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Health Related Quality of Life in Health Care

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (31 August 2021) | Viewed by 42855

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Special Issue Editor

Dr. Thomas G. Poder

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Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montréal, QC H3N 1X9, Canada
Interests: quality-adjusted life-year; preferences

Special Issue Information

Dear Colleagues,

Health-related quality of life (HRQoL) is a cornerstone in the assessment of interventions in healthcare. Whether generic of specific, many instruments have been developed to ensure that clinical studies consider the needs of patients. This can be used to demonstrate the efficacy of a new technology, to document the burden associated to a given disease, or to help decision-makers. In health economics, it is also useful to perform cost-effectiveness and cost-utility studies by considering the preferences of patients. To date, plenty of research is conducted in this field and relates, for example, to the choice of the instrument, methodological development, ability to capture specific health dimensions, etc. This Topical Collection is open to the subject area of health-related quality of life in health care. The keywords listed below provide an outline of some of the possible areas of interest.

Dr. Thomas G. Poder
Guest Editor

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Keywords

Health-related quality of life
Quality-adjusted life-year
Health preference
Health technology assessment
Health care
Health economics
Decision making
Patient-oriented research

Published Papers (12 papers)

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11 pages, 627 KiB

Open AccessArticle

Association of Grip Strength with Quality of Life in the Chinese Oldest Old

by Boqin Xie and Chenjuan Ma

Int. J. Environ. Res. Public Health 2021, 18(23), 12394; https://doi.org/10.3390/ijerph182312394 - 25 Nov 2021

Cited by 2 | Viewed by 1734

Abstract

Emerging studies have suggested an association between grip strength and health-related quality of life (QOL). However, evidence for which specific domains of QOL are associated with grip strength remains limited and inconsistent. Particularly, such evidence is scarce in the oldest old, who constitute one of the most vulnerable populations. This cross-sectional study aimed to examine the association between grip strength and overall QOL as well as specific domains in the oldest old. It included 400 community-dwelling older adults aged 80 years or older from Shanghai, China. QOL was assessed using the WHO Quality of Life of Older Adults instrument, and grip strength was measured using a digital spring-type dynamometer. On average, the overall QOL score was 54.68 (SD = 12.05). Estimates of risk-adjusted linear regressions indicated that higher grip strength was associated with better overall QOL (β = 4.40, p < 0.001) as well as the domains of autonomy (β = 6.74, p < 0.001); fulfillment with past, present, and future activities and achievements (β = 3.52, p = 0.004); and satisfaction with social participation (β = 6.72, p < 0.001). Our findings highlight the importance of maintaining or improving grip strength in delaying or reducing the decline in QOL among the community-dwelling oldest old. Also noteworthy is that the associations between grip strength and specific domains of QOL in the oldest old vary. Full article

(This article belongs to the Special Issue Health Related Quality of Life in Health Care)

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11 pages, 2106 KiB

Open AccessArticle

Association between Anxiety, Depressive Symptoms, and Quality of Life in Patients Undergoing Diagnostic Flexible Video Bronchoscopy

by Beata Brajer-Luftmann, Marcin Mardas, Marta Stelmach-Mardas, Dorota Lojko, Halina Batura-Gabryel and Tomasz Piorunek

Int. J. Environ. Res. Public Health 2021, 18(19), 10374; https://doi.org/10.3390/ijerph181910374 - 01 Oct 2021

Cited by 1 | Viewed by 1669

Abstract

Bronchoscopy is one of the basic invasive procedures in pulmonology accompanied by patients’ anxiety. This study aimed to find an association between predictors of state anxiety/depression and patient’s quality of life (QOL) with pulmonary symptoms undergoing diagnostic flexible video bronchoscopy (FVB). A total of 125 adult patients before FVB were included in a prospective observational study. The quality of life (QOL) was assessed by WHOQOL-BREF questionnaire, the depression possibility by the Beck’s Depression Inventory-II (BDI-II), and the anxiety level by Spielberger’s State-Trait Anxiety Inventory (STAI-S; STAI-T). Results show that the older patients and patients with more comorbidities showed a significantly higher anxiety level. The previous FVB under deep sedation significantly reduced state anxiety. A significantly positive association was found between the STAI score and total BDI-II score. More severe symptoms of anxiety were especially related to lower QOL (physical health, psychological and environmental domains) in patients. Statistically higher trait anxiety in lower social QOL domain scores was observed. Our findings show that high state and trait anxiety were associated with higher depression scores and lower quality of life in the elderly. It seems that the elderly and patients at risk of depression development require more attention in the clinical setting to minimize the anxiety accompanying the bronchoscopy. Full article

