Hintergrund: Um unser, auf dem Solidaritätsprinzip basierendes Gesundheitssystem und dessen Finanzierbarkeit aufrecht zu erhalten, gilt es systematisch Therapien, Medikamente und Technologien auf ihren tatsächlichen Vorteil zu untersuchen und daraus Kosten/Nutzen-Bewertungen entstehen zu lassen. Im Rahmen gesundheitsökonomischer Evaluationen sind Health-Utilities ein Fundament dafür Präferenzen zu messen, bestimmten Gesundheitszuständen Werte zuzuschreiben und somit die Krankheitslast und Einschränkung der Lebensqualität zu bestimmen. Das chronische Handekzem und die unspezifischen chronischen Rückenschmerzen gehören zu den bedeutendsten Krankheitsbildern, wobei die Betroffenen eine erhebliche Beeinträchtigung im alltäglichen Leben erfahren. Gesamtgesellschaftlich spielen der arbeitsmedizinische und der gesundheitsökonomische Aspekt, im Sinne der verursachten direkten und indirekten Kosten dieser chronischen Leiden, eine große Rolle. Zielsetzung: Das Ziel der hier vorliegenden Arbeit war es die Health-Utilities (HU) sowie die „Willingness to Pay“ (WTP) für das chronische Handekzem und die unspezifischen chronischen Rückenschmerzen aus Sicht von Probanden ohne Erkrankung, Beschäftigen im medizinischen Bereich und von Betroffenen selbst zu ermitteln. Weiterhin war von Interesse, inwieweit Vorkenntnisse über die Krankheitsbilder und soziodemographische Faktoren diesen Prozess beeinflussen. Methoden: In dieser monozentrischen, epidemiologischen Studie (Querschnittserhebung) wurden im Rahmen eines einmaligen, interaktiven und computerassistierten Interviews, Nutz-werte sowie ergänzende Indizes zur Bestimmung der Schwere von Gesundheitszuständen aus der Perspektive von Patienten (n=64) sowie Angestellten aus dem Gesundheitssektor (n=126) ermittelt. Das Kollektiv der Betroffenen bestand aus 32 Probanden mit einem chronischen Handekzem (CHE) und 32 Probanden, welche unter chronischen, unspezifischen Rückenschmerzen (CURS) litten. Insgesamt wurden 190 Teilnehmer rekrutiert. Nach Vorlage standardisierter Szenarien mit Beschreibung der Krankheitsbilder wurden die Nutzwerte mithilfe der Time-Trade-off-Methode (TTO) erhoben. Dem Zustand in Krankheit wurde dabei eine verkürzte Lebenszeit in vollständiger Gesundheit gegenübergestellt und die Probanden wählten zwischen diesen zwei Gesundheitszuständen bis zu einem Punkt der Unentschlossenheit. Daraus folgt ein numerischer Wert zwischen null und eins, wobei null dem schlechtesten Gesundheitszustand entspricht, für den die Probanden lieber den Tod vorziehen als weiter mit der Krankheit zu leben. Eins hingegen steht für ein beschwerdefreies Leben, für das keine Lebenszeitverkürzung in Betracht kommt. Folglich repräsentiert ein Nutzwert die Anzahl an Lebensjahren, die die Teilnehmenden hypothetisch bereit waren, für ein Leben ohne die jeweilige chronische Erkrankung, einzutauschen. Ergebnisse: Die unter den Probanden ohne Erkrankung mit Hilfe der TTO-Methode abgeleiteten Nutzwerte, betrugen für das leichte chronische Handekzem 0,92 (Mdn: 0,97) und für das schwere 0,75 (Mdn: 0,77). Das Szenario für unspezifische chronische Rückenschmerzen wurde mit 0,81 (Mdn: 0,90) bewertet. Aus Sicht der Betroffenen mit einem CHE betrug der Mittelwert für die leichte Form 0,91 (Mdn: 0,98), für die schwere Form 0,77 (Mdn: 0,82) und für Rückenschmerzen 0,80 (Mdn: 0,83). Patienten mit CURS bewerteten wie folgt: Nutz-werte für das leichte CHE betrugen im Mittel 0,95 (Mdn: 0,98), für die schwere Form 0,75 (Mdn: 0,81) und für CURS selbst 0,88. Es zeigte sich ein signifikanter Unterschied der Nutzwerte zwischen gesunden Probanden und denen mit CURS bei Bewertung des Sze-narios „unspezifische chronischen Rückenschmerzen“. Im Rahmen der Analyse des Einflusses soziodemographischer Faktoren auf die Health Utilities ergaben sich signifikant unterschiedliche Mittelwerte zwischen den Gruppen bei der Beurteilung des leichten CHE in Abhängigkeit der