Publications by authors named "Fredrick Dermawan Purba"

18 Publications

  • Page 1 of 1

Development of an EQ-5D Value Set for India Using an Extended Design (DEVINE) Study: The Indian 5-Level Version EQ-5D Value Set.

Value Health 2022 Jul 5;25(7):1218-1226. Epub 2022 Jan 5.

Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Objectives: This study aimed to develop the Indian 5-level version EQ-5D (EQ-5D-5L) value set, which is a key input in health technology assessment for resource allocation in healthcare.

Methods: A cross-sectional survey using the EuroQol Group's Valuation Technology was undertaken in a representative sample of 3548 adult respondents, selected from 5 different states of India using a multistage stratified random sampling technique. The participants were interviewed using a computer-assisted personal interviewing technique. This study adopted a novel extended EuroQol Group's Valuation Technology design that included 18 blocks of 10 composite time trade-off (c-TTO) tasks, comprising 150 unique health states, and 36 blocks of 7 discrete choice experiment (DCE) tasks, comprising 252 DCE pairs. Different models were explored for their predictive performance. Hybrid modeling approach using both c-TTO and DCE data was used to estimate the value set.

Results: A total of 2409 interviews were included in the analysis. The hybrid heteroscedastic model with censoring at -1 combining c-TTO and DCE data yielded the most consistent results and was used for the generation of the value set. The predicted values for all 3125 health states ranged from -0.923 to 1. The preference values were most affected by the pain/discomfort dimension.

Conclusions: This is the largest EQ-5D-5L valuation study conducted so far in the world. The Indian EQ-5D-5L value set will promote the effective conduct of health technology assessment studies in India, thereby generating credible evidence for efficient resource use in healthcare.
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http://dx.doi.org/10.1016/j.jval.2021.11.1370DOI Listing
July 2022

EQ-5D-Y-3L and EQ-5D-Y-5L proxy report: psychometric performance and agreement with self-report.

Health Qual Life Outcomes 2022 Jun 3;20(1):88. Epub 2022 Jun 3.

Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.

Background: Self-report is the standard for measuring people's health-related quality of life (HRQoL), including children. However, in certain circumstances children cannot report their own health. For this reason, children's HRQoL measures often provide both a self-report and a proxy-report form. It is not clear whether the measurement properties will be the same for these two forms. We investigated whether it would be beneficial to extend the classification system of the EQ-5D-Y proxy questionnaire from 3 to 5 response levels. The agreement between self-report and proxy-report was assessed for both EQ-5D-Y measures.

Methods: The study included 286 pediatric patients and their caregivers as proxies. At three consecutive measurements-baseline, test-retest and follow-up-the proxies assessed the child's HRQoL using the EQ-5D-Y-3L, EQ-5D-Y-5L, the PedsQL Generic, and matched disease-specific instruments. The proxy versions of EQ-5D-Y-3L and EQ-5D-Y-5L were compared in terms of feasibility, distribution properties, convergent validity, test-retest and responsiveness. Agreement between both EQ-5D-Y proxy versions to their respective self-report versions was assessed at baseline and follow-up.

Results: The proportion of missing responses was 1% for the EQ-5D-Y-3L and 1.4% for the EQ-5D-Y-5L. The frequency of health state with no problems in all dimensions (11111) was slightly lower for the EQ-5D-Y-5L (21.3% vs 16.7%). Regarding the convergent validity with the PedsQL and disease-specific measures, the proxy versions of EQ-5D-Y-3L and EQ-5D-Y-5L had similar magnitudes of associations between similar dimensions. The means of test-retest coefficients between the two versions of the EQ-5D-Y proxy were comparable (0.83 vs. 0.84). Regarding reported improved conditions, responsiveness of the EQ-5D-Y-5L proxy (26.6-54.1%) was higher than that of the EQ-5D-Y-3L proxy (20.7-46.4%). Except for acutely ill patients, agreement between the EQ-5D-Y-5L proxy and self-reports was at least moderate.

Conclusions: Extending the number of levels of the proxy version of EQ-5D-Y can improve the classification accuracy and the ability to detect health changes over time. The level structure of EQ-5D-Y-5L was associated with a closer agreement between proxy and self-report. The study findings support extending the EQ-5D-Y descriptive system from 3 to 5 levels when administered by a proxy, which is often the case in the pediatric population.
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http://dx.doi.org/10.1186/s12955-022-01996-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9164342PMC
June 2022

Estimating the EQ-5D-5L value set for the Philippines.

