Exploring The Impact of Adding A Respiratory Dimension to The EQ-5D-5L

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VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 3 4 7 – A 7 6 6

RESPIRATORY-RELATED DISORDERS – Patient-Reported Outcomes & Patient Preference Studies PRS47 Adding A Decision Aid to Asthma Education: Impact on Decisional Conflict and Appropriate Medication Usage Gagné M1, Légaré F2, Moisan J2, Boulet L1 Center, Quebec Heart and Lung Institute Laval University, Québec, QC, Canada, 2CHU de Quebec Research Center, Québec, QC, Canada

1Research

Objectives: Decision aids (DAs) increase values-based decisions and the use of options that are beneficial to the patients but are underused. We assessed whether adding a DA to education enhanced decisional conflict and the appropriate use of pharmacotherapy among asthma patients.  Methods: We conducted a randomized parallel clinical trial. Educators randomly allocated adults with asthma who were prescribed inhaled corticosteroids (ICS) to the education or education + DA group. The DA presented information on ICS, compared their benefits and risks, and asked patients to weigh them. We measured decisional conflict, using the validated Decisional Conflict Scale (score 0–100, lower is better), and the use of pharmacotherapy, with an interviewer-administered questionnaire. We defined the appropriate medication usage according to 11 hierarchical criteria. Data were collected by blinded assessors at baseline and at two-month follow-up. Between the two time points, within- and between-group changes were estimated by linear mixed effects or generalized estimating equation model.  Results: Of the 51 randomized participants (response rate: 53%; age: 44 ± 13 years; women: n= 32), 47 were included in analyses (education: n= 23/25; education + DA: n= 24/26). Between baseline and follow-up, the mean [95% CI] decisional conflict score decreased in the education group from 14.5 [8.1 to 25.4] to 5.7 [3.1 to 10.4] (P= 0.01) and in the education + DA group from 10.4 [5.7 to 18.2] to 3.1 [1.4 to 5.9] (P= 0.002). The proportion of participants who used their medication appropriately scaled up in the education group from 22% [10%–47%] to 39% [23%–65%] (P= 0.10) and in the education + DA group from 46% [30%–71%] to 58% [42%–82%] (P= 0.32) Improvements were no different between groups.  Conclusions: Education improved decisional conflict whether the DA was added or not. The DA may be used during education interventions as a structure for discussion.

PRS48 Exploring The Impact of Adding A Respiratory Dimension to The EQ5D-5L Hoogendoorn M1, Oppe M2, Boland MR1, Stolk E2, Goossens LM1, Rutten van Mölken M1 University Rotterdam, Rotterdam, The Netherlands, 2EuroQol Research Foundation, Rotterdam, The Netherlands 1Erasmus

Objectives: To evaluate the impact of adding a respiratory dimension (a bolt-on dimension) on EQ-5D-5L health state valuations.  Methods: Based on previously performed regression- and principal component analyses two respiratory bolton candidate items were formulated: 1) limitations in physical activities due to shortness of breath (levels: no/ slight/ moderate/ severe problems/ unable to do) and 2) breathing problems (levels: no/ slight/ moderate/ severe/ extreme problems). Valuation interviews for the selected bolt-ons were performed with a representative sample from the Dutch general public using the standardized interview protocol of the EuroQol group, the EQ-VT. Linear regression models for the TTO data, logit models for the DCE data and combined (e.g. hybrid) models were estimated to assess whether the five levels of the respiratory bolt-on led to significant utility decrements.  Results: For each bolt-on candidate slightly more than 200 valuation interviews were conducted. Observed mean TTO values for health states with a level 4 or 5 for the respiratory dimension were significantly lower compared to the same health states observed in the Dutch EQ-5D-5L valuation study without respiratory dimension. The observed choice probabilities from the DCE for states with a level 4 or 5 were also lower. Results of hybrid models showed that for the bolt-on candidate ‘limitations in physical activities due to shortness of breath’ the utility decrements were significant for level 3 (-0.055), level 4 (-0.087) and level 5 (-0.135). For the ‘breathing problems’ bolt-on, the utility decrements for the same levels were greater (-0.086, -0.219 and -0.327, respectively).  Conclusions: Addition of a respiratory bolt-on on breathing problems or on limitations in physical activities due to shortness of breath to the EQ-5D-5L had a significant effect on the valuation of health states with severe levels of the bolt-on. The bolt-on dimension ‘breathing problems’ showed the greatest impact and therefore seems the most appropriate respiratory bolt-on dimension.

PRS49 Systematic Review of Health State Utilities in Children with Asthma Kua WS1, Davis S2 of Health Malaysia, Petaling Jaya, Malaysia, 2University of Sheffield, Sheffield, UK

