Score AQoL-6D (Adolescent) Health Utility

AQoL-6D scoring

To derive a health utility score from the raw responses to a multi-attribute utility instrument it is necessary to implement a scoring algorithm. Scoring algorithms for the Assessment of Quality of Life Six Dimension (AQoL-6D) are publicly available in SPSS format (https://www.aqol.com.au/index.php/scoring-algorithms).

However, to include scoring algorithms in reproducible research workflows, it is desirable to have these algorithms available in open science languages such as R. The scorz package includes ready4 framework modules of the readyforwhatsnext youth mental health economic model that provide R implementations of the adult and adolescent versions of the AQoL-6D scoring algorithms.

Ingest data

To begin, we ingest an unscored dataset as an instance of the Ready4useDyad from the ready4use package. In this case we download our data from a remote repository.

X <- ready4use::Ready4useRepos(dv_nm_1L_chr = "fakes",
                               dv_ds_nm_1L_chr = "https://doi.org/10.7910/DVN/W95KED",
                               dv_server_1L_chr = "dataverse.harvard.edu") %>%
  ingest(fls_to_ingest_chr = "ymh_clinical_dyad_r4",
         metadata_1L_lgl = F)

To make the ingested dataset easier to interpret, we can add labels from the dictionary.

X <- X %>%
  renew(type_1L_chr = "label")

We can now inspect our ingested dataset using the exhibit method.

exhibit(X,
        display_1L_chr = "head",
         scroll_box_args_ls = list(width = "100%"))

Dataset
Unique client identifier	Round of data collection	Date of data collection	Age	Gender	Sex at birth	Sexual orientation	Aboriginal or Torres Strait Islander	Country Of birth	Speaks English at home	Native English speaker	Education and employment status	Relationship status	Service centre name	Primary diagnosis	Clinical stage	Kessler Psychological Distress Scale (6 Dimension)	Patient Health Questionnaire	Behavioural Activation for Depression Scale	Generalised Anxiety Disorder Scale	Overall Anxiety Severity and Impairment Scale	Screen for Child Anxiety Related Disorders	Social and Occupational Functioning Assessment Scale	Assessment of Quality of Life (6 Dimension) question 1	Assessment of Quality of Life (6 Dimension) question 2	Assessment of Quality of Life (6 Dimension) question 3	Assessment of Quality of Life (6 Dimension) question 4	Assessment of Quality of Life (6 Dimension) question 5	Assessment of Quality of Life (6 Dimension) question 6	Assessment of Quality of Life (6 Dimension) question 7	Assessment of Quality of Life (6 Dimension) question 8	Assessment of Quality of Life (6 Dimension) question 9	Assessment of Quality of Life (6 Dimension) question 10	Assessment of Quality of Life (6 Dimension) question 11	Assessment of Quality of Life (6 Dimension) question 12	Assessment of Quality of Life (6 Dimension) question 13	Assessment of Quality of Life (6 Dimension) question 14	Assessment of Quality of Life (6 Dimension) question 15	Assessment of Quality of Life (6 Dimension) question 16	Assessment of Quality of Life (6 Dimension) question 17	Assessment of Quality of Life (6 Dimension) question 18	Assessment of Quality of Life (6 Dimension) question 19	Assessment of Quality of Life (6 Dimension) question 20
Participant_1	Baseline	2020-03-22	14	Male	Male	Heterosexual	No	Australia	Yes	Yes	Not studying or working	In a relationship	Southport	Other	0-1a	8	7	96	6	6	28	69	2	3	1	2	3	1	1	2	4	3	3	4	2	4	2	2	2	2	2	1
Participant_2	Baseline	2020-06-15	19	Female	Female	Heterosexual	Yes	Other	No	No	Studying only	In a relationship	Regional Centre	Anxiety	0-1a	13	13	63	12	12	41	58	3	3	1	1	3	2	1	3	2	4	4	3	4	3	1	2	2	2	1	1
Participant_3	Baseline	2020-08-20	21	Female	Female	Other	NA	NA	NA	NA	Studying only	Not in a relationship	Canberra	Anxiety	1b	12	17	72	16	12	43	72	2	3	2	5	1	1	1	2	4	5	2	4	2	2	2	1	1	1	1	1
Participant_4	Baseline	2020-05-23	12	Female	Female	Heterosexual	Yes	Other	No	No	Not studying or working	In a relationship	Southport	Depression and Anxiety	2-4	17	17	75	12	10	51	88	1	2	1	1	3	3	1	4	4	3	3	3	4	2	1	1	2	1	3	1
Participant_5	Baseline	2020-04-05	19	Male	Male	Heterosexual	Yes	Other	No	No	Not studying or working	Not in a relationship	Southport	Depression and Anxiety	0-1a	12	22	82	14	14	51	67	2	2	1	3	5	1	1	1	1	5	4	4	3	2	1	2	1	3	2	3
Participant_6	Baseline	2020-06-09	19	Male	Male	Heterosexual	Yes	Other	No	No	Studying only	In a relationship	Regional Centre	Anxiety	1b	11	8	105	8	3	46	60	1	2	2	1	2	2	4	1	3	3	4	3	4	2	1	2	1	2	1	1

