John Brazier - Academia.edu (original) (raw)

Papers by John Brazier

Health and quality of life outcomes, Jan 3, 2018

The increasing emphasis on patient-reported outcomes in health care decision making has prompted ... more The increasing emphasis on patient-reported outcomes in health care decision making has prompted greater rigor in the evidence to support the instruments used. Acceptability and content validity are important properties of any measure to ensure it assesses the relevant aspects of the target concept. The purpose of this study was to evaluate the acceptability and content validity of the EQ-5D 5-Level (EQ-5D-5L) to assess the impact of asthma on patients' lives. Qualitative interviews were conducted with 40 adults with asthma in the United Kingdom. The first 25 interviews used cognitive-debriefing methods to assess the relevance and acceptability of the EQ-5D-5L and two asthma-specific measures for comparison: an asthma-specific, preference-based measure (the Asthma Quality of Life Utility Index-5 Dimensions) and an Asthma Symptom Diary. The final 15 interviews combined concept elicitation to identify patient-perceived asthma impact, and cognitive debriefing to assess relevance an...

Journal of patient-reported outcomes, 2018

There is increasing interest in using Patient Reported Outcome Measures (PROMs) within organisati... more There is increasing interest in using Patient Reported Outcome Measures (PROMs) within organisations delivering health related services. However, organisations have had mixed success in implementing PROMs and there is little understanding about why this may be. Thus, the purpose of this study was to identify the facilitators and barriers to implementing PROMs in organisations. A systematic review of reviews was undertaken. Searches were conducted of five electronic databases: MEDLINE, EMBASE, CINAHL, PsycINFO and the Cochrane Database of Systematic Reviews, during the week of the 20th February 2017. Additional search methods included website searching and reference checking. To be included, a publication had to be a review of the literature, describe its methods and include information related to implementing PROMs. The reviews were extracted using a standardised form and assessed for their risk of bias using the Risk of Bias in Systematic Reviews tool. The findings were synthesised...

Investigative ophthalmology & visual science, Sep 1, 2017

The purpose of this study was to explore the relationship between visual acuity and utility (heal... more The purpose of this study was to explore the relationship between visual acuity and utility (health-related quality of life) in diabetic macular edema (DME) using intravitreal aflibercept data. The relationship between visual acuity in the best-seeing eye (BSE) and worse-seeing eye (WSE) and utility was explored using ordinary least squares (OLS) and random-effects models adjusted for different covariates (age, age2, sex, body mass index, smoking status, glycated hemoglobin, diabetes severity, comorbidities, and geographic region). Utility was measured using the EuroQoL-five dimensions questionnaire (EQ-5D) and Visual Functioning Questionnaire-Utility Index (VFQ-UI). For each model, coefficients (R2) were reported, and WSE/BSE was expressed as the ratio of coefficients (OLS models). Models were independent of treatment effects, and outcomes from all time points (up to week 100) were included where available. Data from 1320 patients with DME were analyzed. In all models, the associat...

Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, Jan 19, 2018

Service user involvement in instrument development is increasingly recognised as important, but i... more Service user involvement in instrument development is increasingly recognised as important, but is often not done and seldom reported. This has adverse implications for the content validity of a measure. The aim of this paper is to identify the types of items that service users felt were important to be included or excluded from a new Recovering Quality of Life measure for people with mental health difficulties. Potential items were presented to service users in face-to-face structured individual interviews and focus groups. The items were primarily taken or adapted from current measures and covered themes identified from earlier qualitative work as being important to quality of life. Content and thematic analysis was undertaken to identify the types of items which were either important or unacceptable to service users. We identified five key themes of the types of items that service users found acceptable or unacceptable; the items should be relevant and meaningful, unambiguous, ea...

