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Preference-based instruments can be categorised into direct and indirect instruments [ 1, 2].
Common indirect instruments in patients with mental disorders are the EQ-5D and the SF-6D [ 3].
In indirect instruments, there are two steps to assess utility weights: first, persons of a reference population value a set of predefined generic or condition-specific health states via direct instruments.
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Based on these valuations, an algorithm is generated to estimate utility weights for each possible health state of the indirect instrument.
Second, patients describe their health state on the indirect instrument, and the corresponding utility weight is assigned to the reported health state.
Along this line, it should also be realized that indirect utility instruments, such as the EuroQol 5 dimensions and Short-form 6 dimensions, are primarily based on self-reported health profiles [ 10, 11].
A sample of patients with a rheumatologist-confirmed diagnosis of rheumatoid arthritis (RA) was previously assembled for a longitudinal study to examine the reliability and responsiveness of the indirect utility instruments [ 26- 28].
Examples of indirect HU instruments include the Health Utilities Index, Mark3 (HUI3) and the Health Utilities Index, Mark2 (HUI2) [ 3], developed using direct HU measures from the standard gamble and visual analog scale (VAS) techniques and the EuroQOL 5-dimensions (EQ-5D) [ 4], developed using direct HU measures from time trade-off and VAS techniques.
Starting from the second year, though, the magnitude of change in health utility measured by indirect-preference instruments was larger than direct-preference ones.
In patients with mental disorders, however, no study has compared the responsiveness of direct and indirect preference-based instruments.
The binocular indirect ophthalmoscope (Keeler Instruments Inc., Pennsylvania, U.S.A) and +20 D lens (Nikon) are used to examine the fundus.
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