Qual Life Res 2022 Sep 9;31(9):2763-2774. Epub 2022 May 9.

Institute of Health Policy and Development Studies, National Institutes of Health, University of the Philippines Manila, Manila, Philippines.

Background: The Philippines has recommended the use of Quality-Adjusted Life Years (QALYs) in government health technology assessments (HTA). We aimed to develop a value set for the EQ-5D-5L based on health preferences of the healthy general adult population in the Philippines.

Methods: Healthy, literate adults were recruited from the Philippine general population with quota targets based on age, sex, administrative region, type of residence, education, income, and ethnolinguistic groups. Each participant's preference was elicited by completing Composite Time Trade-Off (C-TTO) and Discrete Choice Experiment (DCE) tasks. Tasks were computer-assisted using the EuroQol Valuation Technology 2.0. To estimate the value set, we explored 20- and 8-parameter models that either use c-TTO-only data or both c-TTO and DCE (also called hybrid models). Final model choice was guided by principles of monotonicity, out-of-sample likelihood, model fit, and parsimony.

Results: We recruited 1000 respondents with demographic characteristics that approximate the general population such as 49.6% Female, 82% Roman Catholic, 40% in urban areas, and 55% finished high school. None of the 20-parameter models demonstrated monotonicity (logical worsening of coefficients with increasing severity). From the 8-parameter models, the homoscedastic TTO-only model exhibited the best fit. From this model, mobility and pain/ discomfort had the highest effect on utilities.

Conclusion: The selected model for representing the Philippine general population preferences for EQ-5D-5L health states was an 8-parameter homoscedastic TTO-only model. This value set is recommended for use in QALY calculations in support of HTA-informed coverage decisions in the Philippines.
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http://dx.doi.org/10.1007/s11136-022-03143-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9356948PMC
September 2022

Mental health and health-related quality of life among healthcare workers in Indonesia during the COVID-19 pandemic: a cross-sectional study.

BMJ Open 2022 04 8;12(4):e057963. Epub 2022 Apr 8.

Unit of PharmacoTherapy, Epidemiology and Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, Netherlands.

Objectives: Healthcare workers (HCWs) are the front lines during the COVID-19 pandemic. They are more exposed to COVID-19 than other professions. Studies from other countries have shown that the mental health and health-related quality of life (HRQoL) of HCWs were affected during this pandemic. However, studies on mental health in Indonesia remain scarce and no study has evaluated the HRQoL among HCWs. Thus, this study was designed to explore the mental health status and HRQoL among HCWs in Indonesia.

Design: This was a cross-sectional study.

Setting: This was an open online survey in Indonesia conducted from December 2020 to February 2021.

Participants: This study involved HCWs who worked during the COVID-19 pandemic. Of the 502 respondents who accessed the online questionnaire, 392 were included in the analysis.

Outcomes: Mental health status was measured using the 21-item Depression, Anxiety and Stress Scale and HRQoL was measured using the second version of the 12-item Short-Form Health Survey (SF12v2).

Results: The prevalence of depression, anxiety and stress among HCWs was 29.4%, 44.9% and 31.8%, respectively. Using the SF12v2 questionnaire, 354 (90.3%) HCWs were found to have impaired physical component and 156 (39.8%) HCWs have impaired mental component.

Conclusion: The prevalence of mental health problems among HCWs was high in Indonesia. HRQoL, particularly the physical component, was affected in most HCWs. Thus, policymakers should give more attention to the mental health and HRQoL of HCWs during the COVID-19 pandemic.
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http://dx.doi.org/10.1136/bmjopen-2021-057963DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8996007PMC
April 2022

Do health preferences differ among Asian populations? A comparison of EQ-5D-5L discrete choice experiments data from 11 Asian studies.

Qual Life Res 2022 Jul 18;31(7):2175-2187. Epub 2022 Feb 18.

School of Pharmacy, Jian University, No. 601 Huangpudadaoxi, Guangzhou, China.

Introduction: Many countries have established their own EQ-5D value sets proceeding on the basis that health preferences differ among countries/populations. So far, published studies focused on comparing value set using TTO data. This study aims to compare the health preferences among 11 Asian populations using the DCE data collected in their EQ-5D-5L valuation studies.

