Comparison Between The EQ-5D-3L And The EQ-5D-5L In Patients With Acne

BackgroundAs an important method or research tool of health economics,health economics evaluation can rationally and effectively allocate medical and health resources to meet the people's health needs under a limited budget.Health economics evaluation includes four evaluation methods,namely cost-benefit analysis,cost-effectiveness analysis,cost-utility analysis and minimum cost analysis.Compared with the other three methods,the cost-utility analysis takes into account the results of the quantity and quality of life,and fully evaluates the patient's objective health improvement and subjective feelings.The outcome indicator is quality-adjusted life years(QALY).The real difficulty is the acquisition of the quality of life weight in QALY,which is health utility value measurement.The measurement methods of health utility values mainly include direct measurement and indirect measurement.The direct measurement method refers to obtaining the subject's utility value through an intuitive method using a measurement tool.The indirect measurement method mainly uses the multi attribute utility(MAU)instrument to measure the utility value.Indirect measurement is simpler and more convenient than direct measurement methods.At present,the QWB,15D,EQ-5D,HUI,SF-6D and AQoL are commonly used internationally to indirectly measure utility values.The EQ-5D instrument is the most widely used in the world.The EQ-5D instrument was developed by the EuroQoL Group in the 1980s.it consists of a descriptive system and a visual analog scale.The descriptive system includes five dimensions:mobility,self-care,usual activities,pain/discomfort,and anxiety/depression.In 2009,the EQ-5D-5L was developed with each dimension expanded from the original 3 levels to 5 levels.Acne is a common and chronic inflammatory skin disease that affects the sebaceous follicles.Acne are prone to recurrent episodes.In addition to causing pruritus and pain in the body,as well as more serious systemic infections and skin cancers,skin pigmentation or scarring is also very likely to occur,affecting looks and appearance.Acne can seriously affect the mental,psychological and emotional health of patients,thereby affecting the health-related quality of life of patients.There are many studies using EQ-5D instrument in dermatology internationally,which mainly focused on psoriasis.The application of the EQ-5D instrument started late in China,so the current empirical research is not too many,and Mainly concentrated in the field of chronic diseases,the relevant research for acne patients is still in a blank state.In addition,since the official publication of EQ-5D-5L instrument,a number of empirical studies comparing 3L and 5L have been carried out internationally.However,there are relatively few studies on this type of research in mainland China.There are only four related studies.Therefore,there is no comparison between the 3L and 5L based on acne patients.Therefore,this study intends to use the EQ-5D-3L and EQ-5D-5L instruments to measure the health utility value of acne patients to compare the differences between the two,to fill the blank of EQ-5D scale applied to acne patients in Mainland China and empirical studies comparing 3L and 5L based on acne patients at home and abroad,and providing relevant evidence and reference for choosing a more appropriate EQ-5D instrument and the health-related quality of life measurement.Objective(1)Use the EQ-5D-3L and EQ-5D-5L to measure the health utility value of acne patients.(2)To explore the differences between the two instruments in terms of agreement,ceiling effect,redistribution,information discriminating power,convergent validity,and known-group validity.(3)Based on evaluation and comparison of EQ-5D-3L and 5L instruments for acne patients,to fill gaps at home and abroad,to find EQ-5D measurement tools that are more appropriate for acne patients in China,to provide methodological references and basic data support for cost-utility analysis of acne patients' clinical treatment in the future,and to provide references for better application of the EQ-5D in China.MethodsThis study conducted a questionnaire survey of patients with acne outpatients who first visited the Department of Dermatology,Qilu Hospital of Shandong University from March 2017 to March 2018.The questionnaire consists of five parts:First,the individual information;Second,the EQ-5D-3L and 5L instruments;Third,the quality of life instruments,such as Dermatology Life Quality Index(DLQI),Cardiff Acne Disability Index(CADI);fourth is the Global Acne Grading System(GAGS)(this part is filled out by doctor);fifth is a instrument to measure a patient's well-being,the WHO(Five)Well-being Index(WHO-5).Professionals