EQ-5D–Derived Health State Utility Values in Hematologic Malignancies: A Catalog of 796 Utilities Based on a Systematic Review

ObjectivesWe performed a systematic review of health state utility values (HSUVs) obtained using the EQ-5D questionnaire for patients with hematologic malignancies.MethodsThe following databases were searched up to September 2018: MEDLINE, EMBASE, The Cochrane Library, and the EQ-5D publications database on the EuroQol website. Additional references were extracted from reviewed articles. Only studies presenting EQ-Index results were incorporated. In view of the heterogeneity across the included publications, we limited ourselves to a narrative synthesis of original HSUVs found.ResultsFifty-nine studies (described in 63 articles) met the inclusion criteria. Data from 21 635 respondents provided 796 HSUV estimates for hematologic malignancy patients. EQ-Index scores ranged from –0.025 to 0.980. The most represented area was multiple myeloma (4 studies, 11 112 patients, and 249 HSUVs). In clinical areas such as chronic myeloid leukemia, acute myeloid leukemia, chronic lymphocytic leukemia, non-Hodgkin lymphoma, and mantle cell lymphoma, we described over 50 health utilities in each. In contrast, we identified only 13 HSUVs (based on 4 studies and the data of 166 patients) for Hodgkin lymphoma. Areas without EQ-5D–based health utilities comprised: polycythemia vera, primary myelofibrosis, essential thrombocythemia, mastocytosis, myeloid sarcoma, chronic myelomonocytic, eosinophilic leukemia, and neutrophilic leukemia.ConclusionsThere is a wide range of HSUVs available for hematologic cancer patients with different indications. The review provides a catalog of utility values for use in cost-effectiveness models for hematologic malignancies.     

Mapping World Health Organization Quality of Life–BREF Onto 5-Level EQ-5D in Thai Patients With Chronic Diseases

ObjectivesThis study aimed to map the World Health Organization Quality of Life–BREF (WHOQOL-BREF) onto the 5-level EQ-5D (EQ-5D-5L) using a real Thai valuation set of the EQ-5D-5L. The second objective was to explore the impacts of the differences between observed and predicted EQ-5D-5L index scores on the incremental cost-utility ratio (ICUR) using 5 hypothetical scenarios.MethodsThis is a secondary data analysis. A total of 800 outpatients with chronic diseases were recruited from 2 university hospitals in Bangkok, Thailand, between July 2014 and March 2015. The 800 patients were randomly divided into 2 samples: estimation and validation samples. The estimation sample was used to assess the relationships between the EQ-5D-5L index score and 4 WHOQOL-BREF dimension scores and to find the best-fit model and its equation. For the validation sample, the equation of the best-fit model from the estimation sample was used to calculate predicted EQ-5D-5L index scores.ResultsA multiple linear regression showed that only the physical domain of the WHOQOL-BREF was significantly associated with the EQ-5D-5L. Among 11 regression models, the curve estimation found that the inverse model was the best-fit model. The prediction equation of EQ-5D-5L was equal to 1.385 minus 7.572/physical domain of the WHOQOL-BREF. The impacts of the differences between the observed and predicted EQ-5D-5L index scores on ICUR were only 0.4% to 1.8% from the base case.ConclusionsA nonlinear relationship between the physical domain of the WHOQOL-BREF and EQ-5D-5L utility was shown. The impacts of the differences between the observed and predicted EQ-5D-5L index scores on ICUR were minimal.     

Does Changing the Age of a Child to be Considered in 3-Level Version of EQ-5D-Y Discrete Choice Experiment–Based Valuation Studies Affect Health Preferences?