Methods: In the EQ-VT protocol, 196 pairs of EQ-5D-5L health states were valued by a general population sample using DCE method for all studies. DCE data were obtained from the study PI. To understand how the health preferences are different/similar with each other, the following analyses were done: (1) the statistical difference between the coefficients; (2) the relative importance of the five EQ-5D dimensions; (3) the relative importance of the response levels.

Results: The number of statistically differed coefficients between two studies ranged from 2 to 16 (mean: 9.3), out of 20 main effects coefficients. For the relative importance, there is not a universal preference pattern that fits all studies, but with some common characteristics, e.g. mobility is considered the most important; the relative importance of levels are approximately 20% for level 2, 30% for level 3, 70% for level 4 for all studies.

Discussion: Following a standardized study protocol, there are still considerable differences in the modeling and relative importance results in the EQ-5D-5L DCE data among 11 Asian studies. These findings advocate the use of local value set for calculating health state utility.
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http://dx.doi.org/10.1007/s11136-021-03075-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9188617PMC
July 2022

A Pilot Study of Valuation Methods of the EQ-5D and the Impact of Literacy, Cultural, and Religious Factors on Preferences.

Value Health Reg Issues 2022 Jul 7;30:48-58. Epub 2022 Feb 7.

School of Public Health, University of Alberta, Edmonton, AB, Canada.

Objectives: This study aimed to examine the feasibility of the 3-level-EQ-5D valuation methods and the impact of literacy, culture, and religion on the preferences of the Pakistani population.

Methods: Respondents aged 18 to 65 years were recruited using quota sampling. The EuroQol Portable Valuation Technology was used, and data collection was done in Urdu. Graphical presentations were used to elicit responses from illiterate respondents. All interviews were audio recorded and transcribed. Odds ratios associated with the choice impact were assessed.

Results: Usual activities showed highest impact on respondents' choice outcomes, followed by self-care and then anxiety/depression and mobility. Compared with "no problem," any problems in mobility had higher odds for a respondent to not to choose otherwise. The impact of health impairment on usual activities imposed the highest influences choices made. Most of the respondents reported that religion had no impact on their responses. Compared with literate respondents, illiterate respondents were more likely to be older, were unemployed, resided in rural, had lower self-reported health, had lower education/income, and had family members living in the same household with lower income. Although not significant, the number of nontraders was slightly higher in illiterate respondents. Literate respondents indicated cultural beliefs did not affects their responses whereas most of the illiterate respondents highlighted the impact of cultural norms on their responses, especially for self-care.

Conclusions: Preference elicitation methods used in 3-level-EQ-5D valuation studies, namely, time trade-off and discrete choice experiments, are feasible in the Pakistani population. The use of graphical illustrations for illiterate respondents was successful.
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http://dx.doi.org/10.1016/j.vhri.2021.10.003DOI Listing
July 2022

Comparing measurement properties of EQ-5D-Y-3L and EQ-5D-Y-5L in paediatric patients.

Health Qual Life Outcomes 2021 Nov 15;19(1):256. Epub 2021 Nov 15.

Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.

Background: The adult versions EQ-5D-3L and EQ-5D-5L have been extensive compared. This is not the case for the EQ-5D youth versions. The study aim was to compare the measurement properties and responsiveness of EQ-5D-Y-3L and EQ-5D-Y-5L in paediatric patients.

Methods: A sample of patients 8-16 years old with different diseases and a wide range of disease severity was asked to complete EQ-5D-Y-3L, EQ-5D-Y-5L, PedsQL Generic Core Scale, and selected, appropriate disease-specific instruments, three times. EQ-5D-Y-3L and EQ-5D-Y-5L were compared in terms of: feasibility, (re-)distribution properties, discriminatory power, convergent validity, test-retest reliability, and responsiveness.

Results: 286 participating patients suffered from one of the following diseases: major beta-thalassemia, haemophilia, acute lymphoblastic leukaemia, acute illness. Missing responses were comparable between versions of the EQ-5D-Y, suggesting comparable feasibility. The number of patients in the best health state (level profile 11111) was equal in both EQ-5D-Y versions. The projection of EQ-5D-Y-3L scores onto EQ-5D-Y-5L for all dimensions showed that the two additional levels in EQ-5D-Y-5L slightly improved the accuracy of patients in reporting their problems, especially if severe. Convergent validity with PedsQL and disease-specific measures showed that the two EQ-5D-Y versions performed about equally. Test-retest reliability (EQ-5D-Y-3L 0.78 vs EQ-5D-Y-5L 0.84), and sensitivity for detecting health changes, were both better in EQ-5D-Y-5L.

