Utilities value in diabetic retinopathy

Abstract

Health utilities has been used as weighted for a quality adjusted life year in health technology assessment. There are limited data on the utilites value in diabetic retinopathy and retina diseases in the South Asian region. The aim of this project are to estimate the visual health utility (HU) in patients with diabetic retinopathy (DR), age-related macular degeneration (AMD), and cataract. Moreover, we intended to evaluate an appropriate health utility instrument among a direct choice-based, traditional time trade-off (tTTO) and composite time trade-off (cTTO), and multiple attribute utility instrument (MAUI) ( EQ-VAS, European Quality of Life (QoL) Five Dimension (EQ-5D-5L), and Health Utility Index 3 (HUI3) in patients, along with its association to a vision specific QoL measured by the National Eye Institute visual function questionnaire 25 (NEI VFQ-25). In this multicenter cross-sectional survey a total 309 patients from tertiary eye centers (DR=141, wet AMD=90, and cataract=78) were interviewed.We used the cTTO, EQ-5D-5L, HUI3, and NEI VFQ-25 for face-to-face interviews. We collected demographic data and Early Treatment Diabetic Retinopathy Study visual acuity from the participant during particular ophthalmic visits with the interview. The main outcome meaures are health utility and visual acuity.The overall mean utility value from the lead time cTTO, EQ-VAS, EQ-5D-5L, and HUI3 was 0.84 ±0.25, 0.73 ±0.15, 0.70 ±0.19, and 0.68 ±0.26, respectively. The mean NEI VFQ-25 score was 70.71 ±17.76. VA in the best-seeing eye was significantly associated with a negative change in the HU score in cTTO. By contrast, VA in worse-seeing-eyes was associated with the HU in cTTO, EQ-5D-5L and HUI3. HU from cTTO and HUI3 displayed a significant response to severe visual impairment status or worse. HU from HUI3 (r=0.54, p<0.01) and EQ-5D-5L (r=0.43, p<0.01) displayed a moderate correlation with the NEI VFQ-25 score. cTTO shows lower correlation (r=0.21). There were no significant differences in HU among DR , wet AMD, and cataract, upon adjusting for the VA and demographics. Moreover, there was no significant difference in the HU between DR with and with out macular edema. Factors associated with non-trader in tTTO were old age, demographic region, Buddhist religion, and good VA. Thie project conclude that the VA level exerted a higher impact on the patient’s QoL than the type of eye disease. The Low VA resulted in poor QoL and HU. MAUI instruments and cTTO are suitable in HU measurement in DR, wet AMD, and cataract. cTTO, EQ-5D-5L and HUI3 are feasible and responses to the impact of vision in Thai's ophthalmic patients.