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- Modelling health state preference data using fixed and random effects modelsPublication . Ferreira, Lara Noronha; Ferreira, Pedro L.; Pereira, Luis NobreThe use of preference-based measures of health in the measurement of Health Related Quality of Life has become widely used in health economics. Hence, the development of preference-based measures of health has been a major concern for researchers throughout the world. This study aims to model health state preference data using a new preference-based measure of health (the SF- 6D) and to suggest alternative models for predicting health state utilities using fixed and random effects models. It also seeks to investigate the problems found in the SF-6D and to suggest eventual changes to it.
- Exploring the consistency of the SF-6DPublication . Ferreira, Lara Noronha; Ferreira, Pedro L.; Pereira, Luis; Rowen, Donna; Brazier, John E.Objective: The six dimensional health state short form (SF-6D) was designed to be derived from the short-form 36 health survey (SF-36). The purpose of this research was to compare the SF-6D index values generated from the SF 36 (SF-6D(SF-36)) with those obtained from the SF-6D administered as an independent instrument (SF-6D(Ind)). The goal was to assess the consistency of respondents answers to these two methods of deriving the SF-6D. Methods: Data were obtained from a sample of the Portuguese population (n = 414). Agreement between the instruments was assessed on the basis of a descriptive system and their indexes. The analysis of the descriptive system was performed by using a global consistency index and an identically classified index. Agreement was also explored by using correlation coefficients. Parametric tests were used to identify differences between the indexes. Regression models were estimated to understand the relationship between them. Results: The SF-6D(Ind) generates higher values than does the SF-6D(SF-36), There were significant differences between the indexes across sociodemographic groups. There was a significant ceiling effect in the SF-6D(Ind) a but not in the SF-6D(SF-36). The correlation between the indexes was high but less than what was anticipated. The global consistency index identified the dimensions with larger differences. Considerable differences were found in two dimensions, possibly as a result of different item contexts. Further research is needed to fully understand the role of the different layouts and the length of the questionnaires in the respondents' answers. Conclusions: The results show that as the SF-6D was designed to derive utilities from the SF-36 it should be used in this way and not as an independent instrument.
- A hybrid modelling approach for eliciting health state preferences: the Portuguese EQ-5D-5L value setPublication . Ferreira, Pedro L.; Antunes, Patricia; Ferreira, Lara; Pereira, LN; Ramos-Goni, Juan M.Background The EQ-5D is a generic preference-based quality of life measure considered useful for supporting clinical and policy decisions by providing utility values that can easily be converted into quality-adjusted life years to be integrated in cost-utility economic evaluations. Although the three-level classification system of the EuroQol questionnaire (EQ-5D-3L) is still the most popular preference-based instrument used worldwide, several studies reported a ceiling effect on this version, especially in healthy and/or young individuals. In 2009, the EuroQol Group introduced a five-level EQ-5D, which expands the descriptive system from three to five levels within the same five dimensions. For this version to be used in health economic evaluation, societal values need to be assigned to the 3125 health states generated by this instrument. Objectives The aims of this study were to elicit the EQ-5D-5L health state preferences from the general Portuguese population and to derive the Portuguese value set for the EQ-5D-5L. Methods A representative sample of the Portuguese general population aged above 18 years was stratified by age and gender (n = 1451). Between October 2015 and July 2016, 28 interviewers carried out a series of 1-h-long computer-assisted personal interviews following the EuroQol Valuation Technology protocol. Each interview included the valuation of ten health states using the composite time trade-off (cTTO) and seven pairs of discrete choice experiments (DCEs). A standardized tool for quality control was used to assess the quality of the data as well as direct supervision and cross-examination of 10% of the global sample size. Data from both cTTO and DCE valuation tasks were modelled using a censored heteroskedastic hybrid model. Results Interviewers complied with the quality control protocol in providing high-quality valuation data. The hybrid econometric model had consistent and significant parameters. The derived societal values for the Portuguese population ranged from - 0.603 to 1. Conclusion This study provided the Portuguese value set for the EQ-5D-5L on the basis of a hybrid econometric model using cTTO and DCE data. These results represent the preferences of the Portuguese population and are recommended to inform health decision-making in Portugal.
