Observational study of health utilities in adult primary ciliary dyskinesia patients: preliminary data on associations with molecular diagnosis, clinical phenotype and HRQOL measures

Observational study of health utilities in adult primary ciliary dyskinesia patients: preliminary data on associations with molecular diagnosis, clinical phenotype and HRQOL measures

Authors

  • Panayiotis Kouis Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia https://orcid.org/0000-0003-0511-5352
  • Maria G. Kakkoura Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia
  • Stavria Artemis Elia Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia
  • Phivos Ioannou Pediatric Pulmonology Unit, Hospital ‘Archbishop Makarios III’, Nicosia
  • Pinelopi Anagnostopoulou Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia
  • Louiza Potamiti Department of Cancer Genetics, Therapeutics & Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia
  • Maria A. Loizidou Department of Cancer Genetics, Therapeutics & Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia; Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia
  • Mihalis I. Panayiotidis Department of Cancer Genetics, Therapeutics & Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia https://orcid.org/0000-0002-1450-3552
  • Kyriacos Kyriacou Department of Cancer Genetics, Therapeutics & Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia https://orcid.org/0000-0002-4635-0730
  • Andreas Hadjisavvas Department of Cancer Genetics, Therapeutics & Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia
  • Panayiotis K. Yiallouros Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia

Keywords:

Primary ciliary dyskinesia, health utilities, quality of life, rare disease

Abstract

Background: Primary ciliary dyskinesia (PCD) is a congenital disorder characterized by chronic respiratory morbidity. To date, there is no information on PCD-specific preference-based quality of life measures such as health utilities (HU). We cross-sectionally assessed HU in adult PCD patients and explored relationships with genotype, phenotype and quality of life (QOL)-PCD scales.
Methods: Diagnostic testing was performed according to international guidelines, while participants completed the visual analog scale (VAS), time trade off (TTO), standard gamble (SG), and EuroQol 5 dimensions (EQ5D) HU instruments, as well as the QOL-PCD questionnaire. Hierarchical regression was used to identify the QOL-PCD scales that are most predictive of HU.
Results: Among 31 patients, median HU are 0.75 (VAS), 0.86 (EQ5D), 0.91 (TTO) and 0.99 (SG). The underlying genotype is not associated with HU measures. VAS and EQ5D are associated with lung function, while TTO and SG values are not sensitive to any of the examined factors. Among the QOL-PCD scales, physical functioning and lower respiratory symptoms explained much of VAS (R2= 0.419) and EQ5D (R2= 0.538) variability.
Conclusions: Our study demonstrates that HU elicitation in PCD is feasible using both direct and indirect methods. Overall, HU scores are relatively high among adult patients, with higher scores observed in SG and TTO, followed by EQ5D and VAS. VAS and EQ5D HU values are sensitive to lung function as well as to QOL-PCD physical functioning and lower respiratory symptom scores.

Author Biographies

Maria G. Kakkoura, Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia

Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK

Stavria Artemis Elia, Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia

Cyprus International Institute for Environmental & Public Health, Cyprus University of Technology, Limassol, Cyprus

Pinelopi Anagnostopoulou, Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia

Pediatric Pulmonology Unit, Hospital ‘Archbishop Makarios III’, Nicosia, Cyprus

Louiza Potamiti, Department of Cancer Genetics, Therapeutics & Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia

Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus

Maria A. Loizidou, Department of Cancer Genetics, Therapeutics & Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia; Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia

Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus

Mihalis I. Panayiotidis, Department of Cancer Genetics, Therapeutics & Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia

Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus

Kyriacos Kyriacou, Department of Cancer Genetics, Therapeutics & Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia

Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus

Andreas Hadjisavvas, Department of Cancer Genetics, Therapeutics & Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia

Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus

Panayiotis K. Yiallouros, Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia

Pediatric Pulmonology Unit, Hospital ‘Archbishop Makarios III’, Nicosia, Cyprus

References

Boon M, Jorissen M, Proesmans M, De Boeck K. Primary ciliary dyskinesia, an orphan disease. Eur J Pediatr 2013;172:151-62.

Marthin JK, Petersen N, Skovgaard LT, Nielsen KG. Lung function in patients with primary ciliary dyskinesia: a cross-sectional and 3-decade longitudinal study. Am J Respir Crit Care Med 2010;181:1262-8.

Cohen-Cymberknoh M, Simanovsky N, Hiller N, Hillel AG, Shoseyov D, Kerem E. Differences in disease expression between primary ciliary dyskinesia and cystic fibrosis with and without pancreatic insufficiency. Chest 2014;145:738-44.

Shah A, Shoemark A, MacNeill SJ, Bhaludin B, Rogers A, Bilton D, et al. A longitudinal study characterising a large adult primary ciliary dyskinesia population. Eur Respir J 2016;48:441-50.

