Elsevier

Value in Health

Volume 21, Issue 8, August 2018, Pages 1002-1009
Value in Health

Preference-Based Assessments
Health-Related Quality of Life in People Living with Psychotic Illness and Factors Associated with Its Variation

https://doi.org/10.1016/j.jval.2018.02.012Get rights and content
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Abstract

Objectives

To establish whether the four-dimensional Assessment of Quality of Life (AQoL-4D) produces robust utility values in adults with psychotic illness, and identify health inequalities compared with the general population.

Methods

The AQoL-4D was completed by 1613 individuals with an International Classification of Diseases, Tenth Revision, psychotic illness in the 2010 Australian National Survey of Psychosis. Utilities were assessed for this sample and 20 subgroups, and were compared with general population norms. Modified Cohen d was used as an index of effect size. Utilities were collapsed into 10 health-related quality-of-life (HRQOL) bands or decades.

Results

HRQOL in people with psychotic illness was half of the maximum achievable utility (half-“full health”) with a mean utility of 0.49 (95% confidence interval [CI] 0.48–0.51), and showing substantial variability across subgroups. Participants with essentially normal functioning had the highest mean utility (0.72; 95% CI 0.68–0.77), and those with very poor perceived mental health had the lowest (0.22; 95% CI 0.18–0.26). These subgroups showed the most variability. Negative symptoms also gave rise to substantial variation. Among diagnostic categories, only depressive psychosis had a large effect relative to delusional disorders. The distribution of utilities in people with psychotic illness differed markedly from that in the general population, with 6.8% versus 47.2% having values in the highest decade (>0.90–1.00). Utilities were lower in every age group in people with psychosis.

Conclusions

Profound HRQOL impacts are revealed by the AQoL-4D in people with psychotic illness, and marked variations in utilities were observed for key subjective and objective measures. We provide a suite of utility values for economic modeling studies and recommend the AQoL-4D for assessing HRQOL in people with psychotic illness.

Keywords

economic modeling
health inequalities
psychotic disorders
schizophrenia
utility assessment

Cited by (0)

This publication is based on data collected in the framework of the 2010 Australian National Survey of High Impact Psychosis. The members of the Survey of High Impact Psychosis Study Group at that time were V. Morgan (National Project Director), A. Jablensky (Chief Scientific Advisor), A. Waterreus (National Project Coordinator), R. Bush, V. Carr, D. Castle, M. Cohen, C. Galletly, C. Harvey, B. Hocking, A. Mackinnon, P. McGorry, J. McGrath, A. Neil, S. Saw, and H. Stain.