Conclusions: Extending the number of levels did not give clear superiority to EQ-5D-Y-5L over EQ-5D-Y-3L based on the criteria assessed in this study. However, increasing the number of levels benefitted EQ-5D-Y performance in the measurement of moderate to severe problems and especially in longitudinal study designs.
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http://dx.doi.org/10.1186/s12955-021-01889-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8591892PMC
November 2021

EQ-5D-5L in Schizophrenia: differences between patients and nurses' reports.

Health Qual Life Outcomes 2021 Oct 12;19(1):240. Epub 2021 Oct 12.

Faculty of Pharmacy, University of Pancasila, Jakarta, Indonesia.

Purpose: To examine the differences between patient-reports and proxy-reports by nurses of EQ-5D-5L responses among patients with schizophrenia.

Methods: This study was conducted in June-September 2019 in Duren Sawit Regional Public Hospital in Jakarta, Indonesia. The self-report data were obtained by interviewing the patients and the proxy-report data were obtained from the psychiatric nurses. The patients' Positive and Negative Syndrome Scale (PANSS) scores were obtained from their medical records. The data were collected in two time points: (1) when the patients moved from the acute to the quiet rooms (first-test) and (2) when they were discharged from the hospital (second-test). The self and proxy report scores were analysed by the Wilcoxon matched-pairs signed-ranks test and their relationship with the PANSS scores using Spearman's rank correlation coefficient.

Results: There were 206 patients in the final sample. The majority are male (56.8%) with a mean age of 37.5 years (SD = 12.05). Significant differences between the two reports were found in three domains (i.e., self-care, usual activities, and pain/discomfort) in the first-test and two domains (i.e., usual activities and pain/discomfort) in the second-test. Concerning the relationship with the PANSS scores, only three significant correlations were found, all in the proxy-version and in the second-test: mobility (r = 0.139), anxiety/depression (r = 0.2523), and utility scores (r = - 0.176).

Conclusions: The poor-to-fair agreement between patients and nurses reports and the poor correlation with the PANSS scores suggested that it is difficult to decide which report best represents the patients' health status.
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http://dx.doi.org/10.1186/s12955-021-01873-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8513280PMC
October 2021

Marriage and quality of life during COVID-19 pandemic.

PLoS One 2021 8;16(9):e0256643. Epub 2021 Sep 8.

Center for Psychological Innovation and Research, Universitas Padjadjaran, Jatinangor, Indonesia.

COVID-19 pandemic has impacted people around the globe. Countries, including Indonesia, implemented large-scale social restrictions. Since marriage is found to be beneficial to people's quality of life (QoL), the study aimed to examine the QoL of married people in Indonesia during a large-scale social restriction of the COVID-19 pandemic. An online cross-sectional survey using Qualtrics was conducted in June 2020. Respondents' sociodemographic data, spouse data (as reported by the respondents), and pandemic-related data were collected, followed by QoL data, measured by WHQOOL-BREF. WHOQL-BREF consists of 26 questions grouped into four domains: physical, psychological, social relationships, and environmental. Mann-Whitney U, Kruskal-Wallis H and Spearman correlation analyses were employed to compare QoL between groups of sociodemographic characteristics. In total, 603 respondents were recruited. The respondents' mean age is 35.3 years (SD = 7.61), most are females (82%), bachelor degree graduate (95%), Islam (78%), employed (69%), and assigned to work from home during the pandemic (76%). Married men reported better QoL in almost all domains than women; employed respondents reported higher QoL scores than unemployed; higher educated respondents reported higher QoL than those with lower education; respondents with higher income reported higher QoL than those with lower income. We found significant positive correlations between the QoL scores and age, spouse's age, and marriage length, although they were considered small. Compared to Indonesian population normative scores pre-pandemic, our sample reported no difference in physical and social domains, lower in the psychological domain, but higher in the environmental domain. Indonesian married people, especially women, those with low level of education, currently out of work, and below-average financial condition are the ones who reported worse quality of life during the lockdown. These results can help direct the Indonesian government efforts in dealing with psychosocial problems during the COVID-19 pandemic, especially for married couples.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256643PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8425525PMC
September 2021

Valuation of the EQ-5D-3L in Russia.

