健康效用值测量中的映射法及其相关模型概述
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篇名: 健康效用值测量中的映射法及其相关模型概述
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摘要: 目的:为将非效用量表测量结果转化为健康效用值提供方法学参考。方法:查阅国内外文献,总结健康效用值测量中的映射法及其相关模型,并以生存质量量表测量结果转换成欧洲五维健康量表效用值为例,介绍各模型在概率映射中的应用。结果:映射法可通过建立非效用量表和效用量表之间的映射关系,进而得到健康效用值;其常用模型包括普通最小二乘法(OLS)模型、最小绝对离差法(CLAD)模型、Tobit模型、多元Logistic回归(MNL)模型、贝叶斯网络(BN)模型等。其中,OLS模型相对简单,预测效度较好,但会受到天花板效应的限制;Tobit模型不受天花板或地板效应的限制,当误差项满足方差齐性及正态性时,其预测结果优于OLS模型;CLAD模型可用于误差项非方差齐性不适用Tobit模型的情况;MNL模型先通过回归分析确定一种健康状态,再确定其效用值;BN模型预测效度较好,且不涉及计量经济学中的诸多假设和限制条件,但其构建过程受领域专家的影响较大。使用MNL或BN模式计算健康效用值的方法主要有蒙特卡洛模拟法、期望效用值法和最大可能概率法等。利用拟合优度、调整拟合优度、平均误差、均方误差、平均绝对误差等指标进行模型性能评价,可选出最优模型,进而计算健康效用值。结论:由于各映射模型各有优缺点,在临床研究中需要根据实际情况选择不同的映射模型。
ABSTRACT: OBJECTIVE: To provide methodological reference for converting non-utility scale measurement results into health utility values. METHODS: Referring to domestic and foreign literatures, mapping methods and relevant models in health utility measurement were summarized. The effect of each model on probability mapping was introduced by taking the Medical outcomes study 12-item short form health survey measurement results converting into the EuroQol group’s 5-domain utility values as example. RESULTS: The mapping methods can be adopted to obtain the health utility values by establishing the mapping relationship between non-utility scale and utility scale. The common models included ordinary least square (OLS) model,censored least absolute deviations (CLAD) model, Tobit model,multinomial Logistic regression (MNL) model,Bayesian networks (BN) model, etc. OLS model was relatively simple with a good predictive validity,but it would be limited by the ceiling effect; Tobit model was not limited by the ceiling or floor effect,when the error term satisfied the variance homogeneity and normality, prediction result of  Tobit model was better than OLS model; CLAD model can be used for the situation of Tobit model unsuitable for non-variance homogeneity of the error term; MNL model firstly determined a health state by regression analysis and then determined its utility value; the prediction validity of BN model was good and it didn’t involved many assumptions and restrictions condition in econometrics, but the construction of BN model was greatly influenced by domain experts. Main methods for the calculation of health utility value with MNL or BN model were Monte Carlo simulation method, expected-utility method, most-likely probability methed, etc. We can carry out the model performance evaluation by using the R2, the adjusted R2, the mean error, the mean squared error and the mean absolute error, and then select the optimal model to calculate health utility values. CONCLUSIONS: Due to the advantages and disadvantages of each mapping model, it is necessary to select different mapping models based on the actual conditions.
期刊: 2017年第28卷第29期
作者: 孙园园,余正,李洪超
AUTHORS: SUN Yuanyuan,YU Zheng,LI Hongchao
关键字: 映射法;健康效用值;映射模型;生存质量量表;欧洲五维健康量表
KEYWORDS: Mapping method; Health utility value; Mapping model; Medical outcomes study 12-item short form health survey; EuroQol group’s 5-domain
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