effectiveness of treatment interventions for chronic obstructive pulmonary disease. Pharmacoeconomics 2005; 23 (6): 619–37PubMedCrossRef
57.
Rutten-van Mölken MP, Oostenbrink JB, Tashkin DP, et al. Does quality of life of COPD patients as measured by the generic EuroQol five-dimension questionnaire differentiate between COPD severity stages? Chest 2006 Oct; 130 (4): 1117–28PubMedCrossRef
58.
Rutten-van Mölken MRV, Lee TA. Economic modeling in chronic obstructive pulmonary disease. Proc Am Thorac Soc 2006; 3 (7): 630–4PubMedCrossRef
59.
McBride A, Milne R. Hospital-based pulmonary rehabilitation programmes for patients with severe chronic obstructive pulmonary disease. Southampton: Wessex Institute for Health Research and Development, University of Southampton, 1999. DEC report No. 94
60.
Donaldson GC, Wilkinson TM, Hurst JR, et al. Exacerbations and time spent outdoors in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005 Mar 1; 171 (5): 446–52PubMedCrossRef
61.
Brooks R. The measurement and valuation of health status using EQ-5D: a European perspective. In: Brooks R, Rabin R, de Charro F, editors. Evidence from the Euro-Qol BIO MED Research Programme. Dordrecht: Kluwer Academic Publishers, 2003
62.
Bharmal M, Thomas J. Comparing the EQ-5D and the SF-6D descriptive systems to assess their ceiling effects in the US general population. Value Health 2006; 9 (4): 262–71PubMedCrossRef
63.
Ramsey SD, Sullivan SD. The burden of illness and economic evaluation for COPD. Eur Respir J Suppl 2003 Jun; 41: 29–35sCrossRef
64.
Buss AS, da Silva LM. Comparative study of two quality of life questionnaires in patients with COPD. J Bras Pneumol 2009 Apr; 35 (4): 318–24PubMedCrossRef
65.
Briggs A, Glick H, Lozano-Ortega G, et al. Is treatment with ICS and LABA cost-effective for COPD? Multinational economic analysis of the TORCH study. Eur Respir J 2010; 35 (3): 532–9PubMedCrossRef
66.
Decramer M, Dekhuijzen PN, Troosters T, et al. The Bronchitis Randomized On NAC Cost-Utility Study (BRONCUS): hypothesis and design. BRONCUS trial Committee. Eur Respir J 2001 Mar; 17 (3): 329–36
67.
Guyatt GH, King DR, Feeny DH, et al. Generic and specific measurement of health-related quality of life in a clinical trial of respiratory rehabilitation. J Clin Epidemiol 1999 Mar; 52 (3): 187–92PubMedCrossRef
68.
Seemungal TA, Hurst JR, Wedzicha JA. Exacerbation rate, health status and mortality in COPD: a review of potential interventions. Int J Chron Obstruct Pulmon Dis 2009; 4 (1): 203–23PubMedCrossRef
69.
Bourbeau J, Ford G, Zackon H, et al. Impact on patients’ health status following early identification of a COPD exacerbation. Eur Respir J 2007 Nov; 30 (5): 907–13PubMedCrossRef
70.
Aaron SD, Vandemheen KL, Clinch JJ, et al. Measurement of short-term changes in dyspnea and disease-specific quality of life following an acute COPD exacerbation. Chest 2002 Mar; 121 (3): 688–96PubMedCrossRef
71.
Mortimer D, Segal L. Comparing the incomparable? A systematic review of competing techniques for converting descriptive measures of health status into QALY-weights. Med Decis Making 2008; 28 (1): 66–89
72.
Petrillo J, Cairns J. Converting condition-specific measures into preference-based outcomes for use in economic evaluation. Exp Rev Pharmacoeconomics Outcomes Res 2008; 8 (5): 453–61CrossRef
73.
Brazier J, Czoski-Murray C, Roberts J, et al. Estimation of a preference-based index from a condition-specific measure: the King’s health questionnaire. Med Decis Making 2008; 28 (1): 113–26PubMedCrossRef
74.
McKenna SP, Ratcliffe J, Meads DM, et al. Development and validation of a preference based measure derived from the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) for use in cost utility analyses. Health Qual Life Outcomes 2008; 6: 65PubMedCrossRef
75.
