MP729UTILITY SCORES TO ASSESS QUALITY OF LIFE IN PREVALENT HAEMODIALYSIS PATIENTS

Abstract

INTRODUCTION AND AIMS: As chronic illness and comorbidity are replacing acute life threatening disease, Quality of Life (QoL) is becoming increasingly important for evaluation of quality of health care. However, quality of life is a difficult concept and a true estimation of it can be cumbersome. Scoring systems can differ in whether they assess overall QoL vs only health related QoL, or whether they refer to general vs disease specific populations. Utility scores can be used to assess (change in) general status of patients. EuroQol 5D (EQ5D) allows calculating quality adjusted life years (QALY), as used in health economic analysis. Patient Reported Outcomes Measurements Information System (PROMIS) provides scores that can be compared to different reference populations. We intended to assess EQ5D and PROMIS-29 in prevalent haemodialysis patients to assess QoL as compared to the general population and evaluate their concordance. METHOD(S): Prevalent haemodialysis (HD) patients of different dialysis units, including hospital, satellite and home dialysis units, were interviewed by trained nurses using an app containing randomly mixed questions from EQ5D and PROMIS-29. Patients were also asked to indicate on a 7 point Likert scale how they rated their health as compared to people of their age, and how they rated their QoL at the specific day of the interview. Data were centrally collected and stored using SurveyMonkey. Scores were calculated using the software provided by EQ5D and PROMIS initiatives. Statistical analysis was performed using SPSS v24. RESULT(S): A total of 121 patients (74 males, age 67.7+/-15.8), were interviewed. EQ5D utility index (range 0-1) was 0.44+/-0.26. On the EQ5D visual analogue scale (range 0- 100), patients rated their overall QoL as 61.3+/-16.2. Relative health for age and health today (range 1-7) were assessed as 4.6+/-1.3 and 4.8+/-1.4 resp. In PROMIS, HD patients scored poor for the domains physical function (38.9+/-11.8) and fatigue (38.5+/-11.6) (normal range 50+/-10 for the general population), slightly lower than the general population for sleep quality (47.9+/-9.1) and social roles (45.5+/-10.9) and normal for anxiety (49.6+/-10.1) and depression (50.7+/-9.9). This was concordant with the overall results of the EQ5D domains (table) The EQ5D utility index did however not correlate with the 2 subjective scores (Pearson 0.08 and 0.12, both p=NS), and only with "physical function" of the PROMIS domains (Pearson 0.28, p<0.01). CONCLUSION(S): In this cohort of haemodialysis patients, reported EQ5D utility was low. There was no correlation between the two direct subjective scores of health related QoL and the EQ5D utility index, whereas they correlated well with each other. Both PROMIS as EQ5D showed physical function and mobility were problematic, whereas, in contrast, anxiety and depression were comparable to the general population. It can be hypothesised that patients develop coping mechanisms to adapt to their new disease state. EQ5D utility index and subjective assessment of general health status was mainly associated with the physical domain of the PROMIS-29 tool.