title: Does diabetes have an impact on health-state utility? a study of Asians in Singapore.
abstract: OBJECTIVE
  Our objective was to compare the time trade-off (TTO) values of EQ-5D-3L health states elicited from Singaporeans with and without type 2 diabetes mellitus (T2DM) and T2DM patients with and without complications.
  
  
  METHODS
  The TTO values of ten EQ-5D-3L health states were elicited from a consecutive sample of T2DM patients and a general Singaporean population sample using similar valuation protocols. In face-to-face interviews, T2DM patients and members of the general population were asked to value five and ten health states, respectively. The difference in TTO values between the two samples and between T2DM patients with and without complications was examined using multiple linear regression models.
  
  
  RESULTS
  A total of 109 T2DM patients and 46 individuals without T2DM provided data. All ten health states considered, the mean TTO value was -0.02 for the general population sample and -0.04 for T2DM patients, with the unadjusted and adjusted difference being -0.06 (95 % confidence interval [CI] -0.16, 0.03) and 0.02 (95 % CI -0.12, 0.15). The general population sample had systematically lower TTO values for mild health states, with the adjusted difference being -0.13 (95 % CI -0.25, -0.02); while the two samples had similar TTO values for severe health states, with the adjusted difference being 0.02 (95 % CI -0.16, 0.19). T2DM patients without complications had systematically lower TTO values than those with complications, with the adjusted difference being -0.10 (95 % CI -0.23, 0.03).
  
  
  CONCLUSIONS
  It appears that diabetes and its complications affect patients' valuation of health states. Hence, the EQ-5D-3L health-state values based on the general population may underestimate the utility of health interventions for T2DM.
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, 16 Medical Drive, Block MD3, Singapore, 117597, Singapore.
authors.forename: P
authors.initials: P
authors.lastname: Wang
authors.forename: E S
authors.initials: ES
authors.lastname: Tai
authors.forename: J
authors.initials: J
authors.lastname: Thumboo
authors.forename: Hubertus J M
authors.initials: HJ
authors.lastname: Vrijhoef
authors.forename: Nan
authors.initials: N
authors.lastname: Luo
mesh_terms: D000328:Adult; D044466:Asian People / Q000523:psychology*; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000523:psychology*; D004522:Educational Status; D005260:Female; D006442:Glycated Hemoglobin; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012846:Singapore; D011795:Surveys and Questionnaires
chemical_list: D006442:Glycated Hemoglobin
references.citation: Health Econ. 2000 Mar;9(2):127-36
references.pmid: 10721014
references.citation: Qual Life Res. 2005 Aug;14(6):1523-32
references.pmid: 16110932
references.citation: Med Care. 1984 Jun;22(6):543-52
references.pmid: 6738144
references.citation: Pharmacoeconomics. 1998 Jun;13(6):687-96
references.pmid: 10179704
references.citation: Med Decis Making. 1995 Jul-Sep;15(3):201-8
references.pmid: 7564933
references.citation: Pharmacoeconomics. 2014 May;32(5):495-507
references.pmid: 24519603
references.citation: Eur J Health Econ. 2013 Aug;14(4):697-702
references.pmid: 22941035
references.citation: Med Decis Making. 1990 Jan-Mar;10(1):58-67
references.pmid: 2182963
references.citation: Med Care. 1986 Nov;24(11):973-80
references.pmid: 3773579
references.citation: Value Health. 2010 Mar-Apr;13(2):306-9
references.pmid: 19744288
references.citation: J Health Econ. 1996 Apr;15(2):209-31
references.pmid: 10159110
references.citation: Health Econ. 1999 Sep;8(6):541-5
references.pmid: 10544319
references.citation: Med Care. 1997 Nov;35(11):1095-108
references.pmid: 9366889
references.citation: Int J Technol Assess Health Care. 2005 Fall;21(4):511-6
references.pmid: 16262976
references.citation: Eur J Health Econ. 2013 Jul;14 Suppl 1:S53-64
references.pmid: 23900665
references.citation: J Rheumatol. 2001 Mar;28(3):648-56
references.pmid: 11296976
references.citation: Am J Rhinol Allergy. 2011 May-Jun;25(3):99-106
references.pmid: 21679520
references.citation: Health Econ. 2007 Apr;16(4):395-405
references.pmid: 17006963
references.citation: Intensive Care Med. 1996 Dec;22(12):1379-84
references.pmid: 8986489
references.citation: Value Health. 2007 Jul-Aug;10(4):266-72
references.pmid: 17645681
references.citation: Pharmacoeconomics. 1999 Feb;15(2):119-27
references.pmid: 10351186
references.citation: Med Decis Making. 1999 Oct-Dec;19(4):482-6
references.pmid: 10520686
references.citation: Med Care. 1999 May;37(5):479-89
references.pmid: 10335750
references.citation: J Clin Epidemiol. 2006 Jul;59(7):653-64
references.pmid: 16765267
references.citation: Health Econ. 2009 Mar;18(3):363-72
references.pmid: 18702081
references.citation: Appl Health Econ Health Policy. 2005;4(4):201-8
references.pmid: 16466271
references.citation: Jpn J Ophthalmol. 2011 May;55(3):268-276
references.pmid: 21523376
references.citation: Health Econ. 2000 Mar;9(2):109-26
references.pmid: 10721013
references.citation: J Clin Epidemiol. 1989;42(5):459-71
references.pmid: 2732774
references.citation: Health Expect. 2012 Dec;15(4):367-78
references.pmid: 21366809
references.citation: Med Care. 2005 Feb;43(2):173-81
references.pmid: 15655431
references.citation: Med Decis Making. 2010 Jul-Aug;30(4):E57-63
references.pmid: 20511562
references.citation: Qual Life Res. 2003 Sep;12(6):599-607
references.pmid: 14516169
references.citation: Health Qual Life Outcomes. 2011 May 11;9:31
references.pmid: 21569351
references.citation: Med Decis Making. 1999 Jul-Sep;19(3):344-52
references.pmid: 10424841