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    • The DLQI domains and the

    2018-10-29

    The DLQI domains and the EQ-5D, VAS, and TTO were negatively correlated in our study, indicating that chir99021 lower EQ-5D, VAS, and TTO scores were associated with higher DLQI scores. The EQ-5D had the strongest correlations with the DLQI domains, the VAS had the second strongest correlations, and the TTO had the weakest correlations. Although the TTO has a better theoretical basis than the VAS, correlations between the TTO and the DLQI domains were lower than those between the VAS and the DLQI domains. This might have been due to the fact that the VAS question was more straightforward and comprehensible for patients to answer than the TTO question. The psychometric measurement scales had good reliability and validity, and were easy to use. Moreover, the fact that the correlations between health state utilities and the scales have been shown to be high implies that the health state utilities have higher validity. An in-depth analysis of the correlations between the DLQI domains and the health utility measures showed that the EQ-5D had a significant negative correlation with each of the DLQI domains (p < 0.01). This indicated that lower EQ-5D scores were associated with higher DLQI scores, a finding that was consistent with and similar to the results of many previous studies. The VAS was also negatively related to every DLQI domain (p < 0.01), a result consistent with and similar to those of other studies. Finally, negative correlations between the TTO and most of the DLQI domains were also consistent with results reported by Lundberg et al, which indicated that the higher the TTO, the lower the level of each aspect of QOL, as defined by the DLQI domains. However, there were differences in the statistical significance of the correlations between the TTO and two of the DLQI domains. First, our study showed that the TTO and the “personal relationships” domain were negatively correlated at a statistically significant level of 0.01, indicating that respondents with poorer personal relationships would be willing to exchange more life years for perfect health. The “personal relationships” domain was defined using the following questions: “how much has your skin created problems with your partner or any of your close friends or relatives?” and “how much has your skin caused any sexual difficulties?” When a disease is visible, even if it is noncontagious, social activities of patients might be affected because of changes in appearance. Compared with previous studies of Caucasian psoriasis patients, the impacts of psoriasis on relationships with family, friends, and sexual partners among Taiwanese patients were better reflected in the results of the TTO. This may have been due to the fact that Taiwanese people in general are less aware of the noncontagious nature of psoriasis, which results in poorer personal relationships and a stigma associated with Taiwanese psoriasis patents. Second, in our study, the negative correlation between the TTO and the “treatment” domain did not reach statistical significance. The distress caused by treatment was defined by the following statement: “Disease has made the home dirty or treatment takes time.” This indicated that respondents with greater distress caused by treatment were not willing to give up more years of life in exchange for perfect health, which was possibly due to the convenience of accessing medical resources in Taiwan resulting from the nation\'s national health insurance program. This seems to indicate that the TTO is not a valid measure for reflecting the distress caused by psoriasis treatment. The results of our study further showed that the maximum WTP had significant positive correlations with the “leisure” and “personal relationships” domains, and with the overall DLQI score. This suggests that, among Taiwanese psoriasis patients, the impacts of social activities on QOL were particularly well reflected in the maximum WTP. By contrast, Lundberg et al found that only the “treatment” domain had a significant positive correlation with the maximum WTP. Furthermore, they found that the correlations of the other domains with the maximum WTP were not significant or were even negative.