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Type: Journal article
Title: Suitability of the Epworth Sleepiness Scale (ESS) for economic evaluation: an assessment of its convergent and discriminant validity
Author: Kaambwa, B.
Mpundu-Kaambwa, C.
Adams, R.
Appleton, S.
Martin, S.
Wittert, G.
Citation: Behavioral Sleep Medicine, 2018; 16(5):448-470
Publisher: Taylor & Francis
Issue Date: 2018
ISSN: 1540-2002
Statement of
Billingsley Kaambwa, Christine Mpundu-Kaambwa, Robert Adams, Sarah Appleton, Sean Martin and Gary Wittert
Abstract: Objective: To assess the suitability for use within economic evaluation of a widely used sleep-related instrument (the Epworth Sleepiness Scale [ESS]) by examining its convergent and discriminant validity with two widely used generic preference-based instruments (Short-Form 36 [SF-36] and the Assessment of Quality of Life 4 dimensions [AQoL-4D]). Methods: Data from a cross-section of 2,236 community-dwelling Australian men were analyzed. Convergent validity was investigated using Spearman’s correlation, intraclass correlation, and modified Bland-Altman plots, while discriminant validity was examined using Kruskal Wallis tests. Results: All instruments showed good discriminant validity. The ESS was weakly correlated to the Short Form 6 dimension, or SF-6D (derived from the SF-36) and AQoL-4D utilities (r = 0.20 and r = 0.19, respectively). Correlations between ESS and SF-36/AQoL-4D dimensions measuring the same construct were all in the hypothesized directions but also weak (range of absolute r = 0.00 to 0.18). The level of agreement between the ESS and AQoL-4D was the weakest, followed by that between the ESS and SF-6D. Moderate convergent validity was seen between the utilities. Conclusions: The lack of convergent validity between the ESS and the preference-based instruments shows that sleep-related constructs are not captured by the latter. The ESS has, however, demonstrated good discriminant validity comparable to that of the AQoL-4D and the SF-36/SF-6D and would therefore be equally useful for measuring subgroup differences within economic evaluation. We therefore recommend using the ESS within cost-effectiveness analysis as a complement to preference-based instruments in order to capture sleep-specific constructs not measured by the latter.
Keywords: Humans
Reproducibility of Results
Quality of Life
Middle Aged
Cost-Benefit Analysis
Surveys and Questionnaires
Rights: © 2018 Taylor & Francis Group, LLC
DOI: 10.1080/15402002.2016.1228647
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Psychology publications

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