Bekanntschaft zu einer vom CHE betroffenen Person. Ausserdem konnten Zusammenhänge zwischen Vorkenntnissen zu dem Krankheitsbild und der Beur-teilung auf der visuellen Analogskala (VAS) sowie der eigenen WTP beim schweren CHE festgestellt werden. Korrelationen und Regressionen zeigten auf, dass das Alter einen signifikanten Einfluss auf die Bewertung des schweren chronischen Handekzems auf der VAS und das Geschlecht einen Einfluss auf die eigene Zahlungsbereitschaft bei der Bewertung beider Schweregrade hat. Schlussfolgerung: Die beiden chronischen Krankheitsbilder stellen aus Sicht der Beschäftigten im Gesundheitswesen und der Patienten selbst eine erhebliche Beeinträchtigung für die Betroffenen dar. Im Durchschnitt wählten die Teilnehmenden eine 19 bis 25 Prozent kürzere Lebenserwartung um CURS bzw. ein schweres CHE zu vermeiden. Beim Vergleich der Health-Utilities innerhalb der Gruppen zeichnete sich eine hohe Messkonsistenz der Werte ab. Außerdem lagen die HU-Werte der leichten Form des chronischen Handekzems stets unter denen der schweren, was plausibel erscheint und eine gewisse Stabilität der Ergebnisse verspricht. Nutzwerte sind ein wichtiges und nützliches Fundament für gesundheitsökonomische Bewertungen als Basis für die Berechnung und Verwendung von QALYs und somit, als Konsequenz, auch Entscheidungshilfen für therapeutische und präventive Maßnahmen im Gesundheitssystem.:Inhaltsverzeichnis III Abbildungsverzeichnis VII Tabellenverzeichnis IX Abkürzungsverzeichnis XIII 1 Einleitung 1 1.1 Hintergrund 1 1.1.1 Lebensqualität 1 1.1.2 Gesundheitssystem und Kosten 2 1.2 Theoretische Grundlagen – chronisches Handekzem 4 1.2.1 Einführung 4 1.2.2 Gesundheitsökonomischer Aspekt 5 1.2.3 Epidemiologie 6 1.2.4 Diagnosekriterien und klinische Charakteristika 6 1.2.5 Klassifikation/Ätiologie 8 1.2.6 Therapie 12 1.2.7 Verlauf und Prognose 15 1.3 Theoretische Grundlagen – chronische unspezifische Rückenschmerzen 16 1.3.1 Einführung 16 1.3.2 Gesundheitsökonomischer Aspekt 16 1.3.3 Epidemiologie 17 1.3.4 Diagnosekriterien und klinische Charakteristika 18 1.3.5 Ätiologie 21 1.3.6 Therapie 22 1.3.7 Verlauf und Prognose 23 1.4 Gesundheitsökonomie und ihre Methoden 27 1.4.1 Formen gesundheitsökonomischer Evaluationen 28 1.4.2 Das QALY-Konzept 30 1.4.3 Nationaler und internationaler Einsatz von QALYs und KNB im Rahmen von medizinökonomischen Evaluationen 32 1.5 Möglichkeiten zur Ermittlung von Nutzwerten/Messmethoden der Lebensqualität 41 1.6 Ziele und Fragestellungen der Arbeit 45 2 Durchführung, Methoden, Instrumente 47 2.1 Studienbeschreibung 47 2.2 Studienpopulation 47 2.2.1 Patientenzahl 47 2.2.2 Ein- und Ausschlusskriterien/Auswahl der Probanden 47 2.3 Studienvisite/Studienprozeduren 48 2.3.1 Ablauf des standardisierten Interviews 48 2.3.2 Erhebung von soziodemografischen, erkrankungsspezifischen und gesundheitsökonomischen Daten 50 2.3.3 Beschreibung der Erkrankungsszenarien/standardisierte Gesundheitszustände 50 2.3.4 Nutzwertermittlung mittels Time-Trade-off-Methode und VAS aus der Perspektive der Probanden ohne Erkrankung 51 2.3.5 Time-Trade-off-Verfahren und VAS zur Nutzwertermittlung (Perspektive der Betroffenen) 52 2.4 Fragebögen 52 2.4.1 EQ-5D – Euroquol 52 2.4.2 CES-D – Center for Epidemiological Studies Depression Scale 53 2.4.3 WLQ – Work Limitations Questionnaire 53 2.4.4 WPAI – Work Productivity and Impairment Questionnaire 53 2.4.5 HECSI – The Hand Eczema Severity Index 54 2.4.6 PGA – Physician Global Assessment 54 2.4.7 DLQI – Dermatology Life Quality Index 54 2.4.8 Roland Morris Disability Questionnaire 55 2.4.9 BPS – Back Performance Scale 55 2.5 Statistik 56 2.6 Ethische, rechtliche und administrative Aspekte 56 2.6.1 Ethikkommission 57 2.6.2 Finanzierung der Studie 57 2.6.3 Dokumentation und Datenmanagement 57 3 Ergebnisse 59 3.1 Gesamtes Kollektiv 59 3.1.1 Einleitung 59 3.1.2 Soziodemografische Daten von Patienten und Probanden ohne