Skip to main content
SpringerLink
Log in

Reassessing Quality-of-Life Instruments in the Evaluation of New Drugs

  • Current Opinion
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Summary

Investigators use 2 fundamental approaches to the measurement of health-related quality of life (HR-QOL). Generic instruments include health profiles that tap into the full range of HR-QOL issues and are widely applicable, but may lack responsiveness to small but important changes in HR-QOL. Utility measures summarise HR-QOL in a single number between 0 (death) and 1 (full health) and are useful for economic analysis, but may lack responsiveness. Accumulating data suggest the alternatives to generic measures, instruments that are specific to a function or a health problem, are more responsive than generic measures. While direct comparison of the validity and responsiveness of alternative approaches remains limited and should be extended, it is already clear that comprehensive assessment of HR-QOL requires more than 1 type of instrument.

To be useful, HR-QOL instruments must be interpretable. Investigators are beginning to elucidate what constitutes trivial, small but important, or large changes in HR-QOL. Approaches include both within-and between-patient global ratings, observing HR-QOL scores in different patient populations, and observing the magnitude of change in HR-QOL with established interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Article Open access 23 May 2023

Keri J. S. Brady, John Devin Peipert, … The International Society for Quality of Life Research Clinical Practice Special Interest Group, the International Society for Quality of Life Research Clinical Practice Special Interest Group, the International Society for Quality of Life Research Regulatory Health, Technology Assessment Engagement Special Interest Group, and the International Society for Quality of Life Research Psychometrics Special Interest Group

References

  1. Gill TM, Feinstein AR. A critical appraisal of the quality of quality-of-life measurements. JAMA 1994; 272 (8): 619–26

    Article  PubMed  CAS  Google Scholar 

  2. Guyatt GH, Cook OJ. Health status, quality of life, and the individual patient: a commentary on ‘A Critical Appraisal ofQuality-of-Life Measurements’ byTM Gill and AR Feinstein. JAMA 1994; 272: 630–1

    Article  PubMed  CAS  Google Scholar 

  3. Patrick DL, Deyo RA. Generic and disease-specific measures in assessing health status and quality of life. Med Care 1989; 27: F217–32

    Article  Google Scholar 

  4. Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life: basic sciences review. Ann Intern Med 1993; 70: 225–30

    Google Scholar 

  5. Cantril H. The pattern of human concerns. New Brunswick (NJ): Rutgers University Press, 1965

  6. Tandon PK, Stander H, Schwarz Jr RP. Analysis of quality of life data from a randomized, placebo controlled heart-failuretrial. J Clin Epidemiol 1989; 42: 955–62

    Article  PubMed  CAS  Google Scholar 

  7. Smith 0, Baker G, Davies G, et al. Outcomes of add-on treatment with Lamotrigine in partial epilepsy. Epilepsia 1993; 34: 312–22

    Article  PubMed  CAS  Google Scholar 

  8. Chang SW, Fine R, Siegel 0, et al. The impact of diuretic therapy on reported sexual function. Arch Intern Med 1991; 151: 2402–8

    Article  PubMed  CAS  Google Scholar 

  9. Tugwell P, Bombardier C, Buchanan WW, et al. Methotrexate in rheumatoid arthritis: impact on quality of life assessedby traditional standard-item and individualized patient preferencehealth status questionnaires. Arch Intern Med 1990; 150: 59–62

    Article  PubMed  CAS  Google Scholar 

  10. Laupacis A, Wong C, Churchill D. The use of generic and specific quality-of-life measures in hemodialysis patients treatedwith erythropoietin. Control Clin Trials 1991; 12 Suppl.: 1685–795

    Google Scholar 

  11. Goldstein RS, Gort EH, Guyatt GH, et al. Prospective randomized controlled trial of respiratory rehabilitation. Lancet 1994; 344: 1394–7

    Article  PubMed  CAS  Google Scholar 

  12. Bergner M, Bobbit RA, Carter WB, et al. The Sickness Impact Profile: development and final revision of a health statusmeasure. Med Care 1981; 19: 787–805

    Article  PubMed  CAS  Google Scholar 

  13. Tarlov AR, Ware JE, Greenfield S, et al. The Medical Outcomes Study. JAMA 1989; 262: 925–30

    Article  PubMed  CAS  Google Scholar 

  14. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). Med Care 1992; 30: 473–83