- O sistema português de valores do SF-6DPublication . Ferreira, Pedro L.; Ferreira, Lara Noronha; Pereira, Luis NobreIntrodução: Nos últimos tempos tem-se assistido ao desenvolvimento de estudos em alguns países, de forma a obter funções de valoração relativas aos instrumentos de medição de preferências mais utilizados. Na verdade, a evidência sugere que as valorações dos estados de saúde podem diferir de país para país. O objectivo deste estudo foi a determinação de um sistema de valores subjacente ao SF-6D para Portugal. Metodologia: Uma amostra de 55 estados de saúde definidos pelo SF-6D foi valorizada por uma amostra aleatória estratificada da população em geral, utilizando o standard gamble (SG). A pesquisa foi conduzida por entrevistas pessoais, tendo os respondentes valorizado seis estados de saúde, acrescidos do pior estado de saúde definido pelo SF-6D ou da morte imediata. Estimaram-se vários modelos com o objectivo de prever as valorações dos estados de saúde. Numa primeira fase, foram estimados modelos lineares, tanto ao nível individual, como agregado, assim como modelos com efeitos fixos, com efeitos principais e de interacção e com a constante forçada à unidade. Numa segunda fase, foram ainda testados, pelo método dos mínimos quadrados generalizados, modelos com efeitos aleatórios (MEA). Foram também estimados MEA com a constante forçada à unidade pelas equações de estimação generalizadas (EEG). Consideraram-se especificações alternativas, como forma de tomar em consideração o enviesamento das valorações dos estados de saúde. Os modelos foram analisados em termos dos seus coeficientes, ajustamento e capacidade para prever os valores dos estados de saúde captados pelo SG. Resultados: Os MEA e os modelos EEG produziram coeficientes significativos, que se verificou serem robustos nas especificações dos modelos. A utilização de uma bateria de medidas de bondade do ajustamento levou à conclusão que o modelo EEG com efeitos principais era o melhor modelo estimado. Conclusão: Esta investigação demonstra que é possível obter sistemas de pesos para a medição da qualidade de vida relacionada com a saúde. O melhor modelo obtido parece prever adequadamente os valores dos estados de saúde da população portuguesa. No entanto, existem algumas incoerências que devem ser investigadas.
- Comparing the performance of the EQ-5D-3L and the EQ-5D-5L in young Portuguese adultsPublication . Ferreira, Lara Noronha; Ferreira, Pedro L.; Perdigão, Filipa; Pereira, LuisBackground Some studies have reported a ceiling effect in EQ-5D-3L, especially in healthy and/or young individuals. Recently, two further levels have been included in its measurement model (EQ-5D-5L). The purposes of this study were (1) to assess the properties of the EQ-5D-5L in comparison with the standard EQ-5D-3L in a sample of young adults, (2) to foreground the importance of collecting qualitative data to confirm, validate or refine the EQ-5D questionnaire items and (3) to raise questions pertaining to the wording in these questionnaire items. Methods The data used came from a sample of respondents aged 30 or under (n = 624). They completed both versions of the EQ-5D, which were compared in terms of feasibility, level of inconsistency and ceiling effect. Agreement between the instruments was assessed using correlation coefficients and Bland-Altman plots. Known-groups validity of the EQ-5D-5L was also assessed using non-parametric tests. The discriminative properties were compared using receiver operating characteristic curves. Finally, four interviews were conducted for retrospective reports to elicit respondents’ understanding and perceptions of the format, instructions, items, and responses. Results Quantitative results show a ceiling effect reduction of 25.3 % and a high level agreement between both indices. Known-groups validity was confirmed for the EQ-5D-5L. Explorative interviews indicated ambiguity and low degree of certainty in regards to conceptualizing differences between levels moderate-slight across three dimensions. Conclusions The EQ-5D-5L performed better than the EQ-5D-3L. However, the explorative interviews demonstrated several limitations in the EQ-5D questionnaire wording and high context-dependent answers point to lack of illnesses’ experience amongst young adults.
