Background Indirect utility measures are increasingly used to assess health benefits in RCTs and to estimate Quality-adjusted life-years (QALYs) gain in cost-effectiveness models. The EQ-5D is a 5-dimensional multi-attribute questionnaire widely used to calculate QALY. It allows negative utility values which theoretically correspond to health state “worse than death”'.
Objectives To analyse the patients reporting EQ-5D <0 ie in states theoretically labeled “worse than death” and to investigate their health status in a large multicenter trial of patients with rheumatoid arthritis (RA).
Methods EQ-5D measures were assessed in 962 patients of COMEDRA, a national multicentric clinical trial involving patients with stable RA. Clinical outcomes and laboratory measures were also recorded (activity by DAS28, function by HAQ score, Rheumatoid Arthritis Impact of Disease score ...). The characteristics and health status of patients with an EQ-5D<0 were analyzed. Multivariate logistic regression was used to determine which specific aspects of RA were independently associated with states worse than death.
Results At baseline, 38 (4%) patients were in states worse than death. Mean EQ-5D values were -0.073±0.092 (range -0.416 to -0.017). Almost all patients reported moderate problems in mobility, in usual activities, and in self-care. Concerning other domains, 55.3% of patients reported severe anxiety/depression and 44.7% moderate anxiety/depression; 55.3% reported extreme pain/discomfort and 44.7% moderate pain/discomfort. Patients with negative EQ-5D scores had higher disease activity, higher HAQ score, more pain, more fatigue, lower mental component of the RAID, more difficulties in coping and higher CRP than patients with EQ-5D≥0 (all p<0.01). In the logistic regression model, increasing HAQ score, decreasing coping, increasing physician global assessment and increasing fatigue were associated with negative EQ-5D scores (Table 1).
Conclusions HAQ and coping were the main determinants of state worse than death. These results highlight the importance of taking into account patients coping strategies, functional abilities and fatigue to better care for patients and to improve their adaptation to their disease.
Disclosure of Interest None declared