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Al Rabayah A, Roudijk B, Purba FD, Rencz F, Jaddoua S, Siebert U. Valuation of the EQ-5D-3L in Jordan. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-024-01712-z. [PMID: 39225720 DOI: 10.1007/s10198-024-01712-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 07/17/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND In Jordan, no national value set is available for any preference-accompanied health utility measure. OBJECTIVE This study aims to develop a value set for EQ-5D-3L based on the preferences of the Jordanian general population. METHODS A representative sample of the Jordanian general population was obtained through quota sampling involving age, gender, and region. Participants aged above 18 years were interviewed via videoconferencing using the EuroQol Valuation Technology 2.1 protocol. Participants completed ten composite time trade-offs (cTTO) and ten discrete choice experiments (DCE) tasks. cTTO and DCE data were analyzed using linear and logistic regression models, respectively, and hybrid models were applied to the combined DCE and cTTO data. RESULTS A total of 301 participants with complete data were included in the analysis. The sample was representative of the general population regarding region, age, and gender. All model types applied, that is, random intercept model, random intercept Tobit, linear model with correction for heteroskedasticity, Tobit with correction for heteroskedasticity, and all hybrid models, were statistically significant. They showed logical consistency in terms of higher utility decrements with more severe levels. The hybrid model corrected for heteroskedasticity was selected to construct the Jordanian EQ-5D-3L value set as it showed the best fit and lowest mean absolute error. The predicted value for the most severe health state (33333) was - 0.563. Utility decrements due to mobility had the largest weight, followed by anxiety/depression, while usual activities had the smallest weight. CONCLUSION This study provides the first EQ-5D-3L value set in the Middle East. The Jordanian EQ-5D-3L value set can now be used in health technology assessments for health policy planning by the Jordanian health sector's decision-makers.
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Affiliation(s)
- Abeer Al Rabayah
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria.
- Center for Drug Policy and Technology Assessment, Pharmacy Department, King Hussein Cancer Center, Amman, Jordan.
| | - Bram Roudijk
- EuroQol Research Foundation, Rotterdam, The Netherlands
| | | | - Fanni Rencz
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary
| | - Saad Jaddoua
- Pharmacy Department, King Hussein Cancer Center, Amman, Jordan
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT TIROL-University for Health Sciences and Technology, Hall in Tirol, Austria
- Division of Health Technology Assessment, ONCOTYROL-Center for Personalized Cancer Medicine, Innsbruck, Austria
- Center for Health Decision Science, Departments of Epidemiology and Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Cao Y, Zhang H, Luo N, Li H, Cheng LJ, Huang W. Assessing the reliability of a novel cancer-specific multi-attribute utility instrument (FACT-8D) and comparing its validity to EQ-5D-5L in colorectal cancer patients. Qual Life Res 2024:10.1007/s11136-024-03774-1. [PMID: 39225938 DOI: 10.1007/s11136-024-03774-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To examine the test-retest reliability of the Functional Assessment of Cancer Therapy - 8 Dimension (FACT-8D) for the first time, and to conduct a head-to-head comparison of the distribution properties and validity between the FACT-8D and EQ-5D-5L in Colorectal Cancer (CRC) Patients. METHODS We conducted a longitudinal study on Chinese CRC patients, employing Functional Assessment of Cancer Therapy-General (FACT-G) and EQ-5D-5L at baseline, and FACT-G during follow-up (2-7 days from baseline). Utility scores for FACT-8D were derived from all available value sets (Australia, Canada and USA), while EQ-5D-5L scores were obtained from corresponding value sets for various countries. We assessed convergent validity using pairwise polychoric correlations between the FACT-8D and EQ-5D-5L; known-groups validity by discriminating participants' clinical characteristics, and effect size (ES) was tested; test-retest reliability for FACT-8D using kappa and weighted Kappa for choice consistency, and intraclass correlation coefficient (ICC) and Bland-Altman method for utility consistency. RESULTS Among the 287 patients with CRC at baseline, 131 were included in the retest analysis. The utility scores of FACT-8D were highly positively correlated with EQ-5D-5L across various country value sets (r = 0.65-0.77), and most of the dimensions of FACT-8D and EQ-5D-5L were positively correlated. EQ-5D-5L failed to discriminate known-groups in cancer stage across all value sets, whereas both were significant in FACT-8D (ES = 0.35-0.48, ES = 0.38-0.52). FACT-8D showed good test-retest reliability (Cohen's weighted Kappa = 0.494-0.722, ICC = 0.748-0.786). CONCLUSION The FACT-8D can be used as a valid and reliable instrument for clinical evaluation of patients with CRC, outperforming EQ-5D-5L in differentiating clinical subgroups and showing promise for cancer practice and research.
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Affiliation(s)
- Yiyin Cao
- School of Health Management, Harbin Medical University, Harbin, China
| | - Huan Zhang
- The Third Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Haofei Li
- School of Health Management, Harbin Medical University, Harbin, China
| | - Ling Jie Cheng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Weidong Huang
- School of Health Management, Harbin Medical University, Harbin, China.
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Roudijk B, Jonker MF, Bailey H, Pullenayegum E. A Direct Comparison Between Discrete Choice With Duration and Composite Time Trade-Off Methods: Do They Produce Similar Results? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:1280-1288. [PMID: 38843979 DOI: 10.1016/j.jval.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/02/2024] [Accepted: 05/17/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVES Discrete choice experiments including a duration attribute (DCEd) represent a promising candidate method for valuing health-related quality-of-life instruments. However, it has not been established that DCEd can produce similar results as composite time trade-off (cTTO) or EuroQol Valuation Technology (EQ-VT) valuations of the EQ-5D-5L instrument. This study provides a direct comparison between cTTO and EQ-VT, and DCEd valuation methods. METHODS An EQ-VT study was conducted in Trinidad and Tobago to value the EQ-5D-5L. 1079 respondents each completed 10 cTTO tasks and 12 discrete choice experiments tasks without a duration attribute. A separate sample of 970 respondents each completed 18 split-triplet DCEd tasks. Several regression models were applied to the EQ-VT data, and the DCEd data were analyzed using mixed logit models with an exponential discount rate. The estimated values were compared using scatterplots and Bland-Altman plots. RESULTS The ordering of dimensions was identical in level 5 for cTTO/EQ-VT and DCEd models, with pain/discomfort being the most important dimension and usual activities being least important. cTTO/EQ-VT models produced a value for state 55555 ranging between -0.52 and -0.69, whereas this was -0.543 for the nonlinear mixed logit model for the DCEd data. Scatterplots and Bland-Altman plots suggested excellent agreement between cTTO/EQ-VT and DCEd-based estimates. CONCLUSIONS CTTO/EQ-VT and DCEd valuations produce similar results when correcting DCEd for nonlinear time preferences. The ordering of importance of the dimensions and scale are identical, suggesting that the 2 methods measure the same construct and produce similar results.
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Affiliation(s)
- Bram Roudijk
- EuroQol Research Foundation, Rotterdam, The Netherlands; Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Marcel F Jonker
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Centre for Health Economics Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Henry Bailey
- Department of Economics, The University of the West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago; HEU, Centre for Health Economics, The University of the West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Espirito Santo CM, Miyamoto GC, Santos VS, Ben ÂJ, Finch AP, Roudijk B, de Jesus-Moraleida FR, Stein AT, Santos M, Yamato TP. Estimating an EQ-5D-Y-3L Value Set for Brazil. PHARMACOECONOMICS 2024; 42:1047-1063. [PMID: 38954389 PMCID: PMC11343814 DOI: 10.1007/s40273-024-01404-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION The EQ-5D-Y-3L is a generic measure of health-related quality of life in children and adolescents. Although the Brazilian-Portuguese EQ-5D-Y-3L version is available, there is no value set for it, hampering its use in economic evaluations. This study aimed to elicit a Brazilian EQ-5D-Y-3L value set based on preferences of the general adult population. METHODS Two independent samples of adults participated in an online discrete choice experiment (DCE) survey and a composite time trade-off (cTTO) face-to-face interview. The framing was "considering your views for a 10-year-old child". DCE data were analyzed using a mixed-logit model. The 243 DCE predicted values were mapped into the observed 28 cTTO values using linear and non-linear mapping approaches with and without intercept. Mapping approaches' performance was assessed to estimate the most valid method to rescale DCE predicted values using the model fit (R2), Akaike Information Criteria (AIC), root mean squared error (RMSE), and mean absolute error (MAE). RESULTS A representative sample of 1376 Brazilian adults participated (DCE, 1152; cTTO, 211). The linear mapping without intercept (R2 = 96%; AIC, - 44; RMSE, 0.0803; MAE, - 0.0479) outperformed the non-linear without intercept (R2 = 98%; AIC, - 63; RMSE, 0.1385; MAE, - 0.1320). Utilities ranged from 1 (full health) to - 0.0059 (the worst health state). Highest weights were assigned to having pain or discomfort (pain/discomfort), followed by walking about (mobility), looking after myself (self-care), doing usual activities (usual activities), and feeling worried, sad, or unhappy (anxiety/depression). CONCLUSION This study elicited the Brazilian EQ-5D-Y-3L value set using a mixed-logit DCE model with a power parameter based on a linear mapping without intercept, which can be used to estimate the quality-adjusted life-years for economic evaluations of health technologies targeting the Brazilian youth population.