(This article belongs to the Special Issue Health Related Quality of Life in Health Care)

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13 pages, 1396 KiB

Open AccessArticle

Rasch Validation of the VF-14 Scale of Vision-Specific Functioning in Greek Patients

by Ioanna Mylona, Vassilis Aletras, Nikolaos Ziakas and Ioannis Tsinopoulos

Int. J. Environ. Res. Public Health 2021, 18(8), 4254; https://doi.org/10.3390/ijerph18084254 - 16 Apr 2021

Cited by 5 | Viewed by 2165

Abstract

The Visual Functioning-14 (VF-14) scale is the most widely employed index of vision-related functional impairment and serves as a patient-reported outcome measure in vision-specific quality of life. The purpose of this study is to rigorously examine and validate the VF-14 scale on a Greek population of ophthalmic patients employing Rasch measurement techniques. Two cohorts of patients were sampled in two waves. The first cohort included 150 cataract patients and the second 150 patients with other ophthalmic diseases. The patients were sampled first while pending surgical or other corrective therapy and two months after receiving therapy. The original 14-item VF-14 demonstrated poor measurement precision and disordered response category thresholds. A revised eight-item version, the VF-8G (‘G’ for ‘Greek’), was tested and confirmed for validity in the cataract research population. No differential functioning was reported for gender, age, and underlying disorder. Improvement in the revised scale correlated with improvement in the mental and physical component of the general health scale SF-36. In conclusion, our findings support the use of the revised form of the VF-14 for assessment of vision-specific functioning and quality of life improvement in populations with cataracts and other visual diseases than cataracts, a result that has not been statistically confirmed previously. Full article

(This article belongs to the Special Issue Health Related Quality of Life in Health Care)

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17 pages, 1340 KiB

Open AccessArticle

Self-Reported Satisfaction to Treatment, Quality of Life and General Health of Type 2 Diabetes Patients with Inadequate Glycemic Control from North-Eastern Romania

by Elena-Daniela Grigorescu, Cristina-Mihaela Lăcătușu, Ioana Crețu, Mariana Floria, Alina Onofriescu, Alexandr Ceasovschih, Bogdan-Mircea Mihai and Laurențiu Șorodoc

Int. J. Environ. Res. Public Health 2021, 18(6), 3249; https://doi.org/10.3390/ijerph18063249 - 21 Mar 2021

Cited by 11 | Viewed by 3983

Abstract

Type 2 diabetes mellitus (T2DM) undermines health and quality of life (QoL). This cross-sectional study surveyed 138 consenting T2DM patients from North-Eastern Romania with regard to their satisfaction with treatment, diabetes-related impact on QoL, and general health. The Romanian versions of Diabetes Treatment Satisfaction Questionnaire (DTSQ), Audit of Diabetes Dependent Quality of Life (ADDQoL-19), and 36-Item Short Form Health Survey (SF-36) questionnaires were used. Self-reports were analyzed in conjunction with clinical and metabolic profiling. The patients were 57.86 ± 8.82 years old, 49.3% men, treated with oral glucose-lowering drugs, presenting with inadequate glycemic control but without cardiovascular manifestations. The mean DTSQ and ADDQoL scores were 25.46 ± 0.61 and −2.22 ± 1.2, respectively. Freedom to eat, holidays, journeys, leisure, physical health, sex life, freedom to drink, and feelings about the future scored below average. The mean SF-36 physical and mental health scores were 47.78 ± 1.03 and 50.44 ± 1.38, respectively. The mean SF-6D score was 0.59 ± 0.04 (generated retrospectively using SF-36 data). Negative associations were significant between ADDQoL, age (r = −0.16), and body mass index (r = −0.23), p < 0.01. Overall scores did not correlate with diabetes duration (except DTSQ, r = −1.18, p = 0.02) or HbA_1c. The results confirm other researchers’ findings in Europe and nearby countries. Our patients seemed satisfied with treatment despite glycemic imbalance and viewed diabetes as a burden on QoL and especially freedom to eat. Full article

