Health-Related Quality of Life Measures in the Kingdom of Saudi Arabia

Background The Saudi Vision 2030 has transformed the healthcare system in the Kingdom. The Ministry of Health executed a patient-centered approach, the Model of Care, where quality is the ultimate goal for healthcare services.[1] Value is the expected outcome, and multiple health sectors are adapting to the new direction. Value in health can be captured differently depending on the perspective and context of the use. The Saudi healthcare system must be proactive in utilizing various value methods, from the primary approach of net costing to more advanced value dimensions such as productivity, hope, equity, and quality of life (QoL).[2] Patient-reported outcomes (PROs) are tools that attempt to measure health-related quality of life (HRQoL), health and functional status, health behavior and symptoms, and patient experiences.[3] HRQoL has been integrated into the United Kingdom and the United States to assess health decisions, including drug registrations, health technology assessments (HTA), and practice evaluations.[4] In this editorial, I aim to introduce HRQoL and discuss its applicability in pharmacy clinical practice and research. Measuring Health-Related Quality of Life HRQoL is a multi-concept phenomenon defined as the self-perceived status of a person’s physical, mental, and social aspects.[5] It is widely used interchangeably with QoL and health status due to their overlapping criteria, but they distinctly differ.[6] QoL has older historical roots in medical literature, as mentioned in the 1960s, and it engulfs broader aspects beyond health, like safety, politics, and learning.[7] HRQoL focuses on aspects of QoL that are affected by disease or treatments and measures self-reported health status.[5] They can be disease-specific or generic instruments.[6] Disease-specific instruments are tailored for a specific disease condition and measure health status, biological and psychosocial domains for that targeted disease.[8] Clinicians commonly utilize these instruments for various clinical settings. The European Organization for Research and Treatment of Cancer QoL Questionnaire was used to evaluate treatments for patients with advanced cancer.[9] The Health Assessment Questionnaire was adapted to define eligibility and outcomes for treatment trials.[10] Clinical pharmacists interested in similar instruments should browse disease-specific PRO measures organized by the Australian Commission on Safety and Quality in Health Care.[11] Generic HRQoL instruments are developed to be used across multiple conditions and treatments. These instruments have been adapted within population health indicators and are relatively preferred by policymakers.[4] The SF-36 developed by RAND and the EQ-5D developed by the EuroQol Group are known examples of such instruments.[6] The EQ-5D was first introduced in 1990 to capture five dimensions related to QoL: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. As of the latest update, there are 117 Arabic instruments from 15 countries, of which 19 have validated EQ-5D instruments in Arabic for the Kingdom of Saudi Arabia.[12] Innovative Move in the Kingdom Toward Health-Related Quality of Life Measures In 2024, a national project led by Professor Aljedea was published to estimate a Saudi-specific value set for the EQ-5D.[13] Indeed, the valuation was completed using two approaches: time trade-off and discrete choice experiment. This will pave the way for researchers to produce accurate measures when utilizing similar instruments. The results will trigger a positive effect whenever EQ-5D is applied. For instance, the utility score will be more precise and elevate healthcare decisions produced at the macro level, like HTA, or micro level, like pharmacy and therapeutics committees within local hospitals. Moreover, within the clinical pharmacy context, EQ-5D scores can be integrated alongside disease-specific instruments to monitor treatment courses and asses during the evaluation and reimbursement process. The National Health System England has introduced a similar approach where patients must fill out an EQ-5D questionnaire for selected treatments and surgeries for outcomes evaluation.[14] In a previous publication, I saw Saudi researchers adapt the EQ-5D instrument well, particularly in pharmacy. In 2021, 24 articles explored the EuroQol in Saudi Arabia, 11 of which were related to pharmacy practice. Multiple medical conditions were explored like diabetes mellitus, atrial fibrillation, musculoskeletal disorders, back pain, urinary tract infections, chronic obstructive pulmonary disease, and multiple sclerosis.[4] I anticipate more research in the next few years, with more accurate measures since the utility score was normalized to the Saudi population. Call for Action The PROs are not new and are collected in the United States and the United Kingdom, but the major reported setback is the low completion rate. I believe PROs, including HRQoL, will be an integral part of the Saudi healthcare system, creating a significant opportunity for pharmacists to unleash new potential. Pharmacists are positioned in a unique step within the healthcare process, where they can have a holistic perspective regarding patients’ conditions while having direct contact and engagement with patients. To ensure a successful adaptation story, there must be a collaborative approach from all health system stockholders, including pharmacists. The Saudi Clinical Pharmacy Association has led pharmacy practice in multiple domains, and PROs might be the right new expansion. Establishing a PROs special interest group would foster collaboration between practitioners and researchers interested in the field. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.