Erkrankung 59 3.1.3 Kenntnisse über die Krankheitsbilder im gesamten Kollektiv 64 3.1.4 Vergleich der erhobenen Nutz-, VAS- und WTP-Werte im gesamten Probandenkollektiv 66 3.1.5 Einfluss von Vorkenntnissen und soziodemografischen Charakteristika des gesamten Probandenkollektives auf die Nutzwert-, VAS- und WTP-Ermittlung 75 3.2 Patientenkollektiv 89 3.2.1 Krankheitsspezifische Charakteristika und Health-Utilities 89 3.2.2 Die eigene Erkrankung der Patienten mit CHE 93 3.2.3 Die eigene Erkrankung der Patienten CURS 101 3.3 Reliabilitätsanalysen und Zusammenhänge der Messmethoden 106 4 Diskussion 111 4.1 Nutz-, VAS- und WTP-Werte des gesamten Kollektivs der Befragten 112 4.2 Einfluss (Unterschiede) von Vorkenntnissen und soziodemografischen Faktoren auf die Nutzwert-, VAS- und WTP-Ermittlung? 116 4.3 Einfluss (Zusammenhänge) von Vorkenntnissen und soziodemographischen Faktoren auf die Nutz-, VAS- und WTP-Werte im gesamten Kollektiv 117 4.4 Krankheitsspezifische Charakteristika sowie Nutz-, VAS- und WTP-Werte des Patientenkollektives 120 4.5 Abhängigkeit der ermittelten Nutz- und VAS-Werte vom Schweregrad der Erkrankung 121 4.6 Wie zuverlässig sind die Messmethoden? 125 4.7 Ist die Time-Trade-off-Methode ein valides Instrument? 126 4.8 Methodenanwendung in Deutschland und politische Einordnung der Ergebnisse 128 4.9 Stärken dieser Studie 131 4.10 Grenzen dieser Studie und Aussichten 133 5 Zusammenfassung 137 6 Summary 141 Literaturverzeichnis 143 Anhang 165 Erklärung zu Vorabveröffentlichung von Ergebnissen 261

<p>One must consider cost effectiveness when deciding how resources within the health sector should be distributed. Quality adjusted life years (QALYs) are used to measure the value of different medical treatments. QALY is based on utility maximization theory, which suggests that a QALY is always a QALY regardless of who receives it. Therefore, a produced QALY is worth the same regardless of the age or the initial health of the patient. Previous research has shown that these assumptions do not seem to fit the real preferences of individuals. Further, there are different methods of acquiring QALYs that give different outcomes. Two of these methods are Time Trade Off (TTO), in which respondents are confronted with a valuation of health change in time, and Person Trade Off (PTO), where respondents are confronted with a valuation in persons. Arguably, PTO is the preferred method that takes greater account of how individuals wish to allocate the resources of the society. From a distribution perspective focusing on age and initial health status, this paper aims to empirically identify the differences between TTO and PTO considering the measurement of preferences for life quality. The aim is also to examine whether the results obtained are consistent with the theoretical assumptions that are required for the preference to be accepted as a cardinal utility. A quantitative survey was carried out with 58 medical and 61 economics students. Half of the students received PTO and the other half TTO questions. The data collected was analyzed comparing the methods, the two student groups and men against women.</p><p>The results from the survey show that, both with TTO and PTO, respondents on average believe that patients who are at a lower initial health level should be given priority over patients who are at a higher initial health level, and younger patients should be given priority over older patients. No significant differences were seen between PTO and TTO when it came to the age of the patient. Conversely, there was a significant difference between the methods for the valuation based on initial health status of patients. Measured with PTO a treatment for patients who are at a lower initial level is valued 28% higher than a treatment for those patients who are at a higher initial level, while the corresponding figure for TTO was 8%. Between medical students and economic students, there were significant differences in the question of age in the PTO. Between men and women differences were found in both methods.