A Quality-Adjusted Life-Year measure for Multiple Sclerosis: Developing a Patient-Reported Health State Classification System for an MS-Specific Preference-Based Measure

Abstract

Objectives: Increasingly generic preference-based measures of health-related quality of life (HRQoL) are used to estimate quality-adjusted life-years in order to inform resource allocation decisions. Evidence suggests that generic measures may not be appropriate for multiple sclerosis (MS). We report the first stage in the development of an MS-specific preference-based measure to quantify the impact of MS and its treatment: deriving a health state classification system, which is amenable to valuation, from the Multiple Sclerosis Impact Scale (MSIS-29), a widely used patient-reported outcome measure in MS. Methods: The dimensional structure of the MSIS-29 was determined using factor analysis and a conceptual framework of HRQoL in MS. Item performance was assessed, using Rasch analysis and psychometric criteria, to enable the selection of one item to represent each dimension of HRQoL covered by the MSIS-29. Analysis was undertaken using a sample (n=529) from a longitudinal study of people with MS. Results were validated by repeating the analysis with a second sample (n=528). Results: Factor analysis confirmed the two subscale structure of the MSIS-29. Both subscales covered several conceptually independent dimensions of HRQoL. Following Rasch and psychometric analysis an eight-dimensional classification system was developed, named the ‘MSIS-8D’. Each dimension was represented by one item with four response levels. Conclusion: Combining factor analysis with conceptual mapping, and Rasch analysis with psychometric criteria, provides a valid method of constructing a classification system for an MS-specific preference-based measure. The next stage is to obtain preference weights so that the measure can be used in studies investigating MS.