Bridging Heart-Disease Questionnaires: Mapping Algorithms to the MacNew-7D for Economic Evaluation

Patient-reported outcomes are increasingly used to estimate quality-adjusted life-years (QALYs) in economic evaluations. But most cardiac instruments — including the Kansas City Cardiomyopathy Questionnaire (KCCQ), Seattle Angina Questionnaire (SAQ), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) — are not preference-based and cannot directly produce QALYs. The MacNew-7D, a preference-based version of the MacNew, can. The question is: how do you connect them?

This study included 493 participants with heart failure or angina who completed the KCCQ, MLHFQ, SAQ, and MacNew-7D questionnaires. Multiple regression techniques — Gamma Generalized Linear Model (GLM), Bayesian GLM, Linear regression with stepwise selection, and Random Forest — were applied to develop direct mapping algorithms from each non-preference-based instrument onto MacNew-7D utility scores. Cross-validation was used due to the absence of an external validation dataset, and reporting followed the Mapping onto Preference-based measures reporting Standards (MAPS) checklist.

The best models for predicting MacNew-7D utility scores were identified for each questionnaire’s item and domain scores. Random Forest performed strongly for item scores across all three questionnaires and for KCCQ domain scores, while Bayesian GLM and Linear Regression performed best for other configurations. The MacNew-7D thus serves as a bridge enabling QALY estimation from data collected with KCCQ, MLHFQ, or SAQ.

By demonstrating that the MacNew-7D can serve as a utility “hub” for the broader family of cardiac PROMs, this study cements its central role in health economic evaluation of cardiac care. Researchers and health technology assessment bodies can now connect existing datasets to preference-based utilities without re-collecting data — a major practical advance.

Reference:
Senanayake, S., Uchil, R., Sharma, P., Parsonage, W., & Kularatna, S. (2024). Mapping Kansas City cardiomyopathy, Seattle Angina, and minnesota living with heart failure to the MacNew-7D in patients with heart disease. Quality of Life Research, 33(8), 2151–2163. https://doi.org/10.1007/s11136-024-03676-2