Health literacy and logical inconsistencies in valuations of hypothetical health states: results from the Canadian EQ-5D-5L valuation study

Objectives

To examine the association of health literacy with logical inconsistencies in time trade-off valuations of hypothetical health states described by the EQ-5D-5L classification system.

Methods

Data from the EQ-5D-5L Canadian Valuation study were used. Health literacy was assessed using the Brief Health Literacy Screen. A health state valuation was considered logically inconsistent if a respondent gave the same or lower value for a very mild health state compared to the value given to 55555, or gave the same or lower value for a very mild health state compared to value assigned to the majority of the health states that are dominated by the very mild health state.

Results

Average age of respondents (N?=?1209) was 48 (SD?=?17) years, 45% were male, 7% reported inadequate health literacy, and 11% had a logical inconsistency. In adjusted analysis, participants with inadequate health literacy were 2.2 (95%CI: 1.2, 4.0; p?=?0.014) times more likely to provide an inconsistent valuation compared to those with adequate health literacy. More specifically, those who had problems in “understanding written information” and “reading health information” were more likely to have a logical inconsistency compared to those who did not. However, lacking “confidence in completing medical forms” was not associated with logical inconsistencies.

Conclusions

Health literacy was associated with logical inconsistencies in valuations of hypothetical health states described by the EQ-5D-5L classification system. Valuations studies should consider assessing health literacy, and explore better ways to introduce the valuation tasks or use simpler approaches of health preferences elicitation for individuals with inadequate health literacy.

     

慢性病流行现状与基层防治对策

  目的  了解宁夏地区农村慢性病患者健康相关生命质量及其影响因素,为农村地区慢性病管理及预防控制提供参考依据。  方法  于2019年2月采用分层随机整群抽样方法在宁夏彭阳和盐池2个县抽取3267户农村居民进行问卷调查,分析其中年龄 ≥ 15岁且患有 ≥ 1种慢性病的2700例慢性病患者的健康相关生命质量及其影响因素。  结果  宁夏地区2700例农村慢性病患者中,存在自觉疼痛/不适问题1146例（42.4 %）,存在焦虑/沮丧问题677例（25.1 %）,存在行动能力问题664例（24.6 %）,存在日常活动能力问题618例（22.9 %）,存在自我照顾能力问题369例（13.7 %）;宁夏地区农村慢性病患者的健康效用值为（0.93 ± 0.12）;Tobit回归模型分析结果显示,女性健康效用值低于男性,年龄51～60岁、61～70岁和 > 70岁者健康效用值均低于年龄 < 50岁者,小学文化程度者健康效用值高于未上过学者。  结论  宁夏地区农村慢性病患者的健康相关生命质量较差,性别、年龄和文化程度是该地区农村慢性病患者健康效用值的主要影响因素。     

家庭APGAR问卷及其临床应用

目的对前期构建的“基于家庭医生制服务的家庭健康评估指标体系”进行实证研究,以了解斜土社区内居民家庭和个体的主要健康状况及影响因素,为家庭医生开展针对性的分层分类的健康管理提供实用性评估工具。方法选取上海市徐汇区斜土社区内500户常住签约家庭作为研究对象,采用问卷调查的形式进行实证研究评价。结果家庭常住人口(2.2±1.0)人,核心家庭占61.8%。家庭功能良好者占84.6%,有中度及严重障碍者占15.4%。57.9%的个体患有慢性病,在有慢性病患者的家庭中有2、3名患者的分别占38.2%、4.4%, 有2、3、4种及以上慢性病者分别占24.9%、22.1%、34.8%。35.5%的居民偶尔不注意服药,32.2%的居民自觉症状改善时曾停止服药。居民直观式健康量表评分为(75.46±15.47)分,在疼痛或不舒服、日常活动和行动三个维度存在较多的健康问题。结论家庭规模小型化、核心化,少部分家庭存在家庭功能障碍,家庭慢性病患病率较高,多病共存严重,部分居民遵医行为较差,且存在较多的健康问题。在健康评估基础上开展以家庭为单位的健康管理是家庭医生制服务的重点。     

Head-to-head comparison between the EQ-5D-5L and the EQ-5D-3L in general population health surveys

Background

The EQ-5D has been frequently used in national health surveys. This study is a head-to-head comparison to assess how expanding the number of levels from three (EQ-5D-3L) to five in the new EQ-5D-5L version has improved its distribution, discriminatory power, and validity in the general population.