(This article belongs to the Special Issue Health Related Quality of Life in Health Care)

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13 pages, 850 KiB

Open AccessArticle

Validity and Reliability of the Malay Versions of Bloating Severity (BSQ-M) and Quality of Life (BLQoL-M) Questionnaires

by Nurzulaikha Mahd-Ab.lah, Yee Cheng Kueh, Garry Kuan, Fatan Hamamah Yahaya, Mung Seong Wong, Nor Aslina Abd Samat, Nurhazwani Hamid, Nurhayati Mohamad Nor, William E. Whitehead, Syed Ismail Thiwan and Yeong Yeh Lee

Int. J. Environ. Res. Public Health 2021, 18(5), 2487; https://doi.org/10.3390/ijerph18052487 - 03 Mar 2021

Cited by 3 | Viewed by 2224

Abstract

Abdominal bloating (AB) is a prevalent and bothersome symptom, but there are no specific measures for severity and quality of life (QoL) other than the Bloating Severity Questionnaire (BSQ) and Bloating Quality of Life (BLQoL). We aimed to translate the BSQ and BLQoL into the Malay language and to validate them using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) approaches. The 12-item BSQ has two components, seven-item severity in general (SevGen) and five-item severity in the past 24 h (Sev24), and BLQOL has five items. Translation to the Malay language (BSQ-M and BLQoL-M) was performed using standard forward and backward processes. EFA followed by CFA were performed in participants with AB due to functional bowel disorders, with the purpose of examining the validity and reliability of the questionnaires translated into Malay. After EFA with 152 participants, all the items of BSQ-M remained in the model. Total variance extracted was 53.26% for BSQ-M and 58.79% for BLQoL-M. The internal consistency based on Cronbach’s alpha values was 0.52 for SevGen, 0.86 for Sev24, and 0.81 for BLQoL-M. After performing CFA with another 323 participants, the final measurement model for BSQ-M and BLQoL-M fit the data well in terms of several fit indices (BSQ-M: root mean square error of approximation (RMSEA) = 0.050, Comparative Fit Index (CFI) = 0.966, Tucker–Lewis Fit Index (TLI) = 0.956, and standardized root mean squared residual (SRMR) = 0.051; BLQoL-M: RMSEA = 0.071, CFI = 0.985, TLI = 0.962, SRMR = 0.021). The composite reliability for BSQ-M and BLQoL-M were satisfactory (SevGen = 0.83, Sev24 = 0.89, BLQoL = 0.80). The intraclass correlation (ICC) results showed excellent stability for BSQ-M and BLQoL-M, ranging from 0.74 to 0.93. The Malay language versions of BSQ-M and BLQoL-M are valid and reliable instruments for measuring the severity and QoL of AB for the Asian population with functional bowel disorders. Full article

(This article belongs to the Special Issue Health Related Quality of Life in Health Care)

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12 pages, 349 KiB

Open AccessArticle

Assessment of the Quality of Life during COVID-19 Pandemic: A Cross-Sectional Survey from the Kingdom of Saudi Arabia

by Fahad D. Algahtani, Sehar-un-Nisa Hassan, Bandar Alsaif and Rafat Zrieq

Int. J. Environ. Res. Public Health 2021, 18(3), 847; https://doi.org/10.3390/ijerph18030847 - 20 Jan 2021

