title: Healthy-year equivalents in major joint replacement. Can patients provide meaningful responses?
abstract: 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.
authors.affiliation: Dartmouth Medical School, USA.
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Llewellyn-Thomas
authors.forename: Rena
authors.initials: R
authors.lastname: Arshinoff
authors.forename: Mary
authors.initials: M
authors.lastname: Bell
authors.forename: Jack Ivan
authors.initials: JI
authors.lastname: Williams
authors.forename: C David
authors.initials: CD
authors.lastname: Naylor
mesh_terms: 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