We now add meta-data that identifies our dataset as being longitudinal using the YouthvarsSeries module of the youthvars package.

X <- youthvars::YouthvarsSeries(a_Ready4useDyad = X,
                                id_var_nm_1L_chr = "fkClientID",
                                timepoint_var_nm_1L_chr = "round",
                                timepoint_vals_chr = levels(X@ds_tb$round))

We now use the data and meta-data we have created in the previous steps to create an instance of the ScorzAqol6Adol class. This class is specifically designed to facilitate scoring of the adolescent version of the AQoL-6D instrument.

Y <- ScorzAqol6Adol(a_YouthvarsProfile = X)

By default, instances of the ScorzAqol6Adol class are created with a slot specifying a value for the prefix for AQoL-6D questionnaire item responses.

procureSlot(Y,
            slot_nm_1L_chr = "itm_prefix_1L_chr")

## [1] "aqol6d_q"

If this default value needs to be updated to match the prefix used in your dataset, use the renewSlot method.

# Not run
# Y <- renewSlot(Y, slot_nm_1L_chr = "itm_prefix_1L_chr", new_val_xx = "new_prefix")

Calculating scores

To calculate AQoL 6D adolescent utility scores, use the renew method.

Y <- renew(Y)

Viewing the updated dataset

We can inspect our updated dataset using the exhibit method. We can see that the updated dataset now has additional variables that include the intermediate and final calculations for AQoL-6D adolescent utility scores.

exhibit(Y,
        display_1L_chr = "head",
         scroll_box_args_ls = list(width = "100%"))