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Affiliation(s)
- Caique Melo Espirito Santo
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesário Galeno, 448/475, Tatuapé, São Paulo, 03071-000, Brazil
| | - Gisela Cristiane Miyamoto
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesário Galeno, 448/475, Tatuapé, São Paulo, 03071-000, Brazil
| | - Verônica Souza Santos
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesário Galeno, 448/475, Tatuapé, São Paulo, 03071-000, Brazil
| | - Ângela Jornada Ben
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Bram Roudijk
- EuroQol Research Foundation, Rotterdam, The Netherlands
| | | | - Airton Tetelbom Stein
- Department of Public Health, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marisa Santos
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - Tiê Parma Yamato
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesário Galeno, 448/475, Tatuapé, São Paulo, 03071-000, Brazil.
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, Australia.
- Nepean Blue Mountains Local Health District, Penrith, NSW, Australia.
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Yang Z, Rand K, Stolk E, Busschbach J, Luo N. Exploring non-iterative time trade-off methods for valuation of EQ-5D-5L health states. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:1087-1094. [PMID: 38104294 DOI: 10.1007/s10198-023-01647-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION The composite time trade-off (cTTO) method is used as the primary method for valuing EQ-5D-5L health states, but it requires intensive interviewer training and stringent quality control, which increases the burden of conducting cTTO studies. In this study, two non-iterative variants of the TTO method, non-stopping TTO (nTTO) and open-ended TTO (oTTO), were tested head-to-head with the cTTO method aiming to reduce the administration burden. METHODS 31 EQ-5D-5L health states from an orthogonal array was selected and valued by a general public sample in China. Data were collected by 7 interviewers with all interviewers performed an equal number of interviews using all three TTO methods. We compared the value distribution, logical consistency, administration burden, and modeling performance of these three TTO methods. RESULTS In total, 422 participants participated in the valuation interviews, with 139 using the nTTO method, 140 using the oTTO method, and 143 using the cTTO method. Both oTTO and nTTO methods saved around 10 min for conducting an interview. The mean values of three methods were similar with each method showed different characteristics in their value distributions. cTTO outperformed the other two methods in terms of modeling performance. DISCUSSION Both non-iterative TTO methods showed potential for valuing EQ-5D health states, although their data distributions and modeling performance were inferior to the cTTO method. The results of this study showed the potential of these two alternative non-iterative TTO methods.
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Affiliation(s)
- Zhihao Yang
- Department of Health Services Management, Guizhou Medical University, Guiyang, China
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, China
| | - Kim Rand
- Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway
- Maths in Health B.V, Rotterdam, The Netherlands
| | - Elly Stolk
- EuroQol Research Foundation, Rotterdam, The Netherlands
| | - Jan Busschbach
- Section of Medical Psychiatry and Psychotherapy, Erasmus Medical Centrum, Rotterdam, The Netherlands
| | - Nan Luo
- Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2, Singapore, Singapore.
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Farris M, Goodall S, De Abreu Lourenco R, Mulhern B, Manipis K, Meshcheriakova E, Lewandowska M. Estimating Australian Population Utilities for Inherited Retinal Disease Using Time Trade-Off. PHARMACOECONOMICS - OPEN 2024:10.1007/s41669-024-00515-5. [PMID: 39102180 DOI: 10.1007/s41669-024-00515-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE Inherited retinal disease (IRD) causes progressive loss of visual function, degenerating towards complete blindness. Economic evaluation of gene therapies for rare forms of genetic IRDs have had to rely on health-related quality of life (HR-QoL) estimates from other diseases because there is limited data available for such a rare condition. This study aimed to estimate Australian societal-based utility values for IRD health states that can be used in cost-utility analyses (CUA) using a time trade-off (TTO) protocol adapted from a UK study. METHODS The EuroQol Valuation Technology (EQVT) protocol composite TTO (cTTO) framework was followed, which includes worse-than-death (WTD) states and quality control (QC) measures. Preferences were collected from a general population sample of 110 Australian adult participants. Five health state vignettes from the UK study which had been validated with patients and clinicians were presented randomly to participants during videoconferencing (VC) interviews with one of four interviewers. Technical and protocol feasibility were assessed in a pilot of 10 interviews. QC measures were used to monitor interviewers' performance during the study. RESULTS One participant withdrew consent. The final analysis was conducted on 109 respondents (including 4 non-traders). The average time to complete the interview was 44.2 minutes (SD 8.7). Participants reported mean visual analogue scale (VAS) scores between 63.15 for 'moderate impairment' and 17.98 for 'hand motion' to 'no light perception'. Mean health state utilities (HSU) varied between 0.76 (SD 0.26) in 'moderate impairment', and 0.20 (SD 0.58) in 'hand motion' to 'no light perception'. Of all HSU evaluations, 14% were considered WTD which most commonly occurred in the most severe visually impaired health state. CONCLUSION This study provides valuable information on HSUs across a range of IRD health states from the Australian general population perspective. The utilities obtained in this study can be used as inputs into CUA of IRD therapies.
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Affiliation(s)
- Maria Farris
- Novartis Pharmaceuticals Australia, Macquarie Park, Australia.
| | - Stephen Goodall
- Centre for Health Economic Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economic Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Brendan Mulhern
- Centre for Health Economic Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Kathleen Manipis
- Centre for Health Economic Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Elena Meshcheriakova
- Centre for Health Economic Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Milena Lewandowska
- Centre for Health Economic Research and Evaluation, University of Technology Sydney, Sydney, Australia
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Chai Q, Yang Z, Liu X, An D, Du J, Ma X, Rand K, Wu B, Luo N. Valuation of EQ-5D-5L health states from cancer patients' perspective: a feasibility study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:915-924. [PMID: 37837519 DOI: 10.1007/s10198-023-01635-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/20/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES To assess the feasibility of estimating an EQ-5D-5L value set using a small study design in cancer patients and to compare the EQ-5D-5L values based on the preferences of cancer patients with those of the general public. METHODS Patients with clinically diagnosed cancers were recruited from two hospitals in Shanghai, China. In face-to-face interviews using the EQ-PVT survey, health states were valued by cancer patients using both cTTO and DCE methods. cTTO data was modelled alone or jointly with DCE data. Forty-eight models using different model specifications (cross-attribute level effect [CALE] and additive models), random/fixed effects model assumptions, data heteroscedasticity and censoring were estimated. The best performed model was identified in terms of monotonicity of estimated model coefficients and out-of-sample prediction accuracy. RESULTS Data collected from 221 cancer patients who participated in the study were included. The hybrid CALE model using both TTO and DCE data performed best in terms of prediction accuracy (Lin's concordance coefficient = 0.989; root mean squared error = 0.058) and suggested that pain/discomfort and anxiety/depression were the most undesirable health problems. Compared to values based on general Chinese public's health preferences, the values based on cancer patients' preferences were much higher and lower for health states characterized by extreme mobility problems and severe/extreme pain or discomfort, respectively. CONCLUSION This study demonstrated the feasibility of using a small design to develop EQ-5D-5L value sets based on cancer patients' health preferences. Since there were signs of differences between preferences of patients and general population, it may be valuable to develop patient-specific value sets and use them in clinical decision making and economic evaluations.
