Comparison of health state utility measures and disabilities of arm, shoulder and hand questionnaire scores in bilateral hand amputees

Bilateral hand amputation (BHA) is a life-changing event that can result in a great degree of loss of function. Prosthetic limb replacement and Composite tissue allotransplantation are the treatment options. Understanding the BHA in terms of economic utility will help direct future research and upgrading in healthcare delivery. This is a cross-sectional study in 32 BHA who have completed a minimum of six months after wound healing. The primary objective was to assess the convergent validity of three different Health Utility derivation methods, namely the Time Trade-Off (TTO), EuroQol Questionnaire (EQ-5D-5L) and EQ-VAS (EuroQol Visual Analog Scale) among BHA. The secondary objective was to correlate the Disabilities of Arm, Shoulder and Hand (DASH) scores with the Health Utility (HU) scores and see whether the DASH score predicts the HU scores derived by different methods. The mean (SD) HU scores for TTO, VAS and EQ-5D-5L were 0.34 (0.25), 0.61 (0.25) and 0.46 (0.20) respectively. HU derived by the TTO method displayed a weak correlation with EuroQol based derivatives (EQ-VAS & EQ-5D-5L). But there was a moderate correlation between values by EQ-VAS & EQ-5D-5L. Hence, the EuroQol HU derivative is preferable to TTO. The mean (SD) of the DASH score was 48.4 (22.9). There was a strong correlation between the DASH scores and HU derived by different methods. Also, the DASH score is seen to be a good predictor of HU scores. This study is the first to derive health utility and correlate the DASH with HU scores in the BHA scenario.