Qual Life Res
DOI 10.1007/s11136-016-1435-y
Health-related quality of life associated with systemic
corticosteroids
Patrick W. Sullivan1 • Vahram H. Ghushchyan2,3 • Gary Globe4 • Brandon Sucher1
Accepted: 12 October 2016
 Springer International Publishing Switzerland 2016
Abstract
Background Systemic corticosteroids (SCS) are com-
monly used but are associated with adverse effects. Given
their prevalent use, the potential impact of SCS use on
health-related quality of life (HRQoL) is important to
characterize.
Objective To assess the HRQoL of patients taking SCS.
Methods The 2000–2003 Medical Expenditure Panel Sur-
vey was used to examine EQ-5D and SF-6D scores asso-
ciated with SCS use in adults. The study sample was
restricted to those with a condition for which SCS are
prescribed. SCS use was categorized into three levels:
none; 1–3; and C4 prescriptions per year. HRQoL scores
were regressed on SCS use (1–3 or C4 annual prescrip-
tions) controlling for age, gender, race, ethnicity, educa-
tion, income category, geographic region, number of ER
visits, number of outpatient visits, total number of chronic
conditions (for which SCS are not used) and conditions for
which SCS are clinically indicated.
Results There were 54,856 individuals with no SCS
exposure, 2245 with 1–3 and 624 with C4 annual SCS
prescriptions. In adjusted analyses, use of C4 annual SCS
prescriptions appeared to be associated with significantly
lower EQ-5D (US), EQ-5D (UK), SF-6D and EQ-5D VAS
& Patrick W. Sullivan
psulliva@regis.edu
1
Regis University School of Pharmacy, Denver, CO, USA
2
Department of Clinical Pharmacy, Center for Pharmaceutical
Outcomes Research, University of Colorado Aurora, Aurora,
CO, USA
3
American University of Armenia, Yerevan, Armenia
4
Amgen, Inc., Thousand Oaks, CA, USA
scores compared to no exposure: -0.032, -0.047, -0.036,
and -7.58.
Conclusion While SCS are efficacious and widely used for
numerous conditions, results suggest that their use may be
associated with a substantial deleterious impact on
HRQoL. This potential negative effect should be consid-
ered in balance with the cost and efficacy of comparable
treatments.
Keywords Preference-based health-related quality of life

Health-related quality of life
Utility
Patient-reported
outcomes
Background
Systemic corticosteroids (SCS) are an important treatment
because of their potent anti-inflammatory and immuno-
suppressive effects. They are used widely to treat many
conditions, including rheumatoid arthritis, systemic lupus
erythematosus, asthma and inflammatory bowel disease
among many others. In severe asthma, for example, SCS
may be used as a long-term control medication and are
frequently used to treat asthma exacerbations that may
occur many times per year in patients with uncontrolled
asthma. Although SCS may be an efficacious treatment
option for many conditions, they are associated with sig-
nificant adverse effects (AEs). Adverse effects of long-term
exposure to SCS include osteoporosis, hypertension, dia-
betes mellitus, metabolic syndrome, weight gain, cataracts,
glaucoma, gastrointestinal bleeds/ulcers, impaired wound
healing and psychological disorders among many others
[1, 2]. Indeed, asthma guidelines recommend that patients
who are on long-term SCS should receive preventive
treatment for osteoporosis [1].
123

AEs of SCS are prevalent and impactful. Based on
national inpatient data from the Healthcare Cost and
Utilization Project, SCS comprised 9.6 % of all adverse
drug events present upon admission to the hospital and
15.3 % of all that developed in the hospital [3]. In addition
to their deleterious clinical impact, SCS have been shown
to significantly increase healthcare costs. Sarnes et al. [4]
conducted a literature review of the cost of SCS-related
AEs and found the cost to be up to $26,471 (annual; $2009)
for nonfatal MI and up to $18,356 (per event) for fracture.
In the most comprehensive direct assessment of the costs of
SCS-related AEs to date, Shah et al. quantified the eco-
nomic impact of SCS-related AEs in systemic lupus [5].
They found that it costs an additional $784 per year per
SCS user to manage known SCS-related AEs compared to
non-SCS users.
While there is some evidence of the cost of AEs asso-
ciated with SCS use, there are limited studies to date iso-
lating the health-related quality of life (HRQoL) impact of
taking SCS apart from the condition for which they are
used. Given the prevalent use of SCS, the potential dele-
terious impact of SCS use on HRQoL is important to
characterize. The objective of this study was to assess the
HRQoL of patients taking SCS.
Methodology
Data source
The Medical Expenditure Panel Survey (MEPS) is
cosponsored by the Agency for Healthcare Research and
Quality and the National Center for Health Statistics. The
MEPS Household Component is a nationally representative
survey of the US civilian noninstitutionalized population
which contains detailed information on demographic and
socioeconomic characteristics, health conditions and
HRQoL [6]. The sampling frame for the MEPS HC is
drawn from respondents to the National Health Interview
Survey. The NHIS provides a nationally representative
sample of the US civilian noninstitutionalized population,
with over sampling of Hispanics and blacks. The House-
hold Component is based on self-report. Linked to the HC
is a provider-reported Medical Provider Component
(MPC). There are three rounds per year for two years (for a
total of five rounds) in an overlapping panel design in
which respondents completed a battery of questions for the
Household Component on demographic and socioeco-
nomic characteristics, health conditions, insurance status,
utilization of prescription drugs and many other compo-
nents. Data on utilization of prescribed medicines are
obtained by a follow-back survey that collects detailed
information from a sample of pharmacies and healthcare
123
Qual Life Res
providers used by MEPS respondents. The MPC supple-
ments and validates information on pharmacy events.
Medical conditions reported by individuals or the MPC are
mapped to 693 three-digit International Classification of
Diseases, Ninth Revision (ICD-9) codes by professional
coders. Further details on MEPS are available at www.
meps.ahrq.gov.
Adults C18 years of age who responded to the MEPS
Self-administered Questionnaire from years 2000–2003
were included in this analysis. (A sample including
2000–2012 was included in the sensitivity analysis). MEPS
medical conditions files and prescription drug use files
were also merged into the analytic sample. The sample
design of the MEPS-HC survey includes stratification,
clustering, multiple stages of selection and disproportionate
sampling. MEPS sampling weights incorporate adjustment
for the complex sample design and reflect survey nonre-
sponse and population totals from the Current Population
Survey. All analyses incorporated the MEPS sampling and
variance adjustment weights. The inclusion of these sample
weights and adjustments ensures that the results are
nationally representative.
Systemic corticosteroids
SCS were identified in the MEPS data using Cerner Mul-
tum drug codes. Nonsystemic routes were excluded (in-
haled, topical, etc.). After all SCS were identified, a board
certified clinical pharmacist reviewed each drug name and
excluded those that were not relevant. For example,
remaining corticosteroids with nonsystemic routes (e.g.,
topical) were excluded. Fludrocortisone prescriptions were
excluded because it is primarily a mineralocorticoid, and
the authors chose to focus on glucocorticoids.
Adverse selection
One of the main limitations of this kind of observational
research is adverse selection. Individuals taking SCS are
likely to be sicker than those not taking SCS (irrespective
of actual SCS use) because of the nature and severity of the
conditions for which SCS are used. This is referred to as
confounding by indication. Given their higher risk of AEs,
SCS are typically used only in individuals who have a
serious or severe condition. For example, patients with
rheumatoid arthritis (RA) may be treated with SCS. Indi-
viduals with RA have been shown to have lower HRQoL
than those who do not have RA [7]. An analysis of the
association between SCS and HRQoL that does not control
for this underlying condition (RA) may conclude that those
taking SCS have lower HRQoL. However, this association
may be due to having RA and not due to the treatment for
RA (i.e., SCS).
Qual Life Res
We have implemented four specific methods to mitigate
the potential selection bias in this observational research:
(1) limit the study sample to those individuals who have at
least one condition for which SCS are commonly pre-
scribed; (2) control for the specific conditions for which
SCS are prescribed (e.g., RA); (3) control for the baseline
number of outpatient and emergency room visits (repre-
senting severity, acuity and burden of disease); (4) control
for chronic comorbidity (unrelated to SCS use); (5) control
for sociodemographic characteristics.
In order to control for confounding by indication, we
identified all conditions for which SCS are prescribed.
Each prescription drug event in MEPS is ascribed a diag-
nosis (ICD-9 code) for which the drug was prescribed. We
exported all ICD-9 codes associated with SCS use. A board
certified clinical pharmacist then reviewed these ICD-9
codes to identify conditions for which SCS use is clinically
indicated. This resulted in a list of 233 conditions for which
SCS were prescribed in MEPS. The full list of 233 con-
ditions is presented in Table 11 of the Appendix. The study
sample was restricted to those individuals reporting at least
one of these 233 conditions. Regression analyses also
controlled for these conditions in the following manner:
The most prevalent 30 conditions were included individu-
ally as dichotomous variables (most prevalent was deter-
mined by the highest number of individuals reporting SCS
use for the condition). The 30 most prevalent conditions
are listed in Table 6 in the Appendix. The remaining 203
conditions were included in the regressions by creating 9
dichotomous indicator variables (SCS Conditions = 1,
SCS Conditions = 2,…, SCS Conditions C 9) represent-
ing the total number of SCS-related conditions reported by
each individual (excluding the top 30 which were included
individually). For example, if an individual reported having
RA (a ‘‘top 30’’ condition) and 2 conditions from the list of
the remaining 203 conditions, the variable ‘‘SCS Condi-
tions = 2’’ would equal 1 and the dichotomous indicator
variable ‘‘RA’’ would equal 1 in the regressions. The
sample size of each of these categories is also presented in
the Appendix in Table 7.
Independent variables
The main independent variables of interest were related to
SCS use. SCS use was categorized into three levels: no use;
1–3 prescriptions; and C4 prescriptions. Sociodemographic
characteristics were included in the regressions as control
variables. Education was categorized: no completed high
school degree; high school degree but no completed
Bachelor’s degree; Bachelor’s degree; and Master’s or
Ph.D. Race was categorized as Caucasian, black, American
Indian or Other. Age was grouped in the following cate-
gories: 18–29; 30–39; 40–49; 50–59; 60–69; 70–79; C80.
Ethnicity was categorized as Hispanic or non-Hispanic.
Gender (male, female) was included. Poverty category was
categorized by the percentage of the federal poverty level:
poor (\100 %), near poor (100–125 %), low income
(125–200 %), middle income (200–400 %), or high
income (C400 %) (the federal poverty threshold for a
family of four in the contiguous USA was $24,250 in
2015). The total number of reported chronic conditions (by
ICD-9 code) were added together to create seven distinct
dichotomous variables representing the total number of
chronic conditions (NCC): NCC = 1, NCC = 2,…,
NCC C 7. This was used to control for chronic comor-
bidity unrelated to SCS use. Only conditions not on the 233
SCS-related ICD-9 codes were included in this variable.
HRQoL instruments
The EQ-5D-3L is a five-item descriptive system measuring
5 dimensions of health status (mobility, self-care, usual
activities, pain/discomfort and anxiety/depression) with 3
levels per dimension (no problem, some problems and
extreme problems) [8]. Preferences for the different health
states described by the EQ-5D are elicited from a general
population sample from which a scoring algorithm is cre-
ated to define a preference-based score (‘‘utility’’) for each
possible health state [9]. EQ-5D tariffs or scoring systems
are available for numerous countries. This research inclu-
ded the EQ-5D tariffs for the USA [9] and the UK [10].
EQ-5D index scores are anchored on death (value = 0) and
full health (value = 1.0). Scores below zero are possible.
The EQ-5D questionnaire also includes a single-item
question asking about self-perceived health status using a
visual analogue scale (VAS). This question asked respon-
dents to rate their current overall health on a scale that
ranges from 0 to 100, where 0 represents ‘‘worst possible
health’’ and 100 represents ‘‘best possible health.’’ The EQ-
5D has been extensively validated as a generic preference-
based HRQoL instrument in a variety of conditions and
populations in over 6000 publications [11].
The SF-6D provides a preference-based single index
measure that can be used to calculate quality-adjusted life
years (QALYs). The SF-6D is derived from the SF-12,
which has become one of the most widely used measures of
general health. The SF-6D is a classification system com-
posed of six multi-level dimensions derived from responses
to the SF-12 or SF-36. Preference weights can be applied to
the responses on the SF-6D to calculate up to 18,000
unique health state utility values [12].
Minimum clinically important difference (MCID)
The minimum clinically important difference (MCID) is
often used with statistical significance and effect size to
123

