Comparison of the HUI3 and the EQ-5D-3L in a nursing home setting

Background
Accurately assessing changes in the quality of life of older people living permanently in nursing homes is important. The multi-attribute utility instrument most commonly used and recommended to assess health-related quality of life in the nursing home population is the three-level EuroQol EQ-5D-3L. To date, there have been no studies using the Health Utilities Index Mark III (HUI3). The purpose of this study was to compare the level of agreement and sensitivity to change of the EQ-5D-3L and HUI3 in a nursing home population.
Methods
EQ-5D-3L and HUI3 scores were measured as part of a cluster randomised controlled trial of nurse led care coordination in a nursing home population in Perth, Western Australia at baseline and 6-month follow up.
Results
Both measures were completed for 199 residents at baseline and 177 at 6-month follow-up. Mean baseline utility scores for EQ-5D-3L (0.45; 95% CI 0.41–0.49) and HUI3 (0.15; 95% CI 0.10–0.20) were significantly different (Wilcoxon signed rank test, p<0.01) and agreement was poor to moderate between absolute scores from each instrument (intra-class correlation coefficient = 0.63). The EQ-5D-3L appeared more sensitive to change over the 6-month period.
Conclusion
Our findings show that the EQ-5D-3L and HUI3 estimate different utility scores among nursing home residents. These differences should be taken into account, particularly when considering the implications of the cost-effectiveness of particular interventions and we conclude that the HUI3 is no better suited to measuring health-related quality of life in a nursing home population when compared to the EQ-5D-3L.

研究背景
准确评估长期居住在养老院的老年人的生活质量变化，具有重要的实践意义。目前，针对养老院人群，最常用且被推荐用于评估健康相关生活质量的多属性效用工具为三维度欧洲五维健康量表（three-level EuroQol EQ-5D-3L）。截至目前，尚无研究采用健康效用指数第三版（Health Utilities Index Mark III，HUI3）开展相关研究。本研究旨在对比EQ-5D-3L与HUI3在养老院人群中的一致性水平及变化敏感性。

研究方法
EQ-5D-3L与HUI3的评分作为一项针对养老院人群的护士主导照护协调整群随机对照试验的评估内容，于澳大利亚西澳大利亚州珀斯的研究队列中，在基线及6个月随访时分别进行测量。

研究结果
共有199名养老院居民在基线时完成了两项量表的全部评估，177名居民完成了6个月的随访。EQ-5D-3L的平均基线效用得分为0.45（95%置信区间：0.41~0.49），HUI3的平均基线效用得分为0.15（95%置信区间：0.10~0.20），二者差异具有统计学意义（Wilcoxon符号秩检验，p<0.01）；两项工具的绝对评分之间的一致性为弱至中等水平（组内相关系数=0.63）。EQ-5D-3L在6个月随访周期内的变化敏感性更优。

研究结论
本研究结果显示，EQ-5D-3L与HUI3对养老院居民的效用评分估算结果存在显著差异。临床实践中需充分考量这些差异，尤其是在评估特定干预措施的成本效益相关影响时。本研究最终得出结论：相较于EQ-5D-3L，HUI3并不更适合用于评估养老院人群的健康相关生活质量。