Cited by 113 | Viewed by 9771

Abstract

The COVID-19 outbreak emerged as an ongoing crisis at the beginning of the year 2020. Its horrific manifestation at the community level significantly affects various dimensions of the quality of life (QoL) of all individuals. The study aimed to examine some of the predictors of the QoL during the first wave of the COVID-19 pandemic in Saudi Arabia. A cross-sectional online survey questionnaire was used to gather data on the participants’ sociodemographic backgrounds, physical health status, psychological reactions, and QoL. We adapted 12 items from the World Health Organization Quality of Life Instruments (WHOQOL-BREF) to assess the QoL. The Depression, Anxiety and Stress Scale–21 (DASS-21) was used to assess depression, anxiety, and stress. The median and inter-quartile range were used to describe the QoL scores. A multinomial regression analysis was computed between QoL score quartiles and associated factors, and the statistical significance was set at p < 0.05. The results of the multinomial regression analysis demonstrated that males (OR = 1.96; 95% CI = 1.31–2.94); participants aged 26 to 35 years (OR = 5.1; 95% CI = 1.33–19.37); non-Saudi participants (OR = 1.69; 95% CI = 1.06–2.57); individuals with chronic diseases (OR = 2.15; 95% CI = 1.33–3.48); those who lost their job (OR = 2.18; 95% CI = 1.04–4.57); and those with depression (OR = 5.70; 95% CI = 3.59–9.05), anxiety (OR = 5.47; 95% CI = 3.38–8.84), and stress (OR = 6.55; 95% CI = 4.01–10.70) were more likely to be in the first quartile of the QoL scores. While the full model predicting the total QoL score was statistically significant (R² = 0.962, F (750, 753) = 16,705.4, p < 0.001), the three QoL dimensions explained 0.643, 0.283, and 0.036 of the variability in environmental, social, and religious/spiritual dimensions, respectively. The COVID-19 pandemic has significantly influenced various aspects of individuals’ QoL, as well as their physical and psychological health. Community-based interventions are needed to mitigate the pandemic’s negative effects and enhance the health and QoL of the general population. Full article

(This article belongs to the Special Issue Health Related Quality of Life in Health Care)

12 pages, 542 KiB

Open AccessArticle

The Importance of Accounting for Parameter Uncertainty in SF-6D Value Sets and Its Impact on Studies that Use the SF-6D to Measure Health Utility

by Samer A. Kharroubi, Yara Beyh, Esmail Abdul Fattah and Tracey Young

Int. J. Environ. Res. Public Health 2020, 17(11), 3949; https://doi.org/10.3390/ijerph17113949 - 02 Jun 2020

Cited by 3 | Viewed by 2109

Abstract

Background: The parameter uncertainty in the six-dimensional health state short form (SF-6D) value sets is commonly ignored. There are two sources of parameter uncertainty: uncertainty around the estimated regression coefficients and uncertainty around the model’s specification. This study explores these two sources of parameter uncertainty in the value sets using probabilistic sensitivity analysis (PSA) and a Bayesian approach. Methods: We used data from the original UK/SF-6D valuation study to evaluate the extent of parameter uncertainty in the value set. First, we re-estimated the Brazier model to replicate the published estimated coefficients. Second, we estimated standard errors around the predicted utility of each SF-6D state to assess the impact of parameter uncertainty on these estimated utilities. Third, we used Monte Carlo simulation technique to account for the uncertainty on these estimates. Finally, we used a Bayesian approach to quantifying parameter uncertainty in the value sets. The extent of parameter uncertainty in SF-6D value sets was assessed using data from the Hong Kong valuation study. Results: Including parameter uncertainty results in wider confidence/credible intervals and improved coverage probability using both approaches. Using PSA, the mean 95% confidence intervals widths for the mean utilities were 0.1394 (range: 0.0565–0.2239) and 0.0989 (0.0048–0.1252) with and without parameter uncertainty whilst, using the Bayesian approach, this was 0.1478 (0.053–0.1665). Upon evaluating the impact of parameter uncertainty on estimates of a population’s mean utility, the true standard error was underestimated by 79.1% (PSA) and 86.15% (Bayesian) when parameter uncertainty was ignored. Conclusions: Parameter uncertainty around the SF-6D value set has a large impact on the predicted utilities and estimated confidence intervals. This uncertainty should be accounted for when using SF-6D utilities in economic evaluations. Ignoring this additional information could impact misleadingly on policy decisions. Full article

(This article belongs to the Special Issue Health Related Quality of Life in Health Care)

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16 pages, 1159 KiB

Open AccessArticle

The Effects of Performance of Public Sector Health System on Quality of Life in China: Evidence from the CGSS2015

by Zongfeng Sun and Jintao Li

Int. J. Environ. Res. Public Health 2020, 17(8), 2896; https://doi.org/10.3390/ijerph17082896 - 22 Apr 2020

