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Health related quality of life and its drivers

Meet Malwina Hołownia-Voloskova - PhD, health economist, Health Tech Assessment (HTA) specialist and market access consultant. She's worked with all the big pharma companies including Roche, Pfizer and AbbVie. We sat with Malwina to learn about what affect health related quality of life (HRQoL).


What is health related quality of life?

Health related quality of life is a measure of an individual's health and wellbeing. It can be measured using two types of questionnaires: those specific to certain conditions such as multiple sclerosis or rheumatoid arthritis, and those general that can be used for any condition.

The results of these questionnaires can vary, from a single number to a set of numbers or a description. One example of a questionnaire used to measure health related quality of life is the EQ5D 5L, which is a short questionnaire with five domains and one visual analog scale. These five domains cover mobility, self-care, usual activities, pain and discomfort, and anxiety and depression, and provide an indication of the respondent's quality of life.

What are the benefits of looking at health related quality of life?

The main benefit of looking at health-related quality of life is that it allows us to measure the cost-utility of a particular treatment or intervention. This measurement is based on health-related quality of life, which is measured on a scale from zero to one. A score of one indicates full health, while a score of zero point one indicates a state of extreme pain, inability to care for oneself, and anxiety or depression. In some cases, the population may prefer death to a particular state, which is considered worse than zero. By measuring quality of life, we can compare the quality of life of different patients, such as those with rheumatoid arthritis, multiple sclerosis, or those who are fully healthy, and decide which patients should receive more resources.

This is a very interesting topic because it deals with the difficult decision of how to allocate resources to different patients with different diseases. My PhD research for instance focused on population norms. I planned to study the health-related quality of life of different patient groups to determine which groups were underfunded and where more money should be allocated. This research provides a way to manage the problem of deciding which diseases are more or less important.

Why using specifically the EQ5D 5L questionnaire?

The EQ 5D system is a useful tool for measuring quality of life, as it assesses mobility, self-care, usual activity, pain, discomfort, anxiety, and depression. This system is beneficial because it is short and easy for patients to answer, even if they are not used to filling out long questionnaires. It is easy to administer to a wide range of people, including those in public places. Obviously there other great questionnaires like the SF 35 and the EQ 5D 5L has limitations, such as only having five levels of response but it is still the most practical. Additionally, it's easy to translate, allowing for comparison of answers between countries.

What were the most commonly reported quality of life issues?

Pain, discomfort, and depression were the most commonly reported dimensions. That's something you'll see across most countries. This could be due to the fact that these dimensions are the most easily identifiable and relatable. For example, if someone is having a bad day, they may experience physical pain, discomfort, or stress, which could lead to anxiety and depression.

How did you segment your data and what were the findings here?

We used socio-demographic characteristics to segment our results. These included age, gender, socio-economic status, access to the internet, and other factors. Our analysis showed that having no access to the internet was connected to a statistically significant lower health-related quality of life. It could be however that this is due more to age than internet access as old people tend have less access to internet. Overall, respondents over the age of 65 and women had lower health-related quality of life.

What was the most surprising finding?

Our study revealed an interesting finding: women aged 18-24 had a significantly lower health-related quality of life than women aged 25-34. This was surprising, as it is usually the opposite in most other countries. We believe this could be due to the immense pressure these young women face, such as needing to be a student, getting a master's degree, getting married, and being attractive. It is a sad reality, but hopefully there are ways to help them feel better. In response to this, it may be beneficial to allocate a larger budget to reimbursing technology that provides psychology support, and other services to help with depression and anxiety.

When looking at multiple geographies, how did results vary and why?

Different geographies will carry different results that's for sure. Even if some dimensions such as high levels of reported pain, anxiety, and depression tend to be common, those same dimensions can vary greatly if you start segmenting the data. For instance, reported pain of women segmented by age is all over the place from one country to the next. To gain a better understanding of these differences, it is important to consider cultural, budgetary, and technological influences. When comparing 16 or 17 studies, Russia was found to be worse than average across all dimensions, similar to Poland and Bulgaria. In contrast, Vietnam had the best results, followed by China, Tobago. Additionally, when looking at mobility, the best results were found in China for women, Hanoi for men, and Indonesia and Tobago for both genders. When it came to reported pain specifically, United States was the worst. Does this suggests that Asia is generally healthier than countries such as Bulgaria, Germany, Poland, Ireland, and the United States? Likely, but again it's important to consider culture, budget and all other influences in quality of life perception.

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