Elicitation of Health-Related Utility in Perianal Fistula in Crohn’s Disease

Longworth, Louise; Fountain, Donna; Singh, Jeshika; Azzabi, Ismail; Owen, G; Lundstam, Ulf; Sebastian, Shaji

doi:10.1007/s40271-018-0352-2

Cited by 6 publications

(17 citation statements)

References 24 publications

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“…Our results concur with findings from previous studies indicating that perianal fistulas have a considerable impact on HRQoL [ 5 ]. Similarly to our study, Longworth et al [ 22 ] used a 10-year time frame to assess TTO utilities for perianal fistulising health states in the UK. In their study, patients and the general public valued sPFCD health state to a mean of 0.38 and 0.43, while mPFCD resulted in a mean of 0.58 and 0.66, respectively.…”

Section: Discussionmentioning

confidence: 96%

“…The differences may be attributable to the different patient populations in terms of disease characteristics and severity as well as to the methodological variations of TTO between the two studies. For instance, the UK study [ 22 ] employed different health state vignettes and allowed to value health states worse than dead.…”

Section: Discussionmentioning

confidence: 99%

“…Utility studies in CD were mostly conducted about 2 decades ago before or in the early era of biological drugs [ 18 – 20 ], often had a low sample size (< 50 patients) [ 18 , 20 , 21 ], concerned only luminal disease but not PFCD [ 19 , 20 ], or suffered from a number of methodological shortcomings [ 21 ]. A very recent study from the UK used both patients and a general population sample to derive utilities for various PFCD health states [ 22 ]. In this study, luminal disease severity was constant for all health states, and the study focused on surgical outcomes of perianal fistulas.…”

Section: Introductionmentioning

confidence: 99%

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Patient and general population values for luminal and perianal fistulising Crohn’s disease health states

et al. 2019

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Background In patients with Crohn’s disease (CD), luminal disease activity paralleled by perianal fistulas may seriously impair health-related quality of life (HRQoL). Health utility values are not available from patients with CD that reflect the health loss associated with both luminal and perianal CD. Objective To generate utilities for luminal and concomitant perianal fistulising CD health states directly from patients and from members of the general public. Methods A cross-sectional survey was undertaken enrolling CD patients and a convenience sample of members of the general population. Respondents were asked to evaluate four common CD heath states [severe luminal disease (sCD), mild luminal disease (mCD), severe luminal disease with active perianal fistulas (sPFCD), and mild luminal disease with active perianal fistulas (mPFCD)] by 10-year time trade-off (TTO). In addition, patients assessed their current HRQoL by the TTO method. Results Responses of 206 patients (40.8% with perianal fistulas) and 221 members of the general population were analysed. Mean ± SD utilities among patients for sPFCD, sCD, mPFCD and mCD states were 0.69 ± 0.33, 0.73 ± 0.31, 0.80 ± 0.29 and 0.87 ± 0.26. Corresponding values in the general public were: 0.59 ± 0.31, 0.65 ± 0.29, 0.80 ± 0.26 and 0.88 ± 0.25. Patients with active perianal fistulas, previous non-resection surgeries, and higher pain intensity scores valued their current health as worse ( p < 0.05). Conclusions TTO is a feasible method to assess HRQoL in patients with perianal fistulising disease, often not captured by health status questionnaires. Utilities from this study are intended to support the optimization of treatment-related decision making in patients with luminal disease paralleled by active perianal fistulas. Electronic supplementary material The online version of this article (10.1007/s10198-019-01065-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patient and general population values for luminal and perianal fistulising Crohn’s disease health states

et al. 2019

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“…In our series, global quality of life, current level of energy, current quality of life, and current quality of health, as measured with CGQL, were significantly lower in patients with CD compared to that of patients with sporadic perianal disease. In a recent British study, low utility values were assigned to the non-remission health states for perianal fistulae in CD by the general public and patients with CD suggesting the high burden of inadequately managed perianal fistula in CD ( 29 ). In our opinion, all these data demonstrate that is the condition of permanence, of never healing, that makes this condition so difficult to bear and the burden on quality of life so heavy.…”

