Valuing Health-Related Quality of Life in Diabetes
- J. Todd Coffey, MS1,
- Michael Brandle, MD2,
- Honghong Zhou, MS1,
- Deanna Marriott, MAS1,
- Ray Burke, MA23,
- Bahman P. Tabaei, MPH23,
- Michael M. Engelgau, MD, MS4,
- Robert M. Kaplan, PHD5 and
- William H. Herman, MD, MPH236
- 1Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
- 2Division of Endocrinology and Metabolism, University of Michigan, Ann Arbor, Michigan
- 3Michigan Diabetes Research and Training Center, University of Michigan, Ann Arbor, Michigan
- 4Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
- 5Department of Community Medicine, University of California at San Diego, San Diego, California
- 6Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
Abstract
OBJECTIVE—Cost-utility analyses use information on health utilities to compare medical treatments that have different clinical outcomes and impacts on survival. The purpose of this study was to describe the health utilities associated with diabetes and its treatments, complications, and comorbidities.
RESEARCH DESIGN AND METHODS—We studied 2,048 subjects with type 1 and type 2 diabetes recruited from specialty clinics at a university medical center. We administered a questionnaire to each individual to assess demographic characteristics, type and duration of diabetes, treatments, complications, and comorbidities, and we used the Self-Administered Quality of Well Being index (QWB-SA) to calculate a health utility score. We then created regression models to fit the QWB-SA-derived health utility scores to indicator variables for type 1 and type 2 diabetes and each demographic variable, treatment, and complication. The coefficients were arranged in clinically meaningful ways to develop models to describe penalties from the health utility scores for nonobese diabetic men without additional treatments, complications, or comorbidities.
RESULTS—The utility scores for nonobese diet-controlled men and women with type 2 diabetes and no microvascular, neuropathic, or cardiovascular complications were 0.69 and 0.65, respectively. The utility scores for men and women with type 1 diabetes and no complications were slightly lower (0.67 and 0.64, respectively). Blindness, dialysis, symptomatic neuropathy, foot ulcers, amputation, debilitating stroke, and congestive heart failure were associated with lower utility scores.
CONCLUSIONS—Major diabetes complications are associated with worse health-related quality of life. The health utility scores provided should facilitate studies of the health burden of diabetes and the cost-utility of alternative strategies for the prevention and treatment of diabetes.
- DCP, Diabetes Care Profile
- DMH, Diabetes Medical History
- DSQ, Diabetes Staging Questionnaire
- HUI, Health Utilities Index
- QALY, quality-adjusted life-year
- QWB, Quality of Well Being index
- QWB-SA, Self-Administered QWB
- UKPDS, U.K. Prospective Diabetes Study
Footnotes
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Address correspondence and reprint requests to William H. Herman, MD, MPH, University of Michigan Health System, Division of Endocrinology and Metabolism, 1500 East Medical Center Dr., 3920 Taubman Center, Ann Arbor, MI 48109-0354. E-mail: wherman{at}umich.edu.
Received for publication 3 May 2002 and accepted in revised form 2 September 2002.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
- DIABETES CARE