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Affiliation(s)
- Qingqing Chai
- Department of Pharmacy, Huangpu Branch, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhihao Yang
- Health Services Management Department, Guizhou Medical University, Gui'an, China
| | - Xiaoyan Liu
- Department of Pharmacy, Huangpu Branch, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Di An
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiangyang Du
- Department of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiumei Ma
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kim Rand
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Bin Wu
- Department of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
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Bailey H, Roudijk B, Brathwaite R. The EQ-5D-3L valuation study for Bermuda: using an on-line EQ-VT protocol. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-024-01701-2. [PMID: 38982011 DOI: 10.1007/s10198-024-01701-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/15/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND In many countries, methods of economic evaluation and Health Technology Assessment are used to inform healthcare resource allocation decisions. These approaches often require EQ-5D health outcomes measures. This study aimed to create an EQ-5D-3L value set for Bermuda from which EQ-5D-5L Crosswalk values could be obtained. METHODS Respondents in Bermuda were recruited locally. A team of Trinidad-based interviewers with prior EQ-5D-3L valuation experience conducted valuation interviews on-line using the EQ-VT protocol. Respondents completed composite time-trade off (cTTO) and discrete choice experiment (DCE) tasks. A hybrid model that included both the cTTO and DCE data was estimated. An EQ-5D-5L crosswalk value set was then created from the EQ-5D-3L index values. Coefficients in the resulting crosswalk model were compared with those of crosswalk and valuation studies from other countries. RESULTS The valuation tasks were completed by a near-representative sample of 366 adult Bermuda citizens. Half of the respondents reported being in state 11111. The lowest EQ VAS and EQ-5D-3L index values were 20 and - 0.120 respectively. The hybrid model produced all logically consistent and statistically significant coefficients that in turn produced index values that were very similar to those obtained in a preliminary model (MAD of 0.027). DISCUSSION The on-line EQ-VT valuation study was successfully conducted in Bermuda and the values therein can now be used for economic analysis in Bermuda. The Bermuda values differed considerably from those of the other countries against which they were compared. Challenges were encountered with recruitment for an on-line survey in a small population.
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Affiliation(s)
- Henry Bailey
- Department of Economics, The University of the West Indies, St Augustine Campus, St. Augustine, Trinidad and Tobago.
- HEU, Centre for Health Economics, The University of the West Indies, St Augustine Campus, St. Augustine, Trinidad and Tobago.
| | - Bram Roudijk
- EuroQol Research Foundation, Rotterdam, The Netherlands
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ricky Brathwaite
- Bermuda Health Council, Health Economics Directorate, Hamilton, Bermuda
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Jonker MF, Roudijk B. A New and Improved Experimental Design for the Discrete Choice Experiment Module of the EuroQol Valuation Technology Protocol. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02744-X. [PMID: 38977189 DOI: 10.1016/j.jval.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/07/2024] [Accepted: 05/30/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVES The EuroQol Valuation Technology (EQ-VT) protocol, which is used to value the EQ-5D-5L instrument, comprises a composite time trade-off and a discrete choice experiment (DCE) module. Despite significant limitations, the DCE module has not been updated since its inception in 2012. This study aimed to update the EQ-VT DCE design using state-of-the-art methods. METHODS DCE data from 19 EQ-5D-5L valuation studies were summarized using a Bayesian hierarchical meta-analysis model, which created the priors for our Bayesian efficient DCE design. This design comprised 20 subdesigns, each with 12 choice tasks, and included 2 levels that overlapped to reduce the complexity of the choice tasks. The relative efficiency and robustness of the new design were established by comparing the D-errors and minimal sample size requirements for the 19 within-sample and 7 out-of-sample countries with the previous DCE design. RESULTS The updated DCE design shows large reductions in the D-error: by 20% and 22% for the 19 within-sample and 7 out-of-sample countries, respectively. Sample size requirements were also reduced, resulting in an average reduction of 45% for both the within and out-of-sample countries. CONCLUSIONS The updated DCE design outperforms the current EQ-VT design. Given its enhanced performance and reduced complexity, it is set to replace the existing DCE design in future EQ-5D-5L valuation studies using the EQ-VT protocol.
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Affiliation(s)
- Marcel F Jonker
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Bram Roudijk
- EuroQol Research Foundation, Rotterdam, The Netherlands; Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
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Yang Z, Rand K, Luo N. Valuation of Multi-Dimensional Health States With a Bolt-On: Is There a Shortcut? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02757-8. [PMID: 38977194 DOI: 10.1016/j.jval.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 06/21/2024] [Accepted: 06/21/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVES To use the EQ-5D questionnaire with bolt-on dimensions in economic evaluation studies, new value sets are needed. In this study, we explored the feasibility of a new approach called the scaling factor model, which estimates bolt-on value sets using estimated EQ-5D dimensional weights. METHODS We designed a 2-arm study, inviting university students to value health states with and without bolt-on items using the composite time trade-off method. We selected 25 health states from an orthogonal array and added the 5 mildest EQ-5D states in the design. In arm 1, EQ-5D without self-care and standard EQ-5D states were valued, and in arm 2, standard EQ-5D states and EQ-5D with vision were valued. By arm, we compared the mean observed values of health states with and without bolt-on item. Next, by arm, we estimated value sets for the EQ-5D with bolt-on states using both standard model and scaling factor model. Model performances were compared in terms of prediction accuracy and correlation with likelihood-based mean values. RESULTS Adding a five-level bolt-on to EQ-5D resulted in statistically lower values. This effect was consistent across 2 arms and bolt-on items. The scaling factor models outperformed the standard models in all statistics. CONCLUSIONS The scaling factor model offers a methodologically viable and low-cost option for producing value sets for EQ-5D supplemented with bolt-on items. Future studies should further test this method using other bolt-on items and more relevant study populations.
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Affiliation(s)
- Zhihao Yang
- Health Services Management Department, Guizhou Medical University, Guian, China; Medical Psychiatry and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Kim Rand
- Health Services Research Center, Akershus University Hospital, Lørenskog, Norway; Math in Health B.V., Rotterdam, The Netherlands
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
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Bailey H, Jonker MF, Pullenayegum E, Rencz F, Roudijk B. The EQ-5D-5L valuation study for Trinidad and Tobago. Health Qual Life Outcomes 2024; 22:51. [PMID: 38956543 PMCID: PMC11218064 DOI: 10.1186/s12955-024-02266-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 06/04/2024] [Indexed: 07/04/2024] Open
Abstract
PURPOSE The 2016 EQ-5D-3L value set for Trinidad and Tobago (T&T) allows for the calculation of EQ-5D-5L values via the crosswalk algorithm. The 2016 value set was based on methods predating the EQ-VT protocol, now considered the gold standard for developing EQ-5D value sets. Furthermore, direct elicitation of EQ-5D-5L is preferred over crosswalked values. This study aimed to produce an EQ-5D-5L value set for T&T. METHODS A representative sample (age, sex, geography) of adults each completed 10 composite Time Trade-Off (cTTO) tasks and 12 Discrete Choice Experiment (DCE) tasks in face-to-face interviews. The cTTO data were analyzed using a Tobit model that corrects for heteroskedasticity. DCE data were analyzed using a mixed logit model. The cTTO and DCE data were combined in hybrid models. RESULTS One thousand and seventy-nine adults completed the valuation interviews. Among the modelling approaches that were explored, the hybrid heteroskedastic Tobit model produced all internally consistent, statistically significant coefficients, and performed best in terms of out-of-sample predictivity for single states. Compared to the existing EQ-5D-5L crosswalk set, the new value set had a higher number of negative values (236 or 7.6% versus 21 or 0.7%). The mean absolute difference was 0.157 and the correlation coefficient between the two sets was 0.879. CONCLUSION This study provides a value set for the EQ-5D-5L for T&T using the EQ-VT protocol. We recommend this value set for QALY computations relating to T&T.
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Affiliation(s)
- Henry Bailey
- Department of Economics, The University of the West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago.
- HEU, Centre for Health Economics, The University of the West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago.
| | - Marcel F Jonker
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, The Hospital for Sick Children; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Fanni Rencz
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary
| | - Bram Roudijk
- EuroQol Research Foundation, Rotterdam, the Netherlands
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands
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Hill SR, Gibson A, Oluboyede Y, Longworth L, Bennett B, Shaw JW. A Methodological Study to Compare Alternative Modes of Administration With Value EQ-5D Using Preference-Elicitation Techniques. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:784-793. [PMID: 38467189 DOI: 10.1016/j.jval.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 02/07/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES Time trade-off (TTO) and discrete choice experiment (DCE) preference-elicitation techniques can be administered using face-to-face interviews (F2F), unassisted online (UO) surveys, or remote-assisted (RA) interviews. The objective of this study was to explore how the mode of administration affects the quality and reliability of preference-elicitation data. METHODS EQ-5D-5L health states were valued using composite TTO (cTTO) and DCE approaches by the UK general population. Participants were allocated to 1 of 2 study groups. Group A completed both F2F and UO surveys (n = 271), and group B completed both RA and UO surveys (n = 223). The feasibility of survey completion and the reliability and face-validity of data collected were compared across all modes of administration. RESULTS Fewer participants reported receiving sufficient guidance on the cTTO tasks during the UO survey compared with the 2 assisted modes. Participants across all modes typically reported receiving sufficient guidance on the DCE tasks. cTTO data were less reliable from the UO survey compared with both assisted modes, but there were no differences in DCE data reliability. cTTO data from all modes demonstrated face-validity; however, the UO survey produced higher utilities for moderate and severe health states than both assisted modes. Both F2F and RA modes provided comparably reliable data. CONCLUSIONS The reliability of DCE data is not affected by the mode of administration. Interviewer-assisted modes of administration (F2F or RA) yield more reliable cTTO data than unassisted surveys. Both F2F and RA surveys produced similar-quality data.
