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SF-6D health state utilities for lifestyle, sociodemographic and clinical characteristics of a large international cohort of people with multiple sclerosis

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Abstract

Background

While many studies have examined the impacts of multiple sclerosis (MS) on health-related quality of life (HRQoL), none have used the SF-6D multi-attribute utility instrument in a large international cohort (> 2000 subjects) of people with MS.

Objectives

To derive SF-6D health state utilities (HSUs) for participants of the HOLISM (Health Outcomes and Lifestyle In a Sample of people with Multiple Sclerosis) international cohort and to describe the distribution and determinants thereof.

Methods

HSUs were generated using the SF-6D for participants with sufficient SF-36 data [n = 2185/2466 (88.6%)]. Mean HSUs for sociodemographic, clinical and modifiable lifestyle factors (including diet, physical activity, supplement use) were evaluated. Determinants of HSU were then evaluated by linear regression, adjusted for age, sex, MS type, disability, fatigue, and prescription antidepressant use.

Results

Mean HSU for the sample was 0.67 (SD = 0.13) and diminished with increasing MS-related disability, robust to adjustment, supporting the SF-6D’s discriminatory power in people with MS. Severe disability and clinically significant fatigue were each associated with 11% lower HSU (95% CI = − 0.13, − 0.10 and − 0.12, − 0.10), and depression risk with 10%-lower HSU (95% CI = − 0.11, − 0.08). Employment, higher socioeconomic and married/partnered statuses, larger social-network size, greater physical activity, and vitamin D and omega-3 supplement use were associated with significantly higher HSU, and overweight/obese BMI and tobacco smoking with lower HSU. Age, sex, and education were not associated.

Conclusion

Modifiable lifestyle factors including healthy diet, increased physical activity and supplement use were associated with higher HRQOL among people with MS. The SF-6D instrument revealed significant discriminatory power in this international cohort of people with MS.

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Data availability

Data may not be shared due to the conditions approved by our institutional ethics committee, in that all data are stored as re-identifiable information at the University of Melbourne in the form of password-protected computer databases, and only the listed investigators have access to the data. All data have been reported on a group basis, summarising the group findings rather than individual findings so personal information cannot be identified. Therefore, we can supply aggregate group data on request. Readers may contact Steve Simpson-Yap or Tracey Weiland.

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Acknowledgements

We thank all the participants in the HOLISM study for taking the survey and the Bloom Foundation, Wal Pisciotta and the Horne Family Charitable Trust for supporting this study.

Funding

The study was funded by the Bloom Foundation, Wal Pisciotta, and the Horne Family Charitable Trust.

Author information

Authors and Affiliations

  1. Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia

    Julie A. Campbell, Andrew J. Palmer & Steve Simpson-Yap

  2. Neuroepidemiology Unit, Melbourne School of Population & Global Health, The University of Melbourne, Carlton, VIC, Australia

    George A. Jelinek, Tracey J. Weiland, Nupur Nag, Sandra L. Neate, Alysha De Livera & Steve Simpson-Yap

  3. Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia

    Andrew J. Palmer

  4. Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia

    Brendan Mulhern

  5. Baker Heart and Diabetes Institute, Melbourne, VIC, Australia

    Alysha De Livera

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Contributions

GJ, TW, and SN conceived the HOLISM Study, alongside others not included in the authorship of the present manuscript. JC & SSY conceived the present analysis. SSY & ADL contributed to cohort management and cleaned and prepared the data for analysis. JC undertook HSU estimation using the algorithm developed by BM. JC and SSY conceived the data analyses. SSY undertook data analyses. JC and SSY drafted and edited the manuscript. All authors commented on and approved the final version of the manuscript.

Corresponding author

Correspondence to Steve Simpson-Yap.

Ethics declarations

Conflict of interest

GJ receives royalties for his books, Overcoming Multiple Sclerosis and Recovering from Multiple Sclerosis. GJ & SN have received remuneration for conducting lifestyle educational workshops for people with MS. All other authors declare no competing interests.

Ethics approval

The Health Sciences Human Ethics Sub-Committee at the University of Melbourne provided ethical approval for the study (Ethics ID: 1545102).

Informed consent

Participants were asked to read the participant information and to consent before entering the survey.

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Campbell, J.A., Jelinek, G.A., Weiland, T.J. et al. SF-6D health state utilities for lifestyle, sociodemographic and clinical characteristics of a large international cohort of people with multiple sclerosis. Qual Life Res 29, 2509–2527 (2020). https://doi.org/10.1007/s11136-020-02505-6

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