    Article  PubMed  Google Scholar 

  15. Parkerson GR, Gehlback SH, Wagner EH, et al. The Duke-UNC Health Profile: an adult health status instrument for primarycare. Med Care 1981; 19: 806–28

    Article  PubMed  Google Scholar 

  16. Kaplan RM, Bush JW. Health-related quality of life measurement for evaluation research and policy analysis. Health Psychol 1982; 1: 61–80

    Article  Google Scholar 

  17. Feeny DH, Furlong W, Boyle M, et al. Multi-attribute health status classification systems: health utilities index. Pharmacoeconomics 1995; 7 (6): 490–502

    Article  PubMed  CAS  Google Scholar 

  18. Guyatt GH, Kirshner B, Jaeschke R. Measuring health status: what are the necessary measurement properties. J Clin Epidemiol 1992 45: 1341–5

    Article  PubMed  CAS  Google Scholar 

  19. Guyatt GH, Townsend M, Keller JL, et al. Measuring functional status in chronic lung disease: conclusions from a randomizedcontrol trial. Respir Med 1989 83: 293–7

    Article  PubMed  CAS  Google Scholar 

  20. Guyatt GH, Berman LB, Townsend M, et al. A new measure of quality of life for clinical trials inchronic lung disease. Thorax 1987 42: 773–8

    Article  PubMed  CAS  Google Scholar 

  21. Rosenthal M, Lohr KN, Rubenstein RS, et al. A conceptualization and measurement of physiologic health for adults:congestive heart failure. Santa Monica (CA): Rand Corporation, 1981

  22. Mcavin CR, Artvinli M, Naoe H. Dyspnea, disability and distance walked: comparison of estimates of exercise performancein respiratory disease. BMJ 1978; 2: 241–3

    Article  Google Scholar 

  23. Jaeschke R, Guyatt G, Keller J, et al. Measurement of health status: ascertaining the meaning of a change in quality-of-lifequestionnaire score. Control Clin Trials 1989 10: 407–15

    Article  PubMed  CAS  Google Scholar 

  24. Juniper EF, Guyatt GH, Willan A, et al. Determining a minimal important change in a disease-specific quality of life questionnaire. J Clin Epidemiol 1994; 47: 81–7

    Article  PubMed  CAS  Google Scholar 

  25. Juniper EF, Guyatt GH, Feeny DH, et al. Measuring quality of life in children with asthma. Qual Life Res 1996; 5: 27–34

    Article  PubMed  CAS  Google Scholar 

  26. Redelmeier DA, Goldstein RS, Guyatt GH. Assessing the minimal important difference in symptoms: a comparison of twotechniques. J Clin Epidemiol 1996; 49: 1215–9

    Article  PubMed  CAS  Google Scholar 

  27. Deyo RA, Inui TS, Leininger JD, et al. Measuring functional outcomes in chronic disease: a comparison of traditionalscales and a self-administered health status questionnairein patients with rheumatoid arthritis. Med Care 1983; 21: 180–92

    Article  PubMed  CAS  Google Scholar 

  28. Bergner M, Bobbitt RA, Carter WB, et al. The sickness impact profile: development and final revision of a health status measure. Med Care 1981; 19: 787–805

    Article  PubMed  CAS  Google Scholar 

  29. McSweeney AJ, Grant I, Heaton RK, et. al. Life quality of patients with chronic obstructive pulmonary disease. Arch Intern Med 1982; 142: 473–8

    Article  Google Scholar 

  30. Fletcher A, McLoone P, Bulpitt C. Quality of life on angina therapy: a randomised controlled trial of transdermal glyceryltrinitrate against placebo. Lancet 1988; 2: 4–7

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Epidemiology and Biostatistics, Room 2C12, McMaster University Health Sciences Centre, 1200 Main Street West, L8N 325, Hamilton, Ontario, Canada

    Gordon H. Guyatt

  2. Department of Medicine, McMaster University, Hamilton, Ontario, Canada

    Gordon H. Guyatt & Roman J. Jaeschke

Authors
  1. Gordon H. Guyatt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roman J. Jaeschke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gordon H. Guyatt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Guyatt, G.H., Jaeschke, R.J. Reassessing Quality-of-Life Instruments in the Evaluation of New Drugs. Pharmacoeconomics 12, 621–626 (1997). https://doi.org/10.2165/00019053-199712060-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-199712060-00002

Keywords

Search

Navigation