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Whitty JA, Lancsar E, De Abreu Lourenco R, Howard K, Stolk EA. Putting the Choice in Choice Tasks: Incorporating Preference Elicitation Tasks in Health Preference Research. THE PATIENT 2024:10.1007/s40271-024-00696-5. [PMID: 38744798 DOI: 10.1007/s40271-024-00696-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/16/2024]
Abstract
Choice-based preference elicitation methods such as the discrete choice experiment (DCE) present hypothetical choices to respondents, with an expectation that these hypothetical choices accurately reflect a 'real world' health-related decision context and that consequently the choice data can be held to be a true representation of the respondent's health or treatment preferences. For this to be the case, careful consideration needs to be given to the format of the choice task in a choice experiment. The overarching aim of this paper is to highlight important aspects to consider when designing and 'setting up' the choice tasks to be presented to respondents in a DCE. This includes the importance of considering the potential impact of format (e.g. choice context, choice set presentation and size) as well as choice set content (e.g. labelled and unlabelled choice sets and inclusion of reference alternatives) and choice questions (stated choice versus additional questions designed to explore complete preference orders) on the preference estimates that are elicited from studies. We endeavoure to instil a holistic approach to choice task design that considers format alongside content, experimental design and analysis.
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Affiliation(s)
- Jennifer A Whitty
- Patient-Centred Research, Evidera, London, UK.
- Norwich Medical School, The University of East Anglia, Norwich, UK.
| | - Emily Lancsar
- Department of Health Economics Wellbeing and Society, Australian National University, Acton, ACT, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Kirsten Howard
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Elly A Stolk
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- EuroQol Research Foundation, Rotterdam, The Netherlands
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Tsui TCO, Chan KKW, Xie F, Pullenayegum EM. Creating a Multiply Imputed Value Set for the EQ-5D-5L in Canada: State-Level Misspecification Terms Are Needed to Characterize Parameter Uncertainty Correctly. Med Decis Making 2024; 44:405-414. [PMID: 38591189 PMCID: PMC11102641 DOI: 10.1177/0272989x241241328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/27/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Parameter uncertainty in EQ-5D-5L value sets often exceeds the instrument's minimum important difference, yet this is routinely ignored. Multiple imputation (MI) accounts for parameter uncertainty in the value set; however, no valuation study has implemented this methodology. Our objective was to create a Canadian MI value set for the EQ-5D-5L, thus enabling users to account for parameter uncertainty in the value set. METHODS Using the Canadian EQ-5D-5L valuation study (N = 1,073), we first refit the original model followed by models with state-level misspecification. Models were compared based on the adequacy of 95% credible interval (CrI) coverage for out-of-sample predictions. Using the best-fitting model, we took 100 draws from the posterior distribution to create 100 imputed value sets. We examined how much the standard error of the estimated mean health utilities increased after accounting for parameter uncertainty in the value set by using the MI and original value sets to score 2 data sets: 1) a sample of 1,208 individuals from the Canadian general public and 2) a sample of 401 women with breast cancer. RESULTS The selected model with state-level misspecification outperformed the original model (95% CrI coverage: 94.2% v. 11.6%). We observed wider standard errors for the estimated mean utilities on using the MI value set for both the Canadian general public (MI: 0.0091; original: 0.0035) and patients with breast cancer (MI: 0.0169; original: 0.0066). DISCUSSION AND CONCLUSIONS We provide 1) the first MI value sets for the EQ-5D-5L and 2) code to construct MI value sets while accounting for state-level model misspecification. Our study suggests that ignoring parameter uncertainty in value sets leads to falsely narrow SEs. HIGHLIGHTS Value sets for health state utility instruments are estimated subject to parameter uncertainty; this parameter uncertainty may exceed the minimum important difference of the instrument, yet it is not fully captured using current methods.This study creates the first multiply imputed value set for a multiattribute utility instrument, the EQ-5D-5L, to fully capture this parameter uncertainty.We apply the multiply imputed value set to 2 data sets from 1) the Canadian general public and 2) women with invasive breast cancer.Scoring the EQ-5D-5L using a multiply imputed value set led to wider standard error estimates, suggesting that the current practice of ignoring parameter uncertainty in the value set leads to falsely low standard errors.Our work will be of interest to methodologists and developers of the EQ-5D-5L and users of the EQ-5D-5L, such as health economists, researchers, and policy makers.
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Affiliation(s)
- Teresa C. O. Tsui
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Canadian Centre for Applied Research in Cancer Control, Canada
| | - Kelvin K. W. Chan
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Canadian Centre for Applied Research in Cancer Control, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Eleanor M. Pullenayegum
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
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15
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Varriale C, Andrulli G, Meregaglia M, Rencz F, Finch AP. Behind the Scenes: A Qualitative Investigation of Interviewers' Performance in EQ-5D Valuation Studies. PHARMACOECONOMICS - OPEN 2024; 8:389-401. [PMID: 38592657 PMCID: PMC11058132 DOI: 10.1007/s41669-024-00486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND The EuroQol Valuation Technology (EQ-VT) protocol is currently employed by the valuation studies of the EQ family of instruments worldwide. To date, all the evidence in support of the quality control (QC) originates from quantitative indicators. OBJECTIVE We aimed to explore interviewers' conversational patterns in EQ-VT interviews, beyond quantitative QC indicators, and to provide a preliminary exploration of how the interaction between interviewer and respondent impacts data quality. METHODS Two researchers transcribed and independently coded 24 video-recorded interviews from the Italian EQ-5D-5L valuation study, adopting the conversational analysis framework. The analysis identified positive and negative 'patterns' of conversational practice. These were categorized into themes and sub-themes and were used to score a random sample of 42 video-recorded interviews conducted at different time points by seven interviewers. RESULTS The conversational analysis identified 20 positive and 14 negative interview patterns, which were grouped into two main themes (i.e., task execution and communication skills). Positive items included appending questions that stimulated respondents' engagement, providing different explanations for an unclear aspect, supporting the participant with useful information for completing the tasks, and increasing the interview's coherence by confirming the respondent answers. Negative patterns included moving forward in the exercise without making sure that the respondent understood, trying to force an answer from the respondent, speaking too fast, and providing incomplete or incorrect explanations of the task. Most interviewers exhibited a moderate increase in positive patterns or a decrease in negative patterns over time. A certain degree of consistency between the quantitative QC results and the qualitative scoring deriving from the interviewer-respondent interaction was observed, with the best and worst performers of the qualitative scoring showing good and bad scores on key QC items, respectively. CONCLUSIONS The identified positive and negative patterns may be useful to inform the training material of EQ-VT studies worldwide and complement the existing QC process.
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Affiliation(s)
| | | | | | - Fanni Rencz
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary
| | - Aureliano Paolo Finch
- EuroQol Office, EuroQol Research Foundation, Rotterdam, The Netherlands
- Health Values Research and Consultancy, Amsterdam, The Netherlands
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16
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Al-Jedai A, Almudaiheem H, Al-Salamah T, Aldosari M, Almutairi AR, Almogbel Y, AlRuthia Y, Althemery AU, Alluhidan M, Roudijk B, Purba FD, Awad N, O'jeil R. Valuation of EQ-5D-5L in the Kingdom of Saudi Arabia: A National Representative Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:552-561. [PMID: 38342365 DOI: 10.1016/j.jval.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVES To estimate a Saudi-specific value set for the EQ-5D-5L questionnaire using the EuroQol Valuation Technology program and the EuroQol Group's standard protocol. METHODS Participants were quota-sampled from the Saudi adult population based on residency location, age group, gender, education level, and employment status. The participants were guided through the completion of composite time trade-off (cTTO) and discrete choice experiment (DCE) tasks by trained interviewers using EuroQol Valuation Technology software. Quality control (QC) measures were used to ensure good data quality. Random intercept and Tobit models analyzed the cTTO data, as well as models correcting for heteroskedasticity. DCE data were analyzed using conditional logit models, whereas hybrid models were used to analyze the cTTO and DCE data jointly. To evaluate model performance, prediction accuracy, logical consistency, significance level, and goodness of fit were used. RESULTS The valuation study included a representative sample of the Saudi population (N = 1000). The hybrid heteroskedastic model without a constant was chosen as the preferred model for generating the value set. The predicted values ranged from -0.683 for the worst health state ("55555") to 1 for the full health state ("11111"). Pain and discomfort had the largest impact on health-state preference values, whereas usual activities had the least. CONCLUSION The value set for the Kingdom of Saudi Arabia is the first value set for the EQ-5D-5L for any country in the Middle East. The value set can be used in Saudi health system economic evaluations and decision making.