provide perspective on the clinical significance of changes
in HRQL results [13]. MCID values are most relevant
when they are defined for a specific disease state and more
particularly, a specific intervention [14]. Walters et al. [15]
estimated the MCID of the SF-6D to range from 0.011 to
0.097, with mean 0.041. In other research, the MCID was
estimated to be 0.03, 0.033 or 0.05 depending on the
method chosen [16]. Walters et al. estimated the EQ-5D
MCID to range from -0.011 to -0.14, with mean 0.074.
Others have used an effect size of 0.2 and estimated an
MCID of 0.033 for the EQ-5D [17]. None of these MCID
was estimated in an asthma population. All preference-
based HRQL instruments are designed to measure the same
latent construct of utility with anchors of death and full
health. The MCID for the Health Utilities Index has been
estimated to be 0.03 [18].
Statistical analysis
Previous research has shown that preference-based HRQL
scores exhibit ceiling effects with a significant number of
respondents reporting the highest score (1.0). The ceiling
effect is particularly evident with the EQ-5D index. As
discussed in previous publications [7, 19, 20], in these
circumstances the Tobit and Censored Least Absolute
Deviations (CLAD) estimator developed by Powell et al.
[21]. has theoretical advantages over the Ordinary Least
Squares (OLS) estimator [21–23]. In cases where censoring
occurs in less than 50 % of the sample, ‘‘robust regression’’
(robust to censoring, outliers and heteroskedasticity—me-
dian regression) is equivalent to CLAD. In this sample,
censoring occurred in \50 % of the sample and robust
(median) regression was used. Hence OLS, Tobit and
median regression were used in all analyses to estimate
EQ-5D index scores and to determine whether the
assumptions of homoskedasticity and normality were valid.
Because the VAS scores do not exhibit a high degree of
censoring, OLS regression was used.
HRQoL scores were regressed on ‘‘1–3 SCS prescrip-
tions’’ and ‘‘C4 SCS prescriptions’’ (no SCS use as refer-
ence) controlling for age, gender, race, ethnicity,
education, income category, geographic region, number of
ER visits, number of outpatient visits, total number of
chronic conditions (for which SCS are not used), the top 30
most prevalent conditions for which SCS are used listed
individually, and 10 categories representing the total
number of reported conditions for which SCS are used
(with no reported conditions being the reference).
Dependent variables for the main analyses included the
EQ-5D (UK) EQ-5D (US), EQ-5D VAS and the SF-6D.
All of the main analyses for the EQ-5D were conducted in
the MEPS 2000–2003 data, while the main analyses for the
SF-6D were conducted in the 2000–2012 data. The EQ-5D
123
Qual Life Res
questionnaire was discontinued in the MEPS SAQ after
2003. Hence, MEPS data including direct elicitation of the
EQ-5D are only available until 2003. However, the SF-12
instrument is available in more recent data. The largest data
set possible was used for each instrument.
Sensitivity analyses
Sensitivity analysis was conducted on predicted EQ-5D
scores in order to examine whether or not more recent data
or a larger data set would change the results of the analysis
for the EQ-5D. Hence, predicted EQ-5D (from SF-12)
scores resulting in a much larger sample size were exam-
ined for MEPS 2000–2012 data. In previous research, Gray
et al. [24] used multinomial logit to map SF-12 responses
to EQ-5D questionnaire responses in the 2000 MEPS data.
For this research, the Gray algorithm was applied to a
larger data sample (MEPS 2000-2003) to estimate the EQ-
5D response prediction equation. More details of the per-
formance of the Gray et al. [24] algorithm are provided
elsewhere. Briefly, the authors obtain an in-sample (MEPS)
mean squared error (MSE) of 0.03 and a mean absolute
error of 0.11 in predicting actual EQ-5D scores. They also
tested the algorithm in an exogenous data set (Health
Survey for England) with MSE/MAE of 0.04/0.12. Gray
et al. concluded that their algorithm successfully predicts
group mean utility scores and differentiates between
groups with or without known existing illness. The Gray
algorithm was applied to the MEPS 2000–2012 data to
predict EQ-5D responses from actual SF-12 responses. The
country-specific EQ-5D tariffs for the USA (Shaw) and UK
(Dolan) were then calculated based on the predicted EQ-
5D question responses, resulting in predicted EQ-5D tariffs
for 2000–2012 MEPS data.
In addition, a sensitivity analysis was conducted within
one condition. All analyses were restricted to individuals
reporting ICD-9 716 ‘‘Arthropathies’’ to examine whether
this restriction resulted in any change in the general
direction of the results.
Results
The final sample after applying the SCS inclusion criteria
and dropping individuals with missing EQ-5D or covariate
values is presented in Fig. 1. Table 1 shows sociodemo-
graphic characteristics of the MEPS 2000–2003 final (EQ-
5D) regression sample. Individuals who used C4 SCS
prescriptions were older, poorer, had lower education
levels, were more likely to have public insurance, had a
greater number of chronic comorbidities and were less
likely to have private insurance. Appendix Table 12 shows
the descriptive statistics for the MEPS 2000–2012 final SF-
Qual Life Res
Fig. 1 Sample disposition
2000-2003 (EQ-5D) Sample
MEPS >18 positive SAQ
Final Regression Sample
6D regression sample. Table 2 presents the unadjusted
mean HRQoL values by SCS use. Individuals who took C4
prescriptions of SCS had lower HRQoL.
After adjusting for age, gender, race, ethnicity, educa-
tion, income category, geographic region, number of ER
visits, number of outpatient visits, total number of chronic
conditions (for which SCS are not used) and specific
conditions for which SCS are used, use of C4 SCS pre-
scriptions appeared to be associated with significantly
lower HRQoL scores that meet the minimum clinically
important difference (MCID) for the respective instruments
(Table 3). Figure 2 displays the magnitude of the lower
HRQoL scores associated with the use of C4 prescriptions:
EQ-5D US and UK scores were -0.032 and -0.047 points
lower for individuals who used C4 prescriptions compared
to those who used none. SF-6D and EQ-5D VAS scores
were also significantly lower for individuals using C4 SCS
prescriptions (-0.036 and -7.58, respectively). Results of
the regression analyses showed that the assumptions of the
Tobit method were violated. In addition, there were no
substantial differences in the estimates across the three
methods. Hence, the main results are based on median
regression. Final sample sizes for the regressions were as
follows (individuals with missing values were dropped):
EQ-5D 57,428; VAS 55,154; SF-6D 187,671.
Sensitivity analyses restricted to ICD-9 716 showed
coefficients that were similar in magnitude and direction to
those of the entire sample: slightly lower magnitude for the
EQ-5D and VAS but higher for the SF-6D (Table 4).
Sensitivity analyses of predicted scores showed that pre-
dicted EQ-5D US (-0.034) and UK (-0.053) scores were
similarly lower for those using C4 SCS prescriptions
(Table 3). Full regression results are presented in the
‘‘Appendix.’’
2000-2012 (SF-6D) Sample
MEPS >18 positive SAQ
N = 81,634 N = 275,310
SCS condions SCS condions
N = 59,224 N = 196,148
Valid EQ-5D Valid SF-6D
N = 57,725 N = 188,989
All Covariates All Covariates
Final Regression Sample
N = 57,428 N = 187,671
Discussion
The results of this analysis show that use of corticosteroids
is associated with significantly lower HRQoL scores across
all measures. This reduction is statistically significant and
meets the MCID for all instruments. A comparison to
utility decrements for other conditions in the same MEPS
data provides perspective on the magnitude of these results.
After controlling for sociodemographic characteristics,
chronic comorbidity, the conditions for which SCS are
used, and surrogate measures of severity and burden of
disease (outpatient and ER visits), EQ-5D scores for indi-
viduals using C4 prescriptions of SCS ranged from -0.035
to -0.054. In a similar study design using MEPS, the
decrement in EQ-5D scores has been estimated for the
following conditions (among many others) by Sullivan
et al. [7] diabetes (-0.035), heart failure (-0.064) and
emphysema (-0.067). This previous study [7] provides a
catalog of EQ-5D scores associated with 95 common
chronic conditions in the USA. Each of the decrements
from this catalog reflects the impact of the specific condi-
tion after controlling for sociodemographic characteristics
and other comorbidities—similar to the current study
design. A comparison to the current results indicates that
taking C4 prescriptions of SCS is associated with lower
HRQoL comparable to major chronic conditions.
SCS are an effective and inexpensive treatment option
for many conditions. This research provides preliminary
evidence that there may be deleterious HRQoL effects
associated with SCS use. Clinicians and health adminis-
trators should consider these potential negative effects in
balance with the therapeutic benefits of SCS use and may
consider the use of SCS-sparing treatment strategies where
feasible. Researchers assessing the effectiveness of
123
 Table 1 Baseline sociodemographic characteristics (MEPS 2000–2003)
No SCS No SCS (%) SCS (Any) (%) SCS (Any) (%) SCS (1-3 Rx) SCS (1–3 Rx) (%) SCS (C4 Rx) SCS (C4 Rx) (%)
N N N N

