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Medical Decision Making
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Model-Based Methodology for Analyzing Incomplete Quality-of-Life Data and Integrating Them into the Q-Twist Framework

N. Mounier, MD

C. Ferme, MD

H. Flechtner, MD, PhD

M. M. Henry-Amar, MD

E. Lepage, MD, PhD

Background. The standard Q-TWiST approach defines a series of health states and weights each state’s duration according to its quality of life (QOL) to calculate quality-adjusted lifetimes. However, a fixed weight may not adequately reflect time variations in QOL. Methods. To account for measurements derived from irregular visits and informative missing data, the authors estimated the mean QOL profile using a mixed-effect growth curve model for the response, combined with a logistic regression model for the drop-out process. Results. Using data from a clinical study of lymphoma patients, the authors demonstrated better readaptation to normal life for patients younger than 30. Sensitivity analyses and computer simulations demonstrated that modeling the drop-out probability as a function of the QOL measurements is necessary if conditioning by health state is not possible. Conclusion. Our model-based approach is useful to analyze studies with incomplete QOL data, especially when approximate QOL assessment by health state is not possible.

Key Words: quality-adjusted life years • quality of life • survival • Hodgkin lymphoma • longitudinal study • selection model

Medical Decision Making, Vol. 23, No. 1, 54-66 (2003)
DOI: 10.1177/0272989X02239650
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