The Effect of Comorbidities Upon Health-Related Quality-of-Life
- F. Joseph Real (freal{at}nd.edu),
- Gary C Brown (gary0514{at}aol.com),
- Heidi C Brown (hcbrown619{at}hotmail.com),
- Melissa M Brown (mbrown{at}valuebasedmedicine.com)
- Center for Value-Based Medicine, United States
- Center for Value-Based Medicine, Wills Eye Institute, United States
- Center for Value-Based Medicine, United States
- Center for Value-Based Medicine, United States
- Published Online First 17 April 2008
Abstract
Aim: The purpose of the study was to assess whether, and to what degree, comorbidities affect patient quality-of-life.
Methods: A cross-sectional, quality-of-life study of 170 consecutive vitreoretinal patients compared the utility associated with a participant's primary (most incapacitating) disease and the utility associated with a grouping of all of the participants' diseases. The ocular diseases present included diabetic retinopathy (44%), macular degeneration (30%), lattice degeneration/retinal tear (14%), retinal vascular obstruction (5%), uveitis, macular edema, macular pucker (5%) and others (2%). Participants underwent interviewer-administered, time tradeoff utility questions for each disease, then for a compilation of all diseases. Their primary disease was defined by the lowest utility reported for a single disease, while other health conditions were considered comorbidities. A two-tailed, paired t-test was used to compare the means of the primary disease utilities and compilation utilities. .The study was powered to have a 90% chance of detecting an 8% difference in mean utility between the two utility groups
Results: The mean lowest utility for the most disabling single health condition (primary disease) was 0.82 (Standard Deviation = 0.22; 95% Confidence Interval = 0.79 – 0.85. The mean utility for the grouping together of all diseases was 0.80 (SD± 0.24, 95% CI 0.76-0.84). No significant difference was found between the mean utilities of the two groups (p = 0.56).
Conclusions: The overall health-related quality-of-life of a patient in an ophthalmic population with serious diseases appears to be primarily determined by the single disease that most adversely affects the individual's quality-of-life. This conclusion has significant implications in clinical care and when considering the use of comorbidities in cost-utility analyses.
