The relationship between EQ-5D, HAQ and pain in patients with rheumatoid arthritis

Mónica Hernández Alava, Allan Wailoo, Fred Wolfe, Kaleb Michaud

Research output: Contribution to journalArticlepeer-review

63 Scopus citations


Objective. This study aims to provide robust estimates of EQ-5D as a function of the HAQ and pain in patients with RA. Method. Repeated observations were made of patients diagnosed with RA in a US observational cohort (n = 100 398 observations) who provided data on HAQ, pain on a visual analogue scale and the EQ-5D questionnaire. We used a bespoke statistical method based on mixture modelling to appropriately reflect the characteristics of the EQ-5D instrument and to compare this with results from standard multiple regression.Results. EQ-5D can be predicted from summary HAQ and pain scores. We identify four different classes of respondents who differ in terms of disease severity. Unlike the multiple regression, the mixture model exhibits very good fit to the data and does not suffer from problems of bias or predict values outside the feasible range.Conclusion. It is appropriate to model the relationship between HAQ and EQ-5D but only if suitable statistical methods are applied. Linear models underestimate the quality-adjusted life year benefits, and therefore the cost-effectiveness, of therapies. The bespoke mixture model approach outlined here overcomes this problem. The addition of pain as an explanatory variable greatly improves the estimates. Reimbursement agencies rely on these types of analyses when formulating policy on the use of new drug therapies. Clinicians as well as economists should be concerned with these issues.

Original languageEnglish (US)
Article numberkes400
Pages (from-to)944-950
Number of pages7
JournalRheumatology (United Kingdom)
Issue number5
StatePublished - May 2013


  • EQ-5D
  • Economic evaluation
  • HAQ
  • Health outcomes
  • Mapping
  • Pain
  • Quality of life
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Rheumatology
  • Pharmacology (medical)


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