HRQoL Fall 2017-2018 PDF

Yarmouk University College of Pharmacy Pharm 441 Pharmacoeconomics & Pharmacoepidemiology - Spring 2017 Dr. Rasha Arabyat, BPharm, MPH, PhD  Health...

Yarmouk University College of Pharmacy Pharm 441 Pharmacoeconomics & Pharmacoepidemiology - Spring 2017 Dr. Rasha Arabyat, BPharm, MPH, PhD  Health Related Quality of Life HRQoL Health Status Measures Dr. Rasha Arabyat, BPharm, MPH, PhD  Objectives 1. Define the term health-related quality of life (HRQoL) 2. Explain the importance of measuring HRQoL 3. Compare and contrast the use of HRQoL (i.e., nonutility) measures with the use of direct elicitation utility measures (e.g., standard gamble time tradeoff) and indirect elicitation preference-based classification systems (e.g. SF-6D, EQ-5D) 4. Compare and contrast generic measures with disease- specific measures 5. Define reliability, validity, and responsiveness 6. Give examples of common HRQoL measures and discuss their use in PE research Dr. Rasha Arabyat, BPharm, MPH, PhD  Definitions  Quality of life (QoL): a broad concept with many aspects the measures people’s overall perception of their life  Includes both health-related and non-health-related aspects of their lives (economical, political, cultural)  HRQoL: is the part of person’s overall QoL that “represents the functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient  The terms QoL and HRQoL are often used interchangeably Dr. Rasha Arabyat, BPharm, MPH, PhD  Importance  The use of HRQoL measures has been increasing since the mid-1980s.  Traditionally, health has been considered from a biomedical point of view  Repairing injury and reducing the impact or length of illness  Does not compass all of the aspects that are important to health  A broad definition of health was proposed by the WHO “Health is a state f complete physical, mental, and social well-being and not merely the absence of disease”  This definition include other aspects of health (domains) in addition to physical health such as psychological and social functioning that are important to the patient Dr. Rasha Arabyat, BPharm, MPH, PhD  Measures of health states  Utility measures  HRQoL meaures  Preference-based classification systems Dr. Rasha Arabyat, BPharm, MPH, PhD  HRQoL Measures  Used to measure the effects of treatments and diseases from a patient's viewpoint  Also been termed nonutility or nonpreference measures  HRQoL measures are generally used to represent a patient’s estimation of his or her own health at a point in time  HRQoL is measured from the patient’s viewpoint  Respondents to a health status assessment survey might be:  The patient  The patient’s relatives or caregivers  Or the patient's healthcare providers………The questionnaires should always be answered from the patients standpoint Dr. Rasha Arabyat, BPharm, MPH, PhD  HRQoL Measures  Most HRQoL Measures are multidimensional and do not result in one overall score:  A separate mental health score and physical health score for each respondent  It is difficult to use results from health status measures in PE ratios because:  Measurement of the outcome(effectiveness) consists of more than one score to represent different aspects of the disease  The range of possible scores differ between the variety of health status instruments (surveys) available  The result are difficult to interpret Dr. Rasha Arabyat, BPharm, MPH, PhD  Why Measure Health-Related Quality of Life (HR-QOL)?  HR-QOL may differ from clinical outcomes  Increase duration, decrease quality of life  For chronic illness, clinical outcomes alone may not provide adequate outcome measures  Societal perspective - Quality of life as a better measure of value of a treatment than quantity  Another measure for comparing treatments  Focus on the patient’s assessment of the impact of disease and its treatment Dr. Rasha Arabyat, BPharm, MPH, PhD  Outcomes of Medical Treatment (ECHO Model)  Clinical  cure rates, decrease in symptoms, improvement in physiologic measures  Economic  cost of therapy, costs/savings of future health care expenditures, costs of adverse events, unemployment, family care givers  Humanistic  health-related quality of life, disability, quality adjusted life year Dr. Rasha Arabyat, BPharm, MPH, PhD  HR-QOL in Health Care & Clinical Trials  Another tool to measure a treatment’s impact  Relevance to