Rheumatology Advance Access originally published online on February 3, 2006
Rheumatology 2006 45(8):975-981; doi:10.1093/rheumatology/kel027
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The relationship of medical, demographic and psychosocial factors to direct and indirect health utility instruments in rheumatoid arthritis
1 Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Dudley, 2 School of Psychology, University of Birmingham, Birmingham, 3 PharmacoEconomics Research Centre, Department of Management, University of St Andrews, St Andrews, UK, 4 School of Psychology, Massey University, Albany Campus, Auckland, New Zealand and 5 Clinical and Academic Rheumatology, King's College Hospital, GKT School of Medicine, London, UK.
Correspondence to: G. J. Treharne, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK. E-mail: G.J.Treharne{at}bham.ac.uk
Objectives. Cost-effectiveness analysis (CEA) is essential for the comparison of treatments for rheumatoid arthritis (RA). CEA centres on accurate measurement of health utility (HU) preferences. Direct measures of HU in RA patients demonstrate weaker correlations with health status (functional disability and pain) than indirect measures. We examined whether demographic and psychosocial factors relate to HU in RA patients.
Methods. HU was measured for 142 RA patients (76% women; mean age 58.75 yr) directly through standard gamble (SG) and time trade-off (TTO), and indirectly on the EuroQol (EQ-5D). Current pain (100 mm visual analogue scale) and recent functional disability (Health Assessment Questionnaire; HAQ) were assessed. A subsample of 48 provided demographic and psychosocial information (education, employment, marital/family status, knowledge about RA, medication beliefs, desirable responding, social support, optimism, and the Hospital Anxiety and Depression Scale; HADS).
Results. Direct HU had higher means (SG = 0.88, TTO = 0.86) than indirect HU (EQ-5D = 0.52). HAQ functional disability correlated with SG (r = – 0.28), TTO (r = – 0.31) and EQ-5D (r = – 0.67). Current pain correlated with TTO (r = – 0.19) and EQ-5D (r = – 0.36). HADS depression correlated with TTO (r = – 0.35) and EQ-5D (r = – 0.64); HADS anxiety also correlated with EQ-5D (r = – 0.46).
Conclusions. Demographic and psychosocial factors cannot completely explain either the significant differences between direct and indirect HUs in RA patients or the moderate correlations of direct HUs with health status. Characteristics of the SG and TTO may make them inappropriate for HU assessment and CEA among RA patients.
KEY WORDS: Rheumatoid arthritis, Health utility, Standard gamble, Time trade-off, Disability evaluation
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  D L Scott, B Khoshaba, E H Choy, and G H Kingsley Limited correlation between the Health Assessment Questionnaire (HAQ) and EuroQol in rheumatoid arthritis: questionable validity of deriving quality adjusted life years from HAQ Ann Rheum Dis, November 1, 2007; 66(11): 1534 - 1537. [Abstract] [Full Text] [PDF]
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