Dataset
Unique client identifier	Round of data collection	Date of data collection	Age	Gender	Sex at birth	Sexual orientation	Aboriginal or Torres Strait Islander	Country Of birth	Speaks English at home	Native English speaker	Education and employment status	Relationship status	Service centre name	Primary diagnosis	Clinical stage	Kessler Psychological Distress Scale (6 Dimension)	Patient Health Questionnaire	Behavioural Activation for Depression Scale	Generalised Anxiety Disorder Scale	Overall Anxiety Severity and Impairment Scale	Screen for Child Anxiety Related Disorders	Social and Occupational Functioning Assessment Scale	Assessment of Quality of Life (6 Dimension) question 1	Assessment of Quality of Life (6 Dimension) question 2	Assessment of Quality of Life (6 Dimension) question 3	Assessment of Quality of Life (6 Dimension) question 4	Assessment of Quality of Life (6 Dimension) question 5	Assessment of Quality of Life (6 Dimension) question 6	Assessment of Quality of Life (6 Dimension) question 7	Assessment of Quality of Life (6 Dimension) question 8	Assessment of Quality of Life (6 Dimension) question 9	Assessment of Quality of Life (6 Dimension) question 10	Assessment of Quality of Life (6 Dimension) question 11	Assessment of Quality of Life (6 Dimension) question 12	Assessment of Quality of Life (6 Dimension) question 13	Assessment of Quality of Life (6 Dimension) question 14	Assessment of Quality of Life (6 Dimension) question 15	Assessment of Quality of Life (6 Dimension) question 16	Assessment of Quality of Life (6 Dimension) question 17	Assessment of Quality of Life (6 Dimension) question 18	Assessment of Quality of Life (6 Dimension) question 19	Assessment of Quality of Life (6 Dimension) question 20	Assessment of Quality of Life (6 Dimension) item disvalue 1	Assessment of Quality of Life (6 Dimension) item disvalue 2	Assessment of Quality of Life (6 Dimension) item disvalue 3	Assessment of Quality of Life (6 Dimension) item disvalue 4	Assessment of Quality of Life (6 Dimension) item disvalue 5	Assessment of Quality of Life (6 Dimension) item disvalue 6	Assessment of Quality of Life (6 Dimension) item disvalue 7	Assessment of Quality of Life (6 Dimension) item disvalue 8	Assessment of Quality of Life (6 Dimension) item disvalue 9	Assessment of Quality of Life (6 Dimension) item disvalue 10	Assessment of Quality of Life (6 Dimension) item disvalue 11	Assessment of Quality of Life (6 Dimension) item disvalue 12	Assessment of Quality of Life (6 Dimension) item disvalue 13	Assessment of Quality of Life (6 Dimension) item disvalue 14	Assessment of Quality of Life (6 Dimension) item disvalue 15	Assessment of Quality of Life (6 Dimension) item disvalue 16	Assessment of Quality of Life (6 Dimension) item disvalue 17	Assessment of Quality of Life (6 Dimension) item disvalue 18	Assessment of Quality of Life (6 Dimension) item disvalue 19	Assessment of Quality of Life (6 Dimension) item disvalue 20	Disvalue Score for Dimension 1 - Independent Living	Disvalue Score for Dimension 2 - Relationships	Disvalue Score for Dimension 3 - Mental Health	Disvalue Score for Dimension 4 - Coping	Disvalue Score for Dimension 5 - Pain	Disvalue Score for Dimension 6 - Senses	Adult Score Dimension 1 - Independent Living	Adult Score Dimension 2 - Relationships	Adult Score Dimension 3 - Mental Health	Adult Score Dimension 4 - Coping	Adult Score Dimension 5 - Pain	Adult Score Dimension 6 - Senses	Overall score on a 0-1 disvalue scale	Overall score on a life-death disutility scale	AQoL-6D Adolescent Disutility Score (Untransformed)	AQoL-6D Adolescent Disutility Score (Transformed)	Instrument utility score	Instrument utility score rotated	AQol-6D utility	Unweighted AQoL-4D total
Participant_1	Baseline	2020-03-22	14	Male	Male	Heterosexual	No	Australia	Yes	Yes	Not studying or working	In a relationship	Southport	Other	0-1a	8	7	96	6	6	28	69	2	3	1	2	3	1	1	2	4	3	3	4	2	4	2	2	2	2	2	1	0.073	0.240	0.000	0.040	0.461	0.000	0.000	0.133	0.824	0.330	0.368	0.722	0.055	0.826	0.133	0.2	0.072	0.033	0.024	0.000	0.19334101	0.2964368	0.7312060	0.7708396	0.2619285	0.03009428	0.8066590	0.7035632	0.2687940	0.2291604	0.7380715	0.9699057	0.6436897	0.7286568	0.55838936	0.55838936	0.4416106	0.5078265	0.5698492	46
Participant_10	Baseline	2020-08-05	15	Female	Female	Other	Yes	Other	No	No	Studying and working	Not in a relationship	Canberra	Other	0-1a	11	17	34	13	15	38	60	1	2	2	3	5	1	3	3	4	4	3	4	3	3	1	2	2	3	2	1	0.000	0.033	0.041	0.297	1.000	0.000	0.648	0.392	0.824	0.784	0.368	0.722	0.382	0.423	0.000	0.2	0.072	0.223	0.024	0.000	0.27064870	0.7770111	0.8683514	0.6579841	0.1935407	0.13938313	0.7293513	0.2229889	0.1316486	0.3420159	0.8064593	0.8606169	0.7541542	0.8537026	0.74739738	0.74739738	0.2526026	0.3413671	0.3916050	52
Participant_10	Follow-up	2020-11-07	15	Female	Female	Other	Yes	Other	No	No	Not studying or working	Not in a relationship	Regional Centre	Depression	1b	7	17	95	14	10	48	64	2	3	2	1	2	2	2	2	2	3	3	5	3	2	3	1	2	2	3	2	0.073	0.240	0.041	0.000	0.074	0.193	0.197	0.133	0.142	0.330	0.368	1.000	0.382	0.057	0.642	0.0	0.072	0.033	0.205	0.187	0.18835933	0.2602305	0.5155772	0.5858738	0.4342728	0.21476953	0.8116407	0.7397695	0.4844228	0.4141262	0.5657272	0.7852305	0.6473112	0.7327563	0.56418597	0.56418597	0.4358140	0.5027214	0.5645345	47
Participant_100	Baseline	2020-07-19	25	Female	Female	Other	Yes	Other	No	No	Working only	In a relationship	Canberra	Depression and Anxiety	0-1a	7	0	120	3	0	21	76	1	1	1	1	2	1	2	2	2	2	2	2	5	3	2	1	3	1	1	1	0.000	0.000	0.000	0.000	0.074	0.000	0.197	0.133	0.142	0.097	0.064	0.056	1.000	0.423	0.133	0.0	0.338	0.000	0.000	0.000	0.00000000	0.1433888	0.2505682	0.7769222	0.2866694	0.00000000	1.0000000	0.8566112	0.7494318	0.2230778	0.7133306	1.0000000	0.4558633	0.5160373	0.29587849	0.29587849	0.7041215	0.7390198	0.7978085	36
Participant_1000	Baseline	2020-09-06	16	Male	Male	Heterosexual	Yes	Other	No	No	Not studying or working	Not in a relationship	Canberra	Anxiety	0-1a	0	0	128	0	0	0	71	2	1	1	1	1	2	1	2	1	2	2	1	2	3	1	1	1	2	1	1	0.073	0.000	0.000	0.000	0.000	0.193	0.000	0.133	0.000	0.097	0.064	0.000	0.055	0.423	0.000	0.0	0.000	0.033	0.000	0.000	0.02813508	0.1346642	0.1819574	0.3514811	0.0000000	0.01916297	0.9718649	0.8653358	0.8180426	0.6485189	1.0000000	0.9808370	0.2379252	0.2693314	0.08939064	0.08939064	0.9106094	0.9208737	0.9511345	29
Participant_1000	Follow-up	2020-12-20	16	Male	Male	Heterosexual	Yes	Other	No	No	Not studying or working	Not in a relationship	Southport	Anxiety	1b	5	0	117	5	1	14	71	2	2	1	1	1	1	2	1	3	1	2	3	2	2	1	1	1	1	2	1	0.073	0.033	0.000	0.000	0.000	0.000	0.197	0.000	0.392	0.000	0.064	0.338	0.055	0.057	0.000	0.0	0.000	0.000	0.024	0.000	0.04719190	0.1002056	0.2658587	0.2080310	0.0000000	0.01111253	0.9528081	0.8997944	0.7341413	0.7919690	1.0000000	0.9888875	0.2228889	0.2523102	0.07926885	0.07926885	0.9207312	0.9297879	0.9576133	31