ObjectivesThere has been some debate about the choice of perspective and the age of the child considered when completing preference elicitation tasks in the 3-level version of EQ-5D-Y (EQ-5D-Y-3L) valuation protocol. This study aimed to clarify the impact on latent scale EQ-5D-Y-3L values of varying the age of the child experiencing the health state considered by respondents completing the discrete choice experiment (DCE) tasks of the protocol.MethodsWe conducted an online DCE with a representative sample of 1000 adults in the United Kingdom and 1000 adults in the United States. Respondents selected the health state they prefer from a series of DCE paired EQ-5D-Y-3L health state comparisons using their own perspective and that of a hypothetical child from the following age groups: “5-7 years old,” “8-10 years old,” “11-13 years old,” and “14-15 years old.” Data analysis was conducted using separate multinomial logit models for each perspective and country. We also estimated combined models including data from each possible pair of perspectives and used interactions between EQ-5D-Y-3L levels and perspective to determine whether any differences were statistically significant.ResultsNo statistically significant differences in coefficients between perspectives were found in the United States. In the United Kingdom, there were differences between the own perspective and the 5 to 7 years old perspective (looking after myself level 3) and between the 5 to 7 years old perspective and the 8 to 10 years old perspective (usual activities level 3).ConclusionsOur results suggest that there is minimal impact on latent scale values when using different ages of the hypothetical child in the current EQ-5D-Y-3L valuation protocol.     

Future Directions in Valuing Benefits for Estimating QALYs: Is Time Up for the EQ-5D?

The widespread adoption of the EuroQol 5-dimensional questionnaire (EQ-5D) has been important for the comparability, transparency, and consistency of economic evaluations for informing resource allocation in healthcare. The objectives of this article were to (1) critically assess whether the widespread adoption of the EQ-5D and its time trade-off–based value sets to inform economic evaluation is likely to continue and (2) speculate about how benefits may be measured and valued to inform economic evaluation in the future. Evidence supports the use of the EQ-5D in many areas of health, but there are notable gaps. Furthermore, there has been interest among some policy makers in measuring changes in well-being, and in using common outcomes across sectors. Possibilities for measuring well-being alongside health can be achieved through bolt-on dimensions or an entirely new measure capturing both health and well-being. Nevertheless, there are significant concerns about the logic of estimating a common utility function. The development of online valuation methods has had a major impact on the field, which is likely to continue. We, however, recommend more allowance for respondents to consider their answers. There is an ongoing debate on the role of patient values or experience-based values. To date, this has seen limited take-up by decision makers and there are significant technical problems to obtaining representative and meaningful values. Policy makers and the general population must decide on the focus and scope of benefits that are incorporated into economic evaluation, and current evidence on this is mixed. In part, this will determine whether the widespread adoption will continue.     

Censoring Time Trade-off Values at 0 Versus at −1: How Does the Assumption for Worse-Than-Dead Time Trade-off Values Affect the Modeling of EQ-5D-5L Valuation Data?

ObjectivesA recent study found that negative utility values elicited using composite time trade-off (TTO) were barely associated with the severity of EQ-5D-5L health states, suggesting poor discriminative ability. Assuming negative values provide limited information, this study aimed to explore the usefulness of censoring negative TTO values at 0 in modeling EQ-5D-5L valuation data.MethodsWe analyzed EQ-5D-5L valuation data from China, The Netherlands, Canada, Singapore, and Thailand. For each data set, we estimated value sets using 2 Tobit models, one left-censored at −1 (current practice) and one left-censored at 0 (our proposed method), and compared the model performances. We hypothesized that censoring at 0 and censoring at −1 would produce similar values, though on slightly different scales.ResultsWhen censoring at 0, logical inconsistencies and statistical significance were improved but the value range was compressed. In the cross-attribute level effects model, the 3-level parameters were similar between the models censored at 0 and −1, but the rank order of some dimension parameters was altered. Health state values predicted by the 2 censoring models approximated a perfect agreement after rescaling.ConclusionsCensoring TTO values at 0 improved model estimation and fit but produced higher utility values than models censoring at −1. Investigators of future EQ-5D value set studies using the composite TTO method are advised to examine the validity of negative TTO values before choosing modeling strategies.     

Preference Weighting of Health State Values: What Difference Does It Make,and Why?

Background

Most patient-reported outcome measures apply a simple summary score to assess health-related quality of life, whereby equal weight is normally assigned to each item. In the generic preference-based instruments, utility weighting is essential whereby health state values are estimated through preference elicitation and complex algorithms.