PharmacoEconomics, Jan 26, 2018

PharmacoEconomics, Jan 21, 2017

The EORTC QLU-C10D is a new multi-attribute utility instrument derived from the widely used cance... more The EORTC QLU-C10D is a new multi-attribute utility instrument derived from the widely used cancer-specific quality-of-life (QOL) questionnaire, EORTC QLQ-C30. The QLU-C10D contains ten dimensions (Physical, Role, Social and Emotional Functioning; Pain, Fatigue, Sleep, Appetite, Nausea, Bowel Problems), each with four levels. To be used in cost-utility analysis, country-specific valuation sets are required. The aim of this study was to provide Australian utility weights for the QLU-C10D. An Australian online panel was quota-sampled to ensure population representativeness by sex and age (≥ 18 years). Participants completed a discrete choice experiment (DCE) consisting of 16 choice-pairs. Each pair comprised two QLU-C10D health states plus life expectancy. Data were analysed using conditional logistic regression, parameterised to fit the quality-adjusted life-year framework. Utility weights were calculated as the ratio of each QOL dimension-level coefficient to the coefficient on life...

The European journal of health economics : HEPAC : health economics in prevention and care, Jan 30, 2017

To assess the evidence on the validity and responsiveness of five commonly used preference-based ... more To assess the evidence on the validity and responsiveness of five commonly used preference-based instruments, the EQ-5D, SF-6D, HUI3, 15D and AQoL, by undertaking a review of reviews. Four databases were investigated using a strategy refined through a highly sensitive filter for systematic reviews. References were screened and a search for grey literature was performed. Identified citations were scrutinized against pre-defined eligibility criteria and data were extracted using a customized extraction template. Evidence on known group validity, convergent validity and responsiveness was extracted and reviewed by narrative synthesis. Quality of the included reviews was assessed using a modified version of the AMSTAR checklist. Thirty reviews were included, sixteen of which were of excellent or good quality. The body of evidence, covering more than 180 studies, was heavily skewed towards EQ-5D, with significantly fewer studies investigating HUI3 and SF-6D, and very few the 15D and AQoL...

The patient, Feb 5, 2017

The aim was to conduct an empirical assessment of the measurement properties of the preference-ba... more The aim was to conduct an empirical assessment of the measurement properties of the preference-based Child Health Utility 9D (CHU9D) versus the non-preference-based Pediatric Quality of Life Inventory (PedsQL)™ 4.0 Short Form 15 Generic Core Scales (referred to as 'PedsQL') in an Australian community-based sample of adolescents. An online survey including the CHU9D, the PedsQL, a self-reported general health question, and socio-demographic questions was administered to adolescents (aged 15-17 years). Descriptive summary statistics and psychometric analyses were conducted to assess levels of agreement and convergent validity between the instruments. A total of 775 adolescents (mean ± SD age 15.8 ± 0.8 years) completed the survey. The mean ± SD scores of the CHU9D and the PedsQL were 0.72 ± 0.22 and 72.86 ± 16.56, respectively. For both instruments, there were significant differences in health-related quality of life scores according to self-reported health status and socio-ec...

Trials, Mar 1, 2017

NICE guidelines state cognitive behavioural therapy (CBT) is a front-line psychological treatment... more NICE guidelines state cognitive behavioural therapy (CBT) is a front-line psychological treatment for people presenting with depression in primary care. Counselling for Depression (CfD), a form of Person-Centred Experiential therapy, is also offered within Improving Access to Psychological Therapies (IAPT) services for moderate depression but its effectiveness for severe depression has not been investigated. A full-scale randomised controlled trial to determine the efficacy and cost-effectiveness of CfD is required. PRaCTICED is a two-arm, parallel group, non-inferiority randomised controlled trial comparing CfD against CBT. It is embedded within the local IAPT service using a stepped care service delivery model where CBT and CfD are routinely offered at step 3. Trial inclusion criteria comprise patients aged 18 years or over, wishing to work on their depression, judged to require a step 3 intervention, and meeting an ICD-10 diagnosis of moderate or severe depression. Patients are r...

Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, Jan 9, 2016

It has been argued that generic health-related quality of life measures are not sensitive to cert... more It has been argued that generic health-related quality of life measures are not sensitive to certain disease-specific improvements; condition-specific preference-based measures may offer a better alternative. This paper assesses the validity, responsiveness and sensitivity of a cancer-specific preference-based measure, the EORTC-8D, relative to the EQ-5D-3L. A longitudinal prospective population-based cancer genomic cohort, Cancer 2015, was utilised in the analysis. EQ-5D-3L and the EORTC QLQ-C30 (which gives EORTC-8D values) were asked at baseline (diagnosis) and at various follow-up points (3 months, 6 months, 12 months). Baseline values were assessed for convergent validity, ceiling effects, agreement and sensitivity. Quality-adjusted life-years (QALYs) were estimated and similarly assessed. Multivariate regression analyses were employed to understand the determinants of the difference in QALYs. Complete case analysis of 1678 patients found that the EQ-5D-3L values at baseline we...

Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, Jan 21, 2016

Preference-based measures are required to measure the impact of interventions for cost-effectiven... more Preference-based measures are required to measure the impact of interventions for cost-effectiveness analysis. This study assessed the psychometric performance of the EQ-5D-3L in adults with uncontrolled focal (partial-onset) seizures. Data from three Phase III studies of an antiepileptic drug (adjunctive brivaracetam; n = 1095) were used. Analysis included correlations between EQ-5D-3L and Quality of Life in Epilepsy Inventory (QOLIE-31P) and seizure frequency. Known group validity was based on ability of the EQ-5D-3L to discriminate between baseline QOLIE-31P total scores, seizure type and number of antiepileptic drugs using effect sizes (ES). Responsiveness assessed proportions reporting highest or lowest scores, overall change using standardized response means (SRM) and change by responder and clinician/patient evaluation groups using ES. Correlations were weak to moderate (ρ = 0.2-0.4) between EQ-5D-3L dimensions and QOLIE-31P subscales, apart from medication effects (ρ < 0....

International journal of geriatric psychiatry, Jan 22, 2016

We estimated the cost effectiveness of different cognitive screening tests for use by General Pra... more We estimated the cost effectiveness of different cognitive screening tests for use by General Practitioners (GPs) to detect cognitive impairment in England. A patient-level cost-effectiveness model was developed using a simulated cohort that represents the elderly population in England (65 years and older). Each patient was followed over a lifetime period. Data from published sources were used to populate the model. The costs include government funded health and social care, private social care and informal care. Patient health benefit was measured and valued in Quality Adjusted Life Years (QALYs). Base-case analyses found that adopting any of the three cognitive tests (Mini-Mental State Examination, 6-Item Cognitive Impairment Test or GPCOG (General Practitioner Assessment of Cognition)) delivered more QALYs for patients over their lifetime and made savings across sectors including healthcare, social care and informal care compared with GP unassisted judgement. The benefits were du...

There are now a large number of instruments available for assessing health-related quality of lif... more There are now a large number of instruments available for assessing health-related quality of life, many of which are used within economic evaluations. When considering the use of quality-of-life instruments, meaningful questions need to be asked to determine whether an instrument has been used judiciously. Such questions should consider whether the instrument is valid and suitable for the particular study question, whether the instrument is compatible with the economic evaluation framework used, and subsequently whether the conclusions presented in the study are legitimate. In order to illustrate the value of these questions we have applied them to a number of economic evaluations. The studies used were identified via a systematic review of the health economics literature. In our assessment of a sample of published material, we found that reporting is frequently unhelpful and that the inappropriate use of instruments and techniques casts doubt on the conclusions of economic evaluations. Furthermore, our systematic review of the health economics literature has shown that the general format of reported economic evaluations falls short of the commonly accepted ideal. We examined the health economics literature for 1995 and only identified a handful of studies which satisfied the economic evaluation criteria as accepted by most economists. It is hoped that raising awareness of these issues will urge evaluators, referees and publishers not to lose sight of the needs of the decision-maker when considering the detail which should be present in a reported evaluation.

