Mapeo de la Escala de Calidad de Vida de San Martín al EQ-5D-5L en Adultos con Parálisis Cerebral

This contributed the curriculum the communication awarded with the Fedea Prize for the best article presented by a young investigator at the XLIII AES Conference, held in San Cristóbal de la Laguna, of June 26-28, 2024. The article , Written Effect in collaboration with Aritz Adin and Eduardo Sánchez Iriso, is in the process of consideration for publication.

In the amit of the health economy, the evaluation of the impact of health interventions a through measures that capture the quality of life related to health (CVRS) is crucial. In many countries, sanitary technologies evaluation agencies use the utility values ​​derived from the Euroqol (EQ-5D-5L) tool for calculating the years of quality adjusted by quality (AVAC) in their Cost-utility analysis. The EQ-5D-5L is a preferably measure based on the evaluation of dimensions of five health key: mobility, self-care, usual activities, pain/discomfort and anxity/depression. However, one of the main challenges of using generic measures such as EQ-5D-5L is that they are not used in clinical practice, and result. Cerebral paralysis (PC).

The PC is a group of neurological disorders that has no cure, permanently affects movement and postures it, and originates from giving you in the brain during development. It is estimated that its prevalence is 2 to 3 cases per thousand living births in Europe and Spain, significantly affecting the Quality of life Of those who suffer from it. In addition to motor problems, people with PC usually present comorbidities such as epilepsy, disability and limitations of and limitations, which contributes to the complexity of clinical management and affects their overall well -being from pedetric age to Hastezz. This is associated with great welfare and high losses Economic costs of cooling.

A regret that EQ-5D-5L is one of the most used utility measures in cost-utility analysis, its applicability in PC populations is scarce. This is because the dimensions evaluated by EQ-5D-5L without always capture the most requested superses of the CVRS is this population. On the age CVRS in adults with PC. This scale measures dimensions related to global well -being and the CVRS. This tool has proven particularly sensitive to the specific characteristics of the PC. However, the St. MQOL-S NO GENDER DIRECTURE VALUES OF USE NEEDED FOR CALCULATION AVAC IN ECONOMIC EVALUATIONS.

The suitability of the generic measures of existing CVRs for applying in adfensos with PC has received a limited Athennon in the investigation. A mapping algorithm for adults with PC using a generic instrument for this population has not yet developed. Since some relevant domains or domains overlap between St. Mqol-S and EQ-5D-5L, it is plausible that there is a significant relationship between us the instruments.

With this background, the present study Protone develops an algorithm that maps the St. Mqol-S al EQ-5D-5L, thus allowing the use of utility values ​​a starting from a summary species for adults with PC.

The study was developed based on the main mapping guides of generic measures based on specific preferences and measures of cooling, general not based on preferences. Data from 72 adults with PC records were collected in the Spanish Associative for the Care of Persons with Cerebral Palsy (ASPACE), an institution specialized in Navarra. The participants of the participants were selected according to their cognitive capacity to independently complete the St. Mqol-S and EQ-5D-5L life scales at the same time.

St. MQOL-S is a validated scale that measures the quality of life in dimensions: self-determination, emotional well-being, physical well-being, well-being material, rights, development, interpersonal relationships, and social inclusion. Each dimension contains between 11 and 12 items that the participant responds on a four -point Likert scale, where a score mayor in a range of values ​​from 52 to 132 indicates a better quality of life within index of index of CVRS of St. Mqol-S.

The EQ-5D-5L, meanwhile, is a generic tool that measures five health dimensions five levels of severity in each one, generating a useful value that goes from 0 (death) to 1 (perfect health), , Although negative values ​​can also occur. The utility values ​​in this study were calculated using the Spanish EQ-5D-5L rateDeveloped by Ramos-Goñi et al. (2018).

Development of the mapping algorithm

To develop the mapping algorithm Direct mapping modeling approaches: Regression by ordinary minimums (OLS), the generalized linear model (GLM) with Logit link function, and Tobit roars, designed to handle censored data on the EQ-5D-5L response scale. In each of the models, the total scores of the St. Mqol-S and those of its domains differences are included the variables of how, explanatory with the age, sex and type of PC (spabic, discinitics, atáxica and unlacified) . It is important to clarify that the mapping of respect or indirect is not considered due to the size of the mass.

