title: A comparison of four different approaches to measuring health utility in depressed patients.
abstract: BACKGROUND
  A variety of instruments are used to measure health related quality of life. Few data exist on the performance and agreement of different instruments in a depressed population. The aim of this study was to investigate agreement between, and suitability of, the EQ-5D-3L, EQ-5D Visual Analogue Scale (EQ-5D VAS), SF-6D and SF-12 new algorithm for measuring health utility in depressed patients.
  
  
  METHODS
  The intraclass correlation coefficient (ICC) and Bland and Altman approaches were used to assess agreement. Instrument sensitivity was analysed by: (1) plotting utility scores for the instruments against one another; (2) correlating utility scores and depressive symptoms (Beck Depression Inventory (BDI)); and (3) using Tukey's procedure. Receiver Operating Characteristic (ROC) analysis assessed instrument responsiveness to change. Acceptability was assessed by comparing instrument completion rates.
  
  
  RESULTS
  The overall ICC was 0.57. Bland and Altman plots showed wide limits of agreement for each pair wise comparison, except between the SF-6D and SF-12 new algorithm. Plots of utility scores displayed 'ceiling effects' in the EQ-5D-3L index and 'floor effects' in the SF-6D and SF-12 new algorithm. All instruments showed a negative monotonic relationship with BDI, but the EQ-5D-3L index and EQ-5D VAS could not differentiate between depression severity sub-groups. The SF-based instruments were better able to detect changes in health state over time. There was no difference in completion rates of the four instruments.
  
  
  CONCLUSIONS
  There was a lack of agreement between utility scores generated by the different instruments. According to the criteria of sensitivity, responsiveness and acceptability that we applied, the SF-6D and SF-12 may be more suitable for the measurement of health related utility in a depressed population than the EQ-5D-3L, which is the instrument currently recommended by NICE.
authors: Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, Oakfield House, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK. Nicholas.Turner@bristol.ac.uk
authors: Nicholas
authors: N
authors: Turner
authors: John
authors: J
authors: Campbell
authors: Tim J
authors: TJ
authors: Peters
authors: Nicola
authors: N
authors: Wiles
authors: Sandra
authors: S
authors: Hollinghurst
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D000928:Antidepressive Agents / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000145:classification / Q000188:drug therapy / Q000523:psychology*; D006305:Health Status Indicators; D006801:Humans; D038801:International Classification of Diseases; D008875:Middle Aged; D010147:Pain Measurement / Q000592:standards*; D011594:Psychometrics / Q000295:instrumentation* / Q000592:standards; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D057566:Self Report; D011795:Surveys and Questionnaires / Q000592:standards*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents
references: Lancet. 1986 Feb 8;1(8476):307-10
references: 2868172
references: J Clin Epidemiol. 1995 Nov;48(11):1369-78
references: 7490600
references: Psychol Med. 2000 May;30(3):657-68
references: 10883720
references: Psychol Bull. 1966 May;65(5):280-90
references: 5325892
references: Health Econ. 2006 Nov;15(11):1229-36
references: 16625671
references: J Clin Epidemiol. 2003 Apr;56(4):317-25
references: 12767408
references: Health Econ. 2004 Sep;13(9):873-84
references: 15362179
references: Appl Health Econ Health Policy. 2004;3(2):91-102
references: 15702946
references: Contemp Clin Trials. 2012 Mar;33(2):312-9
references: 22101205
references: Am J Psychiatry. 2006 Jan;163(1):28-40
references: 16390886
references: Value Health. 2012 May;15(3):475-84
references: 22583458
references: Health Econ. 2003 Dec;12(12):1061-7
references: 14673814
references: Biometrics. 1988 Sep;44(3):837-45
references: 3203132
references: Med Care. 1997 Nov;35(11):1095-108
references: 9366889
references: Health Econ. 2006 Jul;15(7):653-64
references: 16498700
references: Health Technol Assess. 1999;3(9):i-iv, 1-164
references: 10392311
references: Ann Med. 2001 Jul;33(5):337-43
references: 11491192
references: Qual Life Res. 2011 Dec;20(10):1727-36
references: 21479777
references: Value Health. 2011 Jul-Aug;14(5):732-9
references: 21839412
references: Psychol Med. 1992 May;22(2):465-86
references: 1615114
references: Health Econ. 2004 Jul;13(7):733-7
references: 15259050
references: Cardiovasc Diabetol. 2012 Jul 11;11:35
references: 22515638
references: Health Econ. 2008 Jul;17(7):815-32
references: 17893863
references: Soc Psychiatry Psychiatr Epidemiol. 2009 Jul;44(7):569-78
references: 19011721
references: PLoS Med. 2006 Nov;3(11):e442
references: 17132052
references: J Clin Epidemiol. 2000 May;53(5):459-68
references: 10812317
references: J Health Econ. 2002 Mar;21(2):271-92
references: 11939242
references: Health Econ. 2005 Nov;14(11):1169-89
references: 15942981
references: Med Care. 2004 Sep;42(9):851-9
references: 15319610