QALY Weights for Diabetic Retinopathy—A Comparison of Health State Valuations with HUI-3, EQ-5D,EQ-VAS,and TTO

ObjectiveTo estimate quality-adjusted life-year weights for patients with diabetic retinopathy by using various methods and to investigate the empirical validity of the different measures.MethodsThe study population comprised 152 patients with diabetes in Östergötland County, Sweden. Participants were interviewed by telephone by using the time trade-off (TTO) method and a visual analogue scale (EQ-VAS) (direct valuations) as well as the EuroQol five-dimensional questionnaire (EQ-5D) and the health utilities index mark 3 (HUI-3) (indirect valuations). The quality-adjusted life-year weights were adjusted for potential confounders by using analysis of covariance. The empirical validity of the measures was examined by testing their ability to detect hypothetical differences between severity levels of diabetic retinopathy and by investigating the correlation between the measures and the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25).ResultsAll measures detected significant differences in scores between patient groups classified according to visual impairment in the better eye (analysis of covariance, P < 0.05), but only HUI-3 and EQ-VAS detected significant differences between patient groups classified according to visual impairment or pathological progression in the worse eye. HUI-3 recorded a difference of 0.43 in values between normal vision and blindness in the better eye, which was more than twice the differences captured by the other measures (0.15–0.20). In addition, HUI-3 showed the highest correlation with NEI VFQ-25 (r = 0.54; P < 0.001).ConclusionsIn cost-utility analyses, the choice of quality-adjusted life-year measure may affect whether an intervention is considered cost-effective. Furthermore, if decisions are to be based on values from the general public, HUI-3 can be recommended for cost-utility analyses of interventions directed at diabetic retinopathy.     

Can Social Care Needs and Well-Being Be Explained by the EQ-5D? Analysis of the Health Survey for England

Background

The recent shift to an integrated approach to health and social care aims to provide cohesive support to those who are in need of care, but raises a challenge for resource allocation decision making, in particular for comparison of diverse benefits from different types of care across the two sectors.

Exploration of a cultural-adaptation of the EQ-5D for Thai population: A “bolt-on” experiment

Quality of Life Research - As the EQ-5D was developed in western countries with only five dimensions, it might be insensitive to non-western populations including Thai. This study examined the...     

Health State Values Derived from People with Multiple Sclerosis for a Condition-Specific Preference-Based Measure: Multiple Sclerosis Impact Scale–Eight Dimensions–Patient Version (MSIS-8D-P)

Objective

In economic evaluation, health outcomes are commonly quantified using quality-adjusted life-years (QALYs) derived from the preferences of a sample of the general population. It can be argued that this approach ignores the preferences of people with experience of the condition, and that patient preferences have a place in the valuation of health outcomes. Here we report the estimation of a preference-based index for an existing condition-specific preference-based measure for multiple sclerosis (MS), the MSIS-8D, based on the preferences of people with MS.

A (five-)level playing field for mental health conditions?: exploratory analysis of EQ-5D-5L-derived utility values

Purpose

Economic evaluations of mental health interventions often measure health benefit in terms of utility values derived from the EQ-5D. For the five-level version of the EQ-5D, there are two methods of estimating utility [crosswalk and stated preference (5L-SP)]. This paper explores potential impacts for researchers and decision-makers when comparing utility values derived from either method in the specific context of mental health.

Methods

Baseline EQ-5D-5L data from three large randomised controlled trials of interventions for mental health conditions were analysed. Utility values were generated using each method. Mean utility values were compared using a series of t tests on pooled data and subgroups. Scenario analyses explored potential impacts on cost-effectiveness decisions.

Results

EQ-5D data were available for 1399 participants. The mean utility value for each trial was approximately 0.08 higher when estimated using the 5L-SP approach compared to crosswalk (p?<?0.0001). The difference was greatest among people reporting extreme anxiety/depression (mean utility 5L-SP 0.309, crosswalk 0.084; difference?=?0.225; p?<?0.0001). Identical improvements in health status were associated with higher costs to gain one QALY with the 5L-SP approach; this is more pronounced when improvements are across all domains compared to improvements on the anxiety/depression domain only.

Conclusions

The two approaches produce significantly different utility values in people with mental health conditions. Resulting differences in cost per QALY estimates suggest that thresholds of cost-effectiveness may also need to be reviewed. Researchers and decision-makers should exercise caution when comparing or synthesising data from trials of mental health interventions using different utility estimation approaches.

