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World J Crit Care Med. Jul 9, 2022; 11(4): 236-245
Published online Jul 9, 2022. doi: 10.5492/wjccm.v11.i4.236
Health-related quality-of-life and health-utility reporting in critical care
Vincent Issac Lau, Jeffrey A Johnson, Sean M Bagshaw, Oleksa G Rewa, John Basmaji, Kimberley A Lewis, M Elizabeth Wilcox, Kali Barrett, Francois Lamontagne, Francois Lauzier, Niall D Ferguson, Simon J W Oczkowski, Kirsten M Fiest, Daniel J Niven, Henry T Stelfox, Waleed Alhazzani, Margaret Herridge, Robert Fowler, Deborah J Cook, Bram Rochwerg, Feng Xie
Vincent Issac Lau, Sean M Bagshaw, Oleksa G Rewa, Department of Critical Care Medicine, University of Alberta, Edmonton T6G 2B7, AB, Canada
Jeffrey A Johnson, School of Public Health, Inst Hlth Econ, University of Alberta, Edmonton T6G 2B7, AB, Canada
John Basmaji, Department of Medicine, Division of Critical Care, Western University, London N6A 5W9, Canada
Kimberley A Lewis, Division of Critical Care, McMaster University, Hamilton L8N 4A6, Canada
M Elizabeth Wilcox, Kali Barrett, Interdepartmental Division of Critical Care, University of Toronto, Toronto M5T 2S8, Canada
Francois Lamontagne, Department of Medicine, University Sherbrooke, Sherbrooke J1H 5N4, Canada
Francois Lauzier, Departments of Medicine and Anesthesiology, University Laval, Laval G1V 4G2, Canada
Niall D Ferguson, Department Critical Care Medicine, University of Toronto, Toronto M5G 2C4, Canada
Simon J W Oczkowski, Department of Medicine, McMaster Clin, Hamilton Gen Hosp, McMaster University, Hamilton L8N 4A6, Canada
Kirsten M Fiest, Department of Community Health Sciences & Institute for Public Health, University of Calgary, Calgary T2N 2T9, Canada
Daniel J Niven, Department of Critical Care Medicine, University Calgary, Calgary T2N 2T9, Canada
Henry T Stelfox, Department of Community Health Sciences, University of Calgary, Calgary T2N 2T9, Canada
Waleed Alhazzani, Deborah J Cook, Bram Rochwerg, Department of Medicine, McMaster University, Hamilton L8N 4A6, Canada
Margaret Herridge, Indepartmental Division of Critical Care, University Health Network, Toronto M5G 2C4, Canada
Robert Fowler, Departments of Medicine and Critical Care Medicine, Sunnybrook Health Sciences Center, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto M4N 3M5, Canada
Feng Xie, Health Research Methods, Evidence and Impact, McMaster University, Hamilton L8N 3Z5, Canada
Author contributions: Lau VI, Johnson JA, Bagshaw SM, Rewa OG, Basmaji J, Lewis KA, Wilcox ME, Barrett K, Lamontagne F, Lauzier F, Ferguson ND, Oczkowski SJW, Fiest KM, Niven DJ, HT Stelfox, Alhazzani W, Herridge M, Fowler R, Cook DJ, Rochwerg B, and Xie F had (1) made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; (2) drafted the submitted article and revised it critically for important intellectual content; and (3) provided final approval of the version to be published; Lau VI, Johnson JA, Cook DJ, Rochwerg B, Xie F contributed to conception and background; All the authors contributed to drafting the manuscript and revising the manuscript.
Supported by the EuroQol Research Foundation, No. 299-RA.
Conflict-of-interest statement: Drs. Lau, Xie and Johnson have received funding from EuroQoL Foundation. All other authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vincent Issac Lau, FRCP (C), MD, MSc, Assistant Professor, Critical Care Medicine, University of Alberta, 8440 112 Street NW, Edmonton T6G 2B7, AB, Canada. vinceissaclau@gmail.com
Received: February 3, 2022
Peer-review started: February 3, 2022
First decision: April 13, 2022
Revised: April 16, 2022
Accepted: May 28, 2022
Article in press: May 28, 2022
Published online: July 9, 2022
Abstract

Mortality is a well-established patient-important outcome in critical care studies. In contrast, morbidity is less uniformly reported (given the myriad of critical care illnesses and complications of each) but may have a common end-impact on a patient’s functional capacity and health-related quality-of-life (HRQoL). Survival with a poor quality-of-life may not be acceptable depending on individual patient values and preferences. Hence, as mortality decreases within critical care, it becomes increasingly important to measure intensive care unit (ICU) survivor HRQoL. HRQoL measurements with a preference-based scoring algorithm can be converted into health utilities on a scale anchored at 0 (representing death) and 1 (representing full health). They can be combined with survival to calculate quality-adjusted life-years (QALY), which are one of the most widely used methods of combining morbidity and mortality into a composite outcome. Although QALYs have been use for health-technology assessment decision-making, an emerging and novel role would be to inform clinical decision-making for patients, families and healthcare providers about what expected HRQoL may be during and after ICU care. Critical care randomized control trials (RCTs) have not routinely measured or reported HRQoL (until more recently), likely due to incapacity of some patients to participate in patient-reported outcome measures. Further differences in HRQoL measurement tools can lead to non-comparable values. To this end, we propose the validation of a gold-standard HRQoL tool in critical care, specifically the EQ-5D-5L. Both combined health-utility and mortality (disaggregated) and QALYs (aggregated) can be reported, with disaggregation allowing for determination of which components are the main drivers of the QALY outcome. Increased use of HRQoL, health-utility, and QALYs in critical care RCTs has the potential to: (1) Increase the likelihood of finding important effects if they exist; (2) improve research efficiency; and (3) help inform optimal management of critically ill patients allowing for decision-making about their HRQoL, in additional to traditional health-technology assessments.

Keywords: Critical care, health-related quality of life, Quality-adjusted life-years, Health-utility, Mortality, Morbidity, Kaplan-Meier curves

Core Tip: Health-related quality-of-life and health-utility are patient-important outcome measures that rival even mortality. The purpose of the paper is to outline the steps required for wider adoption of health-related quality-of-life measures in critical care, and what benefits this measurement will yield.