Comparison Of Health Utility Measurement Methods And Quality Of Life Evaluation In Myopia Surgery Patients

BackgroundAs of 2016.approximately 1.4 billion people worldwide suffer from myopia.The incidence rate in East Asia is about twice that of Europe and the United States.At present,the incidence of myopia in urban adolescents in China has reached 78.4%,and the incidence of myopia in college students is as high as 95.5%.Myopia not only affects people’s health,but also causes a serious social and economic burden.As an important part of national healthcare decision-making,health economic evaluation plays an increasingly important role.The effective measurement of health-related quality of life(HRQOL)and health utility value are the key and basis for the evaluation of health economics and HTA,which directly affects its application in decision-making.There are many methods for measuring health utility value,which can be divided into two categories:direct measurement and indirect measurement,Standard game method(SG)and time trade-off method(TTO)are more commonly used in direct measurement methods.The indirect measurement method is mainly based on multi-attribute effect meter(MAU),and MAU is more easily understood by the interviewee.The score system can be converted into utility value,has more advantages in measuring health utility,and is widely used in the world.There are six major adult MAU scales(QWB.15D,EQ-5D,HUI,SF-6D and AQoL).At present,there are many studies on the direct and indirect measurement methods used in the field of ophthalmology in the world.There are few related researches in the country,and the selection and application of different measurement methods lack uniform standards.ObjectivesThis study uses different methods to carry out the measurement of the health utility value of myopia in China,and combines the quality of life assessment,to explore the best measurement method for the value of myopia health utility,and provide effective methodological reference and data support for myopia hygienic economic evaluation.At the same time,analyze the health status and influencing factors of the population and provide basic data support for related research.1.Using direct measurement(TTO,SG)and indirect measurement(AQoL-7D scale)to measure the value of health utility in myopic patients in China;to explore the main influencing factors in the health utility value of affected patients.2.To compare the consistency of the measurement results of the three measurement tools,and 3 tools compare with the visual quality of life scale VFQ-25,to find the health utility value measurement method suitable for the Myopia surgery patients in China.3.Use the visual quality of life(NEI-VFQ-25)to measure the Myopia surgery patients ’ quality of life.The main factors affecting the health-related quality of life in Chinese Myopia surgery patients were analyzed.MethodsSources of this study include literature collection and on-site questionnaire surveys.From October 2014 to March 2016,a questionnaire survey was conducted on 500 myopia patients who were identified as undergoing LASIK laser in situ keratomileusis surgery at an eye hospital in Shandong Province,to collect demographic information and clinical information of the sample population.The health utility values of patients were measured by three measurement methods:TTO,SG,and AQoL-7D.The NEI-VFQ-25 visual function scale was used to measure the health-related quality of life of myopic patients.The AQoL-7D scale has been authorized to use by the corresponding R&D institutions.The design of the TTO and SG problems is based on relevant international literature and is designed in accordance with the characteristics of myopia in China.Finally,with the informed consent of the respondents,the survey was completed by professionally trained investigators.The main analysis methods include:(1)Descriptive analysis and non-parametric rank sum test;(2)Intragroup correlation coefficient(ICC),Spearman correlation coefficient,and Bland-Altman plot method;(3)Ordered multi-classified logistic regression analysis,Two independent sample t tests;(4)Exploratory factor analysis(EFA).Main Results1.Basic conditions of the sample population.Among the 500 respondents,477 respondents who completed the questionnaire were included in the analysis,accounting for 95.4%of the surveyed population.The average age of the sample population is 25.2± 6.0 years,and the ratio of men and women is basically the same.The student population accounts for about 35.4%of the total sample,and those with a bachelor degree or above exceed 50%of the total sample.In terms of place of residence,nearly a quarter of the sample population is from rural areas,and the remaining patients are all’from city areas.2.Health effects and influencing factors of sample population.In this study,TTO,SG and AQoL-7D scales were used to measure the utility values of the sample population.The average health utility values of the three methods were 0.95,0.95,and 0.80,respectively.SG measured the health utility value of respondents in different gender,age,occupation,and educational level of different subgroups was statistically significant(P<0.05);male group utility mean 0.94 ± 0.10,women’s utility value The mean value was 0.96±0.10.In terms of age,the utility value of people over 25 years old was 0.97 ±0.11,and that of persons under 25 was 0.93 ±0.07.In the occupational classification,the utility level of students was relatively low.There was no statistically significant difference between the TTO groups.The utility value of the indirect measurement method AQoL-7D was statistically significant among the subgroups of education level and disease severity(P<0.05).The measured health utility value was significantly lower than the direct measurement method TTO,SG.The resulting utility value decreases as the severity of the disease increases,and as the degree of education continues to increase.3.Comparison of TTO,SG and AQoL-7D meter utility measurement methods.A comparison of the three utility measurement methods of the TTO,SG,and AQoL-7D scales revealed that the SG and TTO had relatively severe ceiling effects(20.5%,7.5%),and the AQoL-7D efficacy meter did not exhibit a significant ceiling effect.The correlation coefficient among the three methods was 0.08,and there have no consistency in the overall group.The analysis of Spearman correlation coefficients for TTO,SG,AQoL-7D,and VFQ showed that the correlation between AQoL-7D and VFQ was high,the correlation coefficient was 0.51,the Spearman correlation coefficient between TTO and SG was 0.21,and there was a low level of correlation.There is no obvious correlation between the other groups.The exploratory factor analysis of AQoL-7D and VFQ shows that there is a significant difference in the composition of the five common factors and the crossover is small.However,there are similarities in the composition of different factor dimensions,and there are overlaps between the factors in the scale,which makes the two scales have a certain degree of substitutability.4.Comparison of measurements in each dimension of the AQoL-7D scale.The score of AQoL-7D relationship dimension was the highest,the average score was 0.94±0.13,the independent life,visual dimension was 0.93±0.11,0.93 ±0.09,and the mental health dimension score was the lowest,about 0.80 ±0.19.AQoL-7D has higher correlation among dimensions,and the correlation between mental health dimension and sensory dimension is the highest,and the correlation coefficient is 0.52.5.Vision-related quality of life in myopic eyes measured on the VFQ-25 scale.The average score of quality of life measured by sample population was 82.70 ±11.82 points.Ordered multi-category Logistic regression analysis showed that among the factors affecting quality of life,education,surgical reasons,and myopia were statistically significant.Comparing with the international results of the same type of data,the results show that there are differences in Chinese and foreign life quality scores under various dimensions.ConclusionsAmong the three health utility measurement methods,the scores of SG and TTO were significantly higher than those of indirect measurement method AQoL-7D,and the ceiling effect was obvious.AQoL-7D had no obvious ceiling effect.The consistency test showed that there was no consistency among the three scales.In the correlation analysis of different scales,the correlation between AQoL-7D and VFQ-25 ophthalmic disease scales was relatively high.Further exploratory factor analysis showed that there are certain similarities between the different factor dimensions,and the factor loads partially overlap.There is substitutability between the scales and at the same time,combined with the international research status,it is recommended that the measurement of the health utility value of myopia be based on the AQoL-7D scale.The main influencing factors of the health effects of the sample population include gender,age,education,and myopia.AQoL-7D has achieved a good measurement effect in terms of mental health,with a lower score in the health dimension of mental dimensions.The average score of life quality measured by VFQ-25 was 82.70 points.The score was lower than that of similar international studies.The reasons for education,operation,and degree of myopia were the main factors affecting the quality of life of the sample population.