     

To what extent does the use of crosswalks instead of EQ-5D value sets impact reimbursement decisions?: a simulation study

Purpose

Inconsistent results have been found on the impact of using crosswalks versus EQ-5D value sets on reimbursement decisions. We sought to further investigate this issue in a simulation study.

Methods

Trial-based economic evaluation data were simulated for different conditions (depression, low back pain, osteoarthritis, cancer), severity levels (mild, moderate, severe), and effect sizes (small, medium, large). For all 36 scenarios, utilities were calculated using 3L and 5L value sets and crosswalks (3L to 5L and 5L to 3L crosswalks) for the Netherlands, the United States, and Japan. Utilities, quality-adjusted life years (QALYs), incremental QALYs, incremental cost-effectiveness ratios (ICERs), and probabilities of cost-effectiveness (pCE) obtained from values sets and crosswalks were compared.

Results

Differences between value sets and crosswalks ranged from −0.33 to 0.13 for utilities, from −0.18 to 0.13 for QALYs, and from −0.01 to 0.08 for incremental QALYs, resulting in different ICERs. For small effect sizes, at a willingness-to-pay of €20,000/QALY, the largest pCE difference was found for moderate cancer between the Japanese 5L value set and 5L to 3L crosswalk (difference = 0.63). For medium effect sizes, the largest difference was found for mild cancer between the Japanese 3L value set and 3L to 5L crosswalk (difference = 0.06). For large effect sizes, the largest difference was found for mild osteoarthritis between the Japanese 3L value set and 3L to 5L crosswalk (difference = 0.08).

Conclusion

The use of crosswalks instead of EQ-5D value sets can impact cost–utility outcomes to such an extent that this may influence reimbursement decisions.

     

How Is Evidence on Test Performance Synthesized for Economic Decision Models of Diagnostic Tests? A Systematic Appraisal of Health Technology Assessments in the UK Since 1997

ObjectivesThe study aims to assess how evidence on diagnostic test accuracy is synthesized and used to inform economic decision modeling for HTA.MethodsAll reports evaluating diagnostic test via an economic decision model published by the NHS Research and Development Health Technology Assessment (HTA) program since 1997 were identified. The methods for evidence synthesis of diagnostic test accuracy data and its use in economic decision modeling in this sample were reviewed.ResultsForty-four HTA reports out of 474 concerned diagnostic accuracy, of which 11 did not do any economic evaluation. Of the remaining 33 HTAs, 14 conducted meta-analyses of diagnostic accuracy in the clinical review but only 8 used such pooled estimates to inform the decision model. A number of meta-analysis methods ranging in complexity were applied to estimate diagnostic accuracy. Nevertheless, when it came to informing the economic decision model, the majority of reviews used independent meta-analytic estimates of sensitivity and specificity.ConclusionsOften, very simplistic methods to estimate diagnostic test accuracy were used for purposes of informing an economic decision model. The assumptions made by the simplistic methods are usually invalid which may lead to suboptimal decisions being made. It is desirable that decision modelers become aware of the rapid evolution of meta-analysis methods in this area; however, further research is still required to identify how the pooled results obtained from the different meta-analysis models should best be used to inform economic decision models.     

Nothing About Us Without Us? A Comparison of Adolescent and Adult Health‐State Values for the Child Health Utility‐9D Using Profile Case Best–Worst Scaling

The main objective of this study was to compare and contrast adolescent and adult values for the Child Health Utility‐9D (CHU9D), a new generic preference‐based measure of health‐related quality of life designed for application in the economic evaluation of treatment and preventive programmes for children and adolescents. Previous studies have indicated that there may be systematic differences in adolescent and adult values for identical health states. An online survey including a series of best–worst scaling discrete choice experiment questions for health states defined by the CHU9D was administered to two general population samples comprising adults and adolescents, respectively. The results highlight potentially important age‐related differences in the values attached to CHU9D dimensions. Adults, in general, placed less weight upon impairments in mental health (worried, sad, annoyed) and more weight upon moderate to severe levels of pain relative to adolescents. The source of values (adults or adolescents) has important implications for economic evaluation and may impact significantly upon healthcare policy. Copyright © 2015 John Wiley & Sons, Ltd.