Koltowska-Haggstrom M, Jonsson B, Isacson D, et al. Using EQ-5D to derive general population-based utilities for the Quality of Life Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA). Value Health 2007; 10 (1): 73–81PubMedCrossRef
76.
Revicki DA, Leidy NK, Brennan-Diemer F, et al. Integrating patient preferences into health outcomes assessment: the multiattribute asthma symptom utility index. Chest 1998; 114 (4): 998–1007PubMedCrossRef
77.
Brazier J, Dixon S. The use of condition specific outcome measures in economic appraisal. Health Econ 1995; 4 (4): 255–64PubMedCrossRef
78.
American Thoracic Society/European Respiratory Society Task Force. Standards for the diagnosis and management of patients with COPD. Version 1.2. New York: American Thoracic Society, 2004 [online]. Available from URL: http://​www.​thoracic.​org/​go/​copd [Accessed 2005 Sep 8]
79.
Fan VS, Ramsey SD, Make BJ, et al. Physiologic variables and functional status independently predict COPD hospitalizations and emergency department visits in patients with severe COPD. COPD 2007 Mar; 4 (1): 29–39PubMedCrossRef
80.
Leidy NK, Wilcox TK, Jones PW, et al. Development of the EXAcerbations of Chronic Obstructive Pulmonary Disease Tool (EXACT): a patient-reported outcome (PRO) measure. Value Health 2010; 13 (8): 965–75PubMedCrossRef
81.
Leidy NK, Wilcox TK, Jones PW, et al. Standardizing measurement of chronic obstructive pulmonary disease exacerbations: reliability and validity of a patient-reported diary. Am J Respir Crit Care Med 2011; 183 (3): 323–9PubMedCrossRef
82.
Brazier JE, Roberts J. The estimation of a preference-based measure of health from the SF-12. Med Care 2004; 42 (9): 851–9PubMedCrossRef
83.
McTaggart-Cowan HM, Marra CA, Yang Y, et al. The validity of generic and condition-specific preference-based instruments: the ability to discriminate asthma control status. Quality Life Res 2008; 17 (3): 453–62CrossRef
84.
Torrance GW. Utility measurement in healthcare: the things I never got to. Pharmacoeconomics 2006; 24 (11): 1069–78PubMedCrossRef
85.
Najafzadeh M, Marra CA, Sadatsafavi M, et al. Cost effectiveness of therapy with combinations of long acting bronchodilators and inhaled steroids for treatment of COPD. Thorax 2008 Nov; 63 (11): 962–7PubMedCrossRef
86.
Petrillo J, Macker S, Davies E, et al. Development of a preference-based algorithm to report utilities for exacerbations of COPD from the EXACT. Value Health 2011; (14) 546–54PubMedCrossRef
87.
Petrillo J, Cairns J. Evaluation of COPD exacerbations using the EXACT-U. European Respiratory Society Annual Congress; 2010 Sep 18–22; Barcelona
88.
Brazier J, Deverill M, Green C, et al. A review of the use of health status measures in economic evaluation. Health Technol Assess 1999; 3 (9): iii-163
89.
Mahler DA, Mackowiak JI. Evaluation of the shortform 36-Item questionnaire to measure health-related quality of life in patients with COPD. Chest 1995 Jun; 107 (6): 1585–9PubMedCrossRef
90.
Burstrom K, Johannesson M, Diderichsen F. A comparison of individual and social time trade-off values for health states in the general population. Health Policy 2006; 76 (3): 359–70PubMedCrossRef
91.
Stiggelbout AM, de Vogel-Voogt E. Health state utilities: a framework for studying the gap between the imagined and the real. Value Health 2008 Jan-Feb; 11 (1): 76–87PubMedCrossRef
92.
93.
94.
Rowen D, Brazier J, Roberts J. Mapping SF-36 onto the EQ-5D index: how reliable is the relationship? Health Qual Life Outcomes 2009; 7: 27PubMedCrossRef
Metadata
Title
Utility Estimation in Chronic Obstructive Pulmonary Disease
A Preference for Change?
Authors
Dr Jennifer Petrillo
Floortje van Nooten
Paul Jones
Maureen Rutten-van MÖlken
Publication date
01-11-2011
Publisher
Springer International Publishing
Published in
PharmacoEconomics / Issue 11/2011
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI
https://doi.org/10.2165/11589280-000000000-00000

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