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Open Access Highly Accessed Research

Minimal clinically important differences for the EQ-5D and QWB-SA in Post-traumatic Stress Disorder (PTSD): results from a Doubly Randomized Preference Trial (DRPT)

Quang A Le1*, Jason N Doctor2, Lori A Zoellner3 and Norah C Feeny4

Author Affiliations

1 Department of Pharmacy Administration and Practice, Western University of Health Sciences, 309 E. Second Street, Pomona, CA 91766-1854, USA

2 Department of Clinical Pharmacy, Pharmaceutical Economics and Policy/Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, 3335 S. Figueroa Street, Unit A, Los Angeles, CA, 90089-7273, USA

3 Department of Psychology/Center for Anxiety and Traumatic Stress, University of Washington, Box 351525, Seattle, WA, 98195-1525, USA

4 Department of Psychological Sciences, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-7123, USA

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Health and Quality of Life Outcomes 2013, 11:59  doi:10.1186/1477-7525-11-59

Published: 12 April 2013

Abstract

Objective

To determine the minimal clinically important difference (MCID) for the health-utility measures EuroQol-5 dimensions (EQ-5D) and Quality of Well Being Self-Administered (QWB-SA) Scale in PTSD patients.

Research design and methods

Two hundred patients aged 18 to 65 years with PTSD enrolled in a doubly randomized preference trial (DRPT) examining the treatment and treatment-preference effects between cognitive behavioral therapy and pharmacotherapy with sertraline and completed the EQ-5D and QWB-SA at baseline and 10-week post-treatment. The anchor-based methods utilized a Clinical Global Impression-Improvement (CGI-I) and Clinical Global Impression-Severity. We regressed the changes in EQ-5D and QWB-SA scores on changes in the anchors using ordinary least squares regression. The slopes (beta coefficients) were the rates of change in the anchors as functions of change in EQ-5D and QWB, which represent our estimates of MCID. In addition, we performed receiver operating characteristic (ROC) curve analysis to examine the relationship between the changes in EQ-5D and QWB-SA scores and treatment-response status. The MCIDs were estimated from the ROC curve where they best discriminate between treatment responders and non-responders. The distribution-based methods used small to moderate effect size in terms of 0.2 and 0.5 of standard deviation of the pre-treatment EQ-5D and QWB-SA scores.

Results

The anchor-based methods estimated the MCID ranges of 0.05 to 0.08 for the EQ-5D and 0.03 to 0.05 for the QWB. The MCID ranges were higher with the distribution-based methods, ranging from 0.04 to 0.10 for the EQ-5D and 0.02 to 0.05 for the QWB-SA.

Conclusions

The established MCID ranges of EQ-5D and QWB-SA can be a useful tool in assessing meaningful changes in patient’s quality of life for researchers and clinicians, and assisting health-policy makers to make informing decision in mental health treatment.

Clinical trial registration

Clinicaltrials.gov; Identifier: NCT00127673.

Keywords:
EQ-5D; QWB-SA; Minimal clinically important difference; PTSD; Doubly randomized preference trial; Prolonged exposure therapy; Sertraline