PURPOSE:Little is known about factors that affect health-related quality of life during the early follow-up of colorectal cancer. This study was designed to identify the factors that contribute to poor health-related quality of life after six weeks of follow-up and to compare the relative performance of instruments best suited to measure it.METHODS:A single-center, prospective study was designed to examine health-related quality of life after potentially curative surgery for colorectal cancer. Two condition-specific and two generic instruments (QLQ-C30, FACT-C, SF12 and EQ-5D) measured quality of life six weeks after discharge. Univariate and multivariate analyses were used to assess the impact of 16 treatment factors, demographic variables, and symptoms on seven global health-related quality of life scores.RESULTS:Questionnaires were obtained from 201 consecutive patients. Five factors were associated with poor health-related quality of life scores at six-week follow-up in the multivariate analysis: reduced preoperative performance status, stomas, diarrhea, constipation, and younger than aged 65 years. No instrument out performed the others. However, condition-specific instruments and those in which patients subjectively rated their overall health-related quality of life were better suited to detect health-related quality of life differences relating to the effects of colorectal cancer treatment.CONCLUSIONS:Younger patients, those with stomas, and those suffering from diarrhea or constipation are more likely to report poor health-related quality of life at six-week follow-up. The routine measurement of health-related quality of life using an instrument that includes a patient-rated scale together with condition-specific items could be used to detect patients at risk of poorer short-term health-related quality of life outcomes.

The purpose of the study was to develop a questionnaire measuring health-related R1 quality of life for children and adolescents with congenital heart disease, the ConQol, that would have both clinical and research applications. We describe here the process of construction of a questionnaire, the piloting and the development of a weighted scoring system, and data on the psychometric performance of the measure in a sample of 640 children and young people recruited via 6 regional centres for paediatric cardiology from across the United Kingdom. The ConQol has two versions, one designed for children aged from 8 to 11 years, and the other for young people aged from 12 to 16 years. Initial findings suggest that it is a valid and reliable instrument, is acceptable to respondents, and is simple to administer in both a research and clinical context.

6013 Background: EORTC QLQC-30 is a generic measure of health-related quality of life (HrQoL) in cancer. Version #3 consists of 28 items with a 4-category response and 2 further general items coded on a 7-point response category scale. Responses are converted into corresponding numeric scores that are summed to produce a total score. However, QLQC-30 cannot be used in cost-effectiveness analysis because it is not standardized on a value scale where full health = 1 and dead = 0. This paper reports on a method for converting QLQC-30 into a weighted index that overcomes this limitation Methods: Baseline observations from a previously reported study of 177 patients with pancreatic cancer were available for analysis. HrQoL was assessed using both the QLQ-C30 and EQ-5D, a generic measure based on 5 dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) that defines 245 health states which can be converted into an index score (EQ-5Dindex) on a scale where dead = 0 and full health = 1. This index was previously calibrated in a national study of the UK population using Time Trade-Off procedures (n=3,395). Results: 28 QLQC-30 items were recoded as dichotomous values and analysed using an OLS regression model with EQ-5Dindex as the dependent variable. 5 items (short walk, sleeping, physical impact on family life, washing/dressing, concentration) and 1 general item (overall health) formed the best fit with an r2 of 0.490. Mean absolute error was less than 0.01. Correlation between observed EQ-5Dindex and estimated values was high. The index based on these items differentiated between patients classified by the Karnofsky Performance Scale. Conclusions: QLQC-30 items can be used to construct a weighted index that represents HrQoL on a 0–1 scale that has legitimacy for use in economic analysis. This index may also have independent status as a measure of health outcomes in cancer. No significant financial relationships to disclose.

Primary Care Trusts (PCTs), charged with improving the health of their population, need to measure the extent to which patients actually benefit from the health care that is provided for them. One way of achieving this is to measure health status of patients over time. The study described here reports on the feasibility of administering the EQ-5D in general practitioner (GP) surgeries and identifies how the results might be used by practices and PCTs to improve the health of their populations. The study took place in an opportunistic sample of 1942 patients attending GP surgeries. One year later, patients who had provided contact details were sent another EQ-5D together with a request for additional information about their use of health care services in the intervening time period. A total of 770 patients completed this follow-up questionnaire. There were significant age effects associated with variation in self-reported health status and also associated with top-level Read diagnostic codes in some groups of patients. The results showed that EQ-5D could be used by individual GP practices to identify patients with specific health problems. This knowledge can also be used by PCTs and other primary care organisations, to better target scarce health resources.