should give guidance to dermatologists.The fourth part of questionnaire is filled in by the doctor.The rest of the questionnaires are filled in by the patients themselves and finally submitted to a dermatologist for inspection to integrity and authenticity of the survey results.Before each patient formally completed the questionnaire,each respondent should read the informed consent form and signed the informed consent form with the consent.The analysis methods mainly include:1.Descriptive analysis(statistical indicators such as mean and standard deviation);2.Non-parametric test,including Mann-Whitney U test,Kruskal-Wallis H test,Wilcoxon test and McNemar test;3.Comparison between EQ-5D-3L and EQ-5D-5L,including agreement,ceiling effect,redistribution,informativity,convergent validity and known-group validity.ResultsIn this study,a total of 698 acne patients attending dermatology clinics were investigated.Among them,59 questionnaires were excluded in the analysis because they did not meet the conditions for inclusion or were not completely filled out.Therefore,639 valid questionnaires were finally included in the analysis.Among the sample population,the average age was 22.4±4.3 years;the proportion of women was higher,accounting for 66.7%;in terms of geographical distribution,more than one-quarter(29.7%)of the respondents were from rural areas;the education overall level of the sample population was on the high side,more than half(57.9%)of the surveyed respondents have an undergraduate degree or above,and junior high school and below only 6.7%of the sample;more than three-fifths of the students are investigated.The highest proportion of unmarried people was 87.6%.The average disease duration was 1.9±2.9 years;the severity of patients showed that the proportion of mild patients(Grade I)was the highest,accounting for 77.3%;the DLQI scores ranged from 0 to 29 points and the average score was 6.9±5.0 points.CADI of acne patients ranged from 0 to 15 points,and the average score was 5.7±2.9 points;the average score of the WHO-5 was 15.8 points,with standard deviation of 4.9 points.The average utility value of the 639 acne patients measured on the EQ-5D-3L was 0.953±0.082(95%CI 0.946 to 0.959).The average utility value of 639 acne patients was measured with the EQ-5D-5L.It was 0.957±0.068(95%confidence interval 0.952 to 0.962).The intra-class correlation coefficient between the two is 0.735,which is greater than 0.7,with high agreement;B-A graph shows that the 95%limits of agreement is-0.13?0.14.The proportion of patients with acne who chose complete health(11111)on the 3L and 5L was 70.7%and 55.1%,respectively.The ceiling effect of 5L decreased most in the anxiety/depression dimension by 20.9%,P<0.001,with statistical significance;the ceiling effect of the pain/discomfort dimension also decreased more(9.9%,P<0.001).Most acne sufferers did not choose severe difficulty or extremely severe difficulties in all dimensions of the 3L and 5L.Only a few patients chose extremes level in the 'pain or discomfort' and 'anxiety/depression' dimensions.After the EQ-5D-3L was redistributed to the 5L,the overall disagreement rate was 2.3%,and the discordance rates of the ' anxiety/depression' and 'pain/uncomfortable'dimensions were higher,being 6.9%and 4.5%,respectively.Among 639 patients with acne,the absolute information Shannon index(H')obtained from the EQ-5D-5L was higher than the EQ-5D-3L.For the relative information Shannon evenness index(J'),the "mobility" and "pain/uncomfortable"dimensions of the 5L were slightly lower than the 3L,and the remaining dimensions were both slightly higher than the 3L for the EQ-5D-5L.Spearman rank correlation analysis showed that the values of health utility of the patients measured by the EQ-5D-3L and the DLQI,CADI,GAGS,and WHO-5 were-0.351,-0.378,-0.205,0.293 respectively,and P<0.001.The r value of the health utility value measured by the EQ-5D-5L scale and the DLQI,CADI,GAGS,and WHO-5 were-0.355,-0.347,-0.186,and 0.299 respectively,and P<0.001 The Tobit model was used for regression analysis.The results showed that the utility values of acne patients measured by the EQ-5D-3L and EQ-5D-5L were the DLQI,CADI,GAGS,and WHO-5 were all statistically significant.ConclusionWhen the EQ-5D was expanded from the original three levels to the five levels,although the 5L still had ceiling effect,it was significantly lower than the 3L;the EQ-5D-3L and the 5L had good agreement,but they cannot be interchanged.The EQ-5D-5L has better discriminative power;the inconsistency between the 3L and 5L is also lower.In addition,the EQ-5D-5L was superior to the 3L in terms of both convergent validity and known-group validity.Therefore,when selecting the EQ-5D instrument for related research,the EQ-5D-5L should be given priority.