836 Russell their health on a continuum from perfect health (1) quantity and quality of life into a single measure to death(0).although health states worse than death For economic analyses,the cost per QALY can be can also be valued and aregenerally represented by negative Index (HUI and sused to calculate OALYs should be n he fully correlated with patient behaviour before these instruments are not interehane eable.caution must be values are used in healthcare decision making.44 3.3 Disease-Specific Instruments The EO-5D.a generic health index developed in the 1990s,derives and evaluates utilities associated Among the most widely used disease-specific with HR-QOL.Although the original form included instruments in RA are the Arthritis Impact Measure. six attributes,the current version is composed of two e e m R and the Rheumatoid Arthritis Quality of nd co e do usual activities.pain/discomfort and anxiety/dep ial inte and affect).A sion.Scores on the EQ-5D range from 1 (perfect ture of the AIMS2 is a section on prior which patients can select three of 12 areas in which health)to-o 59 (worse than dead).A short adminis- tration time and the availability of pre-scored nor- they would like to see improvements during treat- mative values in several populations make the ment (e.g.pain,mobility,work).RAQoL,a 30-item EQ-5D easy to h a yes/no response format,assesse RA.Homajor mood.so ial life,hobbi veryday tasks.person d ha RAOo d the Neth other me ed fo validated in RA.4 Two HUI question cluding sweden ia.Turkey Australia.Its advantages include a direct rele speech ambulation.dexterity vance to items and issues of importance to patients. emotion.cognition and pain)that are scaled on as well as ease of use and short administration time. making it accessible for use in clinical practice. several levels from normal to highly impaired,4 and the HUI2,while similar to the HUI3,is also &eoaeeeatnnmentn ng sens In general,heumatologists have not yet incorpo rated rout of pat health)to (dead) s HR-QOL The SE-6D.another health utility instrum ent.is such 、E based on the SE-36 and SE-12 22 Six domains from rheumatologists who do utilize these instruments in the SF-36 (physical functioning,role limitations everyday practice,the effect on decision making is social functioning.pain.mental health and vitality) not clear are used to calculate a utility score based on weight To address this issue in part,the sixth biannual conference of the Outcome Measures in Rheuma toid Arthritis Clinical Trials group(OMERACT) lues are use developed to combine h836 Russell their health on a continuum from perfect health (1) quantity and quality of life into a single measure.[43] to death (0), although health states worse than death For economic analyses, the cost per QALY can be can also be valued and are generally represented by estimated and compared among the evaluated thera￾negative values (i.e. <0).[37] pies. However, it has been suggested that the under￾The EQ-5D, Health Utilities Index (HUI) and lying assumptions associated with health utility SF-6D are multi-attribute generic instruments that measures used to calculate QALYs should be care￾can be used to calculate utility values. fully correlated with patient behaviour before these [37] Since these values are used in healthcare decision making.[44] instruments are not interchangeable, caution must be taken when comparing studies that have used these different instruments. 3.3 Disease-Specific Instruments [37] The EQ-5D, a generic health index developed in Among the most widely used disease-specific the 1990s, derives and evaluates utilities associated instruments in RA are the Arthritis Impact Measure- with HR-QOL. Although the original form included ment Scales (AIMS)-2, a revised version of the six attributes, the current version is composed of two AIMS,[45] and the Rheumatoid Arthritis Quality of parts, a questionnaire and visual analogue self-rating Life (RAQoL) questionnaire.[23] The multi-dimen- scale.[38,39] The questionnaire includes components sional AIMS2 contains items in 12 areas of health of functionality, pain and psychiatric well-being, that can be grouped in five major domains (physical, and focuses on the five domains: mobility, self-care, social interaction, pain, work and affect). A unique usual activities, pain/discomfort and anxiety/depres- feature of the AIMS2 is a section on priorities, in sion. Scores on the EQ-5D range from 1 (perfect which patients can select three of 12 areas in which health) to –0.59 (worse than dead). A short adminis- they would like to see improvements during treat- tration time and the availability of pre-scored nor- ment (e.g. pain, mobility, work). RAQoL, a 30-item mative values in several populations make the instrument with a yes/no response format, assesses EQ-5D easy to use. The EQ-5D is now widely used mood, social life, hobbies, everyday tasks, personal/ internationally, has been translated into most major social relationships and physical contact.[23] The languages[38] and has been validated in RA.[40] RAQoL was developed in the UK and the Nether- Another health utility measure, the HUI, is a lands,[23] and has been adapted for use in several multi-attribute classification system that has been countries, including Sweden, Estonia, Turkey and validated in RA.[40] Two HUI questionnaires are Australia.[46-48] Its advantages include a direct rele- currently used: the HUI3 consists of eight attributes vance to items and issues of importance to patients, (vision, hearing, speech, ambulation, dexterity, as well as ease of use and short administration time, emotion, cognition and pain) that are scaled on making it accessible for use in clinical practice. several levels from normal to highly impaired,[41] and the HUI2, while similar to the HUI3, is also 4. Use of Assessment Instruments in complementary by providing assessment of inde- Clinical Practice pendent attributes, including sensation, mobility, emotion, cognition, pain, fertility and self-care.[42] In general, rheumatologists have not yet incorpo￾Utility scores on the HUI range from 1 (perfect rated routine assessment of patient-reported out￾health) to 0 (dead). comes such as HR-QOL into everyday clinical prac￾The SF-6D, another health utility instrument, is tice, mainly because of time considerations.[49] For based on the SF-36 and SF-12.[22] Six domains from rheumatologists who do utilize these instruments in the SF-36 (physical functioning, role limitations, everyday practice, the effect on decision making is social functioning, pain, mental health and vitality) not clear. are used to calculate a utility score based on weight- To address this issue in part, the sixth biannual ed preferences for health states derived from exten- conference of the Outcome Measures in Rheuma￾sive interviews in the general population.[22] toid Arthritis Clinical Trials group (OMERACT)[50] Instruments that determine utility values are use- has encouraged novel ways to incorporate patient ful for calculating QALYs, developed to combine perceptions into outcomes research. Patients partici- © 2008 Adis Data Information BV. All rights reserved. Pharmacoeconomics 2008; 26 (10)