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David Feeny

Publications and source records attributed to David Feeny.

29 records · Page 2Linked to original sources
PubMed2003

The Health Utilities Index (HUI): concepts, measurement properties and applications.

This is a review of the Health Utilities Index (HUI) multi-attribute health-status classification systems, and single- and multi-attribute utility scoring systems. HUI refers to both HUI Mark 2 (HUI2) and HUI Mark 3 (HUI3) instruments. The classification systems provide compact but comprehensive frameworks within which to describe health status. The multi-attribute utility functions provide all the information required to calculate single-summary scores of health-related quality of life (HRQL) for each health state defined by the classification systems. The use of HUI in clinical studies for a wide variety of conditions in a large number of countries is illustrated. HUI provides comprehensive, reliable, responsive and valid measures of health status and HRQL for subjects in clinical studies. Utility scores of overall HRQL for patients are also used in cost-utility and cost-effectiveness analyses. Population norm data are available from numerous large general population surveys. The widespread use of HUI facilitates the interpretation of results and permits comparisons of disease and treatment outcomes, and comparisons of long-term sequelae at the local, national and international levels.

Female↗
PubMed2003

Is the Health Utilities Index responsive in total hip arthroplasty patients?

OBJECTIVE: The purpose is to examine the responsiveness of the Health Utilities Index Mark 2 (HUI2), Mark 3 (HUI3), and other generic and disease-specific measures in osteoarthritis patients undergoing total hip arthroplasty (THA). METHODS: Ninety patients (mean age=68.13; SD=8.15) on a waiting list for THA completed measures that included the standard gamble, HUI2, HUI3, SF-36, Harris Hip Scale, WOMAC, and MACTAR. before and after THA. Responsiveness statistics (effect size, standardized response mean, Guyatt's responsiveness statistic, paired-sample t-tests, and relative efficiency statistic) were calculated. RESULTS: The disease-specific measures were more responsive than the generic measures. Rankings of the degree of responsiveness varied depending on the responsiveness statistic used. CONCLUSIONS: Disease-specific measures are the most responsive in THA patients. However, the SF-36, HUI2, and HUI3 had summary scores and domain/attributes scores that were also responsive and provided additional information. Among the generic measures, HUI3 was the most responsive.

Animals↗
PubMed2003

Comparing community-preference-based and direct standard gamble utility scores: evidence from elective total hip arthroplasty.

OBJECTIVES: Do utility scores based on patient preferences and scores based on community preferences agree? The purpose is to assess agreement between directly measured standard gamble (SG) utility scores and utility scores from the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) systems. METHODS: Patients were assessed repeatedly throughout the process of waiting to see a surgeon, waiting for surgery, and recovery after total hip arthroplasty (THA). Group mean scores are compared using paired t-tests. Agreement is assessed using the intraclass correlation coefficient (ICC). RESULTS: The mean SG, HUI2, and HUI3 (SD) scores at assessment 1 are 0.62 (0.31), 0.62 (0.19), and 0.52 (0.21); n=103. At assessment 2, the means are 0.67 (0.30), 0.68 (0.30), and 0.58 (0.22); n=84. There are no statistically significant differences between group mean SG and HUI2 scores. Mean SG and HUI3 scores are significantly different. ICCs are low. CONCLUSIONS: At the mean level for the group, SG and HUI2 scores match closely. At the individual level, agreement is poor. HUI2 scores were greater than HUI3 scores. HUI2 and HUI3 are appropriate for group level analyses relying on community preferences but are not a good substitute for directly measured utility scores at the individual level.

Arthroplasty, Replacement, Hip↗
PubMed2003

Is adherence to drug treatment correlated with health-related quality of life?