Cited by 6 | Viewed by 2660

Abstract

The determinants of quality of life can be social, economic, cultural, and governmental, to name a few. Prior research has shown that demographic factors and social support can have a significant impact on an individual’s quality of life. This research attempts to examine the effects of public sector health system performance on individuals’ quality of life in China, measured by (1) self-reported health, (2) depressed mood, and (3) happiness. The targeted population was individuals aged 18 and above. The primary data was collected from the CGSS2015 (Chinese General Social Survey 2015), and the National Statistical Yearbook was also used. Using various statistical models, this study finds that the correlation coefficients of government performance in providing healthcare for patients on quality of life are 0.144, 0.167, and 0.328, respectively. The more satisfied with medical care and public health delivered by the government, the higher the level of quality of life. In addition, the relationship between government expenditure on public health service and quality of life is positively significant. These findings are robust after weighting methods are used. The performance of the Public Sector Health System has a significantly positive association with quality of life in China. Full article

(This article belongs to the Special Issue Health Related Quality of Life in Health Care)

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11 pages, 912 KiB

Open AccessArticle

A Discrete Choice Experiment on Women’s Preferences for Water Immersion During Labor and Birth: Identification, Refinement and Selection of Attributes and Levels

by Thomas G. Poder, Nathalie Carrier, Mathieu Roy and Chantal Camden

Int. J. Environ. Res. Public Health 2020, 17(6), 1936; https://doi.org/10.3390/ijerph17061936 - 16 Mar 2020

Cited by 3 | Viewed by 2900

Abstract

Objectives: To identify attributes (i.e., characteristics describing a scenario) and levels (i.e., each characteristic may be defined by a different level) that would be included in a discrete choice experiment (DCE) questionnaire to evaluate women’s preferences for water immersion during labor and birth. Methods: A mixed-method approach, combining systematic reviews of the literature and patient focus groups to identify attributes and levels explaining women’s preferences. After the focus groups, preference exercises were conducted and led to the creation of the questionnaire, including the DCE. A qualitative validation of the questionnaire was conducted with women from the focus groups and with medical experts. Results: The literature reviews provided 26 attributes to be considered for childbirth in water, and focus groups identified 14 additional attributes. From these 40 attributes, preference exercises allowed us to select four for the DCE, in addition to the birth mode. Labor duration was also included, even if it was not well ranked, as it is the main clinical outcome in the literature. Validation with experts and women did not change the choice of attributes but slightly changed the levels selected. The final six attributes were: birth mode, duration of the labor phase, pain sensation, risk of severe tears in the perineum during the expulsion of the newborn, risk of death of the newborn, and general condition of the newborn (Apgar) score at 5 minutes. Conclusion: This study allowed us to detail all the stages for the design of a DCE questionnaire. To date, this is the first study of this kind in the context of women’s preferences for water immersion during labor and birth. Full article

(This article belongs to the Special Issue Health Related Quality of Life in Health Care)

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13 pages, 326 KiB

Open AccessArticle

Assessment of the Quality of Life in Patients before and after Coronary Artery Bypass Grafting (CABG): A Prospective Study

by Stana Pačarić, Tajana Turk, Ivan Erić, Želimir Orkić, Anamarija Petek Erić, Andrea Milostić-Srb, Nikolina Farčić, Ivana Barać and Ana Nemčić

Int. J. Environ. Res. Public Health 2020, 17(4), 1417; https://doi.org/10.3390/ijerph17041417 - 22 Feb 2020

Cited by 24 | Viewed by 6015

Abstract

The aim of this study was to examine the quality of life and to report on the utility and QALY measures in patients before and after coronary artery bypass grafting (CABG); to investigate whether the SF-12 is comparable with the SF-36 for measuring health-related quality of life of patients with CABG; and to determine the impact of individual predictors on poor quality of life assessment after rehabilitation. This prospective study was conducted between January 2017 and December 2018 at the University Hospital Center Osijek, at three time points: pre-operation, 1 month after surgery, and after rehabilitation. The study was conducted with the SF-36 and SF-12 health questionnaires on 47 participants. After rehabilitation, there was a significant improvement in all domains of quality of life. The highest score was given to the change in pain (BP); mean scores were 63.8 (95% CI 56.9 to 70.6) (p = 0.001). The lowest grade (the lowest quality) after rehabilitation was in the domain of limitations due to physical difficulties (RP); arithmetic mean was 48.5 (95% CI 41 to 55.9) (p < 0.001). Quality-adjusted life-year was 0.41 (95% CI 0.38–0.44) after the CABG. The results of this study show that patients with coronary heart disease have poor quality of life before surgery. One month after the surgery, the quality of life improved, but was still inadequate. One year after surgery, satisfactory results were obtained in almost all subscales. The SF-36, SF-12, and its components, can be used effectively in patients with CABG. Age, gender, lifestyle, and risk factors in our sample of participants are not predictors of poor quality of life assessment after rehabilitation. Full article