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Affiliation(s)
- Ahmed Al-Jedai
- Alfaisal University Alfaisal University, Colleges of Medicine and Pharmacy, Riyadh, Saudi Arabia; Therapeutics Affairs, Ministry of Health, Riyadh, Saudi Arabia.
| | - Hajer Almudaiheem
- Drug Policy and Regulation Department, Ministry of Health, Riyadh, Saudi Arabia
| | - Tareq Al-Salamah
- College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Emergency Medicine, University of Maryland Medical Centre, Baltimore, MD, USA
| | - Muath Aldosari
- King Saud University College of Dentistry, Riyadh, Saudi Arabia; Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | | | - Yasser Almogbel
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Saudi Arabia
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; Pharmacoeconomics Research Unit, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah U Althemery
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | | | - Bram Roudijk
- EuroQol Research Foundation, Marten Meesweg 107, Rotterdam, The Netherlands
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Lipman SA, Reckers-Droog VT. Comparing heuristic valuation processes between health state valuation from child and adult perspectives. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-023-01668-6. [PMID: 38308719 DOI: 10.1007/s10198-023-01668-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/21/2023] [Indexed: 02/05/2024]
Abstract
OBJECTIVES Health state valuation assumes that respondents trade off between all aspects of choice tasks and maximize their utility. Yet, respondents may use heuristic valuation processes, i.e., strategies to simplify or avoid the trade-offs that are core to health state valuation. The objective of this study is to explore if heuristic valuation processes are more prevalent for valuation from a 10-year-old child's perspective compared to the use of an adult perspective. METHODS We reused existing data in which EQ-5D health states were valued from adult and child perspectives with composite time trade-off (cTTO) and discrete choice experiment (DCE) tasks. Our analyses focused on comparing completion time and responding patterns across both perspectives. We also explored how reflective of a set of heuristic strategies respondents' choices were in both perspectives. RESULTS We found no evidence for systematic differences in completion time across perspectives. Generally, we find different responding patterns in child perspectives, e.g., more speeding, dominance violations, and clustering of utilities at 1.0, 0.8, and 0. Very few heuristic strategies provide a coherent explanation for the observed DCE responses. CONCLUSION Our results provide some, albeit indirect, evidence for differences in heuristic valuation processes between perspectives, although not across all data sources. Potential effects of heuristic valuation processes, such as transfer of responsibility, may be identified through studying responding patterns in cTTO and DCE responses.
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Affiliation(s)
- Stefan A Lipman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Erasmus Centre for Health Economics Research Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Vivian T Reckers-Droog
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Research Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Yan J, Xie S, Johnson JA, Pullenayegum E, Ohinmaa A, Bryan S, Xie F. Canada population norms for the EQ-5D-5L. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:147-155. [PMID: 36828968 DOI: 10.1007/s10198-023-01570-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE In Canada, population norms are only available for 2 provinces, Alberta and Quebec. The objective of this study was to derive the population norms for the EQ-5D-5L based on a representative sample of the Canadian general population. METHODS Data from the Canadian EQ-5D-5L valuation study, a cross-sectional study, were used. A quota sampling method was used to recruit a representative sample of the Canadian general population in terms of age, sex, and education. EQ-5D-5L utilities and EQ VAS were summarized using descriptive statistics and the impact of demographic characteristics on the EQ-5D-5L utilities was evaluated using statistical hypothesis testing and Tobit regression. RESULTS 1207 eligible participants were included in the analysis. Pain/discomfort (53.1%) was the most frequently reported domain with any problem, and self-care (7.6%) domain was the least. The mean (standard deviation [SD]) EQ-5D-5L utility was 0.864 (0.121) and the mean (SD) EQ VAS was 82.3 (14.23). The highest mean EQ-5D-5L utility was 0.881 in age group 25-34 while the lowest was 0.839 in age group 55-64. Participants who had full-time employment, were married, a higher annual household income and no chronic health conditions had significantly higher EQ-5D-5L utilities. CONCLUSION This article reports the first Canadian population norms for the EQ-5D-5L and can be used as population references for economic evaluations and clinical research.
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Affiliation(s)
- Jiajun Yan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Shitong Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | | | - Eleanor Pullenayegum
- The Hospital for Sick Children, Toronto, ON, Canada
- Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
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Yang Z, Devlin NJ, Rand K, Luo N. Testing 2 Alternative Time Trade-Off Methods for Valuation of Children's Health States. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:43-50. [PMID: 37813195 DOI: 10.1016/j.jval.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES Composite time trade-off (cTTO) values for EQ-5D-Y-3L health states tend to be high, raising concerns about sensitivity particularly for mild or moderate health states. We conceptualized and pilot tested 2 alternative time trade-off (TTO) variants: the caregiver TTO (CGTTO) and lag-time TTO (LTTO). METHODS We collected CGTTO and LTTO data in China for 10 EQ-5D-Y-3L health states and compared the resulting values, respondent feedback, and task completion times with those from an EQ-5D-Y-3L valuation study using cTTO. We also examined how age and parental status of respondents could affect TTO values. RESULTS A total of 304 participants were included in this study. Overall, cTTO showed statistically better results in all feedback questions. On a 5-point Likert scale where lower score means greater agreement, the mean (SD) feedback scores for cTTO, LTTO, and CGTTO were 1.18 (0.58), 1.45 (0.91), and 1.65 (1.02) for "easy to understand"; 1.45 (0.91), 1.94 (1.08), and 1.86 (1.24) for "easy to differentiate"; and 3.61 (1.29), 2.97 (1.33), and 3.02 (1.50) for "difficult to decide," respectively. The mean (SD) TTO values of all 10 states were 0.463 (0.494), 0.387 (0.555), and 0.123 (0.710) for cTTO, LTTO, and CGTTO, respectively. The effects of age and parental status on TTO values differed by the 3 methods. CONCLUSIONS LTTO and CGTTO produce values with good characteristics and merit further investigation. Researchers need to be aware of the differences in design and values when using the TTO method to value children's health states.
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Affiliation(s)
- Zhihao Yang
- Department of Health Services Management, Guizhou Medical University, Guiyang, China; Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, China
| | - Nancy J Devlin
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kim Rand
- Health Services Research Centre, Akershus University Hospital, Oslo, Norway; Maths in Health B.V., Rotterdam, The Netherlands
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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Jyani G, Prinja S, Goyal A, Garg B, Kaur M, Grover S. Do people with different sociodemographic backgrounds value their health differently? Evaluating the role of positional objectivity. Front Public Health 2023; 11:1234320. [PMID: 38162609 PMCID: PMC10756676 DOI: 10.3389/fpubh.2023.1234320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Objective The fundamental disconnect between the actual and the perceived health of an individual raises considerable skepticism on the self-reported health data as it may be confounded by an individual's socio-economic status. In this light, the present study aims to assess if people with different sociodemographic backgrounds value their health differently. Methods The health-state valuation using time-trade off was performed in a cross-sectional survey among a representative sample of 2,311 adults from India. Individuals were selected using a multistage stratified random sampling from five Indian states to elicit their present health-state, and to perform the health-state valuation exercise using computer assisted personal interviewing. A single block of standardized health-states was valued by multiple individuals, each belonging to different socio-demographic group. The difference in the valuation of health was assessed using bivariate analysis. The impact of different sociodemographic factors on the health-state valuation was evaluated using Tobit regression model. Results Differences in the valuation of health were observed among different groups of age, religion, family type, state of residence, substance abuse, presence of ailments at the time of valuation, and number of dependent members in the household. Even after controlling for the severity of the administered health states, factors having a significant association with the valuation of health are age, religion, state of residence, substance abuse, family type, number of dependent members in the household, and presence of chronic or both acute and chronic ailments. Younger individuals place a higher value to their health as compared to their older counterparts. As compared to a healthy individual, a person with ailments rates the same health-state as worse. Conclusion Inequalities in self-reported ill-health cannot be attributed to positional objectivity; age, religion, state of residence, substance abuse, family type, dependents, and ailments impact individual health valuation.
