The evaluation and health state valuation of the Quality of Well-being Scale in Trinidad and Tobago, West Indies

Aims. Developing countries in the Caribbean face similar resource allocation challenges as do rich countries. Health-related quality of life (HRQL) measures that can assist in allocation of health care resources have not been tested in these countries. Trinidad and Tobago is an advantageous location to test an HRQL measure for potential use in the Caribbean. It has a single payer health care system, a highly literate population, historical and current migration from other islands.;Methods. We evaluated and performed health state valuation of the Quality of Well-being Scale (QWB) data from a probability sample of the non institutionalized general population of Trinidad adults. The survey included self-reports of chronic conditions as well as items from the 1994 Trinidad and Tobago National Health Interview Survey (TT-NHIS). The TT-NHIS items sort information in several areas including, demographic, health care services utilization, access to health care services and cost of health care services. The project had a 96% response rate. The valuation of health states was used to produce weights for health states for Trinidad and Tobago. The weights (US QWB) currently used in the QWB were derived from a probability sample of non-institutionalized adults in San Diego, California. The US QWB weights and Trinidad QWB weights were used separately to score the health status of the sample. Data were analyzed using bivariate methods that included t-tests for continuous variables and chi-square for categorical variables. Control for the effects of covariates on the variable of interest was achieved with multivariable regression models. The response patterns, correlation and difference in mean health status scores between US weights and Trinidad weights were compared.;Results. The evaluation results are consistent with US results. The results were consistent for bivariate and multivariable methods. Being older, female, having more chronic conditions, and more symptoms/problems were significantly associated with lower mean QWB scores. The valuation of the health status were almost perfectly correlated and showed no statistically significant differences with t-tests.;Conclusions. Both developing and developed countries have the similar pressures to use health care resources wisely. Cost-effectiveness analysis may help inform resource allocation decisions. This project suggests that a HRQL measure can be successfully used in Trinidad and Tobago. Health decision makers in Trinidad and Tobago can use the QWB to compare the effects of different health conditions and health interventions. In addition, investigators can make cross-cultural comparisons of QWB scores for diseases or health conditions.