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The feasibility and validity of a preference-weighted composite endpoint to establish value in geriatric care


As part of the Dutch National Care for the Elderly Programme, The Older Persons and Informal Caregivers Survey Minimum Data Set (TOPICS-MDS) was developed to gather uniform information on outcome measures. Furthermore, to combine the outcome measures into one single index and to promote comparability between studies, a preference-weighted Composite End Point (called: TOPICS-CEP) was developed [1]. The aim of this study was to validate TOPICS-CEP in a large heterogeneous sample of older persons aged ≥65 years.

Materials and methods

Data from 17,603 older persons were derived from TOPICS-MDS (; a public data repository. Feasibility was evaluated by the prevalence of missing values among TOPICS-CEP scores. To assess convergent validity, TOPICS-CEP scores were cross validated against the Cantril’s ladder life satisfaction scale and the EuroQol-5D utility score. Known-group validity of TOPICS-CEP was investigated across socio-demographic and clinical characteristics. To assess whether TOPICS-CEP scores were generalizeble across different settings, we conducted pooled and subgroup analyses: older persons in the general population, general practitioner setting, and hospital.


In the complete sample, TOPICS-CEP scores could be calculated for the majority of the participants (88.7%). There were no floor and ceiling effects found and the distribution was slightly skewed to the left. The correlation between TOPICS-CEP and Cantril’s ladder was 0.43 (95%CI [0.39-0.48]) and the correlation between TOPICS-CEP and EuroQol-5D was 0.63 (95%CI [0.58-0.67]). Expectedly, mean TOPICS-CEP scores differed significantly (p<0.05) across marital status (married or cohabiting: 7.50 versus partner deceased: 7.13), living arrangements (independent living with others: 7.56 versus dependent living: 6.37), dementia (no: 7.43 versus yes: 6.30), depression (no: 7.42 versus yes: 6.26), and dizziness with falls (no: 749 versus yes: 6.42). When stratified by subgroups, similar results were found for feasibility, convergent and known-group validity.


The TOPICS-CEP was able to accurately reflect general wellbeing in a large pooled dataset as well as across subgroups. Our data support that the TOPICS-CEP score is an objective and robust measure for researchers interested in investigating the general well-being of older persons. The TOPICS-CEP guideline version 1.1 is now available online


  1. Hofman CS, Makai P, Buurman BM, de Craen AJM, Boter H, OldeRikkert MGM, Donders ART, Melis RJF: Establishing a composite endpoint for measuring the effectiveness of geriatric interventions based on older persons’ and informal caregivers’ preference weights: A vignette study. BMC Geriatrics. 2014, 14: 51-10.1186/1471-2318-14-51.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Hofman, C., Lutomski, J., Boter, H. et al. The feasibility and validity of a preference-weighted composite endpoint to establish value in geriatric care. BMC Health Serv Res 14 (Suppl 2), P55 (2014).

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