How do Zimbabweans value health states?
How do Zimbabweans value health states?
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DOI：
10.1186/1478-7954-1-11
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发表时间：
2003-12-16
影响因子：
3.3
通讯作者：
Kind, Paul
中科院分区：
文献类型：
--
作者：
Jelsma, Jennifer;Hansen, Kristian;Kind, Paul
背景：基于健康状态评估的生活质量权重常用于成本效用分析和人群健康测量。本文报告试图在津巴布韦的范围内发展生活质量的权重。方法：在哈拉雷高密度郊区随机选择的小住宅区的2，384名居民根据EQ-5D的五个领域（移动性、自我护理、日常活动、疼痛或不适以及焦虑或抑郁）的不同组合评估了38种健康状态的描述符。使用了EQ-5D的英文版。使用时间权衡方法来确定这些值，并分析了19，020个个人对健康状况的偏好。使用残差最大似然线性混合模型来估计用于预测五个域上的所有可能水平组合的值的函数。该模型与三分之二观察结果的随机子集拟合，其余观察结果保留用于预测有效性分析。研究结果与在英国进行的一项类似研究进行了比较。结果：开发了一个可靠的模型来预测未直接评估的状态值。在保留用于验证的观察子集中，预测值和观察值之间的平均绝对差为0.045。发现EQ-5D的所有领域对模型均有显著贡献，无论是中度还是重度水平。严重疼痛的负系数最大，其次是不能自己洗澡和穿衣。结论：尽管普遍较低的教育水平比他们的欧洲同行，城市津巴布韦人似乎重视健康状态的一致的方式，并确定一个全球性的方法来建立生活质量的权重可能是可行的和有效的。然而，由于不同领域的相对权重虽然相互关联，但与欧洲生活质量小组建议的一套标准权重不同，因此应在津巴布韦的情况下使用当地确定的系数。
BACKGROUND: Quality of life weights based on valuations of health states are often used in cost utility analysis and population health measures. This paper reports on an attempt to develop quality of life weights within the Zimbabwe context. METHODS: 2,384 residents in randomly selected small residential plots of land in a high-density suburb of Harare valued descriptors of 38 health states based on different combinations of the five domains of the EQ-5D (mobility, self-care, usual activities, pain or discomfort and anxiety or depression). The English version of the EQ-5D was used. The time trade-off method was used to determine the values, and 19,020 individual preferences for health states were analysed. A residual maximum likelihood linear mixed model was used to estimate a function for predicting the values of all possible combinations of levels on the five domains. The model was fit to a random subset of two-thirds of the observations, with the remaining observations reserved for analysis of predictive validity. The results were compared to a similar study undertaken in the United Kingdom. RESULTS: A credible model was developed to predict the values of states that were not valued directly. In the subset of observations reserved for validation, the mean absolute difference between predicted and observed values was 0.045. All domains of the EQ-5D were found to contribute significantly to the model, both at the moderate and severe levels. Severe pain was found to have the largest negative coefficient, followed by the inability to wash and dress oneself. CONCLUSION: Despite a generally lower education level than their European counterparts, urban Zimbabweans appear to value health states in a consistent manner, and the determination of a global method of establishing quality of life weights may be feasible and valid. However, as the relative weightings of the different domains, although correlated, differed from the standard set of weights recommended by the EuroQol Group, the locally determined coefficients should be used within the Zimbabwean context.