Health-related quality of life and utility in patients receiving biological and non-biological treatments in rheumatoid arthritis

Abstract

Biological treatments earn increasing significance in the treatment of rheumatoid arthritis (RA) but are associated with high incremental cost-effectiveness ratio compared to conventional antirheumatic treatments such as disease-modifying antirheumatic drugs. As the most important objective of medical technologies should be to increase life years and/or patients' health-related quality of life (HRQoL), measuring QoL and utility in RA patients treated with biological therapies is crucial. The objective of this study is to compare the utility and QoL of patients treated with biological (n = 85) and non-biological (n = 168) antirheumatic drugs in Hungary in a cross-sectional non-interventional study. A measure of impairment (Disease Activity Score (DAS)-28), QoL measure (EuroQol five Dimension (EQ-5D) Visual Analogue Scale (VAS), Rheumatoid Arthritis Quality of Life (RAQoL)) and utility measures (indirect: EQ-5D index, direct: time trade-off (TTO)) were applied using an interview method. The Pearson correlation was used to assess the strength of the relationship of different measures in the total study group (n = 253). The EQ-5D index (biological treatment: 0.608, non-biological treatment: 0.483; P = 0.012) and DAS-28 (biological treatment: 3.8, non-biological treatment: 4.5; P = 0.003) showed statistically significant difference between the two subcohorts after adjusting data by age, gender and disease duration. Our results indicate that patients on biological treatment have lower disease activity and higher utility; however, it was not statistically significant in all cases. According to our knowledge, TTO was not used previously in Hungarian RA patients. Utility data concerning biological treatments are essential for cost-utility models in health technology assessment reports for public reimbursement.

Measures of functional status and quality of life in rheumatoid arthritis: Health Assessment Questionnaire Disability Index (HAQ), Modified Health Assessment Questionnaire (MHAQ), Multidimensional Health Assessment Questionnaire (MDHAQ), Health Assessment Questionnaire II (HAQ‐II), Improved Health Assessment Questionnaire (Improved HAQ), and Rheumatoid Arthritis Quality of Life (RAQoL)

“…Correlation with domains of the Nottingham Health Profile (NHP) shows strong relationships between RAQ O L and physical mobility, energy level, and pain (6). The RAQ O L also demonstrates correlations with the Disease Activity Score (r = 0.41–0.82), pain (r = 0.48–0.86), Health Assessment Questionnaire (HAQ) (r = 0.73–0.86), patient global (r = 0.62–0.82), fatigue (r = 0.78), swollen and tender joint count (r = 0.53), modified Sharp score (r = 0.38) and physician global (r = 0.36) (16, 22, 68–70).…”

“…RAQ O L scores correlate with other measures of quality of life in RA cohorts including a rating scale utility (r = −0.63) and EuroQol 5‐domain (EQ‐5D) (r = −0.62 to −0.76) (6, 22, 68, 69).…”

A magyar lakosság egészségi állapota 2000 és 2010 között

“…Különböző betegségekben végzett hazai keresztmetszeti kérdőíves vizsgálatokban többször alkalmazásra került az EQ-5D kérdőív a betegek egészségi állapotának felmérésére, mint például a psoriasis [3,4,5,6], rheumatoid arthritis [7,8,9,10], jóindulatú prosztatamegnagyobbodás [11], epilepszia [12], perifériás artériás obliteratív érbetegség [13], sclerosis multiplex [14], hiperaktív hólyag szindróma [15], szkizofrénia [16], kró-nikus obstruktív tüdőbetegség (COPD) [17,18], demencia [19], Parkinson-kór [20,21,22], arthritis psoriatica [5,23], asztma [17,24] és 2-es típusú cukorbetegség [25] esetében.…”

“…A szakaszok az átlag körüli 95%-os konfi denciaintervallumot jelzik egészségi állapot között (F (9,1962) = 5,17, p<0,001). Az összefüggést a 2. ábra szemlélteti.…”

Preferences of heart failure patients in daily clinical practice: quality of life or longevity?

“…The utility approach is patient‐centred and determines patient preferences. Utility values are often generated using the time trade‐off (TTO) approach –. The more preferable an outcome is to a patient, the more utility is awarded to this particular outcome .…”