Creating summary plots

To create plots, we use the depict method.

We can create a list of summary plots by timepoint for all individual items.

plot_ls <- depict(Y, type_1L_chr = "item_by_time")

We can then select a desired item’s summary plot by using its index number.

plot_ls[[1]]

AQoL-6D Item 1 scores by data-collection round

Alternatively, we can generate individual plots by passing the item index number to the var_idcs_int argument of depict.

depict(Y, type_1L_chr = "item_by_time", var_idcs_int = 2L)

AQoL-6D Item 2 scores by data-collection round

We can also plot domain scores by time.

depict(Y, type_1L_chr = "domain_by_time", var_idcs_int = 1L)

AQoL-6D Independet Living Domain weighted scores by data-collection round

Total AQoL-6D scores can also be plotted using the same approach, where var_idcs_int = 1L is used to plot the weighted total distribution and var_idcs_int = 2L is used for plotting the unweighted total.

depict(Y, type_1L_chr = "total_by_time", var_idcs_int = 1L)

AQoL-6D item total weighted scores by data-collection round

Composite plots can be generated as well, though these are not currently optimised to reliably produce quality plots suitable for publication.

depict(Y, type_1L_chr = "comp_item_by_time")

AQoL-6D item responses by data-collection round

depict(Y, type_1L_chr = "comp_domain_by_time")

## Warning: The dot-dot notation (`..density..`) was deprecated in ggplot2 3.4.0.
## ℹ Please use `after_stat(density)` instead.
## ℹ The deprecated feature was likely used in the youthvars package.
##   Please report the issue to the authors.
## This warning is displayed once every 8 hours.
## Call `lifecycle::last_lifecycle_warnings()` to see where this warning was
## generated.

AQoL-6D weighted domain scores by data-collection round

We can now publicly share our scored dataset and its associated metadata, using Ready4useRepos and its share method as described in a vignette from the ready4use package.

Z <- ready4use::Ready4useRepos(gh_repo_1L_chr = "ready4-dev/scorz", # Replace with details of your repo.
                               gh_tag_1L_chr = "Documentation_0.0") # You must have write permissions.
Z <- share(Z,
           obj_to_share_xx = Y,
           fl_nm_1L_chr = "ymh_ScorzAqol6Adol")

Y is now available for download as the file ymh_ScorzAqol6Adol.RDS from the “Documentation_0.0” release of the scorz package.

AQoL-6D scoring

Ingest data

Calculating scores

Viewing the updated dataset

Creating summary plots

Share output