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Validity and responsiveness of the EuroQol as a measure of health-related quality of life in people enrolled in an AIDS clinical trial

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Abstract

Objective: Brief utility measures are needed in clinical trials in addition to existing descriptive measures of health-related quality of life (HRQOL). We examined the reliability and validity of the EuroQol (EQ-5D) and MOS-HIV and their responsiveness to HIV-related clinical events. Methods: Subjects with advanced HIV disease (CD4 < 100) were enrolled in a randomized trial for CMV prophylaxis (n = 990). The EQ-5D includes a weighted sum of five domains (EQ-5D Index) and a visual analog scale (EQ-VAS). The MOS-HIV has 10 subscales and physical (PHS) and mental health summary scores (MHS). Construct validity of the EQ-5D was tested based on hypothesized relationships to subscales of the MOS-HIV. Relative precision and responsiveness to adverse experiences and opportunistic infections (OIs) were compared for the two instruments. Results: Mean age of the patients was 38, 94% were male, 80% white, and 7% had injected drugs. Mean baseline scores for EQ-5D Index and EQ-VAS were 0.80 and 76.0, respectively, 28 and 4% reported maximum scores. Mean MOS-HIV subscales score ranged from 55 (role) to 84 (cognitive); mean PHS and MHS were 47.4 and 49.5, respectively. Correlations between MOS-HIV subscales and EQ-5D Index ranged from 0.45 (role) to 0.63 (pain); correlations with EQ-VAS ranged from 0.33 (cognitive) to 0.66 (health perceptions). Correlations between MOS-HIV PHS and MHS with EQ-5D Index were 0.61 and 0.58; and with EQ-VAS, 0.57 and 0.60, respectively. Responsiveness to adverse experiences was highest for MOS-HIV pain and PHS (effect sizes = 0.9 and 0.4); pain had the highest relative precision (2.4) for adverse experiences; EQ-VAS had the greatest relative precision (1.6) for developing an OI. Conclusion: In these patients with advanced HIV disease, EQ-5D showed good construct validity, but there may be a ceiling effect for its EQ-5D Index component. EQ-5D was less responsive to adverse events than the MOS-HIV. However, the EQ-VAS was most sensitive to developing an OI and is likely to be a useful measure of HRQOL for generating QALYs in cost-utility studies involving patients with advanced HIV disease.

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Authors and Affiliations

  1. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205-2690, USA

    A.W. Wu, D.L. Jacobson, K.D. Frick & R. Clark

  2. MEDTAP International, 7101 Wisconsin Ave Suite 600, Bethesda, MD, 20814, USA

    D.A. Revicki

  3. Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA

    K.A. Freedberg

  4. Outcomes Research Associates, Inc., Hillsborough, NC, 27278-9397, USA

    J. Scott-Lennox (Scientific Director)

  5. Holmes Division, University of Cincinnati Medical Center, Cincinnati, OH, 45267-0405, USA

    J. Feinberg

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  1. A.W. Wu
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  4. R. Clark
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  7. J. Scott-Lennox
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  8. J. Feinberg
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Wu, A., Jacobson, D., Frick, K. et al. Validity and responsiveness of the EuroQol as a measure of health-related quality of life in people enrolled in an AIDS clinical trial. Qual Life Res 11, 273–282 (2002). https://doi.org/10.1023/A:1015240103565

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