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  • Exploring the consistency of the SF-6D
    Publication . 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.
  • Comparing the performance of the SF-6D and the EQ-5D in different patient groups
    Publication . Ferreira, Lara N.; Ferreira, Pedro L.; Pereira, Luis N.
    Introduction: This research aims to explore the performance of the SF-6D and the EQ-5D in patients suffering from asthma, chronic obstructive pulmonary disease, cataracts, and rheumatoid arthritis. In particular, the aim of this research is twofold: 1) to study the level of agreement between the indexes and the descriptive systems of the dimensions of the SF-6D and the EQ-5D, and 2) to analyze the discriminative ability of the instruments. Material and Methods: A sample of 643 patients completed both the SF-36v2 and the EQ-5D. The discriminative ability of the instruments was analyzed. Furthermore, the level of agreement between the indexes and the descriptive systems of the dimensions of the SF-6D and the EQ-5D were studied. The level of agreement between instruments was investigated using correlation coefficients and the Bland-Altman plots, while the influence of medical condition and other socio-demographic variables was analyzed using non-parametric tests. Paired-samples tests were used to identify differences between the scores. Results and Discussion: The results show a strong correlation and agreement between both indexes. Overall, questionnaire indexes differ by medical condition and socio-demographic groups and both instruments are able to discriminate between socio-demographic groups. Conclusion: This study confirmed the hypothesis that the SF-6D generates higher utility values in less healthy individuals. The SF-6D and the EQ-5D seem to perform differently in each of the diseases studied since the descriptive statistics differ between instruments and the level of correlation is not uniform. Results show that the instruments generate different utility values, but there is a strong agreement between both indexes. Thus, the two instruments are not interchangeable and their results cannot be directly comparable.
  • A portuguese value set for the SF-6D
    Publication . Ferreira, Lara Noronha; Ferreira, Pedro L.; Pereira, Luis Nobre; Brazier, John; Rowen, Donna
    Objectives: The SF-6D is a preference-based measure of health derived from the SF-36 that can be used for cost-effectiveness analysis using cost-per-quality adjusted life-year analysis. This study seeks to estimate a system weight for the SF-6D for Portugal and to compare the results with the UK system weights. Methods: A sample of 55 health states defined by the SF-6D has been valued by a representative random sample of the Portuguese population, stratified by sex and age (n = 140), using the Standard Gamble (SG). Several models are estimated at both the individual and aggregate levels for predicting health-state valuations. Models with main effects, with interaction effects and with the constant forced to unity are presented. Random effects (RE) models are estimated using generalized least squares (GLS) regressions. Generalized estimation equations (GEE) are used to estimate RE models with the constant forced to unity. Estimations at the individual level were performed using 630 health-state valuations. Alternative functional forms are considered to account for the skewed distribution of health-state valuations.Results: The models are analyzed in terms of their coefficients, overall fit, and the ability for predicting the SG-values. The RE models estimated using GLS and through GEE produce significant coefficients, which are robust across model specification. However, there are concerns regarding some inconsistent estimates, and so parsimonious consistent models were estimated. There is evidence of under prediction in some states assigned to poor health. The results are consistent with the UK results. Conclusion: The models estimated provide preference-based quality of life weights for the Portuguese population when health status data have been collected using the SF-36. Although the sample was randomly drowned findings should be treated with caution, given the small sample size, even knowing that they have been estimated at the individual level.