</p> / <p>Kostnadseffektivitet är en av faktorerna som ska tas i beaktande vid beslut om hur resurser inom hälso- och sjukvården ska fördelas. Kvalitetsjusterade levnadsår (QALY) används för att mäta effekten av olika insatser. Måttet baseras på nyttomaximeringsteori vilket leder till att en QALY alltid är en QALY oavsett vem den tillfaller - med andra ord är en QALY som produceras hos en patient lika mycket värd oavsett exempelvis patientens ålder eller initiala tillstånd. Dessa antaganden har i tidigare undersökningar visat sig stämma dåligt med individers preferenser men olika metoder för att ta fram QALY verkar ta olika mycket hänsyn till dem. Två av flera metoder är Time Trade Off (TTO), där respondenter ställs inför en värdering av hälsoförändringar i tid och Person Trade Off (PTO) där respondenter ställs inför en värdering i personer. PTO har påståtts vara en mer rättvisande metod som tar större hänsyn till hur individer vill att samhälleliga resurser ska fördelas. Denna uppsats syftar till att, utifrån ett fördelningsperspektiv med fokus på ålder och initialt hälsotillstånd, empiriskt kartlägga förekomsten av skillnader i preferenser för livskvalitet mätt med PTO respektive TTO, samt att undersöka om de erhållna resultaten överensstämmer med de teoretiska grundantagandena som krävs för att preferenser ska accepteras som kardinala nyttor. För att svara mot syftet utfördes en kvantitativ undersökning på 58 läkar- samt 61 ekonomistudenter. Hälften av studenterna fick PTO-frågor och den andra hälften TTO-frågor. En statistisk bearbetning av insamlad data har gjorts där svaren har jämförts mellan metoderna samt mellan läkar- och ekonomistudenter och kvinnor och män.</p><p>Resultaten från undersökningen visar att både med TTO och PTO anser respondenterna att patienter som befinner sig på en lägre initial nivå ska prioriteras framför patienter som befinner sig på en högre initial nivå samt yngre patienter ska prioriteras framför äldre patienter. Vad gäller hänsyn till patienters ålder uppmättes inga signifikanta skillnader mellan PTO och TTO. Däremot uppmättes en signifikant skillnad mellan metoderna vad gäller hänsyn till initialt hälsotillstånd hos patienter. Mätt med PTO värderas en behandling för de patienter som befinner sig på en lägre initial nivå 28 % högre än en behandling för de patienter som befinner sig på en högre initial nivå medan motsvarande siffra för TTO var 8%. Mellan läkare och ekonomer fanns signifikanta skillnader i frågan gällande ålder i PTO och mellan kvinnor och män återfanns skillnader i båda metoder.</p>

One must consider cost effectiveness when deciding how resources within the health sector should be distributed. Quality adjusted life years (QALYs) are used to measure the value of different medical treatments. QALY is based on utility maximization theory, which suggests that a QALY is always a QALY regardless of who receives it. Therefore, a produced QALY is worth the same regardless of the age or the initial health of the patient. Previous research has shown that these assumptions do not seem to fit the real preferences of individuals. Further, there are different methods of acquiring QALYs that give different outcomes. Two of these methods are Time Trade Off (TTO), in which respondents are confronted with a valuation of health change in time, and Person Trade Off (PTO), where respondents are confronted with a valuation in persons. Arguably, PTO is the preferred method that takes greater account of how individuals wish to allocate the resources of the society. From a distribution perspective focusing on age and initial health status, this paper aims to empirically identify the differences between TTO and PTO considering the measurement of preferences for