1Ministry

Objectives: A cost-utility analysis was performed alongside the PLEASANT clinical trial to assess the cost-effectiveness of a letter intervention in preventing and lessening exacerbations in school-aged children at the start of a new school term. The economic analysis relied on published literature for health utilities estimates as no patient reported outcome measures were collected in the trial. We performed a systematic review to identify preference-based utility values for children with day-to-day asthma symptoms (baseline utility) and children experiencing an asthma exacerbation, and to review the appropriateness of the utility values to be used in the PLEASANT economic analysis.  Methods: Five electronic databases (Ovid MEDLINE, The Cochrane Library, EMBASE, ECONLIT and SCHARR Health Utilities Database) were searched up to 5th July 2014 to identify studies that report preference-based utility values in children with asthma. Results were summarised

narratively and utility data were assessed for quality, relevance to the economic analysis and compliance with the NICE reference case.  Results: A total of 927 studies were identified from the search and 14 studies which met the inclusion criteria were included. Health utilities were elicited using various outcome measurements. EQ-5D was used in 5 studies (35.7%), HUI, PAHOM and direct valuation using vignettes were each reported in 2 studies (14.3%). Three (21.4%) studies estimated utility values from mapping between condition specific measures and the EQ-5D. None of the studies directly measured health utilities in children with asthma exacerbation using a preference-based measure.  Conclusions: There is a lack of robust estimates on utility decrement in children with asthma exacerbation. Future studies in children with asthma should incorporate collection of health state utilities into the study design, taking into account the ethical and methodological considerations of quality-of-life assessment during exacerbation. FUNDING: The PLEASANT study was funded by NIHR Health Technology Assessment Programme (project number 11/01/10). PRS50 Asthma in France: Analysis of 2015 National Health and Wellness Survey Data Hadjiat Y1, Vietri J2 1MundiPharma, Paris, France, 2Kantar

Health, Horsham, PA, USA

Objectives: About 30 million people across Europe < 45 years of age have asthma, and > 4 million in France, but more information on the current level of burden is needed. The present study was conducted to describe the association of asthma with patient reported outcomes among adults in France using current data.  Methods: Data were from the 2015 National Health and Wellness Survey, an internet-based survey of adults 18 and older in France (N= 19,173). Outcomes included the revised SF-36 health survey & self-reported healthcare provider (HCP) visits in the past 6 months. Asthma was defined as experience of asthma in the past 12 months and diagnosis of asthma by a doctor. Respondents with asthma were compared to those without using t-test and chi-square tests. Further analyses were stratified by age to reduce confounding.  Results: One in twenty respondents (n= 918; 4.8%) had asthma. Those with asthma were more likely to be women (65 vs 52%), to smoke (33 vs 24%), and to report depression (15 vs 7%) or anxiety (33 vs 17%; all p< 0.05). Asthma was associated with 3.6 and 4.0-point decrements on mental (MCS) and physical (PCS) component scores of the SF-36, respectively (minimally important difference [MID]= 3.0 points for each). Asthma patients were also more likely to have visited a HCP (95 vs. 86%), emergency room (17 vs 9%), or be hospitalized (13 vs 8%) in the past 6 months, and averaged 2.4 more HCP visits in that time (all p< 0.05). Analysis within age strata confirmed these trends, though differences were smaller among younger respondents.  Conclusions: Asthma continues to be common and burdensome among adults in France, and is associated with increased healthcare use and meaningful decrements in health-related quality of life. PRS51 Systematic Literature Review of Utility Data For House Dust MiteInduced Allergic Asthma and/or Allergic Rhinitis Bartlett C1, Edwards M1, Hahn-Pederson J2, Hammerby E2, Arber M1, Veale T1, Glanville J1 Health Economics Consortium, York, UK, 2ALK Abelló, Hørsholm, Denmark

1York

Objectives: A systematic literature review (SLR) was conducted to identify health related quality of life (HRQoL) data in individuals with house dust mite (HDM) allergic asthma (AA) and/or allergic rhinitis (AR).  Methods: The SLR was guided by a protocol specified before searches began. Its objective was to identify utilities, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), Asthma Quality of Life Questionnaire (AQLQ) and Short Form (SF)-36 outcomes. Primary health states of interest were patients classified by Allergic Rhinitis and its Impact on Asthma (ARIA), modified ARIA (m-ARIA) or Global Initiative for Asthma (GINA) guidelines classifications. 24 bibliographic databases, websites and trial registers were searched up to February 2015. Two reviewers independently selected records, extracted data and assessed study quality. The extracted data were summarized. Results: Nineteen good quality studies (21 documents) were eligible. Data were reported for EQ-5D utility scores, SF-36, RQLQ, and AQLQ. There is large variation in the way that HRQoL data are reported. For example RQLQ, which should be reported on a scale of 0 to 6, was reported as point estimates (range 1.38 to 1.58 in one study), as 5.76 to 11.29 in a second study (which breaches the top of the scale without explanation) and as aggregate cohort scores of the combined RQLQ question domains in a third study (range: 74.96 to 126.02).  Conclusions: The SLR found a large variation in the reporting of HRQoL data for HDM AA and AR. Differences in reporting hinder direct comparison of the scores across studies and contribute to confusion around how the scores should be interpreted since 1.58 (RQLQ point estimate) seems intuitively smaller when compared to an aggregated RQLQ score of 126.02. Interpreting HRQoL scores within HDM AR and AA thus calls for special caution and authors should be encouraged to report scores consistently and with adequate explanation. PRS52 Measuring Treatment Satisfaction and Preference in Patients with Asthma and Copd: Results of A Targeted Literature Review Bassel M, Hanson KA UBC: An Express Scripts Company, Dorval, QC, Canada

Objectives: Treatment satisfaction is an important predictor of real-world medication adherence in chronic medical conditions such as asthma and COPD. The objective of this study was to identify and describe measures used to assess treatment satisfaction and preference in patients with asthma and/or COPD.  Methods: A targeted literature review was conducted in EMBASE and PubMed to identify studies utilizing validated patient-reported outcome (PRO) instruments or study-specific questionnaires and published in 2000-2015. Domains measured by each PRO/questionnaire were recorded to understand important treatment characteristics related