Methods

A representative sample (N?=?7554) from the Catalan Health Interview Survey 2011–2012, aged ≥18, answered both EQ-5D versions, and we evaluated the response redistribution and inconsistencies between them. To assess validity of this redistribution, we calculated the mean of the Visual Analogue Scale (VAS), which measures perceived health. The discriminatory power was examined with Shannon Indices, calculated for each dimension separately. Spanish preference value sets were applied to obtain utility indices, examining their distribution with statistics of central tendency and dispersion. We estimated the proportion of individuals reporting the best health state in EQ-5D-5L and EQ-5D-3L within groups of specific chronic conditions and their VAS mean.

Results

A very small reduction in the percentage of individuals with the best health state was observed, from 61.8% in EQ-5D-3L to 60.8% in EQ-5D-5L. In contrast, a large proportion of individuals reporting extreme problems in the 3 L version moved to severe problems (level 4) in the 5 L version, particularly for pain/discomfort (75.5%) and anxiety/depression (66.4%). The average proportion of inconsistencies was 0.9%. The pattern of the perceived health VAS mean confirmed the hypothesis established a priori, supporting the validity of the observed redistribution. Shannon index showed that absolute informativity was higher in the 5 L version for all dimensions. The means (SD) of the Spanish EQ-5D-3L and EQ-5D-5L indices were 0.87 (0.25) and 0.89 (0.22). The proportion of individuals with the best health state within each specific chronic condition was very similar, regardless of the EQ-5D version (≤?30% in half of the 28 chronic conditions).

Conclusion

Although the proportion of individuals with the best possible health state is still very high, our findings support that the increase of levels provided by the EQ-5D-5L contributed to the validity and discriminatory power of this new version to measure health in general population, as in the national health surveys.

     

Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study

Purpose

The aim of this study was to assess the measurement properties of the 5-level classification system of the EQ-5D (5L), in comparison with the 3-level EQ-5D (3L).

Methods

Participants (n = 3,919) from six countries, including eight patient groups with chronic conditions (cardiovascular disease, respiratory disease, depression, diabetes, liver disease, personality disorders, arthritis, and stroke) and a student cohort, completed the 3L and 5L and, for most participants, also dimension-specific rating scales. The 3L and 5L were compared in terms of feasibility (missing values), redistribution properties, ceiling, discriminatory power, convergent validity, and known-groups validity.

Results

Missing values were on average 0.8 % for 5L and 1.3 % for 3L. In total, 2.9 % of responses were inconsistent between 5L and 3L. Redistribution from 3L to 5L using EQ dimension-specific rating scales as reference was validated for all 35 3L–5L-level combinations. For 5L, 683 unique health states were observed versus 124 for 3L. The ceiling was reduced from 20.2 % (3L) to 16.0 % (5L). Absolute discriminatory power (Shannon index) improved considerably with 5L (mean 1.87 for 5L versus 1.24 for 3L), and relative discriminatory power (Shannon Evenness index) improved slightly (mean 0.81 for 5L versus 0.78 for 3L). Convergent validity with WHO-5 was demonstrated and improved slightly with 5L. Known-groups validity was confirmed for both 5L and 3L.

Conclusions

The EQ-5D-5L appears to be a valid extension of the 3-level system which improves upon the measurement properties, reducing the ceiling while improving discriminatory power and establishing convergent and known-groups validity.     

Comparing EQ-5D-3L and EQ-5D-5L performance in common cancers: suggestions for instrument choosing

Purpose

To compare the performance of three-level EuroQol five-dimensions (EQ-5D-3L) and five-level EuroQol five-dimensions (EQ-5D-5L) among common cancer patients in urban China.

Methods

A hospital-based cross-sectional survey was conducted in three provinces from 2016 to 2018 in urban China. Patients with breast cancer, colorectal cancer, or lung cancer were recruited to complete the EQ-5D-3L and EQ-5D-5L questionnaires. Response distribution, discriminatory power (indicator: Shannon index [H′] and Shannon evenness index [J′]), ceiling effect (the proportion of full health state), convergent validity, and health-related quality of life (HRQoL) were compared between the two instruments.