Frija-Masson J, Bassinet L, Honore I, Dufeu N, Housset B, Coste A, et al. Clinical characteristics, functional respiratory decline and follow-up in adult patients with primary ciliary dyskinesia. Thorax 2017;72:154-60.

Dettmer S, Ringshausen F, Vogel-Claussen J, Fuge J, Faschkami A, Shin HO, et al. Computed tomography in adult patients with primary ciliary dyskinesia: Typical imaging findings. PLoS One 2018;13:e0191457.

Magnin ML, Cros P, Beydon N, Mahloul M, Tamalet A, Escudier E, et al. Longitudinal lung function and structural changes in children with primary ciliary dyskinesia. Pediatr Pulmonol 2012;47:816-25.

Cohen-Cymberknoh M, Weigert N, Gileles-Hillel A, Breuer O, Simanovsky N, Boon M, et al. Clinical impact of Pseudomonas aeruginosa colonization in patients with primary ciliary dyskinesia. Respir Med 2017;131:241-6.

Pifferi M, Bush A, Di Cicco M, Pradal U, Ragazzo V, Macchia P, Boner AL. Health-related quality of life and unmet needs in patients with primary ciliary dyskinesia. Eur Respir J 2010;35:787-94.

McManus IC, Mitchison HM, Chung EM, Stubbings GF, Martin N. Primary ciliary dyskinesia (Siewert's/Kartagener's syndrome): respiratory symptoms and psycho-social impact. BMC Pulm Med 2003;3:4.

McManus I, Stubbings G, Martin N. Stigmatization, physical illness and mental health in primary ciliary dyskinesia. J Health Psychol 2006;11:467-82.

Behan L, Leigh MW, Dell SD, Quittner AL, Hogg C, Lucas JS. Validation of pediatric health‐related quality of life instruments for primary ciliary dyskinesia (QOL‐PCD). Pediatr Pulmonol 2019;54:2011-20.

Lucas JS, Behan L, Dunn Galvin A, Alpern A, Morris AM, Carroll MP, et al. A quality-of-life measure for adults with primary ciliary dyskinesia: QOL-PCD. Eur Respir J 2015;46:375-83.

Queiroz APL, Athanazio RA, Olm MAK, Rubbo B, Casal YR, Lucas J, Behan L. Translation of the quality-of-life measure for adults with primary ciliary dyskinesia and its application in patients in Brazil. J Bras Pneumol 2019;45:e20170358.

Behan L, Leigh MW, Dell SD, Dunn Galvin A, Quittner AL, Lucas JS. Validation of a health-related quality of life instrument for primary ciliary dyskinesia (QOL-PCD). Thorax 2017;72:832-9.

Emiralioglu N, Karadag B, Ozcelik HU. Quality of life questionnaire for Turkish patients with primary ciliary dyskinesia. Turk Thorac J 2017;18:19-22.

Ioannou P, Kouis P, Kakkoura MG, Kaliva M, Toliopoulou A, Andreou KP, et al. Health related quality of life in adult primary Ciliary dyskinesia patients in Cyprus: development and validation of the Greek version of the QOL-PCD questionnaire. Health Qual Life Outcomes 2020;18:105.

Tarride J, Burke N, Bischof M, Hopkins RB, Goeree L, Campbell KP, et al. A review of health utilities across conditions common in paediatric and adult populations. Health Qual Life Outcomes 2010;8:12.

Brundage M, Bass B, Davidson J, Queenan J, Bezjak A, Ringash JP, et al. Patterns of reporting health-related quality of life outcomes in randomized clinical trials: implications for clinicians and quality of life researchers. Qual Life Res 2011;20:653-64.

Neumann PJ, Thorat T, Shi J, Saret CJ, Cohen JT. The changing face of the cost-utility literature, 1990–2012. Value Health 2015;18:271-7.

Yiallouros PK, Kouis P, Kyriacou K, Evriviadou A, Anagnostopoulou P, Matthaiou A, et al. Implementation of multigene panel NGS diagnosis in the national primary ciliary dyskinesia cohort of Cyprus: An island with a high disease prevalence. Hum Mutat 2021;42:e62-e77.

Kouis P, Hadjisavvas A, Middleton N, Papatheodorou SI, Kyriacou K, Yiallouros PK. The effect of L-arginine on ciliary beat frequency in PCD patients, non-PCD respiratory patients and healthy controls. Pulm Pharmacol Ther 2018;48:15-21.

Lucas JS, Barbato A, Collins SA, Goutaki M, Behan L, Caudri D, et al. European Respiratory Society guidelines for the diagnosis of primary ciliary dyskinesia. Eur Respir J 2017;49:1601090.

Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J 2012;40:1324-43.

Nord E. The validity of a visual analogue scale in determining social utility weights for health states. Int J Health Plann Manage 1991;63:234-42.

Attema AE, Edelaar-Peeters Y, Versteegh MM, Stolk EA. Time trade-off: one methodology, different methods. Eur J Health Econ 2013;14:53-64.