123
MEPS (Total N) 54,567 2861 2240 621
Age (mean) 47.0 51.7 50.0 58.7
Age 18-34 14,860 28.0 474 18.5 424 20.9 50 8.4
Age 35-49 16,614 30.3 835 29.1 706 31.2 129 20.5
Age 50-64 12,715 23.2 757 25.7 554 24.5 203 30.7
Age 65-79 7782 13.8 619 21.1 443 19.0 176 29.8
Age [ 80 2596 4.7 176 5.6 113 4.5 63 10.5
Region
Northeast 8581 19.2 427 19.3 338 19.3 89 19.2
Midwest 12,178 23.7 687 23.9 558 24.9 129 19.8
South 20,589 34.8 1157 37.9 899 37.6 258 39.3
West 13,219 22.2 590 18.8 445 18.2 145 21.7
Gender
Male 23,267 45.2 990 36.3 778 36.5 212 35.4
Female 31,300 54.8 1871 63.7 1462 63.5 409 64.6
Race
White 44,974 85.2 2412 86.8 1914 87.6 498 83.7
Black 6958 10.0 322 8.3 227 7.4 95 11.7
American Indian 531 0.8 28 1.0 17 0.9 11 1.4
Other-race 2104 4.0 99 3.9 82 4.1 17 3.2
Ethnicity
Hispanic 9683 9.6 341 6.2 254 5.9 87 7.4
Education
No-degree 12,190 16.5 601 16.2 420 14.3 181 24.2
Less-than-BA 30,934 58.1 1707 60.4 1353 60.7 354 58.8
BA 7660 17.0 360 14.9 309 16.3 51 9.5
MA-PhD 3783 8.4 193 8.4 158 8.7 35 7.4
Insurance coverage
Private 37,972 75.9 2007 76.7 1661 80.3 346 61.5
Public 9811 14.0 692 18.8 447 15.1 245 34.3
Uninsured 6784 10.1 162 4.5 132 4.6 30 4.2
Family income
Poor 7439 9.6 410 10.1 294 9.0 116 15.0
Near poor 2712 3.9 142 4.2 100 3.6 42 6.4
Low income 8081 12.4 391 12.3 278 11.0 113 17.7
Mid-income 16,778 31.0 867 31.3 683 31.6 184 29.7
Qual Life Res
Qual Life Res

* Subpopulation of MEPS age C 18, with positive SAQ weight, valid EQ-5D score, presence of any SCS-related condition and complete values for covariates used in regressions (final
treatments examined in this research should incorporate
SCS (C4 Rx) (%) the effects of treatment on HRQoL.
The estimates provided herein may be particularly
useful in estimating the value of SCS use compared to

8.2
3.7
2.4
0.5
385.2
185.0
31.3

21.4
26.9
22.1
14.8
alternative treatments. Payers in the USA and around the
world are struggling to estimate the value of drug treat-
ments for different conditions. Many payers use cost-utility
SCS (C4 Rx)

analyses to provide a common framework for estimating

value. The results of this research may be useful to provide
166

128
174
143
85
51
24
13
3
estimates of the disutility of taking SCS in cost-utility
N

models of conditions like rheumatoid arthritis, polymyal-

gia rheumatica, systemic lupus erythematosus (SLE),
SCS (1–3 Rx) (%)

asthma, chronic obstructive pulmonary disease and

inflammatory bowel disease among many others.
The individuals included in this study likely include those
44.8

43.2
28.0
14.2
7.7
4.3
1.8
0.5
0.3
253.4
111.4

who have used SCS for many years as well as those just
initiating SCS treatment. However, it is important to note
that these estimates likely do not fully capture the longer-
SCS (1-3 Rx)

term development of AEs associated with SCS use and their

corresponding impact on HRQoL. First, each individual in
885

929
623
328
188
102
47
15
8

MEPS is only followed for two years. Second, long-terms

N

SCS use can result in the development of certain chronic

conditions such as osteoporosis and diabetes mellitus.
SCS (Any) (%)

However, these (and other) chronic conditions were

explicitly controlled for in the regression analyses. Hence,
any negative impact on HRQoL attributable to the devel-
42.2

38.9
27.8
15.8
9.1
5.0
2.2
0.9
0.4
279.1
125.7

opment of long-term AEs was mitigated by the statistical

approach which controlled for chronic comorbidities.
SCS (Any) (%)

A hypothetical example may help provide insight into

how these estimates could be used to model the effects of
SCS use. Longer-term AEs associated with SCS use could
1051

1057
797
471
273
153
71
28
11

be modeled by incorporating the disutility associated with

N

the specific AE from the catalog of EQ-5D scores. The

disutility associated with osteoporosis could be used to
No SCS (%)

quantify the long-term impact of SCS use on HRQoL in an

Non SCS: Chronic conditions for which SCS are not indicated

additive manner. The previously published catalog of EQ-

6.3
2.7
1.1
0.5
0.2
171.0
43.1

88.7
52.8
23.8
12.6

5D scores could be used to quantify the disutilities asso-

ciated with specific long-term AEs such as osteoporosis,
No SCS

diabetes mellitus, glaucoma. [7]. The methodological

7030
3625
1577
628
280
19,557

28,147

138
13,142

approach and data source of the current research are con-

N

sistent with the previously published EQ-5D catalog,

facilitating the combination of estimates in cost-effec-
Chronic Conditions (non SCS?; Mean # of)

tiveness models. For example, consider a hypothetical

Chronic Conditions (All; Mean # of)

patient who has RA and is taking C4 prescriptions of SCS

Chronic Conditions (non SCS) = 0
Chronic Conditions (non SCS) = 1
Chronic Conditions (non SCS) = 2
Chronic Conditions (non SCS) = 3
Chronic Conditions (non SCS) = 4
Chronic Conditions (non SCS) = 5
Chronic Conditions (non SCS) = 6
Chronic Conditions (non SCS) C 7

per year. Because of the SCS use, the patient develops

SCS systemic corticosteroids

osteoporosis after five years. A simple example of how to

model the expected QALYs is provided in Table 5. The
disutility associated with taking SCS is -0.047 (Table 3).
Table 1 continued

regression sample)

The disutilities associated with aging, RA, osteoporosis

and having 2 chronic conditions are taken from the pre-
High income

vious catalog of EQ-5D scores [7]. The baseline (begin-

ning) utility is estimated from the 50 % median EQ-5D
score of patients with RA [7].
?

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Table 2 Unadjusted mean

Mean values N MEPS (total) No SCS SCS (1–3 Rx) SCS (C 4 Rx)
annual SCS prescriptions and
HRQoL values # SCS Prescriptions? n = 57,428 0.13 – 1.34 7.59
EQ-5D US? n = 57,428 0.85 0.85 0.81 0.67
EQ-5D UK? n = 57,428 0.80 0.80 0.75 0.54
VAS? n = 55,154 78.70 79.09 74.56 57.93
SF-6D* n = 187,671 0.79 0.78 0.75 0.65
SCS systemic corticosteroids
* Subpopulation of 2000-2012 MEPS age C18, with positive SAQ weight, valid SF-6D score, presence of
any SCS-related condition and non-missing values for regression covariates (final SF-6D regression
sample)
?
Subpopulation of 2000–2003 MEPS age C18, with positive SAQ weight, valid EQ-5D score, presence of
any SCS-related condition and non-missing values for regression covariates (final EQ-5D regression
sample)

Table 3 Regression results:

Dependent variable Coefficient SE P[t 95 % CI 95 % CI
number of SCS prescriptions
(MEPS 2000–2003) EQ-5D US SCS (1–3 Rx) -0.007 0.003 0.015 -0.013 -0.001
N = 57,428 SCS (C4 Rx) -0.032 0.008 0.000 -0.047 -0.017
EQ-5D UK SCS (1–3 Rx) -0.009 0.003 0.008 -0.016 -0.002
N = 57,428 SCS (C4 Rx) -0.047 0.008 0.000 -0.064 -0.031
SF-6D SCS (1–3 Rx) -0.002 0.003 0.361 -0.008 0.003
N = 187,671 SCS (C4 Rx) -0.036 0.005 0.000 -0.046 -0.026
VAS* SCS (1–3 Rx) -1.321 0.421 0.002 -2.150 -0.492
N = 55,154 SCS (C4 Rx) -7.576 1.000 0.000 -9.545 -5.607
CLAD regression of HRQoL score on SCS 1–3 Rx and SCS C 4 Rx (compared to no SCS) controlling for
age, gender, race, ethnicity, education, income category, geographic region, number of ER visits, number of
outpatient visits and chronic conditions (both SCS-related and non SCS related)
Each two rows (SCS 1–3 Rx and SCS C 4 Rx) present the results of one regression per HRQL score
SCS systemic corticosteroids
* OLS regression was used for VAS