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Affiliation(s)
- Gaurav Jyani
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aarti Goyal
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Basant Garg
- National Health Authority, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Prevolnik Rupel V, Ogorevc M. EQ-5D-5L Value Set for Slovenia. PHARMACOECONOMICS 2023; 41:1515-1524. [PMID: 37341959 PMCID: PMC10570207 DOI: 10.1007/s40273-023-01280-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVES The aim of this valuation study was to produce a value set to support the use of EQ-5D-5L data in decision making in Slovenia. METHODS The study design followed the published EuroQol research protocol, and a quota sample was defined according to age, sex, and region. Overall, 1012 adult respondents completed 10 time trade-off and seven discrete choice experiment tasks in face-to-face interviews. The Tobit model was used to analyse the composite time trade-off (cTTO) data in order to generate values for the 3125 EQ-5D-5L health states. RESULTS The data showed logical consistency, with more severe states being given lower values. The greatest disutility was shown in the pain/discomfort and anxiety/depression dimensions. In the EQ-5D-5L value set, the values range from -1.09 to 1. With the exception of UA5 (unable to perform usual activities), all other levels on all health dimensions were statistically different from 0 and from each other. Compared with the existing EQ-5D-3L value set, there is a slightly lower share of 'worse than dead' states (32.1% compared with 33.7%) and the minimum value is lower. CONCLUSIONS Results have important implications for users of the EQ-5D-5L in Slovenia and regions. It is a robust and up-to-date value set and should be the preferred value set used in adults in Slovenia and in neighbouring countries without their own value set.
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Affiliation(s)
- Valentina Prevolnik Rupel
- Institute for Economic Research, Kardeljeva ploščad 17, Ljubljana, Slovenia.
- DOBA Faculty, Prešernova cesta 1, 2000, Maribor, Slovenia.
| | - Marko Ogorevc
- Institute for Economic Research, Kardeljeva ploščad 17, Ljubljana, Slovenia
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Malik M, Gu NY, Hussain A, Roudijk B, Purba FD. The EQ-5D-3L Valuation Study in Pakistan. PHARMACOECONOMICS - OPEN 2023; 7:963-974. [PMID: 37702988 PMCID: PMC10721573 DOI: 10.1007/s41669-023-00437-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND To utilize EQ-5D in economic evaluations, a societal-based value set is needed. To date, no value sets exist for any EQ-5D instrument in Pakistan. Previous EQ-5D studies conducted in Pakistan 'borrowed' health preferences developed in other countries. However, for a value set to be valid for Pakistani population, it should represent the preferences of the Pakistani population, and culture and living standards of Pakistan. OBJECTIVE The aim of this study was to derive a Pakistani EQ-5D-3L value set. METHODS A moderately representative sample aged 18 years and over was recruited from the Pakistani general population. A multi-stage stratified quota method with respect to ethnicity, gender, age and religion was utilized. Two elicitation techniques, the composite time trade-off (cTTO) and discrete choice experiments (DCE) were applied. Interviews were undertaken by trained interviewers using computer-assisted face-to-face interviews with the EuroQol Portable Valuation Technology (EQ-PVT) platform. To estimate the value set, a hybrid regression model combining cTTO and DCE data was used. RESULTS A total of 289 respondents who completed the interviews were included for the analysis. The hybrid model correcting for heteroskedasticity without a constant was selected as the final model for the value set. It is shown that being unable to do usual activities (level 3) was assigned the largest weight, followed by mobility level 3, self-care level 3, pain/discomfort level 3 and anxiety/depression level 3. The worst health state was assigned the value - 0.171 in the final model. CONCLUSIONS A Pakistani country-specific EQ-5D-3L value set is now available. The availability of this value set may help promote and facilitate health economic evaluations and health-related quality-of-life (HRQoL) research in Pakistan.
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Affiliation(s)
- Madeeha Malik
- Cyntax Health Projects, Contract Research Organization (CRO) and Corporate Firm, Islamabad, Pakistan.
| | - Ning Yan Gu
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Azhar Hussain
- Pak-AustriaFachhochschule: Institute of Applied Sciences and Technology, Haripur, Pakistan
| | - Bram Roudijk
- The EuroQol Research Foundation, Rotterdam, The Netherlands
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Rowen D, Mukuria C, Bray N, Carlton J, Cooper S, Longworth L, Meads D, O'Neill C, Yang Y. UK Valuation of EQ-5D-5L, a Generic Measure of Health-Related Quality of Life: A Study Protocol. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1625-1635. [PMID: 37722593 DOI: 10.1016/j.jval.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/21/2023] [Accepted: 08/09/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVES A high-quality and widely accepted UK EQ-5D-5L value set is urgently required to enable the latest version of EQ-5D scored using recent UK public preferences to inform policy including health technology assessments submitted to the National Institute for Health and Care Excellence. This article outlines the study protocol for the generation of a new EQ-5D-5L UK value set. METHODS Twelve hundred interviews will be undertaken using the composite time trade-off elicitation technique for 102 health states (86 from the international EQ-5D-5L valuation protocol, plus 16 with best predictive performance in an extended design used in the Native American EQ-5D-5L valuation). The sample will be UK adults (age ≥18 years) proportionately representative across England, Wales, Scotland, and Northern Ireland, representative for age, sex, ethnicity, and socioeconomic group, with inclusion of participants with/without health problems. Participants will choose to be interviewed via videoconference (by Zoom) or in-person in a central venue. Data quality will be rigorously assessed. RESULTS The value set will be generated using tobit random effects and heteroscedastic tobit models (with censoring at -1) using all data, excluding time trade-off values highlighted by participants as ones they would reconsider and data from interviewers failing protocol compliance. Quality and acceptance will be achieved by public involvement, regular Steering Group meetings, independent assessment of data quality at 4 time points, and final endorsement of data and analyses. CONCLUSION This study will produce a UK value set for the EQ-5D-5L for use in prospective and retrospective data sets containing EQ-5D-5L data.
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Affiliation(s)
- Donna Rowen
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, England, UK.
| | - Clara Mukuria
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Nathan Bray
- Academy for Health Equity, Prevention and Wellbeing, Bangor University, Bangor, Wales, UK
| | - Jill Carlton
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Sophie Cooper
- National Institute for Health and Care Excellence, London, England, UK
| | | | - David Meads
- Academic Unit of Health Economics, University of Leeds, Leeds, England, UK
| | - Ciaran O'Neill
- Centre for Public Health, Queen's University, Belfast, Northern Ireland; National University of Ireland, Galway, Ireland
| | - Yaling Yang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK
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Xie S, Li M, Wang D, Hong T, Guo W, Wu J. Comparison of the measurement properties of the EQ-5D-5L and SF-6Dv2 among overweight and obesity populations in China. Health Qual Life Outcomes 2023; 21:118. [PMID: 37904216 PMCID: PMC10617156 DOI: 10.1186/s12955-023-02202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/23/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE To evaluate and compare the measurement properties of the EQ-5D-5L and SF-6Dv2 among Chinese overweight and obesity populations. METHODS A representative sample of Chinese overweight and obesity populations was recruited stratified by age, gender, body mass index (BMI), and area of residence. Social-demographic characteristics and self-reported EQ-5D-5L and SF-6Dv2 responses were collected through the online survey. The agreement was assessed using intraclass correlation coefficients (ICC). Convergent validity and known-group validity were examined using Spearman's rank correlation and effect sizes, respectively. The test-retest reliability was assessed using among a subgroup of the total sample. Sensitivity was compared using relative efficiency and receiver operating characteristic. RESULTS A total of 1000 respondents (52.0% male, mean age 51.7 years, 67.7% overweight, 32.3% obesity) were included in this study. A higher ceiling effect was observed in EQ-5D-5L than in SF-6Dv2 (30.6% vs. 2.1%). The mean (SD) utility was 0.851 (0.195) for EQ-5D-5L and 0.734 (0.164) for SF-6Dv2, with the ICC of the total sample was 0.639 (p < 0.001). The Spearman's rank correlation (range: 0.186-0.739) indicated an acceptable convergent validity between the dimensions of EQ-5D-5L and SF-6Dv2. The EQ-5D-5L showed basically equivalent discriminative capacities with the SF-6Dv2 (ES: 0.517-1.885 vs. 0.383-2.329). The ICC between the two tests were 0.939 for EQ-5D-5L and 0.972 for SF-6Dv2 among the subgroup (N = 150). The SF-6Dv2 had 3.7-170.1% higher efficiency than the EQ-5D-5L at detecting differences in self-reported health status, while the EQ-5D-5L was found to be 16.4% more efficient at distinguishing between respondents with diabetes and non-diabetes. CONCLUSIONS Both the EQ-5D-5L and SF-6Dv2 showed comparable reliability, validity, and sensitivity when used in Chinese overweight and obesity populations. The two measures may not be interchangeable given the systematic difference in utility values between the EQ-5D-5L and SF-6Dv2. More research is needed to compare the responsiveness.
