title: A Head-to-Head Comparison of the EQ-5D-5L and AQoL-8D Multi-Attribute Utility Instruments in Patients Who Have Previously Undergone Bariatric Surgery.
abstract: Psychosocial health status is an important and dynamic outcome for bariatric/metabolic surgery patients, as acknowledged in recent international standardised outcomes reporting guidelines. Multi-attribute utility-instruments (MAUIs) capture and assess an individual's health-related quality-of-life (HRQoL) within a single valuation, their utility. Neither MAUIs nor utilities were discussed in the guidelines. Many MAUIs (e.g. EQ-5D) target physical health. Not so the AQoL-8D.
  
  
  
  Our objective was to explore agreement between, and suitability of, the EQ-5D-5L and AQoL-8D for assessing health state utility, and to determine whether either MAUI could be preferentially recommended for metabolic/bariatric surgery patients.
  
  
  
  Utilities for post-surgical private-sector patients (n = 33) were assessed using both instruments and summary statistics expressed as mean [standard deviation (SD)] and median [interquartile range (IQR)]. Interchangeability of the MAUIs was assessed with Bland-Altman analysis. Discriminatory attributes were investigated through floor/ceiling effects and dimension-to-dimension comparisons. Spearman's rank measured associations between the instruments' utility values and with the body mass index (BMI).
  
  
  
  Mean (SD) EQ-5D-5L utility value was 0.84 (0.15) and median 0.84 (IQR 0.75-1.00). Mean (SD) AQoL-8D utility value was 0.76 (0.17) and median 0.81 (IQR 0.63-0.88). Spearman's rank was r = 0.68; (p < 0.001); however, Bland-Altman analysis revealed fundamental differences. Neither instrument gave rise to floor effects. A ceiling effect was observed with the EQ-5D-5L, with 36 % of participants obtaining a utility value of 1.00 (perfect health). These same participants obtained a mean utility of 0.87 on the AQoL-8D, primarily driven by the mental-super-dimension score (0.52).
  
  
  
  The AQoL-8D preferentially captures psychosocial aspects of metabolic/bariatric surgery patients' HRQoL. We recommend the AQoL-8D as a preferred MAUI for these patients given their complex physical/psychosocial needs.
authors: Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia.
authors: Julie A
authors: JA
authors: Campbell
authors: Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia.
authors: Andrew J
authors: AJ
authors: Palmer
authors: Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia.
authors: Alison
authors: A
authors: Venn
authors: Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia.
authors: Melanie
authors: M
authors: Sharman
authors: Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia.
authors: Petr
authors: P
authors: Otahal
authors: Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia. Amanda.Neil@utas.edu.au.
authors: Amanda
authors: A
authors: Neil
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011788:Quality of Life; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards*; D016896:Treatment Outcome