Results

A total of 1802 cancer patients (breast cancer: 601, colorectal cancer: 601, lung cancer: 600) were included, with the mean age of 55.6 years. The average inconsistency rate was 4.4%. Compared with EQ-5D-3L (average: H′?=?1.100, J′?=?0.696), an improved discriminatory power was observed in EQ-5D-5L (H′?=?1.473, J′?=?0.932), especially contributing to anxiety/depression dimensions. The ceiling effect was diminished in EQ-5D-5L (26.5%) in comparison with EQ-5D-3L (34.5%) (p?<?0.001), mainly reflected in the pain/discomfort and anxiety/depression dimensions. The overall utility score was 0.790 (95% CI 0.778–0.801) for EQ-5D-3L and 0.803 (0.790–0.816) for EQ-5D-5L (p?<?0.001). A similar pattern was also observed in the detailed cancer-specific analysis.

Conclusions

With greater discriminatory power, convergent validity and lower ceiling, EQ-5D-5L may be preferable to EQ-5D-3L for the assessment of HRQoL among cancer patients. However, higher utility scores derived form EQ-5D-5L may also lead to lower QALY gains than those of 3L potentially in cost-utility studies and underestimation in the burden of disease.

     

Measuring the acceptability of EQ-5D-3L health states for different ages: a new adaptive survey methodology

Background

Acceptable health and sufficientarianism are emerging concepts in health resource allocation. We defined acceptability as the proportion of the general population who consider a health state acceptable for a given age. Previous studies surveyed the acceptability of health problems separately per EQ-5D-3L domain, while the acceptability of health states with co-occurring problems was barely explored.

Objective

To quantify the acceptability of 243 EQ-5D-3L health states for six ages from 30 to 80 years: 1458 health state–age combinations (HAcs), denoted as the acceptability set of EQ-5D-3L.

Methods

In 2019, an online representative survey was conducted in the Hungarian general population. We developed a novel adaptive survey algorithm and a matching statistical measurement model. The acceptability of problems was evaluated separately per EQ-5D-3L domain, followed by joint evaluation of up to 15 HAcs. The selection of HAcs depended on respondents’ previous responses. We used an empirical Bayes measurement model to estimate the full acceptability set.

Results

1375 respondents (female: 50.7%) were included with mean (SD) age of 46.7 (14.6) years. We demonstrated that single problems that were acceptable separately for a given age were less acceptable when co-occurring jointly (p < 0.001). For 30 years of age, EQ-5D-3L health states of ‘11112’ (11.9%) and ‘33333’ (1%), while for 80 years of age ‘21111’ (93.3%) and ‘33333’ (7.4%) had highest and lowest acceptability (% of population), respectively.

Conclusion

The acceptability set of EQ-5D-3L quantifies societal preferences concerning age and disease severity. Its measurement profiles and potential role in health resource allocation needs further exploration.

     

EQ-5D-5L versus EQ-5D-3L: The Impact on Cost Effectiveness in the United Kingdom

Objectives

To model the relationship between the three-level (3L) and the five-level (5L) EuroQol five-dimensional questionnaire and examine how differences have an impact on cost effectiveness in case studies.

An International Comparison of EQ-5D-5L and EQ-5D-3L for Use in Cost-Effectiveness Analysis

ObjectivesTo estimate the impact of using EQ5D-5L (5L) compared with EQ5D-3L (3L) in cost-effectiveness analyses in 6 countries with 3L and 5L values: Germany, Japan, Korea, The Netherlands, China, and Spain.MethodsEight cost-effectiveness analyses based on clinical studies with 3L provided 11 pairwise comparisons. We estimated cost-effectiveness by applying the appropriate country values for 3L to observed responses. We re-estimated cost-effectiveness for each country by predicting the 5L tariff score for each respondent, for each country, using a previously published mapping method. We compared results in terms of impact on estimated incremental quality-adjusted life-year (QALY) gain and cost-effectiveness ratios.ResultsFor most countries the impact of moving from 3L to 5L is to lower the incremental QALY gain in the majority of comparisons. The only exception to this was Japan, where 4 out of 11 cases (37%) saw lower QALYs gained when using 5L. The mean and median reductions in health gain, in those case studies where 5L does lead to lower health gain, are largest in The Netherlands (84% mean reduction, 41% median reduction), Germany (68% and 27%), and Spain (30% and 31%). For most countries, those studies where 5L leads to lower health gain see larger reductions than the gains in studies showing the opposite tendency.ConclusionsOverall, 3L and 5L are not interchangeable in these countries. Differences between results are large, but the direction of change can be unpredictable. These findings should prompt further investigation into the reasons for differences.     