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Affiliation(s)
- Shitong Xie
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Meixuan Li
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Dingyao Wang
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Tianqi Hong
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Weihua Guo
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
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Jakubczyk M. Re-revisiting the Utilities of Health States Worse than Dead: The Problem Remains. Med Decis Making 2023; 43:875-885. [PMID: 37846095 DOI: 10.1177/0272989x231201147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
BACKGROUND In valuation studies of the EQ-5D-5L instrument, the composite time tradeoff method (cTTO) is often used to elicit preferences. In cTTO, some health states are considered worse than dead (WTD) and are assigned negative utility values. However, these negative values correlate poorly with state severity, which suggests that cTTO is insufficiently sensitive. A recent threshold explanation has been offered to account for the lack of correlation: because the severity threshold beyond which a state is considered WTD differs between respondents, the correlation should be studied for individual respondents clustered by the number of WTD states. The results obtained in such a threshold approach were interpreted to disprove the insensitivity of the cTTO method. AIM To scrutinize the threshold explanation and test whether it indeed refutes the insensitivity of cTTO. METHODS The study uses data from the EQ-5D-5L Polish valuation study, which includes cTTO responses from 1,510 participants, each of whom evaluated 10 EQ-5D-5L states. The correlation analysis and threshold approach are repeated to confirm the results from previous studies. The data are then modified in 2 contrasting ways. First, negative utilities are randomly reshuffled to test whether the threshold approach can capture cTTO insensitivity. Second, individual-level regressions are used to simulate negative values to ensure they correlate with severity at the individual respondent level, verifying whether the overall severity-utility correlation should be observed. RESULTS First, reshuffling negative utilities does not change the results of the threshold approach. Hence, the threshold explanation fails to prove cTTO sensitivity. Second, when sensitivity was introduced on an individual level, a significant overall correlation between severity and negative utility arose. CONCLUSION cTTO is insensitive to severity for WTD states. HIGHLIGHTS For the composite time tradeoff method, the utility values of health states worse than dead correlate poorly with state severity, which suggests that cTTO has insufficient sensitivity.Recently, a so-called threshold explanation was offered for the lack of correlation.I show why the threshold explanation fails and why the composite time tradeoff is indeed insensitive for worse-than-dead states.
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Affiliation(s)
- Michał Jakubczyk
- SGH Warsaw School of Economics, Decision Analysis and Support Unit, Warsaw, Poland
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Zhu W, Zhang M, Pan J, Shi L, Gao H, Xie S. Valuing Chinese medicine quality of life-11 dimensions (CQ-11D) health states using a discrete choice experiment with survival duration (DCE TTO). Health Qual Life Outcomes 2023; 21:99. [PMID: 37612664 PMCID: PMC10463386 DOI: 10.1186/s12955-023-02180-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 08/04/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE To explore generating a health utility value set for the Chinese medicine Quality of life-11 Dimensions (CQ-11D), a utility instrument designed to assess patients' health status while receiving TCM treatment, among the Chinese population. METHODS The study was designed to recruit at least 2400 respondents across mainland China to complete one-to-one, face-to-face interviews. Respondents completed ten discrete choice experiment with survival duration (DCETTO) tasks during interviews. The conditional logit models were used to generate the health utility value set for the CQ-11D using the DCETTO data. RESULTS A total of 2,586 respondents were invited to participate in the survey and 2498 valid interviews were completed (a completion rate of 96.60%). The modified conditional logit model with combing logically inconsistent levels was ultimately selected to construct the health utility value set for the CQ-11D instrument. The range of the measurable health utility value was -0.868 ~ 1. CONCLUSION The study provides the first utility value set for the CQ-11D among the Chinese population. The CQ-11D and corresponding utility value set can be used to measure the health utility values of patients undergoing traditional Chinese medicine interventions, and further facilitate relevant cost-utility analyses. The application of the CQ-11D can support TCM resource allocation in China.
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Affiliation(s)
- Wentao Zhu
- Beijing University of Chinese Medicine, Higher Education Zone in LiangXiang Town, FangShan District, Beijing, 102488, China.
| | - Mengpei Zhang
- Beijing University of Chinese Medicine, Higher Education Zone in LiangXiang Town, FangShan District, Beijing, 102488, China
| | - Jie Pan
- Beijing University of Chinese Medicine, Higher Education Zone in LiangXiang Town, FangShan District, Beijing, 102488, China
| | - Lizheng Shi
- Tulane University, 1440 Canal Street Suite 1900, New Orleans, LA, 70112, USA
| | - Hailiang Gao
- Beijing University of Chinese Medicine, Higher Education Zone in LiangXiang Town, FangShan District, Beijing, 102488, China
| | - Shitong Xie
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072, China
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Jiang R, Pullenayegum E, Shaw JW, Mühlbacher A, Lee TA, Walton S, Kohlmann T, Norman R, Pickard AS. Comparison of Preferences and Data Quality between Discrete Choice Experiments Conducted in Online and Face-to-Face Respondents. Med Decis Making 2023; 43:667-679. [PMID: 37199407 PMCID: PMC10422849 DOI: 10.1177/0272989x231171912] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 03/24/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Discrete choice experiments (DCE) are increasingly being conducted using online panels. However, the comparability of such DCE-based preferences to traditional modes of data collection (e.g., in-person) is not well established. In this study, supervised, face-to-face DCE was compared with its unsupervised, online facsimile on face validity, respondent behavior, and modeled preferences. METHODS Data from face-to-face and online EQ-5D-5L health state valuation studies were compared, in which each used the same experimental design and quota sampling procedure. Respondents completed 7 binary DCE tasks comparing 2 EQ-5D-5L health states presented side by side (health states A and B). Data face validity was assessed by comparing preference patterns as a function of the severity difference between 2 health states within a task. The prevalence of potentially suspicious choice patterns (i.e., all As, all Bs, and alternating As/Bs) was compared between studies. Preference data were modeled using multinomial logit regression and compared based on dimensional contribution to overall scale and importance ranking of dimension-levels. RESULTS One thousand five Online respondents and 1,099 face-to-face screened (F2FS) respondents were included in the main comparison of DCE tasks. Online respondents reported more problems on all EQ-5D dimensions except for Mobility. The face validity of the data was similar between comparators. Online respondents had a greater prevalence of potentially suspicious DCE choice patterns ([Online]: 5.3% [F2FS] 2.9%, P = 0.005). When modeled, the relative contribution of each EQ-5D dimension differed between modes of administration. Online respondents weighed Mobility more importantly and Anxiety/Depression less importantly. DISCUSSION Although assessments of face validity were similar between Online and F2FS, modeled preferences differed. Future analyses are needed to clarify whether differences are attributable to preference or data quality variation between modes of data collection.
