Standard Error of Measurement of 5 Health Utility Indexes across the Range of Health for Use in Estimating Reliability and Responsiveness

Abstract

Background. Standard errors of measurement (SEMs) of health-related quality of life (HRQoL) indexes are not well characterized. SEM is needed to estimate responsiveness statistics, and is a component of reliability. Purpose. To estimate the SEM of 5 HRQoL indexes. Design. The National Health Measurement Study (NHMS) was a population-based survey. The Clinical Outcomes and Measurement of Health Study (COMHS) provided repeated measures. Subjects. A total of 3844 randomly selected adults from the noninstitutionalized population aged 35 to 89 y in the contiguous United States and 265 cataract patients. Measurements. The SF6-36v2™, QWB-SA, EQ-5D, HUI2, and HUI3 were included. An item-response theory approach captured joint variation in indexes into a composite construct of health (theta). The authors estimated 1) the test-retest standard deviation (SEM-TR) from COMHS, 2) the structural standard deviation (SEM-S) around theta from NHMS, and 3) reliability coefficients. Results. SEM-TR was 0.068 (SF-6D), 0.087 (QWB-SA), 0.093 (EQ-5D), 0.100 (HUI2), and 0.134 (HUI3), whereas SEM-S was 0.071, 0.094, 0.084, 0.074, and 0.117, respectively. These yield reliability coefficients 0.66 (COMHS) and 0.71 (NHMS) for SF-6D, 0.59 and 0.64 for QWB-SA, 0.61 and 0.70 for EQ-5D, 0.64 and 0.80 for HUI2, and 0.75 and 0.77 for HUI3, respectively. The SEM varied across levels of health, especially for HUI2, HUI3, and EQ-5D, and was influenced by ceiling effects. Limitations. Repeated measures were 5 mo apart, and estimated theta contained measurement error. Conclusions. The 2 types of SEM are similar and substantial for all the indexes and vary across health.