Qual Life Res 2021 Jul 13;30(7):1997-2007. Epub 2021 Mar 13.

Faculty of Psychology, Universitas Padjadjaran, Jatinangor, Indonesia.

Purpose: The most widely used generic questionnaire to estimate the quality of life for yielding quality-adjusted life years in economic evaluations is EQ-5D. Country-specific population value sets are required to use EQ-5D in economic evaluations. The aim of this study was to establish an EQ-5D-3L value set for Russia.

Methods: A representative sample aged 18+ years was recruited from the Russia`s general population. Computer-assisted face-to-face interviews were conducted based on the standardized valuation protocol using EQ-Portable Valuation Technology. Population preferences were elicited utilizing both composite time trade-off (cTTO) and discrete choice experiment (DCE) techniques. To estimate the value set, a hybrid regression model combining cTTO and DCE data was used.

Results: A total of 300 respondents who successfully completed the interview were included in the primary analysis. 120 (40.0%) respondents reported no health problems of any dimension, and 56 (18.7%) reported moderate health problems in one dimension of the EQ-5D-3L. Median self-rated health using EQ-VAS was 80 with IQR 70-90. Comparing cTTO and DCE-predicted values for 243 health states resulted in a similar pattern. This supports the use of hybrid models. The predicted value based on the preferred model for the worst health state "33333" was -0.503. Mobility dimension had the most significant impact on the utility decrement, and anxiety/depression had the lowest decrement.

Conclusion: Determining a Russian national value set may be considered the first step towards promoting cost-utility analysis use to increase comparability among studies and improve the transferability of healthcare decision-making in Russia.
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http://dx.doi.org/10.1007/s11136-021-02804-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233249PMC
July 2021

Comparing the EQ-5D-3 L and EQ-5D-5 L: studying measurement and scores in Indonesian type 2 diabetes mellitus patients.

Health Qual Life Outcomes 2020 Feb 7;18(1):22. Epub 2020 Feb 7.

Department of Health Sciences, University of Groningen, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, 9700, RB, The Netherlands.

Background: The EuroQoL five-dimensional instrument (EQ-5D) is the favoured preference-based instrument to measure health-related quality of life (HRQoL) in several countries. Two versions of the EQ-5D are available: the 3-level version (EQ-5D-3 L) and the 5-level version (EQ-5D-5 L). This study aims to compare specific measurement properties and scoring of the EQ-5D-3 L (3 L) and EQ-5D-5 L (5 L) in Indonesian type 2 diabetes mellitus (T2DM) outpatients.

Methods: A survey was conducted in a hospital and two primary healthcare centres on Sulawesi Island. Participants were asked to complete the two versions of the EQ-5D instruments. The 3 L and 5 L were compared in terms of distribution and ceiling, discriminative power and test-retest reliability. To determine the consistency of the participants' answers, we checked the redistribution pattern, i.e., the consistency of a participant's scores in both versions.

Results: A total of 198 T2DM outpatients (mean age 59.90 ± 11.06) completed the 3 L and 5 L surveys. A total of 46 health states for 3 L and 90 health states for 5 L were reported. The '11121' health state was reported most often: 17% in the 3 L and 13% in the 5 L. The results suggested a lower ceiling effect for 5 L (11%) than for 3 L (15%). Regarding redistribution, only 6.1% of responses were found to be inconsistent in this study. The 5 L had higher discriminative power than the 3 L version. Reliability as reflected by the index score was 0.64 for 3 L and 0.74 for 5 L. Pain/discomfort was the dimension mostly affected, whereas the self-care dimension was the least affected.

Conclusions: This study suggests that the 5 L-version of the EQ-5D instrument performs better than the 3 L-version in T2DM outpatients in Indonesia, regarding measurement and scoring properties. As such, our study supports the use of the 5 L as the preferred health-related quality of life measurement tool. We did not do a trial but this study was approved by the Medical Ethics Committee of Universitas Gadjah Mada Yogyakarta, Indonesia (document number KE/FK/1188/EC, 12 November 2014, amended 16 March 2015).
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http://dx.doi.org/10.1186/s12955-020-1282-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006062PMC
February 2020

Health-related quality of life in Indonesian type 2 diabetes mellitus outpatients measured with the Bahasa version of EQ-5D.

