Validity and responsiveness of the EQ-5D in assessing and valuing health status in patients with anxiety disorders

Hans-Helmut König, Anja Born, Oliver Günther, Herbert Matschinger, Sven Heinrich, Steffi G Riedel-Heller, Matthias C Angermeyer, Christiane Roick, Hans-Helmut König, Anja Born, Oliver Günther, Herbert Matschinger, Sven Heinrich, Steffi G Riedel-Heller, Matthias C Angermeyer, Christiane Roick

Abstract

Background: The EQ-5D is a generic questionnaire which generates a health profile as well as index scores for health-related quality of life that may be used in cost-utility analysis.

Aims of the study: To examine validity and responsiveness of the EQ-5D in patients with anxiety disorders.

Methods: 389 patients with anxiety disorders completed the EQ-5D at baseline and 6-month follow-up. Subjective measures of quality of life (WHOQOL-BREF) and psychopathology (BAI, BDI-II, BSQ, ACQ, MI) were used for comparison. Validity was analyzed by assessing associations between EQ-5D scores and related other scores. Responsiveness was analyzed by calculating effect sizes of differences in scores between baseline and follow-up for 3 groups indicating more, constant or less anxiety. Meaningful difference scores for shifting to less or more anxiety were derived by means of regression analysis.

Results: 88.4% of respondents reported problems in at least one of the EQ-5D dimension at baseline; the mean EQ VAS score was 63.8. The EQ-5D dimension most consistently associated with the measures used for comparison was 'anxiety/depression'. EQ VAS and EQ-5D index scores were highly correlated (|r|>0.5) with scores of the WHOQOL-BREF dimensions 'physical', 'mental' and 'overall' as well as BAI and BDI-II. The EQ-5D index tended to be the most responsive score. Standardized meaningful difference scores were not significantly different between EQ VAS, EQ-5D index and measures used for comparison.

Conclusions: The EQ-5D seems to be reasonably valid and moderately responsive in patients with anxiety disorders. The EQ-5D index may be suitable for calculating QALYs in economic evaluation of health care interventions for patients with anxiety disorders.

Trial registration: Current Controlled Trials ISRCTN15716049.

Figures

Figure 1
Figure 1
Distribution of responses to items of EQ-5D descriptive system in patient sample (n = 389) and general population (n = 3552) [40]. In the patient sample there were 7 missing values for the EQ-5D items 'mobility', 'self-care', 'usual activities', 10 missing values for the item 'pain/discomfort' and 8 missing values for the item 'anxiety/depression'.