BACKGROUND: Adherence to drug treatment and health-related quality of life (HRQL) are two distinct concepts. Generally one would expect a positive relationship between the two. OBJECTIVES: The purpose of this study was to assess the relationship between adherence and HRQL. METHODS: HRQL was measured using the physical and mental summary measures of the RAND-12 (PHC-12, MHC-12), the SF-12 (PCS-12, MCS-12), HUI-2 and HUI-3. Adherence was assessed using Morisky's instrument. Three longitudinal datasets were used. One dataset included 100 hypertensive patients. Another dataset covered 199 high risk community-dwelling individuals. The third dataset consisted of 365 elderly patients. Spearman's correlation coefficients were used to assess association. Subgroup analyses by type of medication and inter-temporal analyses were also performed. RESULTS: Correlation between adherence and PHC-12 ranged from 0.08 (p = 0.26) to 0.22 (p < 0.01). Correlations between adherence and MHC-12 ranged from 0.11 (p = 0.11) to 0.15 (p < 0.01). Similar results were observed using HUI-2, HUI-3, and SF-12 as well as by type of medication and in the lagged analyses. CONCLUSIONS: Correlations between HRQL and adherence were positive but typically weak or negligible in magnitude.

Aged↗
PubMed2003

Development of disease-specific health-related quality-of-life instruments for children with immune thrombocytopenic purpura and their parents.

PURPOSE: Immune thrombopenic purpura (ITP) is an important childhood hematologic disorder that is often frightening to patients and their parents because of its acute onset and bleeding symptoms. There is no consensus on the management of ITP in children. Pediatric hematologists have differing management philosophies, yet most, explicitly or implicitly, incorporate into their management approach the potential impact on the child's and family's quality of life. There is no validated ITP-specific health-related quality-of-life instrument for use with children with ITP, nor is there one to evaluate the burden experienced by their parents. ITP is usually a self-limited disorder. With current controversy over management approaches, an evaluation of the disease burden experienced by the child and the family may assist with the assessment of alternative treatment approaches. METHODS: Using standard clinimetric methodology, 88 children with acute or chronic ITP, along with their parents, participated in the development of the instruments. RESULTS: The 26-item ITP-Child Quality-of-Life Questionnaire includes five domains: treatment side effect-related, intervention-related, disease-related, activity-related, and family-related. This instrument can be used as a self-completed instrument for most children older than 7 years or as a proxy-completed instrument by parents of children younger than 7 years. The 26-item ITP-Parental Burden Quality-of-Life Questionnaire includes six domains: concerns related to diagnosis/investigation, treatment/disease monitoring, monitoring of child's activities, interference with daily life, disease outcome, and emotional impacts. CONCLUSIONS: The first steps of the development of these formally developed instruments are complete. The instruments are available for study to validate and test their responsiveness through use in clinical research studies. Such instruments are increasingly recognized as important for comprehensive measurement of patient outcomes in this and other areas of pediatric hematology/oncology practice.

Adolescent↗
PubMed2002

Health-related quality-of-life assessment of prenatal diagnosis: chorionic villi sampling and amniocentesis.

This study assesses the health-related quality-of-life (HRQL) effects of chorionic villi sampling (CVS) and genetic amniocentesis (GA), including both process and outcomes of prenatal diagnosis. The HRQL of 126 women participating in a randomized controlled clinical trial of CVS versus GA in Toronto and Hamilton, Ontario, was assessed in four interviews at weeks 8, 13, 18, and 22 of pregnancy. Statistical analyses included analysis of variance, repeated measures analysis of covariance, chi-square, Fisher's exact test, Student's t-tests, and paired t-tests. Utility scores for patients undergoing CVS exceeded those for GA patients at week 18 (p = 0.04). Utility scores for hypothetical health states did not differ significantly by trial arm. CVS results in slightly improved HRQL during prenatal diagnosis. This advantage needs to be weighed against the high disutility patients attach to infrequent outcomes associated with pregnancy losses, equivocal diagnoses, and diagnostic inaccuracy.

Adult↗
PubMed2002

Multiattribute and single-attribute utility functions for the health utilities index mark 3 system.