life quality. The aim is also to examine whether the results obtained are consistent with the theoretical assumptions that are required for the preference to be accepted as a cardinal utility. A quantitative survey was carried out with 58 medical and 61 economics students. Half of the students received PTO and the other half TTO questions. The data collected was analyzed comparing the methods, the two student groups and men against women. The results from the survey show that, both with TTO and PTO, respondents on average believe that patients who are at a lower initial health level should be given priority over patients who are at a higher initial health level, and younger patients should be given priority over older patients. No significant differences were seen between PTO and TTO when it came to the age of the patient. Conversely, there was a significant difference between the methods for the valuation based on initial health status of patients. Measured with PTO a treatment for patients who are at a lower initial level is valued 28% higher than a treatment for those patients who are at a higher initial level, while the corresponding figure for TTO was 8%. Between medical students and economic students, there were significant differences in the question of age in the PTO. Between men and women differences were found in both methods. / Kostnadseffektivitet är en av faktorerna som ska tas i beaktande vid beslut om hur resurser inom hälso- och sjukvården ska fördelas. Kvalitetsjusterade levnadsår (QALY) används för att mäta effekten av olika insatser. Måttet baseras på nyttomaximeringsteori vilket leder till att en QALY alltid är en QALY oavsett vem den tillfaller - med andra ord är en QALY som produceras hos en patient lika mycket värd oavsett exempelvis patientens ålder eller initiala tillstånd. Dessa antaganden har i tidigare undersökningar visat sig stämma dåligt med individers preferenser men olika metoder för att ta fram QALY verkar ta olika mycket hänsyn till dem. Två av flera metoder är Time Trade Off (TTO), där respondenter ställs inför en värdering av hälsoförändringar i tid och Person Trade Off (PTO) där respondenter ställs inför en värdering i personer. PTO har påståtts vara en mer rättvisande metod som tar större hänsyn till hur individer vill att samhälleliga resurser ska fördelas. Denna uppsats syftar till att, utifrån ett fördelningsperspektiv med fokus på ålder och initialt hälsotillstånd, empiriskt kartlägga förekomsten av skillnader i preferenser för livskvalitet mätt med PTO respektive TTO, samt att undersöka om de erhållna resultaten överensstämmer med de teoretiska grundantagandena som krävs för att preferenser ska accepteras som kardinala nyttor. För att svara mot syftet utfördes en kvantitativ undersökning på 58 läkar- samt 61 ekonomistudenter. Hälften av studenterna fick PTO-frågor och den andra hälften TTO-frågor. En statistisk bearbetning av insamlad data har gjorts där svaren har jämförts mellan metoderna samt mellan läkar- och ekonomistudenter och kvinnor och män. Resultaten från undersökningen visar att både med TTO och PTO anser respondenterna att patienter som befinner sig på en lägre initial nivå ska prioriteras framför patienter som befinner sig på en högre initial nivå samt yngre patienter ska prioriteras framför äldre patienter. Vad gäller hänsyn till patienters ålder uppmättes inga signifikanta skillnader mellan PTO och TTO. Däremot uppmättes en signifikant skillnad mellan metoderna vad gäller hänsyn till initialt hälsotillstånd hos patienter. Mätt med PTO värderas en behandling för de patienter som befinner sig på en lägre initial nivå 28 % högre än en behandling för de patienter som befinner sig på en högre initial nivå medan motsvarande siffra för TTO var 8%. Mellan läkare och ekonomer fanns signifikanta skillnader i frågan gällande ålder i PTO och mellan kvinnor och män återfanns skillnader i båda metoder.