References

    1. EuroQol Group. Complete List of references.
    1. Brooks R. EuroQol: the current state of play. Health Policy. 1996;37:53–72. doi: 10.1016/0168-8510(96)00822-6.
    1. EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy. 1990;16:199–208. doi: 10.1016/0168-8510(90)90421-9.
    1. Drummond M, Jonsson B, Rutten F. The role of economic evaluation in the pricing and reimbursement of medicines. Health Policy. 1997;40:199–215. doi: 10.1016/S0168-8510(97)00901-9.
    1. Gold M, Siegel J, Russel L, Weinstein M. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press; 1996.
    1. Rasanen P, Roine E, Sintonen H, Semberg-Konttinen V, Ryynanen OP, Roine R. Use of quality-adjusted life years for the estimation of effectiveness of health care: A systematic literature review. Int J Technol Assess Health Care. 2006;22:235–241. doi: 10.1017/S0266462306051051.
    1. Konnopka A, Leichsenring F, Leibing E, König HH. Cost-of-illness studies and cost-effectiveness analyses in anxiety disorders: A systematic review. J Affect Disord. 2009;114:14–31. doi: 10.1016/j.jad.2008.07.014.
    1. Pollack MH, Endicott J, Liebowitz M, Russell J, Detke M, Spann M, Ball S, Swindle R. Examining quality of life in patients with generalized anxiety disorder: clinical relevance and response to duloxetine treatment. J Psychiatr Res. 2008;42:1042–1049. doi: 10.1016/j.jpsychires.2007.11.006.
    1. Leichsenring F, Hoyer J, Beutel M, Herpertz S, Hiller W, Irle E, Joraschky P, König HH, de Liz TM, Nolting B. The social phobia psychotherapy research network. The first multicenter randomized controlled trial of psychotherapy for social phobia: rationale, methods and patient characteristics. Psychother Psychosom. 2009;78:35–41. doi: 10.1159/000162299.
    1. Supina AL, Johnson JA, Patten SB, Williams JV, Maxwell CJ. The usefulness of the EQ-5D in differentiating among persons with major depressive episode and anxiety. Qual Life Res. 2007;16:749–754. doi: 10.1007/s11136-006-9159-z.
    1. Lamers LM, Bouwmans CA, van Straten A, Donker MC, Hakkaart L. Comparison of EQ-5D and SF-6D utilities in mental health patients. Health Econ. 2006;15:1229–1236. doi: 10.1002/hec.1125.
    1. Whynes DK. TOMBOLA Group. Responsiveness of the EQ-5D to HADS-identified anxiety and depression. J Eval Clin Pract. 2009;15:820–825. doi: 10.1111/j.1365-2753.2008.01102.x.
    1. Löwe B, Spitzer S, Zipfel S, Herzog W. Gesundheitsfragebogen für Patienten (PHQ-D). Komplettversion und Kurzform. Testmappe mit Manual, Fragebögen, Schablonen. Karlsruhe: Pfizer GmbH; 2002.
    1. World Health Organisation. The ICD-10 classification of mental and behavioral disorders: clinical descriptions and diagnostic guidelines. Geneva, World Health Organisation; 1992.
    1. König HH, Born A, Heider D, Matschinger H, Heinrich S, Riedel-Heller SG, Surall D, Angermeyer MC, Roick C. Cost-effectiveness of an optimised care model for patients with anxiety disorders in primary care. Brit J of Psychiat. 2009;195:308–317. doi: 10.1192/bjp.bp.108.058032.
    1. Schulenburg JM, Claes C, Greiner W, Uber A. Die deutsche Version des Euro-Qol-Fragebogens. Zeitschrift für Gesundheitswissenschaften. 1998;6:3–20.
    1. Dolan P. Modeling valuations for EuroQol health states. Med Care. 1997;35:1095–1108. doi: 10.1097/00005650-199711000-00002.
    1. Sapin C, Fantino B, Nowicki ML, Kind P. Usefulness of EQ-5D in assessing health status in primary care patients with major depressive disorder. Health Qual Life Outcomes. 2004;2:20. doi: 10.1186/1477-7525-2-20.
    1. WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med. 1998;28:551–558. doi: 10.1017/S0033291798006667.
    1. Angermeyer MC, Kilian R, Matschinger H. WHOQOL-100 und WHOQOL-BREF, Handbuch für die deutschsprachige Version der WHO-Instrumente zur Erfassung von Lebensqualität. Göttingen: Hogrefe-Verlag; 2000.
    1. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clincal Psychology. 1988;56:893–897. doi: 10.1037/0022-006X.56.6.893.
    1. Steer RA, Ranieri WF, Beck AT, Clark DA. Further Evidence for the Validity of the Beck Anxiety Inventory with Psychiatric Outpatients. J Anxiety Disord. 1993;7:195–205. doi: 10.1016/0887-6185(93)90002-3.
    1. de Beurs E, Wilson KA, Chambless DL, Goldstein AJ, Feske U. Convergent and divergent validity of the Beck Anxiety Inventory for patients with panic disorder and agoraphobia. Depress Anxiety. 1997;6:140–146. doi: 10.1002/(SICI)1520-6394(1997)6:4<140::AID-DA2>;2-G.
    1. Fydrich T, Dowdall D, Chambless DL. Reliability and Validity of the Beck Anxiety Inventory. J Anxiety Disord. 1992;6:55–61. doi: 10.1016/0887-6185(92)90026-4.