Although this approach enables modeling the impact of

EQ-5D US EQ-5D UK SF-6D VAS*
0.000 taking SCS on utility, future analyses would benefit from
prospectively following patients over the long term to
-0.010
specifically quantify the HRQoL impact of developing
-0.020 chronic conditions associated with taking SCS.
-0.030
The estimates associated with SCS use are marginal
disutilities, after controlling for the condition for which
-0.040 SCS were prescribed. For example, if an individual with
-0.050
RA was prescribed C4 prescriptions of SCS, the negative
impact of taking SCS would be -0.047 on EQ-5D UK
-0.060 scores after controlling for having RA. Having RA results
SCS (1-3 Rx) in a significant decrement in EQ-5D scores: The coefficient
-0.070
SCS ( 4 Rx) was -0.127 in EQ-5D UK scores (Appendix Table 8: ICD-
-0.080 9 714). This research focuses on the shorter-term delete-
rious impact of taking SCS, which results in an additional
Fig. 2 HRQoL associated with systemic corticosteroids by number
of annual prescriptions. *VAS score is divided by 100 to enable marginal decrement of -0.047 in EQ-5D UK scores
comparison on similar scale. SCS systemic corticosteroids. CLAD beyond that of having RA (or other conditions).
regression of HRQoL score on SCS 1–3 Rx and SCS C 4 Rx The sensitivity analyses using predicted EQ-5D scores
(compared to no SCS) controlling for age, gender, race, ethnicity,
showed very similar results to the main analyses. The main
education, income category, geographic region, number of ER visits,
number of outpatient visits and chronic conditions (both SCS-related sample using directly elicited EQ-5D scores was suffi-
and non SCS related). OLS regression was used for VAS ciently large to result in consistent estimates, and the

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Table 4 Sensitivity analysis—

Dependent Variable Coefficient SE P[t 95 % CI 95 % CI
regression results: number of
SCS prescriptions (Restricted to EQ-5D US SCS (1–3 Rx) -0.001 0.004 0.690 -0.009 0.006
ICD-9 716; MEPS 2000–2003)
N = 7635 SCS (C4 Rx) -0.028 0.005 0.000 -0.037 -0.019
EQ-5D UK SCS (1–3 Rx) -0.008 0.010 0.415 -0.028 0.011
N = 7635 SCS (C4 Rx) -0.028 0.010 0.006 -0.048 -0.008
SF-6D SCS (1–3 Rx) 0.001 0.006 0.860 -0.010 0.012
N = 21,083 SCS (C4 Rx) -0.054 0.008 0.000 -0.070 -0.037
VAS? SCS (1–3 Rx) -2.239 1.113 0.045 -4.432 -0.046
N = 7398 SCS (C4 Rx) -6.236 1.760 0.000 -9.703 -2.769
CLAD regression of HRQoL score on SCS 1–3 Rx and SCS C 4 Rx (compared to no SCS) controlling for
age, gender, race, ethnicity, education, income category, geographic region, number of ER visits, number of
outpatient visits and chronic conditions (both SCS-related and non SCS related)
Each two rows (SCS 1–3 Rx and SCS C 4 Rx) present the results of one regression per HRQL score
SCS systemic corticosteroids
?
OLS regression was used for VAS
* Sensitivity analysis of subpopulation of individuals age C 18 with ICD-9 716

Table 5 Example: calculating the QALY impact of SCS

Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9 Year 10

Baseline RA [7] 0.7780 0.7780 0.7780 0.7780 0.7780 0.7780 0.7780 0.7780 0.7780 0.7780
Age [7] -0.0007 -0.0007 -0.0007 -0.0007 -0.0007 -0.0007 -0.0007 -0.0007 -0.0007 -0.0007
RA [7] -0.0844 -0.0844 -0.0844 -0.0844 -0.0844 -0.0844 -0.0844 -0.0844 -0.0844 -0.0844
SCS -0.0470 -0.0470 -0.0470 -0.0470 -0.0470 -0.0470 -0.0470 -0.0470 -0.0470 -0.0470
Osteoporosis [7] NA NA NA NA -0.0182 -0.0182 -0.0182 -0.0182 -0.0182 -0.0182
NCC = 2 [7] NA NA NA NA -0.0942 -0.0942 -0.0942 -0.0942 -0.0942 -0.0942
QALYs 0.6459 0.6459 0.6459 0.6459 0.5335 0.5335 0.5335 0.5335 0.5335 0.5335
Discounted QALYs 0.6459 0.6271 0.6088 0.5911 0.4740 0.4602 0.4468 0.4338 0.4211 0.4089
RA rheumatoid arthritis, NCC number of chronic conditions, SCS systemic corticosteroids
* Discount rate is 3 % annually

similarity of the results suggests that the use of older MEPS
data was not a significant concern. In addition, the sensi-
tivity analysis restricting the sample to ICD-9 716 showed
very similar coefficients compared to the larger sample and
provides support for the robustness of the study design.
Although the current research found a significant nega-
tive association between SCS use and generic, preference-
based HRQoL scores, it is not clear precisely how SCS use
affects specific domains of HRQoL. Previous qualitative
research has shown that SCS use may impact the following
domains: depression, irritability, sleep, hunger, weight,
skin, gastric, pain, disease anxiety and medication anxiety
[25]. Other studies have suggested that SCS use may affect
mood, causing depression, suicidal ideation, and anxiety,
and cause physical problems that can have psychological
effects such as fractures or weight gain [25–27]. One of the
limitations of using the EQ-5D-3L and the SF-6D in this
research is that they are generic instruments. They do not
contain any items or domains related to the AEs of SCS. In
cancer, for example, there are instruments that explicitly
include questions about the AEs associated with treatment
[28]. A more specific HRQoL instrument may provide a
more robust estimate of the impact of SCS-related AEs on
HRQoL. Future studies into the specific domains of pref-
erence-based HRQoL instruments affected by SCS use
would be beneficial. With better understanding of how SCS
use impacts HRQoL, it is possible that clinicians can target
treatments that may mitigate their negative effects, par-
ticularly where use of SCS is clinically necessary. Clini-
cians currently treat AEs associated with SCS use. For
example, asthma guidelines recommend that patients who
are on long-term SCS should receive preventive drug
treatment for osteoporosis [1].
There are limitations associated with this research. As
discussed previously, any comparison of individuals taking
SCS to those not taking SCS in observational research runs

123

the risk of confounding by indication and selection bias.
This potential selection bias is very clear when examining
the stark differences in unadjusted means for those who use
C4 SCS prescriptions compared to those who do not use
SCS (Tables 1, 2). The statistical approach attempted to
mitigate this potential bias by controlling for SCS-related
conditions, chronic comorbidities, baseline outpatient and
emergency visits and sociodemographics. However, bias
may still exist. The regression results highlight the neces-
sity of controlling for these characteristics: The coefficients
associated with each of these confounders were substantial
and statistically significant. For example, the EQ-5D (US)
decrement associated with the following was quite sub-
stantial: ICD-9 714 RA (SCS-related condition:-0.083);
public insurance (-0.042); high income versus poor
(0.045); two non-SCS chronic conditions (-0.077).
Nonetheless, it remains a possibility that there are unob-
served differences between the SCS groups that may bias
the results. It is also possible that controlling for chronic
conditions that are considered long-term AEs of SCS use
(such as osteoporosis and diabetes mellitus) reduced the
negative impact of SCS use. Results should be interpreted
with caution considering the limitations of observational
research. A future randomized, controlled trial would
provide the most internally valid results. In addition, it is
possible that more granular measures of SCS exposure
could provide additional insight. For example, the number
of days of exposure, the average daily dose or the cumu-
lative annual dose may be informative. It is possible that
the final analytic sample is different from the initial MEPS
sample prior to dropping individuals with missing values.
MEPS uses a valid and reliable national survey design that
has been in use since the 1970s. The response rate in this
research is good for both the EQ-5D and SF-6D final
regression samples. Nonetheless, it is possible that there
are differences in those individuals who failed to complete
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the instruments or other covariate values that may impact
the interpretation of the results. The current study provides
preliminary results that the number of annual prescriptions
is associated with HRQoL, but future research exploring
other measures may be beneficial. An advantage of using a
simple measure like the number of annual prescriptions is
that it is easily replicated in clinical practice and research
without the need for more complicated calculations or data
availability such as days supplied or the date of fill.
Conclusions
While SCS are an efficacious and widely used treatment for
numerous conditions, the results presented herein suggest
that their use may be associated with a substantial delete-
rious impact on HRQoL. This negative effect needs to be
considered in balance with the cost and effectiveness of
SCS and treatment alternatives. Future studies are needed
to corroborate these findings.
Funding This study was funded by a research grant from Amgen,
Inc.
Compliance with ethical standards
Conflict of interest Dr. Sullivan has received research grants from
Amgen, Inc. Dr. Globe is an employee and stockholder of Amgen,
Inc. Dr. Ghushchyan declares that he has no conflict of interest. Dr.
Sucher declares that he has no conflict of interest.
Ethical approval This article does not contain any studies with
human participants or animals performed by any of the authors.
Appendix
See Appendix Tables 6, 7, 8, 9, 10, 11 and 12.
Qual Life Res

Table 6 Number of individuals reporting the most prevalent 30 conditions with indications for SCS in MEPS 2000–2003
Condition ICD-9 No SCS SCS (Any) SCS (1–3 Rx) SCS (C4 Rx)
(N)

ICD-9 716 arthropathies nec/nos* 7095 594 401 193

ICD-9 477 allergic rhinitis* 6457 560 466 94
ICD-9 493 asthma* 2771 551 426 125
ICD-9 724 back disorder nec and nos* 6113 355 283 72
ICD-9 782 skin/oth integument symp* 2532 334 259 75
ICD-9 473 chronic sinusitis* 3921 325 282 43
ICD-9 490 bronchitis nos 2513 322 262 60
ICD-9 460 acute nasopharyngitis 8274 293 232 61
ICD-9 786 resp sys/oth chest symp* 2773 267 196 71
ICD-9 530 diseases of esophagus* 3156 266 195 71
ICD-9 729 other soft tissue dis* 2921 266 192 74
ICD-9 692 contact dermatitis* 895 264 244 20
ICD-9 008 intestinal infection nec* 6070 246 205 41
ICD-9 486 pneumonia, organism nos 1019 216 148 68
ICD-9 733 oth bone and cartilage dis* 1874 215 118 97
ICD-9 959 injury nec/nos* 3262 191 150 41
ICD-9 719 joint disorder nec and nos* 2624 181 130 51
ICD-9 536 stomach function disord* 2297 172 101 71
ICD-9 787 gi system symptoms* 1592 167 114 53
ICD-9 784 symptoms invol head/neck* 2525 166 135 31
ICD-9 478 oth uppr respiratory dis* 1889 147 124 23
ICD-9 487 influenza* 3537 138 117 21
ICD-9 714 oth inflamm polyarthrop* 327 134 45 89
ICD-9 995 certain adverse eff nec* 619 133 114 19
ICD-9 492 emphysema* 481 131 76 55
ICD-9 722 intervertebral disc dis* 1375 130 108 22
ICD-9 346 migraine* 1973 128 108 20
ICD-9 246 oth disorders of thyroid* 2024 126 75 51
ICD-9 715 osteoarthrosis et al.* 663 75 59 16
ICD-9 491 chronic bronchitis* 118 28 20 8