Although the aetiology, pathophysiology and treatment of acute compartment syndrome have been well described in the literature, there is limited information on the long-term impact of compartment syndrome on quality of life. We reviewed the medical records and radiographs of all the patients treated with surgical decompression of compartment syndrome. Between 1993 and 1998, 42 cases were identified. There were 30 cases of tibial compartment syndrome and 12 cases involving other limbs. These 30 patients were recalled for a follow-up assessment during which they were asked to complete an EQ-5D (EuroQol), a standardised measure of health related quality of life based on five dimensions (self-care, pain/discomfort, mobility, usual activities and anxiety/depression). Patients were compared with EQ-5D age/sex norms derived from a randomly selected group of patients that had sustained isolated closed tibial shaft fractures. The minimum follow-up time was 12 months. Patients who stated that the appearance of the surgical site was a problem, reported significantly poorer health related quality of life than did patients who had no problem with the appearance. Patients with skin graft reported more problems with pain and discomfort than patients without skin graft. Patients with faster closure times of the wound showed significantly better self-rated health status than patients in whom the wound closure time was longer. Although the patients in this study reported significantly more problems on the dimensions of EQ-5D than were reported in the control group, their overall self-rated health was not statistically different. This study has demonstrated that compartment syndrome may be associated with long-term impact on health related quality of life.

Socio-demographic information was collected from 52 (45 men, seven women) currently drinking moderately dependent alcohol misusers attending an outpatient clinic in South London for medical assessment and treatment. Assessments at baseline and 12-week follow-up included: (i) Severity of Alcohol Dependence (SADQ) (baseline only), (ii) Hospital Anxiety and Depression Scale (HADS); (iii) Nottingham Health Profile sleep subscale (NHP) and (iv) the EuroQoL (EQ-5D). The main outcome measure was drinking at a "sensible level" at 12-week follow-up as recommended by the Royal College of Psychiatrists. There were significant interactions between sleeping badly, lying awake at night and HADS depression scores. The Health-related Quality of Life (HrQoL) of this group was poor compared to general population norms. Lower EQ-5D index scores were associated with poorer educational attainment and lower EQ-5D Visual Analogue Scale (VAS) patient ratings with greater baseline alcohol consumption. Clinician ratings on the EQ-5D VAS were consistently lower than the patient ratings. The correlations between patient self-assessment and clinician ratings (EQ-5D VAS) were not significant. The forty-seven subjects (90%) who were successfully followed-up showed a significant reduction in the total amount of alcohol consumed. Ten (21%) subjects returned to sensible drinking levels at 12 weeks but there was not a corresponding improvement in HrQoL, sleep, or affective status scores or biochemical measures in these subjects.

health interventions at all levels of the healthcare system. •Following the recommendations of the Washington Panel on Cost-Effectiveness in Health and Medicine and more recently published guidance of the U.K. NICE, it is generally accepted that when generic HrQoL measures are used in the computation of quality-adjusted life years (QALYs) then the values applied should represent the social preferences of the relevant population. •Despite the urgent need for appropriate methodologies to support decision-making processes and to improve the use of scare resources in the healthcare sector of Latin American countries, little is know about how health is valued.

Few studies have compared preference values for health states obtained in different countries. The present study compared Spanish and United Kingdom (UK) time trade-off values for EuroQol-5D health states. The same preference elicitation protocol was followed in both countries. Differences in values for 43 health states rated directly were analyzed using t tests, and regression coefficients generated by random effects modeling were compared by aggregating the 2 value sets and using dummy variables to analyze country effect by dimension and level of severity. For the milder health states, Spanish and UK value assignation was similar; for intermediate health states, Spanish values were both higher and lower than UK values, whereas for health states worse than death, UK values were generally higher than Spanish values. There were statistically significant differences (P < 0.01) in values for 34.9% of health states rated directly, and some preference reversals between countries. UK raters ascribed greater importance to dimensions of pain/discomfort and anxiety/depression, whereas Spanish raters placed more importance on functional dimensions of mobility and self-care. Further analysis is required to determine how these differences affect cost-effectiveness and cost-utility analyses.

Health professionals provide care with some purpose in mind. It is reasonable to assume that they are therefore interested in observing and measuring health outcomes. In the recent past, it has become fashionable to describe health outcomes in terms of their impact on 'quality of life', a widely used term that is usually left undefined. Measures of health-related quality of life (HRQoL) are now in common usage in clinical studies. The construction of both generic and condition-specific measures of HRQoL relies heavily on the choice of descriptive domains, a process that often reflects the personal values of the developer of the instrument. Subjective valuation is a recurring phenomenon in the construction and application of HRQoL measures. These values should not be restricted to the private judgement of the clinician alone. The challenge for those evaluating clinical interventions is to make such values explicit and to extend the franchise to society as a whole.

Pharmaceuticals, Welwyn Garden City, UK, 4 The King’s Fund, London, UK, 5 Diabetes UK, London, UK