    1. Wilson KA, de Beurs E, Palmer C, Chambless DL. In: The use of psychological testing for treatment planning and outcomes assessment: Instrumentation for adults and future directions. Maruisch ME, editor. Vol. 2. Mahwah, NJ: Lawrence Erlbaum Associates; 2009. The Beck Anxiety Inventory; pp. 971–992.
    1. Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess. 1996;67:588–597. doi: 10.1207/s15327752jpa6703_13.
    1. Chambless DL, Caputo GC, Bright P, Gallagher R. Assessment of fear of fear in agoraphobics: the body sensations questionnaire and the agoraphobic cognitions questionnaire. Journal of Consulting and Clincal Psychology. 1984;52:1090–1097. doi: 10.1037/0022-006X.52.6.1090.
    1. Chambless DL, Caputo GC, Jasin SE, Gracely EJ, Williams C. The Mobility Inventory for Agoraphobia. Behav Res Ther. 1985;23:35–44. doi: 10.1016/0005-7967(85)90140-8.
    1. Craske MG, Rachman S, Tallman K. Mobility, cognitions and panic. Journal of Psychopathology and Behavioral Assessment. 1986;8:199–210. doi: 10.1007/BF00959832.
    1. Ehlers A, Margraf J, Chambles DL. Fragebogen zu körperbezogenen Ängsten, Kognitionen und Vermeidung, AKV. Weinheim: Beltz; 1993.
    1. Cronbach LJ, Meehl PE. Construct validity in psychological tests. Psychol Bull. 1955;52:281–302. doi: 10.1037/h0040957.
    1. Food and Drug Administration. Draft guidance for industry patient reported outcome measures: use in medical product development in supporting labeling claims. Fed Regist. 2006;71:5862–5863.
    1. Revicki DA, Cella D, Hays RD, Sloan JA, Lenderking WR, Aaronson NK. Responsiveness and minimal important differences for patient reported outcomes. Health Qual Life Outcomes. 2006;4 doi: 10.1186/1477-7525-4-70.
    1. Guyatt GH, Osoba D, Wu AW, Wyrwich KW, Norman GR. Methods to explain the clinical significance of health status measures. Mayo Clin Proc. 2002;77:371–383. doi: 10.4065/77.4.371.
    1. Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials. 1989;10:407–415. doi: 10.1016/0197-2456(89)90005-6.
    1. Cohen J. Statistical Power Analysis for Behavioral Science. Hilsdale, NJ: Lawrence Earlbaum Associates; 1988.
    1. Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003;41:582–592. doi: 10.1097/00005650-200305000-00004.
    1. Clogg CC, Petkova E, Haritou A. Statistical methods for comparing regression coefficients between models. American Journal of Sociology. 1995;100:1261–1293. doi: 10.1086/230638.
    1. StataCorp. Stata Statistical Software: Release 10. College Station, TX, Stata Corp LP; 2007.
    1. König HH, Bernert S, Angermeyer MC. [Health Status of the German population: results of a representative survey using the EuroQol questionnaire] Gesundheitswesen. 2005;67:173–182. doi: 10.1055/s-2005-857991.
    1. Brazier J, Roberts J, Tsuchiya A, Busschbach J. A comparison of the EQ-5D and SF-6D across seven patient groups. Health Econ. 2004;13:873–884. doi: 10.1002/hec.866.
    1. König HH, Bernert S, Angermeyer MC, Matschinger H, Martinez M, Vilagut G, Haro JM, de Girolamo G, de Graaf R, Kovess V. Comparison of population health status in six european countries: results of a representative survey using the EQ-5D questionnaire. Med Care. 2009;47:255–261. doi: 10.1097/MLR.0b013e318184759e.
    1. Günther OH, Roick C, Angermeyer MC, König HH. The responsiveness of EQ-5D utility scores in patients with depression: A comparison with instruments measuring quality of life, psychopathology and social functioning. J Affect Disord. 2008;105:81–91. doi: 10.1016/j.jad.2007.04.018.
    1. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999;282:1737–1744. doi: 10.1001/jama.282.18.1737.
    1. Kroenke K, Spitzer RL, Williams JB, Monahan PO, Lowe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146:317–325.
    1. Greiner W, Claes C, Busschbach JJ, Graf von der Schulenburg JM. Validating the EQ-5D with time trade off for the German population. European Journal of Health Economics. 2005;6:124–130. doi: 10.1007/s10198-004-0264-z.
    1. Günther O, Roick C, Angermeyer MC, König HH. The EQ-5D in alcohol dependent patients: Relationships among health-related quality of life, psychopathology and social functioning. Drug Alcohol Depend. 2007;86:253–264. doi: 10.1016/j.drugalcdep.2006.07.001.
    1. König HH, Roick C, Angermeyer MC. Validity of the EQ-5D in assessing and valuing health status in patients with schizophrenic, schizotypal or delusional disorders. European Psychiatry. 2007;22:177–187. doi: 10.1016/j.eurpsy.2006.08.004.

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