Table 7 Full regression results EQ-5D (UK) CLAD

eq5d_UK Coef. SE t P[t [95 % Conf. Interval]

OCS_N1_3 -0.00892 0.003379 -2.64 0.008 -0.01554 -0.0023

OCS_N4 m -0.0472 0.008471 -5.57 0 -0.06381 -0.0306
N_erv -0.01977 0.001172 -16.86 0 -0.02207 -0.01747
N_OP -0.00159 8.59E-05 -18.56 0 -0.00176 -0.00143
age35_49 -0.03377 0.002116 -15.96 0 -0.03792 -0.02963
age50_64 -0.05758 0.002439 -23.6 0 -0.06236 -0.0528
age65_79 -0.03386 0.002178 -15.54 0 -0.03813 -0.02959
age80_m -0.04987 0.003698 -13.49 0 -0.05712 -0.04262
Midwest -0.00105 0.001392 -0.75 0.452 -0.00377 0.001681
South -0.00719 0.001389 -5.18 0 -0.00991 -0.00447
West -0.00188 0.001468 -1.28 0.2 -0.00476 0.000997
female -0.00058 0.001084 -0.53 0.596 -0.0027 0.00155
black -0.00246 0.00174 -1.41 0.157 -0.00587 0.000949

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Table 7 continued
eq5d_UK Coef. SE t P[t [95 % Conf. Interval]

aindian -0.02306 0.01409 -1.64 0.102 -0.05068 0.004555

other_race 0.001709 0.002287 0.75 0.455 -0.00277 0.006191
hispanic 0.009159 0.001453 6.3 0 0.006311 0.012007
L_than_BA 0.019717 0.002724 7.24 0 0.014378 0.025057
BA 0.040412 0.002908 13.9 0 0.034713 0.046111
MA_PhD 0.056277 0.003015 18.67 0 0.050368 0.062186
pub_ins -0.06358 0.002091 -30.41 0 -0.06768 -0.05948
uninsur -0.03307 0.004012 -8.24 0 -0.04093 -0.02521
near_poor 0.009532 0.003747 2.54 0.011 0.002188 0.016877
low_incm 0.026258 0.00351 7.48 0 0.019378 0.033138
mid_incm 0.045864 0.002454 18.69 0 0.041054 0.050673
high_incm 0.056357 0.002518 22.38 0 0.05142 0.061293
ncc_a_1 -0.07578 0.001466 -51.68 0 -0.07866 -0.07291
ncc_a_2 -0.08926 0.002018 -44.24 0 -0.09322 -0.08531
ncc_a_3 -0.10583 0.002865 -36.94 0 -0.11144 -0.10021
ncc_a_4 -0.11919 0.003983 -29.93 0 -0.127 -0.11139
ncc_a_5 -0.12543 0.00465 -26.97 0 -0.13455 -0.11632
ncc_a_6 -0.15109 0.006235 -24.23 0 -0.16331 -0.13887
ncc_a_7 m -0.16238 0.009374 -17.32 0 -0.18075 -0.144
Otr_OCS_c1 -0.00125 0.001388 -0.9 0.369 -0.00397 0.001473
Otr_OCS_c2 -0.01453 0.001935 -7.51 0 -0.01832 -0.01073
Otr_OCS_c3 -0.02782 0.002638 -10.54 0 -0.03299 -0.02265
Otr_OCS_c4 -0.04145 0.003505 -11.82 0 -0.04832 -0.03458
Otr_OCS_c5 -0.03998 0.005744 -6.96 0 -0.05124 -0.02872
Otr_OCS_c6 -0.04778 0.006888 -6.94 0 -0.06128 -0.03428
Otr_OCS_c7 -0.04831 0.012398 -3.9 0 -0.07261 -0.02401
Otr_OCS_c8 -0.10473 0.03347 -3.13 0.002 -0.17033 -0.03913
Otr_OCS_c9_m -0.02956 0.027491 -1.08 0.282 -0.08344 0.024324
icd493 -0.02017 0.003445 -5.85 0 -0.02692 -0.01342
icd714 -0.12705 0.010166 -12.5 0 -0.14697 -0.10713
icd716 -0.08368 0.001887 -44.35 0 -0.08738 -0.07998
icd710 -0.08289 0.015057 -5.51 0 -0.11241 -0.05338
icd492 -0.07913 0.008927 -8.86 0 -0.09663 -0.06163
icd692 0.006285 0.004045 1.55 0.12 -0.00164 0.014213
icd496 -0.08884 0.008122 -10.94 0 -0.10476 -0.07292
icd490 -0.00518 0.002019 -2.57 0.01 -0.00914 -0.00122
icd255 -0.07031 0.029286 -2.4 0.016 -0.12771 -0.01291
icd477 0.006377 0.001334 4.78 0 0.003763 0.008991
icd518 -0.02011 0.015736 -1.28 0.201 -0.05096 0.010728
icd782 -0.00485 0.001922 -2.52 0.012 -0.00861 -0.00108
icd725 -0.02563 0.023531 -1.09 0.276 -0.07175 0.020494
icd135 -0.04763 0.02182 -2.18 0.029 -0.0904 -0.00486
icd555 -0.07962 0.055515 -1.43 0.152 -0.18842 0.029194
icd715 -0.0792 0.004632 -17.1 0 -0.08828 -0.07012
icd473 -0.0002 0.001795 -0.11 0.912 -0.00372 0.003319
icdV42 -0.05383 0.027837 -1.93 0.053 -0.10839 0.000726
icd486 -0.03199 0.002938 -10.89 0 -0.03775 -0.02623
icd729 -0.05197 0.00289 -17.99 0 -0.05764 -0.04631

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Table 7 continued
eq5d_UK Coef. SE t P[t [95 % Conf. Interval]

icd786 -0.01787 0.002082 -8.58 0 -0.02195 -0.01379

icd724 -0.06448 0.001946 -33.13 0 -0.06829 -0.06066
icd491 -0.03228 0.019569 -1.65 0.099 -0.07063 0.006078
icd709 0.009007 0.004663 1.93 0.053 -0.00013 0.018146
icd719 -0.05851 0.002575 -22.72 0 -0.06356 -0.05347
icd446 0.045503 0.057143 0.8 0.426 -0.0665 0.157504
icd722 -0.12116 0.00313 -38.72 0 -0.1273 -0.11503
icd593 -0.04213 0.007936 -5.31 0 -0.05768 -0.02657
icd274 -0.02 0.006407 -3.12 0.002 -0.03256 -0.00745
icd995 0.006879 0.005862 1.17 0.241 -0.00461 0.018368
_cons 0.931172 0.003763 247.44 0 0.923796 0.938548

Table 8 Full regression results EQ-5D (US) CLAD

eq5d_US Coef. SE t P[t [95 % Conf. Interval]

OCS_N1_3 -0.00721 0.00296 -2.44 0.015 -0.01301 -0.00141

OCS_N4 m -0.03187 0.007537 -4.23 0 -0.04665 -0.0171
N_erv -0.01471 0.000966 -15.22 0 -0.0166 -0.01282
N_OP -0.0011 6.29E-05 -17.42 0 -0.00122 -0.00097
age35_49 -0.03245 0.002327 -13.95 0 -0.03701 -0.02789
age50_64 -0.04908 0.002342 -20.96 0 -0.05367 -0.04449
age65_79 -0.02837 0.002253 -12.59 0 -0.03279 -0.02395
age80_m -0.03858 0.003021 -12.77 0 -0.0445 -0.03266
Midwest -0.00039 0.00163 -0.24 0.811 -0.00359 0.002805
South -0.0052 0.001562 -3.33 0.001 -0.00826 -0.00214
West -0.00142 0.001622 -0.88 0.381 -0.0046 0.001758
female -0.00091 0.001116 -0.81 0.417 -0.00309 0.001282
black -0.00079 0.002192 -0.36 0.717 -0.00509 0.003502
aindian -0.01829 0.006958 -2.63 0.009 -0.03193 -0.00466
other_race 0.00219 0.002657 0.82 0.41 -0.00302 0.007398
hispanic 0.007802 0.00155 5.03 0 0.004764 0.010839
L_than_BA 0.013583 0.001944 6.99 0 0.009772 0.017394
BA 0.028847 0.002219 13 0 0.024496 0.033197
MA_PhD 0.045454 0.002554 17.8 0 0.040448 0.050459
pub_ins -0.04209 0.00155 -27.16 0 -0.04513 -0.03906
uninsur -0.02878 0.002994 -9.61 0 -0.03465 -0.02291
near_poor 0.009901 0.003064 3.23 0.001 0.003894 0.015907
low_incm 0.021481 0.002529 8.49 0 0.016524 0.026438
mid_incm 0.036916 0.002068 17.85 0 0.032862 0.04097
high_incm 0.045423 0.002091 21.72 0 0.041325 0.049521
ncc_a_1 -0.06914 0.001768 -39.1 0 -0.07261 -0.06568
ncc_a_2 -0.07733 0.002201 -35.13 0 -0.08164 -0.07302
ncc_a_3 -0.08617 0.002557 -33.69 0 -0.09118 -0.08116
ncc_a_4 -0.09594 0.004006 -23.95 0 -0.10379 -0.08809
ncc_a_5 -0.09202 0.004431 -20.77 0 -0.10071 -0.08334

