K SHAH1, F MURTAGH2, K MCGEECHAN3, S CRAIL4, A BURNS5, A TRAN1, R MORTON1
1NHMRC Clinical Trials Centre, University Of Sydney, Camperdown, Australia, 2Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, , United Kingdom, 3School of Public Health, University of Sydney, Camperdown, Australia, 4Royal Adelaide Hospital, Adelaide, Australia, 5Royal Free Hospital, London NHS Foundation Trust, , United Kingdom
Aim: To measure and compare ‘wellbeing’ and health-related quality of life (HRQOL) among people over 75-years treated with either comprehensive conservative care or dialysis.
Background: A broader notion of wellbeing related to an individual’s capability to do the things that are important to them (based on Sen’s capability theory), rather than solely HRQOL, is proposed as a more meaningful measure to value healthcare. The capability index, ICECAP-O, measures five domains: attachment, role, enjoyment, security, and control.
Methods: A prospective cross-sectional study among people over 75-years with end-stage kidney disease treated with conservative care or dialysis was undertaken in three renal units in the UK and Australia (2014-2016). Wellbeing was scored on a 0-1 scale (0=no capability, 1=full capability) using UK population values and presented as mean values with standard deviation (SD). Student t-tests assessed difference in means between groups; and Pearson’s correlation coefficient assessed convergence validity between capability and HRQOL using the Short-Form 6D (SF-6D).
Results: Of 129 patients, mean age 82 years [IQR 78-85], 65% males, 46(36%) were managed with conservative care and 83(64%) managed with dialysis. The mean capability index for the whole cohort was 0.72 [SD 0.19]; significantly higher in those with private versus public health insurance (0.79 [SD 0.15]; 0.71 [SD 0.19]; p=0.03); and similar in those managed with conservative care compared with dialysis (0.76 [SD 0.20]; 0.71 [SD 0.18]; p=0.14). The dialysis group reported lower capability in four of five domains: role, enjoyment, security and control. Convergence validity between the two instruments was moderate (Pearson’s coefficient 0.56, p<0.0001).
Conclusions: Wellbeing measured using a capability index provides additional insights into the impact of dialysis on older people, than HRQOL measurement alone.
Karan Shah is a Health Economist at NHMRC Clinical Trials Centre, University of Sydney. Prior to his full-time role as a Health Economist, he pursued Masters of Science in Health Economics at Heidelberg University in Germany. He has research interest in methodological development in estimating quality of life, within trial health economic models, quantitative research methods: systematic reviews, meta-analysis, statistical analysis, assessment of test evaluation and monitoring.