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Understanding the Relationship between the EQ-5D, SF-6D, HAQ and Disease Activity in Inflammatory Arthritis


  • Roisin Adams
  • Cathal Walsh
  • Douglas Veale
  • Barry Bresnihan
  • Oliver FitzGerald
  • Michael Barry


Background: The growth of economic analyses and in particular cost-utility analyses (CUA), which use the QALY as a measure of outcome, has heightened the interest in the methodologies used to calculate the QALY. The EQ-5D has produced quite different utility values from that of the SF-6D. This article seeks to understand these differences using a cohort of patients with inflammatory arthritis. Objective: To examine the relationship between the disease-specific measure, Health Assessment Questionnaire (HAQ) disability index (DI) and the preference-based measures, SF-6D, EQ-5D and European League Against Arthritis (EULAR) Disease Activity Score (DAS) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Methods: Patients with RA and PsA (n=504) attending a tertiary rheumatology referral centre completed the HAQ, SF-6D and the EQ-5D before starting biological therapy and again 12 months later. The SF-36 was converted into a utility using the preference-based SF-6D. Clinical outcomes such as the DAS, joint counts and laboratory measures were also recorded. We calculated single index utility scores from the preference-based instruments using UK population norms. We used regression analysis to derive a mapping function and calculated utility scores from the HAQDI and the DAS 28. Results: The mean utility observed at baseline for RA was 0.43 for the EQ-5D and 0.54 for the SF-6D and for PsA was 0.49 for the EQ-5D and 0.57 for the SF-6D. The utility gain demonstrated by the EQ-5D was over twice that of the SF-6D. The EQ-5D scored 17% of the RA group as less than 0 (state defined as worse than death); 7% of this group remained less than 0 at followup. The distribution of the utility estimates was similar for both RA and PsA. Conclusions: Our findings draw attention to the impact of states worse than death on the overall distribution for the EQ-5D derived utilities and how these impact on its use in practice. EQ-5D-derived QALY changes are over twice that of the SF-6D. The implication of this for decision makers is that cost-effectiveness evaluations for treatments in this disease class are likely to be very sensitive to the choice of utility measure. Copyright Adis Data Information BV 2010

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  • Roisin Adams & Cathal Walsh & Douglas Veale & Barry Bresnihan & Oliver FitzGerald & Michael Barry, 2010. "Understanding the Relationship between the EQ-5D, SF-6D, HAQ and Disease Activity in Inflammatory Arthritis," PharmacoEconomics, Springer, vol. 28(6), pages 477-487, June.
  • Handle: RePEc:spr:pharme:v:28:y:2010:i:6:p:477-487
    DOI: 10.2165/11533010-000000000-00000

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    References listed on IDEAS

    1. Brazier, John & Roberts, Jennifer & Deverill, Mark, 2002. "The estimation of a preference-based measure of health from the SF-36," Journal of Health Economics, Elsevier, vol. 21(2), pages 271-292, March.
    2. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453, Decembrie.
    3. Kharroubi, Samer A. & Brazier, John E. & Roberts, Jennifer & O'Hagan, Anthony, 2007. "Modelling SF-6D health state preference data using a nonparametric Bayesian method," Journal of Health Economics, Elsevier, vol. 26(3), pages 597-612, May.
    4. Kharroubi, Samer & Brazier, John E. & O'Hagan, Anthony, 2007. "Modelling covariates for the SF-6D standard gamble health state preference data using a nonparametric Bayesian method," Social Science & Medicine, Elsevier, vol. 64(6), pages 1242-1252, March.
    5. Stirling Bryan & Louise Longworth, 2005. "Measuring health-related utility:," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(3), pages 253-260, September.
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    Cited by:

    1. Nick Kontodimopoulos & Panagiotis Bozios & John Yfantopoulos & Dimitris Niakas, 2013. "Longitudinal predictive ability of mapping models: examining post-intervention EQ-5D utilities derived from baseline MHAQ data in rheumatoid arthritis patients," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 307-314, April.
    2. Hui Jin & Bei Wang & Qian Gao & Jianqian Chao & Siyuan Wang & Lin Tian & Pei Liu, 2012. "Comparison between EQ-5D and SF-6D Utility in Rural Residents of Jiangsu Province, China," PLOS ONE, Public Library of Science, vol. 7(7), pages 1-5, July.
    3. Fan Yang & Titus Lau & Evan Lee & A. Vathsala & Kee Chia & Nan Luo, 2015. "Comparison of the preference-based EQ-5D-5L and SF-6D in patients with end-stage renal disease (ESRD)," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(9), pages 1019-1026, December.

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