Third International Congress Drug Therapy in HIV Infection 3-7 November 1996 Glasgow, UK

COMPREHENSIVE OUTCOME ASSESSMENT: STATUS AND FUNCTIONING

Samuel A Bozzette, M.D., Ph. D.
Veterans' Affairs Med Ctr-San Diego, U Cal San Diego, and RAND Mail Code 111N1 3350 LaJolla Village Drive, San Diego, CA sbozzette@ucsd.edu

Int Cong Drug Therapy HIV 1996 Nov 3-7;3:Abstract No. 11.3
AIDS 1996, Vol. 10 (Suppl. 2);S7

Recently, there has been an appropriate re-focusing on the use of laboratory markers of HIV disease activity in drug development and clinical practice. However, patients, physicians, and administrators need more information to make appropriate decisions regarding available HIV therapies. The kinds of information required can be grouped into biological, clinical, functional, and economic level outcomes. Despite the relevance of functional outcomes to clinical practice, they are often poorly understood by clinicians.

Functional measures can be divided into two kinds. Observable outcomes capture an aspect of physical reality such as disability (e.g. bed days) and ability to perform activities of daily living (ADL's; e.g. personal care) or instrumental ADL's (IADL's; e.g. balancing a checkbook). Subjective outcomes, which capture abstract concepts such as "well being," can be divided into measures of status or functioning, and measures of value or preferences.

Health status or health related quality of life scales developed from a psychometric tradition Many, such as the MOS, SIP, QWB and EuroQual, have been demonstrated to be robust, reliable, and valid. Such measures may be disease-specific or generic, summary or multidimensional, or have single or multiple questions on each concept. Value includes the concepts of satisfaction and preference. Adequate satisfaction measures focus on serious concepts such as trust and respect for autonomy rather than the "amenities of care." Measures of expressed preference or utility arose from an economic tradition as a substitute for revealed preference, or market choices. Such measures are often difficult for patients to understand and complete, and, as estimates of subjective benefit, relate to clinical phenomena less well than do health status measures.

Presenting author: Samuel A Bozzette, M.D., Ph. D.

1996-11-03
11.3

Originally published in AIDS Volume 10, Supplement 2 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701

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