Time Trade-Off를 이용한 아동의 일반적 건강상태기술체계인 CH-6D의 가치평가
A Valuation of CH-6D, a Generic Health Descriptive System for Children, Using Time-Trade Off
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초록
본 연구의 목적은 최근 국내에서 개발된 Child Health-6D(CH-6D)를 사용하여 정의할 수 있는 2,304가지 건강상태에 대한 가치를 나타내는 가치(tariff)를 산출하는 것이었다. 조사 대상은 거주지가 서울이고 20세 이상 성인 중 조사여부에 대한 동의를 얻은 사람에 한하여 173명으로 진행되었으며, 이들에게 26가지 건강상태에 대해 조사를 진행하였다. 분석방법으로는 변량효과 모형을 이용하였고, 각각의 level과 상호작용 변수를 각각 독립변수로 두고, 종속변수는 1-TTO의 가치값을 놓고 분석하였다. 최적모형의 가능성이 있는 모형은 Ea34m1sq+I3m1로 나타났으며, 이 모형의 MAE(Mean Absolute Error)값을 계산하여 0.0631을 얻었다. 이 추정모형을 사용하여 건강상태 2,304개에 대한 가치점수를 얻었다. 이 모형에서 level 4까지 있는 영역에서 level 4의 회귀계수의 크기는 친구들과 어울려 놀기, 공부, 운동/뛰기, 힘 순이었으며 level 3까지 있는 영역에서 level 3의 회귀계수는 기분, 아픔/불편감 순으로 나타났다. 전체 평균 ICC값은 0.835로 만족할 만한 수준이었다. 본 연구에서 개발된 tariff를 사용하여 향후 CH-6D의 신뢰성과 타당성 평가가 이뤄진다면 우리나라 고유의 특성을 반영하여 개발된 CH-6D의 임상 및 정책 활용도가 높아질 수 있을 것이다.
Abstract
The objective of this study was to estimate the preference-based values of the 2,304 types of health states defined by the Child Health-6 Dimension (CH-6D) developed recently in South Korea. The subjects of this study were 173 Seoul dwellers who whose age was between 20 and 60. The subjects evaluated 26 health states using the time trade-off (TTO) method. A random effect model was used to estimate the values of the 2,304 health states. Various interaction variables as well as dummy variables estimating the main effect of each item were included in the model, while the dependent variable was defined as 1-TTO. The optimal model was turned out to be Ea34m1sq+I3m1 of which the mean absolute error (MAE) was 0.0631. Values of 2,304 health states were estimated using this model. Among the four items which had four levels, the regression coefficient of the level four was greatest for ‘playing with friends,’ followed by ‘studying,’ ‘exercising/running,’ and ‘vitality.’ Between the two items with three levels, the regression coefficient of ‘mood’ was greater than ‘pain/discomfort.’ Mean ICC at individual level was 0.835, which was satisfactory. Now that the tariff of the CH-6D is developed, further studies are needed for testing the validity and reliability of the CH6D so that the clinical and policy use of the CH-6D will be enhanced.
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