Qual Life Res 2019 May 16;28(5):1179-1190. Epub 2019 Jan 16.

Unit of Pharmacotherapy, Epidemiology & Economics (PTE2), Department of Pharmacy, Faculty of Science and Engineering (FSE), University of Groningen, Groningen, The Netherlands.

Objectives: To present EuroQol-5D (EQ-5D) index scores in Indonesian type 2 diabetes mellitus (T2DM) outpatients and to investigate the associations between EQ-5D and socio-demographic characteristics and clinical condition.

Methods: Socio-demographic data were collected by interviewing participants, clinical data were obtained from treating physicians and self-reporting. Participants originated from primary and secondary care facilities in the Java and Sulawesi regions. Ordinal regression analysis was conducted with the quintiles of the EQ-5D index scores as the dependent variable to investigate the multivariate association with the participants' socio-demographic characteristics and clinical condition.

Results: 907 participants completed the five-level Indonesian version of the EQ-5D. The mean age of the participants was 59.3 (SD 9.7), and 57% were female. The overall EQ-5D index score was 0.77 (0.75-0.79). Male participants had a higher EQ-5D index score compared to females, and the highest percentage of self-reported health problems was in the pain/discomfort dimension (61%). Factors identified as being significantly associated with lower EQ-5D index scores were: (i) treatment in secondary care, (ii) lower educational level, (iii) dependency on caregivers, (iv) not undergoing T2DM therapy, and (v) being a housewife.

Conclusion: This study provides estimates of EQ-5D index scores that can be used in health economic evaluations. As housewives were found to experience more T2DM-related pain/discomfort and anxiety/depression, targeted approaches to reduce these problems should be aimed specifically at this group of patients. Potential approaches could involve disease-specific-counselors (health literacy partners) who provide routine monitoring of T2DM therapy as well as improved health promotion among T2DM communities.
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http://dx.doi.org/10.1007/s11136-019-02105-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6470109PMC
May 2019

Test-Retest Reliability of EQ-5D-5L Valuation Techniques: The Composite Time Trade-Off and Discrete Choice Experiments.

Value Health 2018 10 26;21(10):1243-1249. Epub 2018 Mar 26.

Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC University Medical Center, Rotterdam, The Netherlands.

Objectives: To explore the test-retest reliability of the composite time trade-off (C-TTO) and discrete choice experiment (DCE) used in the Indonesian five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) valuation study.

Methods: A representative sample aged 17 years and older was recruited from the Indonesian general population by stratified quota sampling with respect to residence, sex, and age. Trained interviewers conducted computer-assisted face-to-face interviews using the EuroQol valuation technology. Each respondent valued 10 health states using C-TTO and 7 pairs of health states in a DCE exercise. The retest interview was conducted after 2 weeks by the same interviewer. The Wilcoxon matched-pairs signed-rank test, intraclass correlation coefficient, and multilevel regression were applied in comparing the C-TTO test and retest data. For DCE, the analysis of proportions was used.

Results: A total of 226 respondents with characteristics similar to the Indonesian population completed the retest interview. For C-TTO, 82 (95.3%) of 86 health states had no significant mean value differences between test and retest. The mean value of the second test was statistically significantly higher than that of the first test by 0.042. For DCE, 72.5% of responses were identical. DCE retest showed a different pattern concerning the relative importance of the dimensions, whereas the C-TTO remained the same.

Conclusions: C-TTO is stable over time, whereas in DCE the relative values of the dimensions shift. The results support the use of the C-TTO, in particular the Indonesian EQ-5D-5L value set, and suggest a critical examination of the reliability of DCE results over time.
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http://dx.doi.org/10.1016/j.jval.2018.02.003DOI Listing
October 2018

Quality of life and health status of Indonesian women with breast cancer symptoms before the definitive diagnosis: A comparison with Indonesian women in general.

PLoS One 2018 19;13(7):e0200966. Epub 2018 Jul 19.

Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands.

