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Extending the Q-TWiST Method

Carolyn E. Schwartz, ScD; Bernard F. Cole, PhD; Richard D. Gelber, PhD

Arch Neurol. 1995;52(8):754-762.

Abstract
Background
Current clinical research and outcomes assessment on multiple sclerosis rely on an approach to disability measurement that is heavily influenced by ambulation. Not only is this strategy often insensitive to the clinical changes affected by pharmacotherapeutic or rehabilitative interventions but it also disregards the symptoms that patients seem to consider most enervating. We propose a new method for evaluating clinical interventions in terms of their impact on the symptoms of multiple sclerosis, side effects, parameters of exacerbation, and disease progression, while considering the patient's perspective.

Methods
The extended Q-TWiST method yields an estimation of treatment trade-offs in terms of Quality-adjusted Time Without Symptoms and Toxicities (Q-TWiST). An illustration of this method is presented by using a hypothetical clinical trial of two treatments. The trade-offs between the two treatments are highlighted to facilitate treatment decision making by using individual patient importance weights.

Conclusion
We discuss applications to other clinical research and other chronic diseases.

Author Affiliations
From Frontier Science and Technology Research Foundation Inc, Brookline, Mass, and the Rocky Mountain Multiple Sclerosis Center, Englewood, Colo (Dr Schwartz); the Department of Community Health and Division of Applied Mathematics, Brown University, Providence, RI (Dr Cole); and the Division of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Harvard School of Public Health, Boston, Mass (Dr Gelber).

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