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Development of the Incontinence Utility Index: estimating population-based utilities associated with urinary problems from the Incontinence Quality of Life Questionnaire and Neurogenic Module.

Cuervo J, Castejón N, Khalaf KM, Waweru C, Globe D, Patrick DL - Health Qual Life Outcomes (2014)

Bottom Line: The abbreviated health state classification system generated from the NDO sample contained 5 attributes with 3 levels of response and had adequate psychometrical properties: significant differences in scores according to the reduction in the frequency of urinary incontinence episodes [UIE] (p < 0.001); Spearman correlation coefficient with number of daily UIE = -0.43; p < 0.01 and Intraclass Correlation Coefficient (ICC, 95% CI) with the original version = 0.90 (0.89-0.91; p < 0.001).Model fits were acceptable (R-squared = 0.923 and 0.978).The newly developed IUI is a preference-based measure for urinary problems related to NDO that provides general population-based utility scores with adequate predictive validity.

View Article: PubMed Central - PubMed

Affiliation: LASER Analytica, C/Azcárraga 12 A, Oviedo, 33010, Asturias, Spain. Jesus.Cuervo@la-ser.com.

ABSTRACT

Background: Generic utility instruments may not fully capture the impact and consequences of urinary problems. Condition-specific preference-based measures, developed from previously validated disease-specific patient-reported outcomes instruments, may add relevant information for economic evaluations. The aim of this study was to develop a condition-specific preference-based measure, the Incontinence Utility Index (IUI), for valuing health states associated with urinary problems.

Methods: A two-step process was implemented. First, an abbreviated health state classification system was developed from the Incontinence Quality of Life Questionnaire (I-QOL) and Neurogenic Module by applying Rasch modelling, classical psychometrical testing and expert criteria to data from two pivotal trials comprised of neurogenic detrusor overactivity (NDO) patients. Criterion, convergent validity and concordance with the original instrument was assessed in the abbreviated version. Then, a multi-attribute utility function (MAUF) was estimated from a representative sample of the UK non-institutionalized adult general population. Visual analogue and time-trade off (TTO) evaluations were applied in the elicitation process. Predictive validity of the MAUF was tested comparing estimated and direct utility scores.

Results: The abbreviated health state classification system generated from the NDO sample contained 5 attributes with 3 levels of response and had adequate psychometrical properties: significant differences in scores according to the reduction in the frequency of urinary incontinence episodes [UIE] (p < 0.001); Spearman correlation coefficient with number of daily UIE = -0.43; p < 0.01 and Intraclass Correlation Coefficient (ICC, 95% CI) with the original version = 0.90 (0.89-0.91; p < 0.001). Next, 442 participants were interviewed (398 cases were valid, generating 2,388 TTO evaluations) to estimate the social preferences for derived health states. Mean age was 44.75 years (interquartile range 33.5-55.5) and 60.1% were female. An overall algorithm for the IUI was estimated and transformed onto a dead = 0.00 and full health = 1.00 scale. Model fits were acceptable (R-squared = 0.923 and 0.978). Predictive validity was adequate: ICC (95% CI) = 0.928 (0.648-0.985) and Mean of Absolute Differences = 0.038.

Conclusions: The newly developed IUI is a preference-based measure for urinary problems related to NDO that provides general population-based utility scores with adequate predictive validity.

Trial registration: ClinicalTrials.gov: NCT00461292, NCT00311376.

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Related in: MedlinePlus

Presentation diagram of the time trade-off technique. Life P= The most desirable health state/Full health/The best health state imaginable. Life A= A given health stated derived from the abbreviated health state classification system.
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Fig1: Presentation diagram of the time trade-off technique. Life P= The most desirable health state/Full health/The best health state imaginable. Life A= A given health stated derived from the abbreviated health state classification system.

Mentions: Time Trade-Off rating (TTO) for power function estimation and for evaluation of MAUF predictive validity. A total of 6 different states were assessed: 3 corner states and all the intermediate or marker states previously described. During the elicitation process, a “ping-pong” presentation was used to converge on an indifference point between the alternatives (Figure 1). All participants were requested to think about the differences between the health states compared in each exercise, always keeping in mind that all other important, broader factors would remain constant (family, job, friends, income, etc.) under all the presented scenarios.