Thesis (MPhil (Philosophy))--University of Stellenbosch, 2006. / ENGLISH ABSTRACT: Every individual has a mental image of what a ‘good’ life entails. Whether this idea of a good life is based on hedonist, preference satisfaction or ideal theories, or a combination of these theories, it forms the underlying framework that indicates and measures how well or how poorly we are doing. The smaller the discrepancy between these suppositions we nurture and our real circumstances, the greater the degree of wellbeing and satisfaction we experience. This satisfaction with our lives can be indicated on objective and subjective scales, and these serve as a direct reflection of our quality of life. In addition to self experienced quality of life, quality of life is also seen as the aim of health care. However, as the World Health Organization (WHO) sketches an almost utopian view of health, the field is deemed to be so wide that it includes man in his totality. This state of total psychological, physical and social welfare is further seen as a primary or basic necessity to which everyone is entitled. Human welfare, or quality of life, viewed from a healthcare perspective, serves as the criterion for substantiating, informing and guiding health care. Not only are choices regarding the type and degree of intervention in the therapeutic situation guided by this, but quality of life is also regarded as the single cut-off point for determining whether continued existence would be better or worse than not existing at all. A further outcome of quality of life is the use of QALYs (quality-adjusted life years) and TTO (Time trade-off). These instruments are designed to determine the net efficiency of therapeutic intervention by combining two dimensions, namely quality and quantity of life. Quality of life and [healthy] lifespan are therefore combined in a single framework of value assessment, and this framework is applied as the main criterion for allocating limited resources. This application of quality of life has been adjusted to serve as the main measure for determining the value of a life. In this study quality of life will critically be investigated with the focus on self experienced quality of life; quality of life as the aim of health care; and quality of life as the determining factor to place a value on a human life. The study indicates that the concept of quality of life had to undergo a natural and unavoidable development and expansion to keep pace with the changed medical ethos of our times. The writer indicates that the transformation of quality of life as the aim of healthcare to quality of life as the factor for determining the value of a life is currently ethically unacceptable in its application. Finally, a more acceptable development that includes referred competition and social responsibility is suggested.

<p>The aim with this thesis was to study cardiovascular disease and hypertension, use of drugs and health from an epidemiological perspective. Various methods - self-rated health (SRH), health related quality of life (HRQL) - the 36-item short form questionnaire (SF-36) - and health utility measurements - the rating scale (RS) and the time-trade off (TTO) methods - were employed.</p><p>Data from the Swedish Adoption/Twin Study of Aging (SATSA) in 1984, 1987, 1990, and 1993 as well as a general population survey conducted in Uppsala County in 1995 were used.</p><p>Persons who have cardiovascular disease, both with and without drug treatment, were found to have a lower SRH as compared to others in the population. Longitudinal analyses showed that SRH was relatively stable over time among persons with cardiovascular disease. Both having a low SRH and having cardiovascular disease were associated with a higher mortality rate.</p><p>Hypertensives were found to have a lower HRQL than do others in the general population as measured by the SF-36. The lowest scoring was found in the general health perception scale (GH), whereas role emotional (RE) and mental health (MH) were the scales least affected by hypertension.</p><p>Nearly 20 percent of the antihypertensive drug users reported side effects.The pattern of side effects was similar to that reported in clinical trials. Both hypertension itself and the drug treatment were found to have an impact on the patient's health-state utility as measured by the RS. Comparative analyses showed that health utilities and psychometric quality-of-life instruments were only moderately correlated among hypertensives. </p><p>The results also showed that inequalities in HRQL were present with respect to several sociodemographic factors. </p><p>In summary, this thesis revealed that persons with cardiovascular disease and/or with hypertension experience poorer health than others in the population. The poor health may be caused both by the disease and/or the drug treatment. The results in this thesis also suggested that special attention and care should be directed to persons with cardiovascular disease and/or hypertension reporting ill health. This especially is important given that low HRQL can be a riskfactor for subsequent cardiovascular events or complications which in turn might result in higher mortality rate.</p>

The aim with this thesis was to study cardiovascular disease and hypertension, use of drugs and health from an epidemiological perspective. Various methods - self-rated health (SRH), health related quality of life (HRQL) - the 36-item short form questionnaire (SF-36) - and health utility measurements - the rating scale (RS) and the time-trade off (TTO) methods - were employed. Data from the Swedish Adoption/Twin Study of Aging (SATSA) in 1984, 1987, 1990, and 1993 as well as a general population survey conducted in Uppsala County in 1995 were used. Persons who have cardiovascular disease, both with and without drug treatment, were found to have a lower SRH as compared to others in the population. Longitudinal analyses showed that SRH was relatively stable over time among persons with cardiovascular disease. Both having a low SRH and having cardiovascular disease were associated with a higher mortality rate. Hypertensives were found to have a lower HRQL than do others in the general population as measured by the SF-36. The lowest scoring was found in the general health perception scale (GH), whereas role emotional (RE) and mental health (MH) were the scales least affected by hypertension. Nearly 20 percent of the antihypertensive drug users reported side effects.The pattern of side effects was similar to that reported in clinical trials. Both hypertension itself and the drug treatment were found to have an impact on the patient's health-state utility as measured by the RS. Comparative analyses showed that health utilities and psychometric quality-of-life instruments were only moderately correlated among hypertensives. The results also showed that inequalities in HRQL were present with respect to several sociodemographic factors. In summary, this thesis revealed that persons with cardiovascular disease and/or with hypertension experience poorer health than others in the population. The poor health may be caused both by the disease and/or the drug treatment. The results in this thesis also suggested that special attention and care should be directed to persons with cardiovascular disease and/or hypertension reporting ill health. This especially is important given that low HRQL can be a riskfactor for subsequent cardiovascular events or complications which in turn might result in higher mortality rate.