Objectives: Breast cancer (BC) is prevalent in low and middle-income countries (LMICs) where the majority of cases are diagnosed in late stages. The aims of this study were: (1) to assess quality of life (QOL) and health status of Indonesian women with BC symptoms before definitive diagnosis; (2) to compare QOL and health status between women with BC symptoms before definitive diagnosis and Indonesian women in general; (3) to evaluate the association between demographic variables (age, residence, social economic status and education level) and QOL within the Indonesian women with BC symptoms before definitive diagnosis.

Methods: We used WHOQOL-BREF to measure QOL and EQ-5D-5L for health status. Multivariate analysis of covariance (MANCOVA) was used to compare QOL and health status between women with BC symptoms and women from the general Indonesian population in order to control for confounders. Regression analyses were used for testing the association between the demographic variables, QOL, and health status.

Results: In comparison with the data from the women from the general population (n = 471), the women with BC symptoms (n = 132) reported lower QOL, especially in physical and psychological domains. They also reported more problems in all dimensions of health status. Higher education and monthly income were positively associated with QOL and health status among the women with BC symptoms.

Conclusion: Before receiving a definitive diagnosis, women who visit hospitals with symptoms of BC, report a lower QOL and health status than women in general. Our results suggest that healthcare providers should provide targeted strategies for women with BC symptoms to improve their QOL.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200966PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053201PMC
January 2019

Living in uncertainty due to floods and pollution: the health status and quality of life of people living on an unhealthy riverbank.

BMC Public Health 2018 06 22;18(1):782. Epub 2018 Jun 22.

Department of Clinical, Neuro & Developmental Psychology, VU University, Amsterdam, The Netherlands.

Background: People living on the banks of polluted rivers with yearly flooding lived in impoverished and physically unhealthy circumstances. However, they were reluctant to move or be relocated to other locations where better living conditions were available. This study aimed to investigate the health status, quality of life (QoL), happiness, and life satisfaction of the people who were living on the banks of one of the main rivers in Jakarta, Indonesia, the Ciliwung.

Methods: Respondents were 17 years and older and recruited from the Bukit Duri community (n = 204). Three comparison samples comprised: i) a socio-demographically matched control group, not living on the river bank (n = 204); ii) inhabitants of Jakarta (n = 305), and iii) the Indonesian general population (n = 1041). Health status and QoL were measured utilizing EQ-5D-5L, WHOQOL-BREF, the Happiness Scale, and the Life Satisfaction Index. A visual analogue scale question concerning respondents' financial situations was added. MANOVA and multivariate regression analysis were used to analyze the differences between the Ciliwung respondents and the three comparison groups.

Results: The Ciliwung respondents reported lower physical QoL on WHOQOL-BREF and less personal happiness than the matched controls but rated their health (EQ-5D-5L) and life satisfaction better than the matched controls. Similar results were obtained by comparison with the Jakarta inhabitants and the general population. Bukit Duri inhabitants also perceived themselves as being in a better financial situation than the three comparison groups even though their incomes were lower.

Conclusions: The recent relocation to a better environment with better housing might improve the former Ciliwung inhabitants' quality of life and happiness, but not necessarily their perceived health, satisfaction with life, and financial situations.
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http://dx.doi.org/10.1186/s12889-018-5706-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6013864PMC
June 2018

Quality of life of the Indonesian general population: Test-retest reliability and population norms of the EQ-5D-5L and WHOQOL-BREF.

PLoS One 2018 11;13(5):e0197098. Epub 2018 May 11.

Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC University Medical Center, Rotterdam, The Netherlands.

Objectives: The objective of this study is to obtain population norms and to assess test-retest reliability of EQ-5D-5L and WHOQOL-BREF for the Indonesian population.

Methods: A representative sample of 1056 people aged 17-75 years was recruited from the Indonesian general population. We used a multistage stratified quota sampling method with respect to residence, gender, age, education level, religion and ethnicity. Respondents completed EQ-5D-5L and WHOQOL-BREF with help from an interviewer. Norms data for both instruments were reported. For the test-retest evaluations, a sub-sample of 206 respondents completed both instruments twice.

Results: The total sample and test-retest sub-sample were representative of the Indonesian general population. The EQ-5D-5L shows almost perfect agreement between the two tests (Gwet's AC: 0.85-0.99 and percentage agreement: 90-99%) regarding the five dimensions. However, the agreement of EQ-VAS and index scores can be considered as poor (ICC: 0.45 and 0.37 respectively). For the WHOQOL-BREF, ICCs of the four domains were between 0.70 and 0.79, which indicates moderate to good agreement. For EQ-5D-5L, it was shown that female and older respondents had lower EQ-index scores, whilst rural, younger and higher-educated respondents had higher EQ-VAS scores. For WHOQOL-BREF: male, younger, higher-educated, high-income respondents had the highest scores in most of the domains, overall quality of life, and health satisfaction.