Section: Discussionmentioning

confidence: 99%

Impact on Quality of Life of Seton Placing in Perianal Crohn's Disease

et al. 2022

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IntroductionOften, in perineal Crohn's disease (CD), a seton is placed to guarantee a constant drainage and prevent septic complication while biologic therapy is ongoing. This study aimed to assess the long-term quality of life after surgery for perineal CD in relation to seton placing.Patients and MethodsData of 65 consecutive patients with CD and non-CD operated on from 2014 to 2019 for perianal fistula or abscess were retrieved. Forty-three had CD and 14 of them had a seton placed during surgery and they kept it on while they had anti-TNF-alpha therapy. Patients were interviewed with the Cleveland Global Quality of Life (CGQL) and SF-12 quality of life questionnaires. Disease activity was defined as Harvey-Bradshaw Index (HBI) and Perianal Disease Activity Index (PDAI). Comparisons between groups were carried out with the nonparametric tests, and multiple regression models were used to assess predictors of quality of life.ResultsThe total CGQL score and SF-12 mental component score (MCS) were significantly higher (and thus better) in the seton group than in patients treated without seton. On the contrary, SF-12 physical component score (PCS) was not different between the two groups. HBI was significantly better in patients in the seton group. At multivariate analysis, seton placement and HBI were confirmed to be independent predictors of long-term SF-12 MCS whereas only HBI confirmed to be a predictor of total CGQL score.ConclusionsSeton placing during anti-TNF-alpha therapy is independently associated with a better MCS. Unexpectedly, this device, instead of to cause psychological distress, seems to assure patients during their biologic therapy providing psychological benefit beyond the mere medical effect.

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“…Comparatively, patients may provide preferences that are similarly valid in both online and F2F data collection because they may be more motivated and have greater insight into/experience with suboptimal health states, i.e., informedness. Longworth et al used the cTTO to elicit preferences for Crohn's disease outcomes from patients and general population respondents drawn from online panels [26]. Following exclusion of logically inconsistent results, the authors found that both the general population and patients provided valid utility values.…”

Section: Discussionmentioning

confidence: 99%

Comparison of online and face-to-face valuation of the EQ-5D-5L using composite time trade-off

et al. 2020

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Objective The aim of this study was to compare online, unsupervised and face-to-face (F2F), supervised valuation of EQ-5D-5L health states using composite time trade-off (cTTO) tasks. Methods The official EuroQol experimental design and valuation protocol for the EQ-5D-5L of 86 health states were implemented in interviewer-assisted, F2F and unsupervised, online studies. Validity of preferences was assessed using prevalence of inconsistent valuations and expected patterns of TTO values. Respondent task engagement was measured using number of trade-offs and time per task. Trading patterns such as better-than-dead only was compared between modes. Value sets were generated using linear regression with a random intercept (RILR). Value set characteristics such as range of scale and dimension ranking were evaluated between modes. Results Five hundred one online and 1,134 F2F respondents completed the surveys. Mean elicited TTO values were higher online than F2F when compared by health state severity. Compared to F2F, a larger proportion of online respondents did not assign the poorest EQ-5D-5L health state (i.e., 55555) the lowest TTO value ([Online] 41.3% [F2F] 12.2%) (p < 0.001). A higher percentage of online cTTO tasks were completed in 3 trade-offs or fewer ([Online] 15.8% [F2F] 3.7%), (p < 0.001). When modeled using the RILR, the F2F range of scale was larger than online ([Online] 0.600 [F2F] 1.307) and the respective dimension rankings differed. Conclusions Compared to F2F data, TTO tasks conducted online had more inconsistencies and decreased engagement, which contributed to compromised data quality. This study illustrates the challenges of conducting online valuation studies using the TTO approach.

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Elicitation of Health-Related Utility in Perianal Fistula in Crohn’s Disease

Cited by 6 publications

References 24 publications

Patient and general population values for luminal and perianal fistulising Crohn’s disease health states

Patient and general population values for luminal and perianal fistulising Crohn’s disease health states

Impact on Quality of Life of Seton Placing in Perianal Crohn's Disease

Comparison of online and face-to-face valuation of the EQ-5D-5L using composite time trade-off

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