Healthy-year equivalents in major joint replacement. Can patients provide meaningful responses?
OBJECTIVE
Healthy-years equivalents (HYEs) have been proposed as an evaluative measure with advantages over quality-adjusted life-years (QALYs). The main purpose was to assess the feasibility of eliciting HYEs from patients who have undergone major joint replacement; a secondary objective was to examine relationships with postsurgical health status.


METHODS
Pre- and postsurgical reports of perceived comorbidity and current arthritic burden were obtained from 194 patients, using a comorbidity checklist, summary scores from the Western Ontario/McMaster Osteoarthritis Questionnaire (WOMAC), summary scores derived from six Likert scales, and holistic utility scores for the same attributes. After surgery, HYEs for the full across-time health profile were also elicited.


RESULTS
All measures of arthritic burden were sensitive to pre/postsurgical changes (p = .0001), and comorbidity scores were stable. Two HYE subgroups emerged. An HYE-invariant subgroup ascribed full HYEs to their profiles, while reporting higher Likert (t = 2.1309; p = .0344) and utility (s = 4.1504; p = .0001) scores for their postsurgical health state. An HYE-variant subgroup reported HYEs that were weakly but significantly (p < .009) correlated with Likert (r = .30), utility (rs = .25), and comorbidity (r = -.26) scores for their postsurgical state.


CONCLUSIONS
Our results indicate that patients can understand the HYE assessment procedures and provide interpretable responses. However, a significant proportion reports invariant HYEs that could inflate estimates of the overall mean HYE. Further exploration of the HYEs reported by different clinical and attitudinal populations is needed before widespread adoption of this measure.
Llewellyn-Thomas
Hilary A
HA
Dartmouth Medical School, USA.
Arshinoff
Rena
R
Bell
Mary
M
Williams
Jack Ivan
JI
Naylor
C David
CD
D000328:Adult; D000368:Aged; D001168:Arthritis / Q000601:surgery*; D019643:Arthroplasty, Replacement / Q000706:statistics & numerical data*; D001294:Attitude to Health; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D017063:Outcome Assessment, Health Care / Q000379:methods*; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D020377:Self Efficacy; D018434:Sickness Impact Profile; D013673:Technology Assessment, Biomedical; D026712:Value of Life