BACKGROUND: The Health Utilities Index Mark 3 (HUI3) is a generic multiattribute preference-based measure of health status and health-related quality of life that is widely used as an outcome measure in clinical studies, in population health surveys, in the estimation of quality-adjusted life years, and in economic evaluations. HUI3 consists of eight attributes (or dimensions) of health status: vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain with 5 or 6 levels per attribute, varying from highly impaired to normal. OBJECTIVES: The objectives are to present a multiattribute utility function and eight single-attribute utility functions for the HUI3 system based on community preferences. STUDY DESIGN: Two preference surveys were conducted. One, the modeling survey, collected preference scores for the estimation of the utility functions. The other, the direct survey, provided independent scores to assess the predictive validity of the utility functions. MEASURES: Preference measures included value scores obtained on the Feeling Thermometer and standard gamble utility scores obtained using the Chance Board. RESPONDENTS: A random sample of the general population (> or =16 years of age) in Hamilton, Ontario, Canada. RESULTS: Estimates were obtained for eight single-attribute utility functions and an overall multiattribute utility function. The intraclass correlation coefficient between directly measured utility scores and scores generated by the multiattribute function for 73 health states was 0.88. CONCLUSIONS: The HUI3 scoring function has strong theoretical and empirical foundations. It performs well in predicting directly measured scores. The HUI3 system provides a practical way to obtain utility scores based on community preferences.

Adolescent↗
PubMed2002

Comparison of total hip arthroplasty performed with and without cement : a randomized trial.

BACKGROUND: This study was designed to compare the fixation of a Mallory-Head total hip prosthesis with and without cement. METHODS: Two hundred and fifty patients with osteoarthritis of the hip were randomized to receive a Mallory-Head total hip prosthesis designed for insertion with cement or the same prosthesis designed for insertion without cement. Neither the patient nor the outcomes assessor was aware of the type of prosthesis. Outcomes were assessed with respect to mortality, revision arthroplasty, health-related quality of life (evaluated with the Harris hip score, Merle d'Aubign and Postel hip score, McMaster-Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the time trade-off technique), and the six-minute-walk test. Patients were seen at three, six, and twelve months and yearly thereafter. RESULTS: The prosthesis was inserted with cement in 124 patients and without cement in 126 patients. The mean age of the patients was sixty-four years, 48% were female, and the mean duration of follow-up was 6.3 years. There were thirteen revisions in the group that had fixation with cement and six in the group that had fixation without cement (p = 0.11), and more femoral components were revised in the group that had fixation with cement (twelve versus one; p = 0.002). All health-related quality-of-life measures improved postoperatively in both groups. CONCLUSIONS: In this randomized trial, the group that had the cemented Mallory-Head hip prostheses required more revisions of the femoral component than did the group with the cementless Mallory-Head prostheses, which was perhaps related to the titanium-alloy femoral stem. Our findings are specific to the implants evaluated in this study.

Aged↗
PubMedDate not supplied

How robust is the Health Utilities Index Mark 2 utility function?

PURPOSE: The utility function for the Health Utilities Index Mark 2 (HUI2) system is based on preference measurements from a random sample of parents with exclusion of inconsistent respondents. Would results without exclusions or from a different group of parents have differed? METHODS: Scores were obtained from parents of patients (n = 59) undergoing treatment for cancer. Mean scores from the 2 sets of parents were compared:parents of patients and parents from the general population. Three multiattribute utility functions were estimated. Mean scores for HUI2 states using the functions were compared. RESULTS: Most differences in mean scores between different groups were not statistically significant (P < 0.05). Differences in parameter estimates among the 3 utility functions were 0.05 or less. The exponent on the power function for the parent-of-patient group was 2.16, within 6% of that for random sample parents. The intraclass correlation between scores for 144 health states derived from the random-sample-parents and parents-of-patients functions was 0.99; the mean difference per state in scores was 0.018. CONCLUSION: The HUI2 scoring function generalizes well in that different groups of parents give similar results. The HUI2 scoring function is robust in that the functions without and with exclusions generate scores that are very close in value.

Canada↗