Background Chronic low back pain (LBP) is a common health problem, with a large potential for primary prevention. Health utilities (HU) reflect which proportion of their expected remaining life time individuals would hypothetically trade to be alleviated of a health condition of interest. A value of 0 means “prefer to die immediately”, a value of 1 means “not willing to trade any life time”. The aim of this cross-sectional study was to assess HU for LBP patients and for healthy participants and to examine whether HU for LBP are useful indicators to substantiate preventive and therapeutic decision making. Methods Healthy participants (n = 126) and LBP patients (n = 32) were recruited mainly among the employees of a tertiary care hospital in Germany. Standardized LBP scenarios were presented to all participants and HU values were assessed using the time-trade-off method. Results Median HU for LBP were 0.90 (IQR 0.31) for participants and 0.93 (IQR 0.10) for LBP patients. Measurements were consistent across illness severity ratings with HU and with a visual analogue scale (VAS); in the healthy sample the intraclass correlation coefficient (ICC) was 0.61 (95% CI 0.23–1.00, F(1125) = 190, p < .001), in the patient sample the ICC was 0.66 (95% CI = 0.24–1.00, F(1,31) = 62, p < .001). 8% of participants reported HU of 1. There was no statistically significant relation between HU and age, income, or gender. Conclusion On average, participants chose a 7 to 10% shorter life expectancy to avoid LBP, but almost 1 in 10 participants were not willing to trade any life years. The results indicate a certain stability of HU due to the comparability of HU ratings across patients and healthy participants, the measurement consistency when comparing VAS and HU ratings, and the lack of association between demographic variables and HU. This underlines the usefulness of HU for measuring illness severity in comparative health economics evaluations of preventive and therapeutic measures that address chronic LBP or other pain-characterized diseases. Future studies should focus on different LBP intensities and derive stratified HU that reflect the distribution of pain intensity in the population.

Background Chronic low back pain (LBP) is a common health problem, with a large potential for primary prevention. Health utilities (HU) reflect which proportion of their expected remaining life time individuals would hypothetically trade to be alleviated of a health condition of interest. A value of 0 means “prefer to die immediately”, a value of 1 means “not willing to trade any life time”. The aim of this cross-sectional study was to assess HU for LBP patients and for healthy participants and to examine whether HU for LBP are useful indicators to substantiate preventive and therapeutic decision making. Methods Healthy participants (n = 126) and LBP patients (n = 32) were recruited mainly among the employees of a tertiary care hospital in Germany. Standardized LBP scenarios were presented to all participants and HU values were assessed using the time-trade-off method. Results Median HU for LBP were 0.90 (IQR 0.31) for participants and 0.93 (IQR 0.10) for LBP patients. Measurements were consistent across illness severity ratings with HU and with a visual analogue scale (VAS); in the healthy sample the intraclass correlation coefficient (ICC) was 0.61 (95% CI 0.23–1.00, F(1125) = 190, p < .001), in the patient sample the ICC was 0.66 (95% CI = 0.24–1.00, F(1,31) = 62, p < .001). 8% of participants reported HU of 1. There was no statistically significant relation between HU and age, income, or gender. Conclusion On average, participants chose a 7 to 10% shorter life expectancy to avoid LBP, but almost 1 in 10 participants were not willing to trade any life years. The results indicate a certain stability of HU due to the comparability of HU ratings across patients and healthy participants, the measurement consistency when comparing VAS and HU ratings, and the lack of association between demographic variables and HU. This underlines the usefulness of HU for measuring illness severity in comparative health economics evaluations of preventive and therapeutic measures that address chronic LBP or other pain-characterized diseases. Future studies should focus on different LBP intensities and derive stratified HU that reflect the distribution of pain intensity in the population.