The OLS model was selected as the base model due to its wide use in Previous Mapeo Studies. This model assumes a linear relationship between the predictor variables and the useful value of the EQ-5D-5L. However, given that the utility values ​​are not distributed normal to, the models GLM and Tobit models were also explored, which better adjust the biased distributions and the lmesters censored in the stages of the respects of the EQ-5D-5L.

The selection of the best model was carried out based on several adjustment metrics, including the Absolute Absolute Middle Error (MAE) and the middle quadrabic error (RMSE), which evaluate discrepancy between predicted values ​​and observations. Analysis of Cruzada Validario Repeated to ensure that the developed models were not overjusted and could generalize other data sets.

Figure 1. mapping algorithm

The results showed that the OLS model that used the total st. MQOL-S scores, together with age, sex and the type of cerebral palsy, was the most precise to predict the utility values ​​of EQ-5D-5L . This model presented the slightest average absolute error (MAE: 0.1131) and error and quadratic medium (RMSE: 0.1545), which makes it the most robust model model to estimate users in ADFINS CONC.

Cross validation also showed that the OLS model was the most appropriate to predict utilities in un observed data, since it minimized bias in predictions both in the low -cohos high values ​​of the high cohos of the EQ-5D-5L. The GLM model showed a lower, special level in the prediction of lower utility values, while the Tobit model was useful to limit predictions in the upper extreme of the scale.

In terms of correlation, a positive relationship is observed before the scores with total of St. Mqol-S and the EQ-5D-5L (R = 0.77; p <0.05), the one suggests that both scales They capture important dimensions of the CVRs in adendos with PC. In addition, the analysis of the individual domains of the St. MQOL-S showed that the domains of self-determination, physical well-being, well-being, rights and development material were the most meaning to predict the profits of the EQ-5D-5L.

The preferred allocation algorithm, represented by the OLS model, is presented as a linear relationship between the EQ-5D-5L index and the total pointed of the San Martín Life Scale, controlling by Sociodemographic Varianbles (Age and Sex) and clinical topos of cerebral paralysis, with a medium adjustment a negative constant.

Implications for economic evaluation

The development of this algorithm has important involvements for economic evaluation in the context of the PC in adults.

1. In the absence of direct preference data, policy researchers can use this algorithm to estimate usefulness values ​​of the EQ-5D-5L a starting from St. MQOL-S scores, facilitating the calculation of AVAC for analysis for analysis of cost-utility. This is particularly relevant in Spain, where EQ-5D-5L is one of the measures recommended by the National Health System and economic evaluation agencies.
2. The mapping between St. Mqol-S and the EQ-5D-5L also allows a more direct comparison between interventions designed to improve the quality of life of adults with PC. This not only optimizes the allocation of health resources, but also allows a better competition for the impact of interventions on this populations species. Since the PC is a condition that entails A significant economic burdenFor both the families and for the health system, the ability to perform robust economic analysis is essential for resource planning and guarantee a CVRS BUYA to these patients.

The study provides an innovative tool for the economic evaluation of interventions in adults with PC, developing the first mapping algorithm between the San Martín quality scale and the EQ-5D-5L. The results show that the algorithm is able to precisely predict the necessary utility values ​​for the cost-utility analysis, providing a solution when direct utility decades are not coutled.

This advance is particularly relevant to researchers who work in the evaluation of health technologies and those responsible for populations in populations with significant discopacities such as PC, since it persists to integrate CVRS spice measures into the ecumic analysis. In a context where the utility values ​​is increasing a population little studied in the literation The litera of the economic evaluation for a population little studied in the literation The literary of the economic evaluation for a population little studied in the litera of the evaluation of Lasimica for a population little studied in the litera of the evaluation of Lasmica for a population little studied in the litera of the Evaluón de Lascita Economic evaluations.