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Original Investigation | Socioeconomics and Health Services

Development of a Preference-Based Index From the National Eye Institute Visual Function Questionnaire–25

Anne M. Rentz, MSPH1; Jonathan W. Kowalski, PharmD, MS2; John G. Walt, MBA2; Ron D. Hays, PhD3; John E. Brazier, PhD4; Ren Yu, MA1; Paul Lee, MD5,6; Neil Bressler, MD7; Dennis A. Revicki, PhD1
[+] Author Affiliations
1Evidera, Bethesda, Maryland
2Allergan Inc, Irvine, California
3Department of Medicine, University of California, Los Angeles
4School of Health and Related Research, Sheffield University, Sheffield, England
5Duke University, Durham, North Carolina
6now with Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
7Retina Division, Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Ophthalmol. 2014;132(3):310-318. doi:10.1001/jamaophthalmol.2013.7639.
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Importance  Understanding how individuals value health states is central to patient-centered care and to health policy decision making. Generic preference-based measures of health may not effectively capture the impact of ocular diseases. Recently, 6 items from the National Eye Institute Visual Function Questionnaire–25 were used to develop the Visual Function Questionnaire–Utility Index health state classification, which defines visual function health states.

Objective  To describe elicitation of preferences for health states generated from the Visual Function Questionnaire–Utility Index health state classification and development of an algorithm to estimate health preference scores for any health state.

Design, Setting, and Participants  Nonintervention, cross-sectional study of the general community in 4 countries (Australia, Canada, United Kingdom, and United States). A total of 607 adult participants were recruited from local newspaper advertisements. In the United Kingdom, an existing database of participants from previous studies was used for recruitment.

Interventions  Eight of 15 625 possible health states from the Visual Function Questionnaire–Utility Index were valued using time trade-off technique.

Main Outcomes and Measures  A θ severity score was calculated for Visual Function Questionnaire–Utility Index–defined health states using item response theory analysis. Regression models were then used to develop an algorithm to assign health state preference values for all potential health states defined by the Visual Function Questionnaire–Utility Index.

Results  Health state preference values for the 8 states ranged from a mean (SD) of 0.343 (0.395) to 0.956 (0.124). As expected, preference values declined with worsening visual function. Results indicate that the Visual Function Questionnaire–Utility Index describes states that participants view as spanning most of the continuum from full health to dead.

Conclusions and Relevance  Visual Function Questionnaire–Utility Index health state classification produces health preference scores that can be estimated in vision-related studies that include the National Eye Institute Visual Function Questionnaire–25. These preference scores may be of value for estimating utilities in economic and health policy analyses.

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Figure.
Visual Function Questionnaire–Utility Index Validity of Known Groups From a Recent Interventional Uveitis Study42,a

BCVA indicates best-corrected visual acuity; VFQ-UI, Visual Function Questionnaire–Utility Index; and error bars, standard error of the mean.aThe overall nonstudy eye mean (SD) Early Treatment Diabetic Retinopathy Study BCVA at baseline across all subjects was 76.9 (14.74).

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