title: Why do patients with inflammatory arthritis often score states "worse than death" on the EQ-5D? An Investigation of the EQ-5D classification system.
abstract: OBJECTIVE
  Using inflammatory arthritis patients as an example, we investigate EuroQol-5D (EQ-5D) profiles resulting in states worse than death (WTD), and the heath status of patients occupying these states.
  
  
  METHODS
  Baseline data from two UK trials were used that reflected the range of arthritis states/severity found in routine practice. EQ-5D profiles resulting in negative valuations (i.e., states WTD) based on UK weights were identified. EQ-5D scores for these profiles from alternative valuation sets, including a reanalysis of the UK weights, were compared. The health status and characteristics of patients, and factors associated with patients in the low distribution of the EQ-5D and those with WTD EQ-5D scores were identified.
  
  
  RESULTS
  Seven hundred patients were included in the analysis. Sixty-two (9%) patients occupied states WTD. Patients occupied 9 of the possible 84 health profiles with negative scores (53% occupied one profile); this profile was not rated WTD by any of the alternative EQ-5D scoring algorithms. All WTD profiles included severe pain/discomfort plus moderate problems in >or=3 other domains. Patients with WTD valuations reported higher levels of pain, and feeling downhearted and low on alternative health status measures.
  
  
  CONCLUSIONS
  Pain was the predominant factor in the WTD EQ-5D profiles occupied by arthritis patients. Patients occupying states WTD have poorer health-related quality of life than patients in low "better than death" states. Valuations of profiles vary according to how sets of preference weights for health profiles were developed. Further research should explore whether WTD valuations are supported by qualitative evidence and reflect the patient's health and experience of disease.
authors.affiliation: arc Epidemiology Unit, The University of Manchester, Manchester, UK. mark.harrison@manchester.ac.uk
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Harrison
authors.forename: Linda M
authors.initials: LM
authors.lastname: Davies
authors.forename: Nick J
authors.initials: NJ
authors.lastname: Bansback
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: McCoy
authors.forename: Tracey M
authors.initials: TM
authors.lastname: Farragher
authors.forename: Suzanne M M
authors.initials: SM
authors.lastname: Verstappen
authors.forename: Andrew
authors.initials: A
authors.lastname: Hassell
authors.forename: Deborah P M
authors.initials: DP
authors.lastname: Symmons
mesh_terms: D000368:Aged; D001168:Arthritis / Q000150:complications / Q000523:psychology*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000523:psychology; D003643:Death; D003863:Depression / Q000209:etiology / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010146:Pain / Q000209:etiology / Q000523:psychology*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D006113:United Kingdom