ABSTRACT Rationale: ARMD is one of the leading causes of incurable blindness and visual impairmen... more ABSTRACT Rationale: ARMD is one of the leading causes of incurable blindness and visual impairment in the industrialised countries. The main effect of ARMD is to reduce the ability of the individual to engage in everyday activities that require central vision. ARMD has been shown to impact significantly upon a person's Health Related Quality of Life (HRQoL)(Brown et al, 2000; Espallargues et al, 2005)). In a previous study, health state values were obtained for visual acuity (VA) states from 209 patients with unilateral or bilateral ARMD (Espallargues, 2005). Patients underwent tests of visual function and completed health status questionnaires (HUI-3, EQ-5D, SF-6D) and time trade off (TTO) for their own current state. Only HUI-3 and TTO were found to be significantly related to VA group (P The HUI-3 has one crude dimension for assessing the impact of visual impairment and it does not take into account many of the specific effects of ARMD. A member of the general population presented with a detailed description of the vision impairment caused by ARMD may give the state a different value to that implied by the HUI-3. The innovative use of custom-made contact lenses provides an opportunity for non-patient subjects to gain personal experience of having ARMD. Objectives: The aim was to examine the feasibility of using this method of simulation and to compare the results from this experiment with those obtained from the patients using generic preference-based measures (HUI-3 and EQ-5D) and patient's own TTO. Methodology: A random sample of the general population were recruited into the study (n=108). Custom-made contact lenses were used to approximately reproduce three vision states (reading limit, legal blindness in UK, and state that patients with untreated ARMD will reach). Recruits underwent baseline assessments of visual function and health state valuations. Following the insertion of each lens, recruits undertook five daily living tasks (three relating to reading, watching TV and recognising faces) and completed the HUI-3 and TTO. VA was recorded for each state. The lenses were ordered randomly to minimise any order effects. Results: A significant relationship was found between visual acuity and TTO values. This was stronger than that found for HUI-3 and patient's own TTO. Socio-demographic characteristics were not found to be statistically significant, although baseline TTO utility values were positively associated with TTO values for simulated states. Conclusions: ARMD has a major impact on general population TTO health state values. Differences across four vision groups appear larger than those predicted by a generic preference-based measure and patient data TTO values. For conditions that are difficult to describe, such as ARMD, then simulation methods may offer an important method for obtaining better informed general population preferences. References: Brown et al. Utility values and Age-related Macular Degeneration. Arch Ophthalmol. 2000;118:47-51 Espallargues et al. The impact of Age-Related Macular Degeneration on Health State Utility Values. Invest Ophthal Vis Sci. 2005; 46(11):4016-4023

Pharmacoeconomics, 2009

This paper reviews the role of patient preferences within the framework of cost-effectiveness ana... more This paper reviews the role of patient preferences within the framework of cost-effectiveness analysis (CEA). CEA typically adopts a system-wide perspective by focusing upon efficiency across groups in the allocation of scarce healthcare resources, whereas treatment decisions are made over individuals. However, patient preferences have been shown to have a direct impact on the outcome of an intervention via psychological factors or indirectly via patient adherence/compliance rates. Patient values may also be in conflict with the results of CEA through the valuation of benefits. CEA relies heavily on the QALY model to reflect individual preferences, although the healthy year equivalent offers an alternative measure that may be better at taking individual preferences into account. However, both measures typically use mean general population or mean patient values and therefore create conflict with individual-level preferences. For CEA to reflect practice, it must take into account the impact of individual patient preferences even where general population preferences are used to value the benefits of interventions. Patient preferences have implications for cost effectiveness through costs and outcomes, and it is important that cost-effectiveness models incorporate these through its structure (e.g. allowing for differing compliance rates) and parameter values, including clinical effectiveness. It will also be necessary to try to predict patient preferences in order to estimate any impact on cost effectiveness through analyses of revealed and stated preference data. It is recognized that policy makers are concerned with making interventions available to patients and not forcing them to consume healthcare. One way of moving towards this would be to adopt a two-part decision process: the identification of the most cost-effective therapy using mean general population values (i.e. the current rule), then also making available those treatments that are cheaper than the most cost-effective therapy.