Usefulness of EQ-5D in Assessing Health Status in Primary Care Patients with Major Depressive Disorder

Health and Quality of Life Outcomes

Paul Kind¹  Marie-Laure Nowicki³  Bruno Fantino²  Christophe Sapin⁴ 

[1] Centre for Health Economics, University of York, England, UK;Agoras, Lyon, France;H. Lundbeck A/S, Paris, France;Altipharm, Paris, France

关键词: health status;    cost-effectiveness;    patient-reported outcome;    health-related quality of life;    major depressive disorder;   

Others  :  1216970
DOI  :  10.1186/1477-7525-2-20

 received in 2004-03-08, accepted in 2004-05-05,  发布年份 2004

【 摘 要 】

Objectives

Major depressive disorder (MDD) is a prevalent psychiatric disorder associated with impaired patient functioning and reductions in health-related quality of life (HRQL). The present study describes the impact of MDD on patients' HRQL and examines preference-based health state differences by patient features and clinical characteristics.

Methods

95 French primary care practitioners recruited 250 patients with a DSM-IV diagnosis of MDD for inclusion in an eight-week follow-up cohort. Patient assessments included the Montgomery Asberg Depression Rating Scale (MADRS), the Clinical Global Impression of Severity (CGI), the Short Form-36 Item scale (SF-36), the Quality of Life Depression Scale (QLDS) and the EuroQoL (EQ-5D).

Results

The mean EQ-5D utility at baseline was 0.33, and 8% of patients rated their health state as worse than death. There were no statistically significant differences in utilities by demographic features. Significant differences were found in mean utilities by level of disease severity assessed by CGI. The different clinical response profiles, assessed by MADRS, were also revealed by EQ-5D at endpoint: 0.85 for responders remitters, 0.72 for responders non-remitter, and 0.58 for non-responders. Even if HRQL and EQ-5D were moderately correlated, they shared only 40% of variance between baseline and endpoint.

Conclusions

Self-reported patient valuations for depression are important patient-reported outcomes for cost-effectiveness evaluations of new antidepressant compounds and help in further understanding patient compliance with antidepressant treatment.