(This article belongs to the Special Issue Health Related Quality of Life in Health Care)

15 pages, 782 KiB

Open AccessArticle

Examining the Feasibility and Acceptability of Valuing the Arabic Version of SF-6D in a Lebanese Population

by Samer A. Kharroubi, Yara Beyh, Marwa Diab El Harake, Dalia Dawoud, Donna Rowen and John Brazier

Int. J. Environ. Res. Public Health 2020, 17(3), 1037; https://doi.org/10.3390/ijerph17031037 - 06 Feb 2020

Cited by 12 | Viewed by 2936

Abstract

Objectives: The SF-6D is a preference-based measure of health developed to generate utility values from the SF-36. The aim of this pilot study was to examine the feasibility and acceptability of using the standard gamble (SG) technique to generate preference-based values for the Arabic version of SF-6D in a Lebanese population. Methods: The SF-6D was translated into Arabic using forward and backward translations. Forty-nine states defined by the SF-6D were selected using an orthogonal design and grouped into seven sets. A gender-occupation stratified sample of 126 Lebanese adults from the American University of Beirut were recruited to value seven states and the pits using SG. The sample size is appropriate for a pilot study, but smaller than the sample required for a full valuation study. Both interviewers and interviewees reported their understanding and effort levels in the SG tasks. Mean and individual level multivariate regression models were fitted to estimate preference weights for all SF-6D states. The models were compared with those estimated in the UK. Results: Interviewers reported few problems in completing SG tasks (0.8% with a lot of problems) and good respondent understanding (5.6% with little effort and concentration), and 25% of respondents reported the SG task was difficult. A total of 992 SG valuations were useable for econometric modeling. There was no significant change in the test–retest values from 21 subjects. The mean absolute errors in the mean and individual level models were 0.036 and 0.050, respectively, both of which were lower than the UK results. The random effects model adequately predicts the SG values, with the worst state having a value of 0.322 compared to 0.271 in the UK. Conclusion: This pilot confirmed that it was feasible and acceptable to generate preference values with the SG method for the Arabic SF-6D in a Lebanese population. However, further work is needed to extend this to a more representative population, and to explore why no utility values below zero were observed. Full article

(This article belongs to the Special Issue Health Related Quality of Life in Health Care)

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22 pages, 777 KiB

Open AccessSystematic Review

Dimensions Used in Instruments for QALY Calculation: A Systematic Review

by Moustapha Touré, Christian R. C. Kouakou and Thomas G. Poder

Int. J. Environ. Res. Public Health 2021, 18(9), 4428; https://doi.org/10.3390/ijerph18094428 - 21 Apr 2021

Cited by 12 | Viewed by 3130

Abstract

Economic assessment is of utmost importance in the healthcare decision-making process. The quality-adjusted life-year (QALY) concept provides a rare opportunity to combine two crucial aspects of health, i.e., mortality and morbidity, into a single index to perform cost-utility comparison. Today, many tools are available to measure morbidity in terms of health-related quality of life (HRQoL) and a large literature describes how to use them. Knowing their characteristics and development process is a key point for elaborating, adapting, or selecting the most well-suited instrument for further needs. In this aim, we conducted a systematic review on instruments used for QALY calculation, and 46 studies were selected after searches in four databases: Medline EBSCO, Scopus, ScienceDirect, and PubMed. The search procedure was done to identify all relevant publications up to 18 June 2020. We mainly focused on the type of instrument developed (i.e., generic or specific), the number and the nature of dimensions and levels used, the elicitation method and the model selected to determine utility scores, and the instrument and algorithm validation methods. Results show that studies dealing with the development of specific instruments were mostly motivated by the inappropriateness of generic instruments in their field. For the dimensions’ and levels’ selection, item response theory, Rasch analysis, and literature review were mostly used. Dimensions and levels were validated by methods like the Loevinger H, the standardised response mean, or discussions with experts in the field. The time trade-off method was the most widely used elicitation method, followed by the visual analogue scale. Random effects regression models were frequently used in determining utility scores. Full article

(This article belongs to the Special Issue Health Related Quality of Life in Health Care)

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