- Erratum to: Reducing the floor effect in the SF-6D: a feasibility study (vol 7, pg 193, 2012)Publication . Ferreira, Lara Noronha; Ferreira, Pedro L.; Pereira, Luis; Rowen, DonnaErratum to: Reducing the Floor Effect in the SF-6D: A Feasibility Study
- Validity and reliability of the Portuguese version of the modified Migraine Disability AssessmentPublication . Ferreira, Pedro L.; Luzeiro, Isabel; Lopes, Margarida; Jorge, André; Silva, Bruno; Ferreira, LaraBackground Migraine Disability Assessment Scale (MIDAS) is a useful tool to measure headache-related disability. Modified MIDAS with 4-week recall period reduces recall bias and improves accuracy of the results. This study aimed at validating mMIDAS in Portuguese. Methods Studied population consisted of adult migraine patients attending a headache outpatient clinic. Reliability was assessed by internal consistency and reproducibility in a 3-week test-retest. Content validity was evaluated by two expert panels. Construct validity was tested by comparing mMIDAS-P index in socioeconomic and clinical patient groups and scale unidimensionality was evidenced by factor analysis. Criterion validity was tested using EQ-5D-5L and HADS. Results Ninety-two patients, 88% female, mean age of 44 years, participated. They had, in average, 9.7 headache days in previous month, pain averaging 7.5/10. About 69.9% were on a migraine prophylactic treatment, and 42.4% had severe disability; 29.4 and 13.0% showed, respectively, moderate/severe anxiety and depression. Content validity showed that mMIDAS-P is simple and clinically useful. It did not show to be determined by patient’s sociodemographic characteristics and it was correlated with depression scale and EQ-5D-5L. Test-retest demonstrated high reproductive reliability and good internal consistency. Conclusion mMIDAS-P is valid and reliable. We strongly recommend it for clinical and research use.
- Quality of life asymmetries based on the residencePublication . Ferreira, Pedro L.; Antunes, Patricia; Ferreira, Lara; Pereira, LNQuality of life (QoL) self-perceptions are, by definition a subjective indicator. Based on the type of residence, the purpose of this paper was to examine possible asymmetries regarding the selfperception of QoL and their opinions regarding life and death.
- How consistent are health utility values?Publication . Ferreira, Pedro L.; Ferreira, Lara Noronha; Pereira, Luis NobreThe use of preference-based generic instruments to measure the health-related quality of life of a general population or of individuals suffering from a specific disease has been increasing. However, there are several discrepancies between instruments in terms of utility results. This study compares SF-6D and EQ-5D when administered to patients with cataracts and aims at explaining the differences. Agreement between EQ-5D and SF-6D health state classifications was assessed by correlation coefficients. Simple correspondence analysis was used to assess the agreement among the instrument’s descriptive systems and to investigate similarities between dimensions’ levels. Cluster analysis was used to classify SF-6D and EQ-5D levels into homogeneous groups. There was evidence of floor effects in SF-6D and ceiling effects in EQ-5D. Comparisons of means showed that SF-6D values exceeded EQ-5D values. Agreement between both instruments was high, especially between similar dimensions. However, different valuation methods and scoring algorithms contributed to the main differences found. We suggest that one or both instruments should be revised, in terms of their descriptive systems or their scoring algorithms, in order to overcome the weakness found.
- An application of the SF-6D to create health values in Portuguese working age adultsPublication . Ferreira, Lara Noronha; Ferreira, Pedro L.; Pereira, Luis Nobre; Brazier, JohnObjectives : This study describes the health-related quality of life(HRQOL) of the Portuguese working age population and investigates sociodemographic differences. Methods : Subjects randomly selected from the working age population ( n =2,459) were assessed using the SF-36v2 and converted into the preference-based SF-6D. Results : The mean SF-6D utility value was 0.70 (range 0.63–0.73). The mean utility value was lower for the lower educational level than for the highest. Women, people living in rural areas and older adults reported lower levels of utility values. Non-parametric tests showed that health utility values were signifi cantly related to employment; unskilled manual workers reported utility values lower than non-manual workers. For different diseases, mean utility values ranged from 0.58 (sexual diseases) to 0.66 (hepatic conditions). Cluster analysis was adopted to classify individuals into three groups according to their answers to the SF-6D dimensions. Multinomial logit regression was used to detect sociodemographic characteristics affecting the probability of following each cluster pattern. This study yielded normative data by age and gender for the SF-6D. Conclusions: The authors conclude that SF-6D is an effective tool for measuring HRQOL in the community so that different population groups can be compared. The preference-based measure used seems to discriminate adequately across sociodemographic differences. These results allow a better understanding of the impact of sociodemographic variables on the burden of illness perception.