A social preference valuations set for EQ-5D health states in Flanders, Belgium

This study aimed at deriving a preference valuation set for EQ-5D health states from the general Flemish public in Belgium. A EuroQol valuation instrument with 16 health states to be valued on a visual analogue scale was sent to a random sample of 2,754 adults. The initial response rate was 35%. Eventually, 548 (20%) respondents provided useable valuations for modeling. Valuations for 245 health states were modeled using a random effects model. The selection of the model was based on two criteria: health state valuations must be consistent, and the difference with the directly observed valuations must be small. A model including a value decrement if any health dimension of the EQ-5D is on the worst level was selected to construct the social health state valuation set. A comparison with health state valuations from other countries showed similarities, especially with those from New Zealand. The use of a single preference valuation set across different health economic evaluations within a country is highly preferable to increase their usability for policy makers. This study contributes to the standardization of outcome measurement in economic evaluations in Belgium.     

Comparison between the EQ-5D-5L and the EQ-5D-3L in patients with hepatitis B

Objectives

The purpose of the study was to compare psychometric properties of the EQ-5D-5L (5L) and the EQ-5D-3L (3L) health outcomes assessment instruments in patients with hepatitis B in China.

Methods

Patients, including hepatitis B virus carriers and those with active or inactive chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis or hepatocellular carcinoma, answered a questionnaire composed of 5L, socio-demographic information, 3L, and the visual analog scale (VAS), respectively. After 1 week, a retest was conducted for inpatients. We compared acceptability, face validity, redistribution properties, convergent validity, known-group validity, discriminatory power, ceiling effect, test–retest reliability, and responsiveness of 5L and 3L.

Results

A total of 369 outpatients and 276 inpatients were recruited for the first interview. Of the inpatients, 183 were used in the retest. Most patients preferred 5L–3L. The 3L–5L response pairs had an inconsistency rate of 2.4 %. Correlation with the VAS was greater with 5L than with 3L. Age, education, and comorbidity were associated with health-related quality of life (HRQoL). 5L discriminated more infectious conditions than 3L. In all dimensions, the Shannon’s index from 5L was larger while in three dimensions the Shannon’s evenness index from 5L was slightly larger. The ceiling effect was reduced in 5L. In patients with stable health states, no significant difference was detected in the weighted kappa between 5L and 3L, but intraclass correlation coefficient of 5L was higher than that of 3L. In patients with improved health states, HRQoL was seen as increased in both 5L and 3L, without significant difference.

Conclusions

The EQ-5D-5L was more suitable than the EQ-5D-3L in the patients with hepatitis B in China.     

A comparison of United Kingdom and Spanish general population time trade-off values for EQ-5D health states.

Few studies have compared preference values for health states obtained in different countries. The present study compared Spanish and United Kingdom (UK) time trade-off values for EuroQol-5D health states. The same preference elicitation protocol was followed in both countries. Differences in values for 43 health states rated directly were analyzed using t tests, and regression coefficients generated by random effects modeling were compared by aggregating the 2 value sets and using dummy variables to analyze country effect by dimension and level of severity. For the milder health states, Spanish and UK value assignation was similar; for intermediate health states, Spanish values were both higher and lower than UK values, whereas for health states worse than death, UK values were generally higher than Spanish values. There were statistically significant differences (P < 0.01) in values for 34.9% of health states rated directly, and some preference reversals between countries. UK raters ascribed greater importance to dimensions of pain/discomfort and anxiety/depression, whereas Spanish raters placed more importance on functional dimensions of mobility and self-care. Further analysis is required to determine how these differences affect cost-effectiveness and cost-utility analyses.     

Correction to: Time and lexicographic preferences in the valuation of EQ-5D-Y with time trade-off methodology

The European Journal of Health Economics -     

Japanese population norms for preference-based measures: EQ-5D-3L,EQ-5D-5L,and SF-6D

Quality of Life Research - The purpose of this study was to measure the population norms for the Japanese versions of preference-based measures (EQ-5D-3L, EQ-5D-5L, and SF-6D). We also considered...