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Table 8 continued
eq5d_US Coef. SE t P[t [95 % Conf. Interval]

ncc_a_6 -0.12108 0.011068 -10.94 0 -0.14277 -0.09939

ncc_a_7 m -0.11939 0.006427 -18.58 0 -0.13199 -0.10679
Otr_OCS_c1 -0.00052 0.001632 -0.32 0.752 -0.00371 0.002683
Otr_OCS_c2 -0.01278 0.00198 -6.45 0 -0.01666 -0.0089
Otr_OCS_c3 -0.02441 0.002145 -11.38 0 -0.02861 -0.0202
Otr_OCS_c4 -0.03355 0.002833 -11.84 0 -0.0391 -0.028
Otr_OCS_c5 -0.03007 0.003307 -9.09 0 -0.03656 -0.02359
Otr_OCS_c6 -0.03652 0.00407 -8.97 0 -0.0445 -0.02854
Otr_OCS_c7 -0.03455 0.011098 -3.11 0.002 -0.0563 -0.0128
Otr_OCS_c8 -0.08002 0.028071 -2.85 0.004 -0.13504 -0.025
Otr_OCS_c9_m -0.00951 0.009663 -0.98 0.325 -0.02845 0.009427
icd493 -0.01488 0.002167 -6.87 0 -0.01912 -0.01063
icd714 -0.08269 0.012791 -6.47 0 -0.10776 -0.05762
icd716 -0.05246 0.00165 -31.79 0 -0.05569 -0.04922
icd710 -0.0502 0.007992 -6.28 0 -0.06586 -0.03453
icd492 -0.05229 0.0066 -7.92 0 -0.06523 -0.03936
icd692 0.005991 0.003744 1.6 0.11 -0.00135 0.013329
icd496 -0.06912 0.011879 -5.82 0 -0.09241 -0.04584
icd490 -0.00465 0.002826 -1.65 0.1 -0.01019 0.000885
icd255 -0.05902 0.034429 -1.71 0.086 -0.1265 0.008463
icd477 0.004506 0.001367 3.3 0.001 0.001826 0.007186
icd518 -0.02525 0.00843 -3 0.003 -0.04177 -0.00873
icd782 -0.00217 0.002093 -1.03 0.301 -0.00627 0.001937
icd725 -0.00145 0.014776 -0.1 0.922 -0.03041 0.02751
icd135 -0.04315 0.01406 -3.07 0.002 -0.07071 -0.0156
icd555 -0.06459 0.042408 -1.52 0.128 -0.14771 0.018529
icd715 -0.05309 0.003556 -14.93 0 -0.06006 -0.04612
icd473 -0.00052 0.002164 -0.24 0.812 -0.00476 0.003726
icdV42 -0.03278 0.030302 -1.08 0.279 -0.09217 0.026613
icd486 -0.02298 0.003843 -5.98 0 -0.03051 -0.01544
icd729 -0.03504 0.002183 -16.05 0 -0.03932 -0.03076
icd786 -0.01214 0.002424 -5.01 0 -0.0169 -0.00739
icd724 -0.04695 0.001708 -27.49 0 -0.0503 -0.0436
icd491 -0.01819 0.010526 -1.73 0.084 -0.03882 0.002444
icd709 0.004364 0.003871 1.13 0.26 -0.00322 0.011951
icd719 -0.0394 0.002422 -16.27 0 -0.04415 -0.03466
icd446 0.049885 0.027434 1.82 0.069 -0.00389 0.103655
icd722 -0.08265 0.002801 -29.51 0 -0.08814 -0.07716
icd593 -0.02706 0.003721 -7.27 0 -0.03436 -0.01977
icd274 -0.01153 0.006058 -1.9 0.057 -0.0234 0.000348
icd995 0.005199 0.003599 1.44 0.149 -0.00186 0.012253
_cons 0.944605 0.003141 300.73 0 0.938449 0.950762

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Table 9 Full regression results SF-6D CLAD

sf6d Coef. SE t P[t [95 % Conf. Interval]

OCS_N1_3 -0.00242 0.00265 -0.91 0.361 -0.00762 0.002772

OCS_N4 m -0.03574 0.00514 -6.95 0 -0.04582 -0.02567
N_erv -0.01682 0.000823 -20.45 0 -0.01844 -0.01521
N_OP -0.00052 1.56E-05 -33.2 0 -0.00055 -0.00049
age35_49 -0.01203 0.00129 -9.33 0 -0.01456 -0.0095
age50_64 -0.00391 0.001501 -2.6 0.009 -0.00685 -0.00097
age65_79 0.035623 0.001856 19.2 0 0.031986 0.03926
age80_m 0.000868 0.002755 0.31 0.753 -0.00453 0.006266
Midwest -0.0013 0.001502 -0.87 0.385 -0.00425 0.00164
South -0.00839 0.001455 -5.77 0 -0.01125 -0.00554
West -0.00854 0.001613 -5.29 0 -0.0117 -0.00538
female -0.01506 0.001003 -15.01 0 -0.01702 -0.01309
black 0.003893 0.001465 2.66 0.008 0.001022 0.006765
aindian -0.00059 0.004827 -0.12 0.903 -0.01005 0.008871
other_race -0.01184 0.002181 -5.43 0 -0.01612 -0.00757
hispanic 0.002307 0.001584 1.46 0.145 -0.0008 0.00541
L_than_BA 0.016462 0.001585 10.39 0 0.013356 0.019568
BA 0.021909 0.001869 11.72 0 0.018246 0.025572
MA_PhD 0.024861 0.002185 11.38 0 0.020579 0.029142
pub_ins -0.05019 0.001658 -30.28 0 -0.05343 -0.04694
uninsur -0.03188 0.002047 -15.58 0 -0.03589 -0.02787
near_poor 0.016402 0.003153 5.2 0 0.010223 0.022581
low_incm 0.02577 0.002117 12.17 0 0.021621 0.029919
mid_incm 0.044334 0.001877 23.62 0 0.040656 0.048012
high_incm 0.065942 0.001938 34.04 0 0.062145 0.06974
ncc_a_1 -0.03808 0.001326 -28.72 0 -0.04068 -0.03548
ncc_a_2 -0.06715 0.001904 -35.27 0 -0.07088 -0.06342
ncc_a_3 -0.09198 0.002255 -40.79 0 -0.0964 -0.08756
ncc_a_4 -0.11404 0.002908 -39.21 0 -0.11974 -0.10834
ncc_a_5 -0.12015 0.003204 -37.5 0 -0.12643 -0.11387
ncc_a_6 -0.13675 0.005278 -25.91 0 -0.14709 -0.1264
ncc_a_7 m -0.13082 0.005049 -25.91 0 -0.14071 -0.12092
Otr_OCS_c1 -0.01057 0.001409 -7.5 0 -0.01333 -0.00781
Otr_OCS_c2 -0.02935 0.001552 -18.92 0 -0.03239 -0.02631
Otr_OCS_c3 -0.03653 0.00194 -18.83 0 -0.04034 -0.03273
Otr_OCS_c4 -0.05087 0.002324 -21.89 0 -0.05543 -0.04632
Otr_OCS_c5 -0.05377 0.003636 -14.79 0 -0.06089 -0.04664
Otr_OCS_c6 -0.05548 0.004828 -11.49 0 -0.06494 -0.04602
Otr_OCS_c7 -0.05155 0.007744 -6.66 0 -0.06673 -0.03638
Otr_OCS_c8 -0.06178 0.005035 -12.27 0 -0.07165 -0.05192
Otr_OCS_c9_m -0.03895 0.005464 -7.13 0 -0.04966 -0.02825
icd493 -0.01742 0.001999 -8.71 0 -0.02133 -0.0135
icd714 -0.06784 0.003719 -18.24 0 -0.07513 -0.06055
icd716 -0.05004 0.001776 -28.18 0 -0.05352 -0.04656
icd710 -0.03435 0.005973 -5.75 0 -0.04605 -0.02264
icd492 -0.04771 0.00346 -13.79 0 -0.0545 -0.04093
icd692 0.005889 0.00277 2.13 0.033 0.000461 0.011317
icd496 -0.01958 0.005572 -3.51 0 -0.0305 -0.00866

123
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Table 9 continued
sf6d Coef. SE t P[t [95 % Conf. Interval]

icd490 -0.00782 0.002139 -3.65 0 -0.01201 -0.00363

icd255 -0.02829 0.028265 -1 0.317 -0.08369 0.027107
icd477 0.000825 0.001458 0.57 0.571 -0.00203 0.003683
icd518 -0.02233 0.007077 -3.15 0.002 -0.0362 -0.00846
icd782 -0.00592 0.002117 -2.8 0.005 -0.01007 -0.00177
icd725 -0.0438 0.006337 -6.91 0 -0.05622 -0.03138
icd135 -0.05717 0.019115 -2.99 0.003 -0.09463 -0.0197
icd555 -0.04221 0.002264 -18.64 0 -0.04664 -0.03777
icd715 -0.04611 0.002747 -16.78 0 -0.05149 -0.04073
icd473 0.001746 0.001588 1.1 0.272 -0.00137 0.004858
icdV42 0.05323 0.020011 2.66 0.008 0.014009 0.092452
icd486 -0.02138 0.003156 -6.77 0 -0.02756 -0.01519
icd729 -0.03968 0.002265 -17.52 0 -0.04412 -0.03524
icd786 -0.00977 0.002126 -4.6 0 -0.01394 -0.0056
icd724 -0.03741 0.001522 -24.58 0 -0.04039 -0.03443
icd491 -0.01777 0.00399 -4.45 0 -0.02559 -0.00995
icd709 0.016778 0.003267 5.14 0 0.010375 0.02318
icd719 -0.02698 0.001764 -15.3 0 -0.03044 -0.02353
icd446 0.025881 0.037047 0.7 0.485 -0.04673 0.098493
icd722 -0.07399 0.00338 -21.89 0 -0.08062 -0.06737
icd593 -0.01338 0.003567 -3.75 0 -0.02037 -0.00639
icd274 -0.00721 0.003505 -2.06 0.04 -0.01408 -0.00034
icd995 0.000693 0.00415 0.17 0.867 -0.00744 0.008826
_cons 0.841685 0.002896 290.6 0 0.836008 0.847362

Table 10 Full regression results VAS OLS

VAS Coef. SE t P[t [95 % Conf. Interval]

OCS_N1_3 -1.32094 0.42061 -3.14 0.002 -2.14953 -0.49235

OCS_N4 m -7.5757 0.999524 -7.58 0 -9.54474 -5.60665
N_erv -1.51405 0.16097 -9.41 0 -1.83115 -1.19694
N_OP -0.0633 0.006435 -9.84 0 -0.07598 -0.05063
age35_49 -3.02879 0.224077 -13.52 0 -3.47022 -2.58736
age50_64 -3.18205 0.286461 -11.11 0 -3.74638 -2.61773
age65_79 -0.20883 0.333093 -0.63 0.531 -0.86502 0.447356
age80_m -3.46023 0.558355 -6.2 0 -4.56018 -2.36028
Midwest 0.3977 0.322461 1.23 0.219 -0.23754 1.032943
South -0.53862 0.289278 -1.86 0.064 -1.10849 0.031252
West -0.87586 0.391784 -2.24 0.026 -1.64767 -0.10405
female 0.80444 0.157567 5.11 0 0.494036 1.114845
black -0.30843 0.368797 -0.84 0.404 -1.03495 0.418094
aindian -0.92643 0.938445 -0.99 0.325 -2.77515 0.922284
other_race -1.91808 0.453464 -4.23 0 -2.81139 -1.02476
hispanic 0.390054 0.313682 1.24 0.215 -0.22789 1.008002
L_than_BA 2.770248 0.314261 8.82 0 2.15116 3.389336
BA 3.636102 0.346106 10.51 0 2.95428 4.317925