Development of the Incontinence Utility Index: estimating population-based utilities associated with urinary problems from the Incontinence Quality of Life Questionnaire and Neurogenic Module.

Cuervo J, Castejón N, Khalaf KM, Waweru C, Globe D, Patrick DL - Health Qual Life Outcomes (2014)

Presentation diagram of the time trade-off technique. Life P= The most desirable health state/Full health/The best health state imaginable. Life A= A given health stated derived from the abbreviated health state classification system.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4196092&req=5

Fig1: Presentation diagram of the time trade-off technique. Life P= The most desirable health state/Full health/The best health state imaginable. Life A= A given health stated derived from the abbreviated health state classification system.
Mentions: Time Trade-Off rating (TTO) for power function estimation and for evaluation of MAUF predictive validity. A total of 6 different states were assessed: 3 corner states and all the intermediate or marker states previously described. During the elicitation process, a “ping-pong” presentation was used to converge on an indifference point between the alternatives (Figure 1). All participants were requested to think about the differences between the health states compared in each exercise, always keeping in mind that all other important, broader factors would remain constant (family, job, friends, income, etc.) under all the presented scenarios.

Bottom Line: The abbreviated health state classification system generated from the NDO sample contained 5 attributes with 3 levels of response and had adequate psychometrical properties: significant differences in scores according to the reduction in the frequency of urinary incontinence episodes [UIE] (p < 0.001); Spearman correlation coefficient with number of daily UIE = -0.43; p < 0.01 and Intraclass Correlation Coefficient (ICC, 95% CI) with the original version = 0.90 (0.89-0.91; p < 0.001).Model fits were acceptable (R-squared = 0.923 and 0.978).The newly developed IUI is a preference-based measure for urinary problems related to NDO that provides general population-based utility scores with adequate predictive validity.

View Article: PubMed Central - PubMed

Affiliation: LASER Analytica, C/Azcárraga 12 A, Oviedo, 33010, Asturias, Spain. Jesus.Cuervo@la-ser.com.

ABSTRACT

Background: Generic utility instruments may not fully capture the impact and consequences of urinary problems. Condition-specific preference-based measures, developed from previously validated disease-specific patient-reported outcomes instruments, may add relevant information for economic evaluations. The aim of this study was to develop a condition-specific preference-based measure, the Incontinence Utility Index (IUI), for valuing health states associated with urinary problems.

Methods: A two-step process was implemented. First, an abbreviated health state classification system was developed from the Incontinence Quality of Life Questionnaire (I-QOL) and Neurogenic Module by applying Rasch modelling, classical psychometrical testing and expert criteria to data from two pivotal trials comprised of neurogenic detrusor overactivity (NDO) patients. Criterion, convergent validity and concordance with the original instrument was assessed in the abbreviated version. Then, a multi-attribute utility function (MAUF) was estimated from a representative sample of the UK non-institutionalized adult general population. Visual analogue and time-trade off (TTO) evaluations were applied in the elicitation process. Predictive validity of the MAUF was tested comparing estimated and direct utility scores.

Results: The abbreviated health state classification system generated from the NDO sample contained 5 attributes with 3 levels of response and had adequate psychometrical properties: significant differences in scores according to the reduction in the frequency of urinary incontinence episodes [UIE] (p < 0.001); Spearman correlation coefficient with number of daily UIE = -0.43; p < 0.01 and Intraclass Correlation Coefficient (ICC, 95% CI) with the original version = 0.90 (0.89-0.91; p < 0.001). Next, 442 participants were interviewed (398 cases were valid, generating 2,388 TTO evaluations) to estimate the social preferences for derived health states. Mean age was 44.75 years (interquartile range 33.5-55.5) and 60.1% were female. An overall algorithm for the IUI was estimated and transformed onto a dead = 0.00 and full health = 1.00 scale. Model fits were acceptable (R-squared = 0.923 and 0.978). Predictive validity was adequate: ICC (95% CI) = 0.928 (0.648-0.985) and Mean of Absolute Differences = 0.038.

Conclusions: The newly developed IUI is a preference-based measure for urinary problems related to NDO that provides general population-based utility scores with adequate predictive validity.

Trial registration: ClinicalTrials.gov: NCT00461292, NCT00311376.

Show MeSH
Related in: MedlinePlus