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Responsiveness of spondyloarthritis-specific health utilities based on the ASAS Health Index (U-ASAS-HI): an
Omar-Javier Calixto1,2,3,4, Xenofon Baraliakos1,2, Annelies Boonen5,6
1Department of Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany.
Objectives:
To assess responsiveness of the spondyloarthritis (SpA)-specific universal health utility from the ASAS Health Index (U-ASAS-HI) compared with generic health utilities (EQ-5D-5L and SF-6D).
Methods:
Data were used from patients with SpA participating in the ASAS-HI international validation study and starting TNF inhibitor (TNFi), conventional synthetic DMARD (csDMARD) or NSAID. A priori hypotheses on correlation of change in utility and change in external health anchors between baseline and follow-up were tested. Standardized response mean (SRM) and Cohen's effect size (ES) were calculated in each treatment group. The ability of changes in utilities to discriminate between BASDAI-50% (non)-responders was assessed by standardized estimate of change and receiver operating characteristic (ROC) analyses.
Results:
219 patients were included (110 TNFi, 37 csDMARD, and 72 NSAID). Mean (s.d.) age was 37 (13) years and 63% were male. Hypotheses on correlations of change scores were confirmed for 75% of comparisons for U-ASAS-HI and EQ-5D-5L, but not for SF-6D. As expected, SRM and ES for the U-ASAS-HI were large in the TNFi-treated group, moderate in the csDMARD group and small to moderate in the NSAID group. The hypothesized larger SRM and ES for U-ASAS-HI compared with EQ-5D and SF-6D could not be consistently confirmed across the three treatment groups. Ability to discriminate between BASDAI-50% responders and non-responders did not differ among utility instruments in ROC comparison.
Conclusion:
In a context where change is expected, the SpA-specific U-ASAS-HI correlates as expected with changes in other SpA-specific outcomes and shows good responsiveness, which is similar to but not better than for generic utilities.
