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https://hdl.handle.net/2440/133685
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Type: | Journal article |
Title: | Validation of a novel diabetic retinopathy utility index using discrete choice experiments |
Author: | Fenwick, E.K. Bansback, N. Gan, A.T.L. Ratcliffe, J. Burgess, L. Wong, T.Y. Lamoureux, E.L. |
Citation: | British Journal of Ophthalmology, 2019; 104(2):188-193 |
Publisher: | BMJ Journals |
Issue Date: | 2019 |
ISSN: | 0007-1161 1468-2079 |
Statement of Responsibility: | Eva K Fenwick, Nick Bansback, Alfred Tau Liang Gan, Julie Ratcliffe, Leonie Burgess, Tien Yin Wong, Ecosse Luc Lamoureux |
Abstract: | Background/aims To validate a preference-based Diabetic Retinopathy Utility Index (DRU-I) using discrete choice experiment (DCE) methods and assess disutilities associated with vision-threatening DR (VTDR: severe non-proliferative DR, proliferative DR and clinically significant macular oedema) and associated vision impairment. Methods The DRU-I comprises five quality-of-life dimensions, including Visual symptoms, Activity limitation/mobility, Lighting and glare, Socio-emotional well-being and Inconvenience, each rated as no, some, or a lot of difficulty. The DRU-I was developed using a DCE comprising six blocks of nine choice sets which, alongside the EuroQoL-5D (EQ-5D-3L) and Vision and Quality of Life (VisQoL) utility instruments, were interviewer-administered to participants. To ensure the DRU-I was sensitive to severe disease, we oversampled patients with VTDR. Data were analysed using conditional logit regression. Results Of the 220 participants (mean +/-SD age 60.1+/-11.3 years; 70.9% men), 57 (29.1%) and 139 (70.9%) had non-VTDR and VTDR, respectively, while 157 (71.4%), 20 (9.4%) and 37 (17.3%) had no, mild or moderate/severe vision impairment, respectively. Regression coefficients for all dimensions were ordered as expected, with worsening levels in each dimension being less preferred (theoretical validity). DRU-I utilities decreased as DR severity (non-VTDR=0.87; VTDR=0.80; p=0.021) and better eye vision impairment (none=0.84; mild=0.78; moderate/severe=0.72; p=0.012) increased. DRU-I utilities had low (r=0.39) and moderate (r=0.58) correlation with EQ-5D and VisQoL utilities, respectively (convergent validity). Discussion The DRU-I can estimate utilities associated with vision-threatening DR and associated vision impairment. It has the potential to assess the cost effectiveness of DR interventions from a patient perspective and inform policies on resource allocation relating to DR. |
Keywords: | Humans Vision Disorders Diabetic Retinopathy Activities of Daily Living Severity of Illness Index Logistic Models Cross-Sectional Studies Health Status Cost of Illness Quality of Life Adult Aged Middle Aged Female Male Surveys and Questionnaires Outcome Assessment, Health Care |
Rights: | © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. |
DOI: | 10.1136/bjophthalmol-2019-313899 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/1072987 http://purl.org/au-research/grants/nhmrc/1045280 |
Published version: | http://dx.doi.org/10.1136/bjophthalmol-2019-313899 |
Appears in Collections: | Public Health publications |
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