Conclusions: This study provides representative estimates of self-reported health status and quality of life for the general Indonesian population as assessed by the EQ-5D-5L and WHOQOL-BREF instruments. The descriptive system of the EQ-5D-5L and the WHOQOL-BREF have high test-retest reliability while the EQ-VAS and the index score of EQ-5D-5L show poor agreement between the two tests. Our results can be useful to researchers and clinicians who can compare their findings with respect to these concepts with those of the Indonesian general population.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0197098PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5947896PMC
July 2018

The Indonesian EQ-5D-5L Value Set.

Pharmacoeconomics 2017 Nov;35(11):1153-1165

Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC University Medical Center, Wytemaweg 80, Room Na-2019, 3015 CN, Rotterdam, The Netherlands.

Background: The EQ-5D is one of the most used generic health-related quality-of-life (HRQOL) instruments worldwide. To make the EQ-5D suitable for use in economic evaluations, a societal-based value set is needed. Indonesia does not have such a value set.

Objective: The aim of this study was to derive an EQ-5D-5L value set from the Indonesian general population.

Methods: A representative sample aged 17 years and over was recruited from the Indonesian general population. A multi-stage stratified quota method with respect to residence, gender, age, level of education, religion and ethnicity was utilized. Two elicitation techniques, the composite time trade-off (C-TTO) and discrete choice experiments (DCE) were applied. Interviews were undertaken by trained interviewers using computer-assisted face-to-face interviews with the EuroQol Valuation Technology (EQ-VT) platform. To estimate the value set, a hybrid regression model combining C-TTO and DCE data was used.

Results: A total of 1054 respondents who completed the interview formed the sample for the analysis. Their characteristics were similar to those of the Indonesian population. Most self-reported health problems were observed in the pain/discomfort dimension (39.66%) and least in the self-care dimension (1.89%). In the value set, the maximum value was 1.000 for full health (health state '11111') followed by the health state '11112' with value 0.921. The minimum value was -0.865 for the worst state ('55555'). Preference values were most affected by mobility and least by pain/discomfort.

Conclusions: We now have a representative EQ-5D-5L value set for Indonesia. We expect our results will promote and facilitate health economic evaluations and HRQOL research in Indonesia.
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http://dx.doi.org/10.1007/s40273-017-0538-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656740PMC
November 2017

Employing quality control and feedback to the EQ-5D-5L valuation protocol to improve the quality of data collection.

Qual Life Res 2017 05 31;26(5):1197-1208. Epub 2016 Oct 31.

Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC University Medical Center Rotterdam, s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.

Objectives: In valuing health states using generic questionnaires such as EQ-5D, there are unrevealed issues with the quality of the data collection. The aims were to describe the problems encountered during valuation and to evaluate a quality control report and subsequent retraining of interviewers in improving this valuation.

Methods: Data from the first 266 respondents in an EQ-5D-5L valuation study were used. Interviewers were trained and answered questions regarding problems during these initial interviews. Thematic analysis was used, and individual feedback was provided. After completion of 98 interviews, a first quantitative quality control (QC) report was generated, followed by a 1-day retraining program. Subsequently individual feedback was also given on the basis of follow-up QCs. The Wilcoxon signed-rank test was used to assess improvements based on 7 indicators of quality as identified in the first QC and the QC conducted after a further 168 interviews.

Results: Interviewers encountered problems in recruiting respondents. Solutions provided were: optimization of the time of interview, the use of broader networks and the use of different scripts to explain the project's goals to respondents. For problems in interviewing process, solutions applied were: developing the technical and personal skills of the interviewers and stimulating the respondents' thought processes. There were also technical problems related to hardware, software and internet connections. There was an improvement in all 7 indicators of quality after the second QC.

Conclusion: Training before and during a study, and individual feedback on the basis of a quantitative QC, can increase the validity of values obtained from generic questionnaires.
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http://dx.doi.org/10.1007/s11136-016-1445-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376385PMC
May 2017
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