【 授权许可】

   
2004 Sapin et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

【 参考文献 】

• [1]Williams JW Jr, Kerber CA, Mulrow CD, Medina A, Aguilar C: Depressive disorders in primary care: prevalence, functional disability and identification. J Gen Intern Med 1995, 10:7-12.
• [2]Le Pape A, Lecomte T: Prévalence et prise en charge de la dépression. Paris: Centre de Recherche en Economie de la Santé 1999.
• [3]Hays RD, Wells KB, Sherbourne CD, Rogers W, Spritzer K: Functioning and well-being outcomes of patients with depression compared with chronic general medical illnesses. Arch Gen Psychiatry 1995, 52:11-9.
• [4]Saarijarvi S, Salminen JK, Toikka T, Raitasalo R: Health-related quality of life among patients with major depression. Nord J Psychiatry 2002, 56:261-4.
• [5]Lecrubier Y: The burden of depression and anxiety in general medicine. J Clin Psychiatry 2001, 62:4-9.
• [6]Goff VV: Depression: a decade of progress, more to do. NHPF Issure Brief 2002, 786:1-14. (Nov 22)
• [7]Nierenberg AA: Current perspectives on the diagnosis and treatment of major depressive disorder. Am J Manag Care 2001, 7:S353-66.
• [8]Brown C, Schulberg HC, Prigerson HG: Factors associated with symptomatic improvement and recovery from major depression in primary care patients. Gen Hosp Psychiatry 2000, 22:242-50.
• [9]Revicki DA, Simon GE, Chan K, Katon W, Heiligenstein J: Depression, health-related quality of life, and medical cost outcomes of receiving, recommended levels of antidepressant treatment. J Fam Pract 1998, 47:446-52.
• [10]Reynolds CF 3rd: Treatment of major depression in late life: a life cycle perspective. Psychiatr Q 1997, 68:221-46.
• [11]Weinstein MC, Siegel JE, Gold MR, Kamlet MS, Russell LB: Recommendations of the Panel on Cost-Effectiveness in Health and Medicine. JAMA 1996, 276:1253-8.
• [12]Bennett KJ, Torrance GW: Measuring health state preferences and utilities: rating scale, time trade-off and standard gamble techniques. In Quality of Life and Pharmacoeconomics in Clinical Trials. 2nd edition. Edited by Spilker B. Philadelphia: Lipincott-Raven; 1996.
• [13]de Boer AG, Stalmeier PF, Sprangers MA, de Haes JC, van Sandick JW, Hulscher JB, van Lanschot JJ: Transhiatal vs extended transthoracic resection in oesophageal carcinoma: patients' utilities and treatment preferences. Br J Cancer 2002, 86:851-7.
• [14]Tosteson AN, Hammond CS: Quality-of-life assessment in osteoporosis: health-status and preferenced-based measures. Pharmacoeconomics 2002, 20:289-303.
• [15]Smith DS, Krygiel J, Nease RF Jr, Sumner W 2nd, Catalona WJ: Patient preferences for outcomes associated with surgical management of prostate cancer. J Urol 2002, 167:2117-22.
• [16]Chouinard G, Albright PS: Economic and health state utility determinations for schizophrenic patients treated with risperidone or haloperidol. J Clin Psychopharmacol 1997, 17:298-307.
• [17]Wells KB, Sherbourne CD: Functioning and utility for current health status of patients with depression or chronic medical conditions in managed, primary care practices. Arch Gen Psychiatry 1999, 56:897-904.
• [18]Bennett KJ, Torrance GW, Boyle MH, Guscott R: Cost-utility analysis in depression: the McSad utility measure for depression health state. Psychiatr Serv 2000, 51:1171-6.
• [19]Schaffer A, Levitt AJ, Hershkop SK, Oh P, MacDonald C, Lanctot K: Utility scores of symptom profiles in major depression. Psychiatry Res 2002, 110:189-97.
• [20]Lenert LA, Morss S, Goldstein MK, Bergen MR, Faustman WO, Garber AM: Measurement of the validity of utility elicitations performed by computerized interview. Med Care 1997, 35:915-20.
• [21]Revicki DA, Wood M: Patient-assigned health state utilities for depression-related outcomes: differences by depression severity and antidepressant medications. J Affect Disord 1998, 48:25-36.
• [22]Committee for Proprietary Medicinal Products: Note for Guidance on Clinical Assessment of Medicinal Products in the Treatment of Depression. London: EMEA 2002.
• [23]American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Washington DC: American Psychiatric Association 4th edition. 1994.
• [24]Montgomery SA, Asberg M: A New Depression Scale Designed to be Sensitive to Change. Br J Psychiatry 1979, 134:382-9.
• [25]Leplège A, Ecosse E, Verdier A, Perneger TV: The French SF-36 Health Survey: translation, cultural adaptation and preliminary psychometric evaluation. J Clin Epidemiol 1998, 51:1013-23.
• [26]Ware JE Jr, Gandek B, Kosinski M, Aaronson NK, Apolone G, Brazier J, Bullinger M, Kaasa S, Leplège A, Prieto L, Sullivan M, Thunedborg K: The equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries. J Clin Epidemiol 1998, 51:1167-70.
• [27]Hunt SM, McKenna SP: The QLDS, a scale for the measurement of quality of life in depression. Health Policy 1992, 22:307-19.
• [28]McKenna SP, Doward LC, Kohlmann T, Mercier C, Niero M, Paes M, Patrick D, Ramirez N, Thorsen H, Whalley D: International development of the Quality of Life in Depression Scale (QLDS). J Affect Disord 2001, 63:189-99.
• [29]EuroQoL Group: EuroQoL – a new facility for the measurement of health-related quality of life. Health Policy 1990, 16:199-208.
• [30]Dolan P, Gudex C, Kind P, Williams A: A social tariff for EuroQoL: Results from a UK General Population Survey. University of York: Center for Health Economics 1995.
• [31]Kohn Y, Zislin J, Agid O, Hanin B, Troudard T, Shapira B, Bloch M, Gur E, Ritsner M, Lerer B: Increased prevalence of negative life events in subtypes of major depressive disorder. Compr Psychiatry 2001, 42:57-63.
• [32]Angst J, Angst F, Stassen HH: Suicide risk in patients with major depressive disorder. J Clin Psychiatry 1999, 60:57-62.
• [33]Bennett KJ, Torrance GW, Boyle MH, Guscott R, Moran LA: Development and testing of a utility measure for major, unipolar depression (McSad). Qual Life Res 2000, 9:109-20.
• [34]Pyne JM, Patterson TL, Kaplan RM, Ho S, Gillin JC, Goldshan S, Grant I: Preliminary longitudinal assessment of quality of life in patients with major depression. Psychopharmacol Bull 1997, 33:23-9.
• [35]Pyne JM, Patterson TL, Kaplan RM, Gillin JC, Koch WL, Grant I: Assessment of quality of life of patients with major depression. Psychiatr Serv 1997, 48:224-30.
• [36]Torrance GW, Feeny D: Utilities and quality-adjusted life years. Int J Technol Assess Health Care 1989, 5:559-75.
• [37]Revicki DA, Kaplan RM: Relationship between psychometric and utility-based approaches to the measurement of health-related quality of life. Qual Life Res 1993, 2:477-87.
• [38]Apolone G, De Carli G, Brunetti M, Garattini S: Health-related quality of life (HR-QOL) and regulatory issues. An assessment of the EMEA recommendations on the use of HR-QOL measures in drug approval. Pharmacoeconomics 2001, 19:187-95.
• [39]Simon GE, VonKorff M, Heiligenstein JH, Revicki DA, Grothaus L, Katon W, Wagner EH: Initial antidepressant choice in primary care: effectiveness and cost of fluoxetine versus tricyclic antidepressants. JAMA 1996, 275:1897-902.
• [40]Gold MR, Siegal JE, Russell LB, Weinstein MC, eds: Cost-Effectiveness in Health and Medicine. New York: Oxford University Press; 1996.