patients and society  Measure of treatment effects beyond clinical measures  Determine changes in conditions which may be difficult to quantify clinically (e.g. chronic fatigue syndrome)  Identify specific components (domains) of HRQOL that are impacted by treatment Dr. Rasha Arabyat, BPharm, MPH, PhD  Health Domains of HRQOL Dr. Rasha Arabyat, BPharm, MPH, PhD  Domains in HR-QOL  Definition: An aggregate of variables which specify a component of HR-QOL  Domains usually measured in HR-QOL  Physical status and functional abilities  General health perceptions  Psychological status and well being  Social and role functioning Dr. Rasha Arabyat, BPharm, MPH, PhD  Domains of HR-QOL Dr. Rasha Arabyat, BPharm, MPH, PhD  HRQoL Measures  Researchers can choose between: 1. Tools that focus on general health status (Generic measures) 2. Tools that focus on specific aspects of the disease under study (Disease-specific measures)  It is often desirable to include a combination of both types of assessment tools, the generic and the disease specific. Dr. Rasha Arabyat, BPharm, MPH, PhD  General or Generic Measures  The score from a generic health status instrument can be compared for many disease states and conditions.  The score from the general measures may not be sensitive to clinically relevant differences for every disease or condition. Dr. Rasha Arabyat, BPharm, MPH, PhD  General or Generic Measures  SF-36 is the most common generic HRQoL instrument used in the US Dr. Rasha Arabyat, BPharm, MPH, PhD  The medical outcomes short-form surveys  The SF-36:  The short form of the Medical Outcomes Survey hat consists of 36 items  A multipurpose survey of general or generic health status  Yields a profile of 8 concepts as well as summary physical and mental health measures  Also includes a self-evaluation of change in health during the past year  Useful in comparisons of relative burden of different diseases  It may be useful in estimating the relative benefits of different treatments  A shorter versions have also been developed (SF-12, SF-6)  Online information about the SF-36 and SF-12 can be found at http://www.sf-36.org and http://www.qualitymetric.com Dr. Rasha Arabyat, BPharm, MPH, PhD  WHO - QOL  The World Health Organization Quality of Life (WHOQOL) project - 1991  International cross-culturally comparable quality of life assessment instrument.  Individual's perceptions in the context of:  Culture and value systems  Personal goals, standards and concerns Dr. Rasha Arabyat, BPharm, MPH, PhD  WHO-QOL  WHOQOL-BREF instrument  Shorter version of the original instrument (100 items) that may be more convenient for use in large research studies or clinical trials  26 items  Domains: physical health, psychological health, social relationships, and environment.  Reference: Murphy B, Herrman H, Hawthorne G, Pinzone T, Evert H (2000). Australian WHOQoL instruments: User’s manual and interpretation guide. Australian WHOQoL Field Study Centre, Melbourne, Australia. Dr. Rasha Arabyat, BPharm, MPH, PhD  WHOQOL-BREF Dr. Rasha Arabyat, BPharm, MPH, PhD  Administering a HRQOL  Frequency of administration  Baseline plus regular intervals  Example: 6 months, 1 year  At beginning/end of disease-related events  How can data be used?  Track individual changes  Between group comparisons (clinical trial)  A potential source of data for monitoring during trial  Follow specific guidelines of the instrument for administration to assure uniformity and consistency  Self vs. proxy (family or provider)  Instructions Dr. Rasha Arabyat, BPharm, MPH, PhD  Publication  Raisch DW, Campbell HM, Garnand DA, Jones MA, Sather MR, Naik R, Ling W.Health- related quality of life changes associated with buprenorphine treatment for opioid dependence. Qual Life Res 2012;21:1177-83. Dr. Rasha Arabyat, BPharm, MPH, PhD  Quality of Life Changes During Opiate Dependence Treatment  Purpose: Assess quality of life changes during treatment  A sub-study within a clinical trial of various dosages of buprenorphine  Methods:  SF-36 via computer in 96 patients enrolled in clinical trial of buprenorphine for opiate dependence  Data collected at baseline and every 4 weeks during 16 week study  All patients received active treatment at varying dosages Dr. Rasha Arabyat, BPharm, MPH, PhD SF – 36 Profile in Opioid Dependence Treatment  Significant improvements (p