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Table 10 continued
VAS Coef. SE t P[t [95 % Conf. Interval]

MA_PhD 4.784337 0.433144 11.05 0 3.93105 5.637623

pub_ins -6.26707 0.401365 -15.61 0 -7.05775 -5.47638
uninsur -2.83908 0.329892 -8.61 0 -3.48896 -2.1892
near_poor 1.837561 0.620566 2.96 0.003 0.615057 3.060064
low_incm 2.464996 0.470185 5.24 0 1.53874 3.391251
mid_incm 4.351327 0.394614 11.03 0 3.573944 5.128709
high_incm 6.476824 0.42982 15.07 0 5.630086 7.323562
ncc_a_1 -4.055 0.214439 -18.91 0 -4.47744 -3.63256
ncc_a_2 -6.93709 0.291184 -23.82 0 -7.51072 -6.36347
ncc_a_3 -9.49726 0.40352 -23.54 0 -10.2922 -8.70234
ncc_a_4 -12.0109 0.548815 -21.89 0 -13.092 -10.9297
ncc_a_5 -14.0875 1.14525 -12.3 0 -16.3436 -11.8314
ncc_a_6 -14.5136 1.531543 -9.48 0 -17.5307 -11.4964
ncc_a_7 m -16.8177 2.844447 -5.91 0 -22.4212 -11.2142
Otr_OCS_c1 -0.37394 0.248413 -1.51 0.134 -0.86331 0.115428
Otr_OCS_c2 -1.67917 0.263243 -6.38 0 -2.19776 -1.16059
Otr_OCS_c3 -2.47999 0.327478 -7.57 0 -3.12511 -1.83486
Otr_OCS_c4 -3.52598 0.374135 -9.42 0 -4.26302 -2.78894
Otr_OCS_c5 -4.24021 0.615303 -6.89 0 -5.45235 -3.02808
Otr_OCS_c6 -5.03125 0.961282 -5.23 0 -6.92495 -3.13754
Otr_OCS_c7 -4.85819 1.180326 -4.12 0 -7.1834 -2.53297
Otr_OCS_c8 -8.80988 2.793945 -3.15 0.002 -14.3139 -3.30586
Otr_OCS_c9_m -3.0503 2.649304 -1.15 0.251 -8.26938 2.168783
icd493 -2.60485 0.394468 -6.6 0 -3.38195 -1.82776
icd714 -8.26555 1.229294 -6.72 0 -10.6872 -5.84386
icd716 -4.35823 0.305038 -14.29 0 -4.95915 -3.75731
icd710 -6.22948 1.459902 -4.27 0 -9.10546 -3.3535
icd492 -8.63747 1.085755 -7.96 0 -10.7764 -6.49855
icd692 1.068676 0.508176 2.1 0.037 0.067579 2.069772
icd496 -8.24914 2.43334 -3.39 0.001 -13.0428 -3.45551
icd490 -0.6296 0.38141 -1.65 0.1 -1.38097 0.121772
icd255 -5.20167 3.521972 -1.48 0.141 -12.1399 1.736547
icd477 0.856392 0.232282 3.69 0 0.398801 1.313982
icd518 -5.21254 1.194693 -4.36 0 -7.56606 -2.85901
icd782 -0.72158 0.448397 -1.61 0.109 -1.60492 0.161754
icd725 -6.86895 3.005485 -2.29 0.023 -12.7897 -0.9482
icd135 -4.57075 2.786823 -1.64 0.102 -10.0607 0.919243
icd555 -10.0369 2.385308 -4.21 0 -14.7359 -5.33786
icd715 -2.44097 0.836023 -2.92 0.004 -4.08792 -0.79402
icd473 1.013732 0.241317 4.2 0 0.538343 1.489122
icdV42 -3.17248 5.050025 -0.63 0.53 -13.1209 6.77598
icd486 -3.8954 0.691411 -5.63 0 -5.25746 -2.53333
icd729 -3.95195 0.421752 -9.37 0 -4.7828 -3.12111
icd786 -2.04044 0.361459 -5.65 0 -2.75251 -1.32837
icd724 -3.30882 0.270352 -12.24 0 -3.84141 -2.77623
icd491 -1.46225 1.760238 -0.83 0.407 -4.92989 2.005387
icd709 1.820759 0.575811 3.16 0.002 0.686423 2.955095
icd719 -1.52118 0.397553 -3.83 0 -2.30435 -0.738

123
 Qual Life Res

Table 10 continued
VAS Coef. SE t P[t [95 % Conf. Interval]

icd446 2.953329 6.31619 0.47 0.641 -9.48945 15.39611

icd722 -7.08017 0.654286 -10.82 0 -8.3691 -5.79124
icd593 -6.15766 1.198378 -5.14 0 -8.51844 -3.79688
icd274 -2.28461 0.72169 -3.17 0.002 -3.70632 -0.86289
icd995 0.247616 0.781344 0.32 0.752 -1.29162 1.786849
_cons 81.64659 0.543356 150.26 0 80.57619 82.71699

Table 11 Conditions with indications for SCS in MEPS Table 11 continued

Condition ICD-9 Condition ICD-9
(N) (N)

ICD-9 493 asthma* ICD-9 382 otitis media, suppur/nos*

ICD-9 477 allergic rhinitis*
ICD-9 716 arthropathies nec/nos*
ICD-9 724 back disorder nec and nos*
ICD-9 530 diseases of esophagus*
ICD-9 473 chronic sinusitis*
ICD-9 719 joint disorder nec and nos*
ICD-9 460 acute nasopharyngitis
ICD-9 490 bronchitis nos
ICD-9 782 skin/oth integument symp*
ICD-9 786 resp sys/oth chest symp*
ICD-9 008 intestinal infection nec*
ICD-9 729 other soft tissue dis*
ICD-9 692 contact dermatitis*
ICD-9 733 oth bone and cartilage dis*
ICD-9 714 oth inflamm polyarthrop*
ICD-9 486 pneumonia, organism nos
ICD-9 715 osteoarthrosis et al.*
ICD-9 722 intervertebral disc dis*
ICD-9 536 stomach function disord*
ICD-9 959 injury nec/nos*
ICD-9 787 gi system symptoms*
ICD-9 492 emphysema*
ICD-9 346 migraine*
ICD-9 784 symptoms invol head/neck*
ICD-9 246 oth disorders of thyroid*
ICD-9 491 chronic bronchitis*
ICD-9 478 oth uppr respiratory dis*
ICD-9 995 certain adverse eff nec*
ICD-9 487 influenza*
ICD-9 726 periph enthesopathies*
ICD-9 599 oth urinary tract disor*
ICD-9 496 chr airway obstruct nec
ICD-9 564 funct digestive dis nec*
ICD-9 709 other skin disorders*
ICD-9 728 dis of muscle/lig/fascia*
ICD-9 274 gout*
ICD-9 355 mononeuritis leg*
ICD-9 308 acute reaction to stress*
ICD-9 518 other lung diseases*
ICD-9 710 diff connective tiss dis*
ICD-9 785 cardiovascular sys symp*
ICD-9 173 other malig neopl skin*
ICD-9 465 ac uri mult sites/nos*
ICD-9 285 anemia nec/nos*
ICD-9 079 viral inf in oth dis/nos*
ICD-9 723 other cervical spine dis*
ICD-9 727 oth dis synov/tend/bursa*
ICD-9 595 cystitis*
ICD-9 519 oth resp system diseases*
ICD-9 239 unspecified neoplasm*
ICD-9 410 acute myocardial infarct*
ICD-9 706 sebaceous gland disease*
ICD-9 354 mononeuritis upper limb*
ICD-9 788 urinary system symptoms*
ICD-9 847 sprain of back nec/nos*
ICD-9 436 cva
ICD-9 462 acute pharyngitis
ICD-9 259 oth endorine disorders*
ICD-9 360 disorders of the globe*
ICD-9 053 herpes zoster*
ICD-9 686 oth local skin infection*
ICD-9 593 oth renal and ureteral dis*
ICD-9 034 strep throat/scarlet fev*
ICD-9 367 disorders of refraction*

