Association between knee symptoms, change in knee symptoms over 6–9 years, and SF-6D health state utility among middle-aged Australians

Ambrish Singh, Julie A. Campbell, Alison Venn, Graeme Jones, Leigh Blizzard, Andrew J. Palmer, Terence Dwyer, Flavia Cicuttini, Changhai Ding, Benny Antony

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5 Citations (Scopus)


Objectives: Health state utilities (HSUs) are an input metric for estimating quality-adjusted life-years (QALY) in cost–utility analyses. Currently, there is a paucity of data on association of knee symptoms with HSUs for middle-aged populations. We aimed to describe the association of knee symptoms and change in knee symptoms with SF-6D HSUs and described the distribution of HSUs against knee symptoms’ severity. Methods: Participants (36–49-years) were selected from the third follow-up (completed 2019) of Australian Childhood Determinants of Adult Health study. SF-6D HSUs were generated from the participant-reported SF-12. Association between participant-reported WOMAC knee symptoms’ severity, change in knee symptoms over 6–9 years, and HSUs were evaluated using linear regression models. Results: For the cross-sectional analysis, 1,567 participants were included; mean age 43.5 years, female 54%, BMI ± SD 27.18 ± 5.31 kg/m2. Mean ± SD HSUs for normal, moderate, and severe WOMAC scores were 0.820 ± 0.120, 0.800 ± 0.120, and 0.740 ± 0.130, respectively. A significant association was observed between worsening knee symptoms and HSUs in univariable and multivariable analyses after adjustment (age and sex). HSU decrement for normal-to-severe total-WOMAC and WOMAC-pain was − 0.080 (95% CI − 0.100 to − 0.060, p < 0.01) and − 0.067 (− 0.085 to − 0.048, p < 0.01), exceeding the mean minimal clinically important difference (0.04). Increase in knee pain over 6–9 years was associated with a significant reduction in HSU. Conclusion: In a middle-aged population-based sample, there was an independent negative association between worse knee symptoms and SF-6D HSUs. Our findings may be used by decision-makers to define more realistic and conservative baseline and ongoing HSU values when assessing QALY changes associated with osteoarthritis interventions.

Original languageEnglish
Pages (from-to)2601-2613
Number of pages13
JournalQuality of Life Research
Issue number9
Publication statusPublished - Sept 2021


  • Health state utility
  • Osteoarthritis
  • Population norm
  • QALY
  • SF-6D

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