Health-related quality of life in patients with uveitis

Abstract

Background/aimsTo measure health-related quality of life (HRQOL) in patients with uveitis using time trade-off (TTO) and standard gamble (SG) methods of direct utility analysis.MethodsConsecutive patients attending a tertiary referral uveitis clinic were administered standardised, interview-delivered TTO and SG questionnaires and completed the European Quality of Life Five Dimensions Five Level (EQ5D-5L) questionnaire. Clinical data recorded included best-corrected visual acuity, uveitis anatomical and clinical classifications, duration since diagnosis, disease activity, current medication and any ocular or systemic comorbidities.ResultsTwo hundred patients with uveitis (124 female, 76 male, median age 54 years) were included. Overall mean TTO utility was 0.831 (95% CI 0.802 to 0.860); mean SG utility was 0.868 (95% CI 0.840 to 0.896) and mean EQ5D-5L utility was 0.742 (95% CI 0.702 to 0.782). There was a negative correlation between visual acuity and mean HRQOL (6/12 or better: TTO 0.86, SG 0.893; 6/15–6/60: TTO 0.662, SG 0.742; worse than 6/60: TTO 0.608, SG 0.712). Poor vision in the better- seeing eye (p=0.004), bilateral disease (p=0.047) and concurrent glaucomatous optic neuropathy (p=0.005) were predictors of poor TTO HRQOL. No correlation was found between HRQOL and duration of diagnosis, a flare of uveitis or being on systemic therapy. Patients with uveitis with poor vision have a TTO value worse than patients with end-stage renal failure on haemodialysis or those with AIDS.ConclusionLoss of vision resulting from uveitis is associated with reduced HRQOL. The TTO and SG utility values appear directly dependent on the degree of vision loss and not on the duration of disease or systemic medications.

Creating a Health Utility Value for Birdshot Chorioretinopathy

“…The mean value for SG was higher (0.94) than for TTO (0.9). A previous study also reported SG values higher than TTO values in patients with uveitis 13 and this has been attributed to inherent biases that differ in SG and TTO. 17,18 Yet it may also reflect that despite being worried about their condition patients would prefer to continue with their present level of visual function rather than risk any chance of immediate death.…”

“…The 0.3 cutoff was chosen as this was used in a previous article on TTO and SG in uveitis. 13 The causes for visual acuities worse than 0.3 in any eye were CME (n = 4), foveal atrophy (n = 2), . No anterior chamber cells were seen in any eye, all intraocular pressures were normal, a degree of cataract was documented in 11 eyes and 8 eyes were pseudophakic.…”

“…There have been two previous studies looking at direct health utilities in patients with uveitis 13,14 and they both found a reduction of TTO in their patient cohorts. The methodology of these studies differed as one used a 10-year horizon, i.e.…”

“…patients were asked to choose between x years with healthy eyes and 10 years in their current state of eye health, 14 and the other used the same methodology as this study. 13 There is debate as to the most appropriate TTO methodology to use. 19 In their series of 200 uveitis patients Shamdas et al reported a mean TTO value of 0.831 (lower than this study) and showed that the worse the visual acuity in the better-seeing eye the lower the TTO value.…”

“…There have been two recent publications reporting TTO in uveitis patients and both have shown a reduction in HRQOL, but only a small number of patients with BCR were included. 13,14 We wished to create a direct health utility for BCR using TTO and SG. This may provide additional information on how the disease globally affects their HRQOL and as a consequence could lead to a change in the way these patients are assessed and the care they receive.…”