Gafni A. The standard gamble method: what is being measured and how it is interpreted. Health Serv Res 1994;29:207-24.

Yfantopoulos JN, Chantzaras AE. Validation and comparison of the psychometric properties of the EQ-5D-3L and EQ-5D-5L instruments in Greece. Eur J Health Econ 2017;18:519-31.

Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 2011;20:1727-36.

Kontodimopoulos N, Niakas D. Overcoming inherent problems of preference-based techniques for measuring health benefits: an empirical study in the context of kidney transplantation. BMC Health Serv Res 2006;6:1-9.

Hogg K, Shaw J, Coyle D, Fallah P, Carrier M, Wells P. Validity of standard gamble estimated quality of life in acute venous thrombosis. Thromb Res 2014;134:819-25.

Liu L, Li S, Zhao Y, Zhang J, Chen G. Health state utilities and subjective well-being among psoriasis vulgaris patients in mainland China. Qual Life Res 2018;27:1323-33.

Bharmal M, Thomas III J. Comparing the EQ‐5D and the SF‐6D descriptive systems to assess their ceiling effects in the US general population. Value Health 2006;9:262271.

Grutters JP, Joore MA, van der Horst F, Verschuure H, Dreschler WA, Anteunis LJ. Choosing between measures: comparison of EQ-5D, HUI2 and HUI3 in persons with hearing complaints. Qual Life Res 2007;16:1439-49.

Zhu J, Yan X, Liu C, Wang H, Wang L, Cao S, et al. Comparing EQ-5D-3L and EQ-5D-5L performance in common cancers: suggestions for instrument choosing. Qual Life Res 2021;30:841-54.

Salaffi F, Stancati A, Carotti M: Responsiveness of health status measures and utility-based methods in patients with rheumatoid arthritis. Clin Rheumatol 2002;21:478-87.

Chevreul K, Michel M, Brigham KB, López-Bastida J, Linertová R, Oliva-Moreno J, et al. Social/economic costs and health-related quality of life in patients with cystic fibrosis in Europe. Eur J Health Econ 2016;17:s7-18.

Bradley JM, Blume SW, Balp MM, Honeybourne D, Elborn JS. Quality of life and healthcare utilisation in cystic fibrosis: a multicentre study. Eur Respir J 2013;41:571-7.

Cohen-Cymberknoh M, Simanovsky N, Hiller N, Hillel AG, Shoseyov D, Kerem E. Differences in disease expression between primary ciliary dyskinesia and cystic fibrosis with and without pancreatic insufficiency. Chest 2014;145:738-44.

Davis SD, Ferkol TW, Rosenfeld M, Lee H, Dell SD, Sagel SD, et al. Clinical features of childhood primary ciliary dyskinesia by genotype and ultrastructural phenotype. Am J Respir Crit Care Med 2015;191:316-24.

Emiralioğlu N, Taşkıran EZ, Koşukcu C, Bilgiç E, Atilla P, Kaya B, et al. Genotype and phenotype evaluation of patients with primary ciliary dyskinesia: First results from Turkey. Pediatr Pulmonol 2020;55:383-93.

Pifferi M, Bush A, Mulé G, Gracci S, Fonnesu R, Michelucci A, et al. Longitudinal lung volume changes by ultrastructure and genotype in primary ciliary dyskinesia. Ann Am Thorac Soc 2021;18:963-70.

Horani A, Ferkol TW. Advances in the genetics of primary ciliary dyskinesia: clinical implications. Chest 2018;154:645-52.

Knowles MR, Ostrowski LE, Leigh MW, Sears PR, Davis SD, Wolf WE, et al. Mutations in RSPH1 cause primary ciliary dyskinesia with a unique clinical and ciliary phenotype. Am J Respir Crit Care Med 2014;189:707-17.

Yiallouros PK, Kouis P, Pirpa P, Michailidou K, Loizidou MA, Potamiti L, et al. Wide phenotypic variability in RSPH9-associated primary ciliary dyskinesia: review of a case-series from Cyprus. J Thorac Dis 2019;11:2067-75.

Tsevat J. What do utilities measure? Med Care 2000;38:II160-4.

Arnold D, Girling A, Stevens A, Lilford R. Comparison of direct and indirect methods of estimating health state utilities for resource allocation: review and empirical analysis. BMJ 2009;339:b2688.

Karimi M, Brazier J, Paisley S. How do individuals value health states? A qualitative investigation. Soc Sci Med 2017;172:80-8.

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Published

20-12-2022

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1.
Kouis P, Kakkoura MG, Elia SA, Ioannou P, Anagnostopoulou P, Potamiti L, et al. Observational study of health utilities in adult primary ciliary dyskinesia patients: preliminary data on associations with molecular diagnosis, clinical phenotype and HRQOL measures. Multidiscip Respir Med [Internet]. 2022 Dec. 20 [cited 2024 Jul. 4];17. Available from: https://mrmjournal.org/index.php/mrm/article/view/881