123
Qual Life Res
Table 11 continued
Condition ICD-9
(N)
ICD-9 389 hearing loss*
ICD-9 840 sprain shoulder and arm*
ICD-9 V07 prophylactic measures*
ICD-9 525 other dental disorder*
ICD-9 790 abnormal blood findings*
ICD-9 459 oth circulatory disease*
ICD-9 845 sprain of ankle and foot*
ICD-9 388 disorders of ear nec*
ICD-9 174 malig neo female breast*
ICD-9 989 tox eff oth nonmed subst*
ICD-9 136 inf/parasite dis nec/nos*
ICD-9 707 chronic ulcer of skin*
ICD-9 789 oth abdomen/pelvis symp*
ICD-9 708 urticaria*
ICD-9 596 other bladder disorders*
ICD-9 455 hemorrhoids*
ICD-9 110 dermatophytosis*
ICD-9 424 oth endocardial disease*
ICD-9 611 other breast disorders*
ICD-9 924 contusion leg and oth site*
ICD-9 375 lacrimal system disorder*
ICD-9 041 bact inf in oth dis/nos*
ICD-9 569 oth intestinal disorders*
ICD-9 721 spondylosis et al.*
ICD-9 696 psoriasis/like disorders*
ICD-9 523 gingival/periodontal dis*
ICD-9 351 facial nerve disorders*
ICD-9 558 oth noninf gastroenterit*
ICD-9 695 erythematous conditions*
ICD-9 602 oth prostatic disorders*
ICD-9 162 mal neo trachea/lung*
ICD-9 586 renal failure nos
ICD-9 844 sprain of knee and leg*
ICD-9 444 arterial embolism*
ICD-9 185 malign neopl prostate
ICD-9 701 oth skin hypertro/atroph*
ICD-9 V41 prob w special functions*
ICD-9 555 regional enteritis*
ICD-9 199 malignant neoplasm nos*
ICD-9 682 other cellulitis/abscess*
ICD-9 725 polymyalgia rheumatica
ICD-9 781 nerv/musculskel sys symp*
ICD-9 135 sarcoidosis
ICD-9 836 dislocation of knee*
ICD-9 466 ac bronchitis/bronchiol*
ICD-9 340 multiple sclerosis
ICD-9 573 oth liver disorders*
Table 11 continued
Condition ICD-9
(N)
ICD-9 919 superficial inj oth site*
ICD-9 698 pruritus and like cond*
ICD-9 528 oral soft tissue disease*
ICD-9 848 sprain nec*
ICD-9 737 curvature of spine*
ICD-9 255 adrenal gland disorders*
ICD-9 279 dis immune mechanism*
ICD-9 314 hyperkinetic syndrome*
ICD-9 386 vertiginous syndromes*
ICD-9 511 pleurisy*
ICD-9 693 dermat d/t intern agent*
ICD-9 380 disorder of external ear*
ICD-9 202 oth mal neo lymph/histio*
ICD-9 349 cns disorder nec/nos*
ICD-9 463 acute tonsillitis
ICD-9 215 oth ben neo soft tissue*
ICD-9 464 ac laryngitis/tracheitis*
ICD-9 704 hair and follicle disease*
ICD-9 075 infectious mononucleosis
ICD-9 556 idiopathic proctocolitis*
ICD-9 996 replace and graft complic*
ICD-9 289 other blood disease*
ICD-9 V47 oth probl w internal org*
ICD-9 117 other mycoses*
ICD-9 208 leukemia-unspecif cell*
ICD-9 287 purpura and oth hemor cond*
ICD-9 839 dislocation nec*
ICD-9 446 polyarterit nodosa et al.*
ICD-9 V42 organ transplant status*
ICD-9 338
ICD-9 527 salivary gland diseases*
ICD-9 922 contusion of trunk*
ICD-9 070 viral hepatitis*
ICD-9 577 diseases of pancreas*
ICD-9 923 contusion of upper limb*
ICD-9 V49 limb problem/problem nec*
ICD-9 846 sprain sacroiliac region*
ICD-9 179 malig neopl uterus nos
ICD-9 381 nonsuppur otitis media*
ICD-9 471 nasal polyps*
ICD-9 V10 hx of malignant neoplasm*
ICD-9 V43 organ replacement nec*
ICD-9 364 iris/ciliary body dis*
ICD-9 288 wbc disorders*
ICD-9 348 other brain conditions*
ICD-9 515 postinflam pulm fibrosis
ICD-9 198 s malig neo oth sites*
123

Table 11 continued
Condition ICD-9
(N)
ICD-9 251 oth pancreatic disorder*
ICD-9 470 deviated nasal septum
ICD-9 717 internal derangemnt knee*
ICD-9 170 mal neo bone/artic cart*
ICD-9 358 myoneural disorders*
ICD-9 921 contusion eye and adnexa*
ICD-9 374 disorders of eyelids nec*
ICD-9 505 pneumoconiosis nos
ICD-9 571 chr liver dis/cirrhosis*
ICD-9 229 benign neoplasm nec/nos*
ICD-9 356 hered periph neuropathy*
ICD-9 756 oth musculoskelet anomal*
ICD-9 203 multiple myeloma et al.*
ICD-9 920 contusion face/scalp/nck
ICD-9 345 epilepsy*
ICD-9 373 inflammation of eyelids*
ICD-9 257 testicular dysfunction*
ICD-9 277 metabolism dis nec/nos*
ICD-9 601 prostatic inflammation*
ICD-9 V54 oth orthopedic aftercare*
ICD-9 038 septicemia*
ICD-9 155 malignant neoplasm liver*
ICD-9 189 mal neo urinary nec/nos*
ICD-9 191 malignant neoplasm brain*
ICD-9 195 mal neo oth/ill-def site*
ICD-9 371 corneal opacity/disorder*
ICD-9 583 nephritis nos*
ICD-9 952 spinal cord inj w/o fx*
ICD-9 377 disorders of optic nerve*
ICD-9 730 osteomyelitis*
ICD-9 353 nerve root/plexus dis*
ICD-9 423 oth pericardial disease*
ICD-9 088 oth arthropod-borne dis*
ICD-9 133 acariasis*
ICD-9 245 thyroiditis*
ICD-9 253 pituitary/hypothalm dis*
ICD-9 322 meningitis, unspecified*
123
Qual Life Res
Table 11 continued
Condition ICD-9
(N)
ICD-9 384 disord tympanic memb nec*
ICD-9 201 hodgkin’s disease*
ICD-9 697 lichen*
ICD-9 225 benign neo nervous syst*
ICD-9 461 acute sinusitis*
ICD-9 992 effect of heat/light*
ICD-9 757 congen skin anomalies*
ICD-9 099 other venereal disease*
ICD-9 154 malig neo rectum/anus*
ICD-9 157 malignant neo pancreas*
ICD-9 323 encephalomyelitis*
ICD-9 336 spinal cord disease nec*
ICD-9 411 oth ac ischemic hrt dis*
ICD-9 482 oth bacterial pneumonia*
ICD-9 691 atopic dermatitis*
ICD-9 186 malign neopl testis*
ICD-9 357 inflam/toxic neuropathy*
ICD-9 949 burn unspecified*
ICD-9 207 other specified leukemia*
ICD-9 359 muscular dystrophies*
ICD-9 928 crushing injury of leg*
ICD-9 224 benign neoplasm of eye*
ICD-9 508 resp cond d/t ext agent*
ICD-9 694 bullous dermatoses*
ICD-9 732 osteochondropathies*
ICD-9 915 superficial inj finger*
ICD-9 990 effects radiation nos
ICD-9 370 keratitis*
ICD-9 397 endocardial disease nec*
ICD-9 483 pneumonia: organism nec*
ICD-9 171 mal neo soft tissue*
ICD-9 284 aplastic anemia*
ICD-9 581 nephrotic syndrome*
ICD-9 641 antepart hem and plac prev*
ICD-9 770 oth nb respiratory cond*
ICD-9 956 inj periph nerv pelv/leg*
Qual Life Res

Table 12 Baseline sociodemographic characteristics (MEPS 2000–2012: SF-6D Sample)

No SCS No SCS SCS SCS SCS SCS SCS SCS
N (%) (Any) (Any) (1–3 Rx) (1–3 Rx) (C4 Rx) (C4 Rx)
N (%) N (%) N (%)

MEPS (Total N) 178,838 8833 7013 1820

Age (mean) 47.7 51.7 50.1 58.9
Age 18–34 48,323 27.2 1486 18.3 1344 20.7 142 7.9
Age 35–49 51,089 27.8 2480 27.3 2098 28.8 382 20.5
Age 50–64 45,234 25.7 2586 28.9 1985 28.1 601 32.5
Age 65–79 25,462 14.2 1757 19.8 1248 17.7 509 28.8
Age [ 80 8730 5.1 524 5.7 338 4.7 186 10.4
Region
Northeast 27,796 18.6 1336 18.1 1042 17.9 294 19.1
Midwest 39,217 23.3 2220 25.6 1828 26.3 392 22.3
South 66,915 35.3 3583 38.3 2831 38.2 752 38.9
West 44,910 22.8 1694 18.0 1312 17.6 382 19.7
Gender
Male 76,172 45.4 3106 37.8 2450 37.4 656 39.2
Female 102,666 54.6 5727 62.2 4563 62.6 1164 60.8
Race
White 138,602 84.0 7130 87.1 5758 87.9 1372 83.5
Black 27,664 10.1 1251 8.6 898 7.9 353 11.8
American Indian 1598 0.8 76 0.7 55 0.7 21 1.0
Other-race 10,974 5.1 376 3.6 302 3.6 74 3.6
Ethnicity
Hispanic 34,583 10.6 1062 6.4 809 6.1 253 7.8
Education
No-degree 37,405 14.6 1627 13.1 1155 11.9 472 18.5
Less-than-BA 101,067 57.7 5210 59.5 4172 59.5 1038 59.6
BA 26,678 18.3 1308 17.6 1106 18.6 202 13.3
MA-PhD 13,688 9.5 688 9.8 580 10.1 108 8.7
Insurance coverage
Private 116,538 73.1 6030 75.4 5042 78.1 988 63.3
Public 37,163 15.9 2149 18.5 1413 15.5 736 32.1
Uninsured 25,137 11.0 654 6.0 558 6.4 96 4.5
Family income
Poor 27,988 10.4 1298 9.8 937 8.9 361 14.0
Near poor 9794 4.0 482 4.0 337 3.5 145 6.5
Low income 27,238 12.6 1253 12.3 927 11.5 326 16.1
Mid-income 53,499 30.5 2614 30.0 2115 30.3 499 28.5
High income 60,319 42.5 3186 43.9 2697 45.9 489 34.9
Chronic Conditions (All; Mean # of) 204.6 323.1 294.7 450.3
Chronic Conditions (non SCS?; Mean # of) 112.2 148.4 134.6 210.2
Chronic Conditions (non SCS) = 0 84,604 47.4 3010 35.7 2659 39.1 351 20.1
Chronic Conditions (non SCS) = 1 40,132 22.6 2202 24.8 1780 25.3 422 22.5
Chronic Conditions (non SCS) = 2 24,842 13.9 1528 17.0 1131 16.0 397 21.1
Chronic Conditions (non SCS) = 3 15,164 8.2 1006 10.7 706 9.5 300 16.2
Chronic Conditions (non SCS) = 4 7929 4.4 554 6.0 376 5.1 178 10.2
Chronic Conditions (non SCS) = 5 3591 2.0 308 3.3 209 2.8 99 5.3
Chronic Conditions (non SCS) = 6 1620 0.9 144 1.6 89 1.2 55 3.3
Chronic Conditions (non SCS) C 7 956 0.5 81 0.9 63 0.9 18 1.2

SCS systemic corticosteroids

?
Non SCS: Chronic conditions for which SCS are not indicated
* Subpopulation of 2000–2012 MEPS age C 18, with positive SAQ weight, valid SF-6D score, presence of any SCS-related condition and
complete values for covariates used in regressions (final regression sample)

123

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