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Affiliation(s)
- Ruixuan Jiang
- Center for Observational and Real-World Evidence, Merck & Co., Inc, Rahway, NJ, USA
| | | | - James W. Shaw
- Patient-reported Outcomes Assessment, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Axel Mühlbacher
- Duke Department of Population Health Sciences and Duke Global Health Institute, Duke University, Durham, NC, USA, Germany
| | - Todd A. Lee
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Surrey Walton
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Thomas Kohlmann
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
| | - Richard Norman
- Curtin University School of Public Health, Perth, Australia
| | - A. Simon Pickard
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
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Jyani G, Yang Z, Sharma A, Goyal A, Stolk E, Purba FD, Grover S, Kaur M, Prinja S. Evaluation of EuroQol Valuation Technology (EQ-VT) Designs to Generate National Value Sets: Learnings from the Development of an EQ-5D Value Set for India Using an Extended Design (DEVINE) Study. Med Decis Making 2023; 43:692-703. [PMID: 37480281 PMCID: PMC10422850 DOI: 10.1177/0272989x231180134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 04/27/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION Countries develop their EQ-5D-5L value sets using the EuroQol Valuation Technology (EQ-VT) protocol. This study aims to assess if extension in the conventional EQ-VT design can lead to development of value sets with improved precision. METHODS A cross-sectional survey was undertaken in a representative sample of 3,548 adult respondents, selected from 5 different states of India using a multistage stratified random sampling technique. A novel extended EQ-VT design was created that included 18 blocks of 10 health states, comprising 150 unique health states and 135 observations per health state. In addition to the standard EQ-VT design, which is based on 86 health states and 100 observations per health state, 3 extended designs were assessed for their predictive performance. The extended designs were created by 1) increasing the number of observations per health state in the design, 2) increasing the number of health states in the design, and 3) implementing both 1) and 2) at the same time. Subsamples of the data set were created for separate designs. The root mean squared error (RMSE) and mean absolute error (MAE) were used to measure the predictive accuracy of the conventional and extended designs. RESULTS The average RMSE and MAE for the standard EQ-VT design were 0.055 and 0.041, respectively, for the 150 health states. All 3 types of design extensions showed lower RMSE and MAE values as compared with the standard design and hence yielded better predictive performance. RMSE and MAE were lowest (0.051 and 0.039, respectively) for the designs that use a greater number of health states. Extending the design with inclusion of more health states was shown to improve the predictive performance even when the sample size was fixed at 1,000. CONCLUSION Although the standard EQ-VT design performs well, its prediction accuracy can be further improved by extending its design. The addition of more health states in EQ-VT is more beneficial than increasing the number of observations per health state. HIGHLIGHTS The EQ-5D-5L value sets are developed using the standardized EuroQol Valuation Technology (EQ-VT) protocol. This is the first study to empirically assess how much can be gained from extending the standard EQ-VT design in terms of sample size and/or health states. It not only presents useful insights into the performance of the standard design of the EQ-VT but also tests the potential extensions in the standard EQ-VT design in terms of increasing the health states to be directly valued as well as the number of observations recorded to predict the utility value of each of these health states.The study demonstrates that the standard EQ-VT design performs good, and an extension in the design of the standard EQ-VT can lead to further improvement in its performance. The addition of more health states in EQ-VT is more beneficial than increasing the number of observations per health state. Extending the design with inclusion of more health states marginally improves the predictive performance even when the sample size was fixed at 1,000.The findings of the study will streamline the systematic process for generating precise EQ-5D-5L value sets, thus facilitating the conduct of credible, transparent, and robust outcome valuation in health technology assessments.
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Affiliation(s)
- Gaurav Jyani
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Zhihao Yang
- Guizhou Medical University, Guiyang, People’s Republic of China
| | - Atul Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aarti Goyal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Elly Stolk
- EuroQol Research Foundation, Rotterdam, South Holland, the Netherlands
| | - Fredrick Dermawan Purba
- Department of Developmental Psychology, Faculty of Psychology, Universitas Padjadjaran, Bandung, Jawa Barat, Indonesia
| | - Sandeep Grover
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manmeet Kaur
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kellenaers JTF, Rijkers K, van Mastrigt GAPG, Schijns OEMG, Hoogland G, Dings J, van Kuijk S, Vlooswijk MCG, Wagner LGL, Idema S, van Straaten IECW, van der Salm SMA, Majoie MHJM. Resective Epilepsy Surgery, QUality of life and Economic evaluation (RESQUE): the change in quality of life after resective epilepsy surgery-protocol for a multicentre, prospective cohort study. BMJ Open 2023; 13:e064263. [PMID: 37407053 DOI: 10.1136/bmjopen-2022-064263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Resective epilepsy surgery is often seen as a last resort when treating drug-resistant epilepsy. Positive results on quality of life (QoL) and economic benefits after surgery argue for a less restrictive attitude towards epilepsy surgery for drug-resistant epilepsy. QoL and economic benefits are country-dependent. The objective of the Resective Epilepsy Surgery, QUality of life and Economic evaluation (RESQUE) trial is to evaluate the change in QoL before and after epilepsy surgery in Dutch people with drug-resistant epilepsy. The results will form part of an economic evaluation of epilepsy surgery in people with epilepsy (PWE) in The Netherlands. METHODS AND ANALYSIS A longitudinal prospective multicentre cohort study involving 100 PWE undergoing epilepsy surgery between 2019 and 2025 is being performed in three Dutch academic hospitals. Excluded are PWE who have a lower level of intelligence (TIQ<70) or who do not master the Dutch language. Before surgery and 3, 6, 12 and 24 months after surgery, PWE receive validated online questionnaires (QOLIE-31, EQ-5D, iMCQ and iPCQ) on QoL, cost of care, expectations and satisfaction. Primary outcome is the change in QoL. Secondary outcomes are change in generic QoL, seizure reduction (International League Against Epilepsy Outcome Classification), medical consumption, productivity, the correlation between QoL and seizure reduction and expectation of and satisfaction with the surgery. ETHICS AND DISSEMINATION The study design has been approved by the Medical Ethics Review Committee (METC) of Maastricht UMC+ (2019-1134) and the Amsterdam UMC (vu). At the time of writing, UMC Utrecht is in the process of considering approval. The study will be conducted according to the Dutch Medical Research Involving Human Subjects Act and the Declaration of Helsinki. The results will be publicly disclosed and submitted for publication in international peer-reviewed scientific journals. There is no veto on publication by the involved parties. TRIAL REGISTRATION NL8278; Pre-results.
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Affiliation(s)
- Julia T F Kellenaers
- Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Kim Rijkers
- Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Olaf E M G Schijns
- Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Govert Hoogland
- Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jim Dings
- Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sander van Kuijk
- Clinical Epidemiology and Medical Technology Assessment, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | | | | | - Sander Idema
- Department of Neurosurgery, Amsterdam UMC VUMC Site, Amsterdam, The Netherlands
| | | | - Sandra M A van der Salm
- Department of Neurology, University Medical Centre Utrecht Brain Centre, Utrecht, The Netherlands
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Yang Z, Jiang J, Wang P, Wu J, Fang Y, Feng D, Xi X, Luo N. Using Time Trade-Off Values to Estimate EQ-5D-Y Value Sets: An Exploratory Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:968-973. [PMID: 36921897 DOI: 10.1016/j.jval.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 01/13/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES The published international EQ-5D-Y-3L valuation protocol does not recommend the composite time trade-off (cTTO) method as the primary valuation method because of 2 major concerns. First, the cTTO method was shown to generate high values. Second, the cTTO method is not as feasible for valuing children's health as other established methods. This study aimed to explore the feasibility of using cTTO values alone to estimate EQ-5D-Y-3L value sets. METHODS We analyzed the cTTO data derived from the recently completed Chinese EQ-5D-Y-3L valuation study in which a total of 28 health states were valued. We assessed the feasibility of the cTTO tasks in terms of survey completion time and participant-reported difficulty of understanding the task, differentiating the health states, and deciding the answer. We also examined the data distribution characteristics and modeled the data using different models. RESULTS In total, 418 participants completed the cTTO interview. On average, participants took approximately 35.70 minutes (SD 12.42) to complete the interview and made 13.21 moves (SD 9.00) in the cTTO tasks. There were 74.16%, 59.33%, and 11.48% of participants indicated that it was easy to understand the cTTO tasks, easy to differentiate between the health states, and difficult to decide on an indifference point, respectively. The data distribution was smooth, and a random-effects model performed the best in terms of coefficient significance, monotonicity, and predictive accuracy. CONCLUSION Our finding suggests that estimating EQ-5D-Y-3L value sets using cTTO data alone is feasible and therefore could be considered as an option in future valuation studies for EQ-5D-Y-3L.
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Affiliation(s)
- Zhihao Yang
- Health Services Management Department, Guizhou Medical University, Gui'an, China; College of Pharmacy, Jinan University, Guangzhou, China
| | - Jie Jiang
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Pei Wang
- School of Public Health, Fudan University, Shanghai, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Yu Fang
- Department of Pharmacy Administration, School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Da Feng
- School of Pharmacy, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Xiaoyu Xi
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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Yang Z, Rand K, Busschbach J, Luo N. Cross-Attribute Level Effects Models for Modeling Modified 5-Level Version of EQ-5D Health State Values: Is Less Still More? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:865-872. [PMID: 36566885 DOI: 10.1016/j.jval.2022.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/27/2022] [Accepted: 12/12/2022] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Cross-attribute level effects (CALE) model has demonstrated better predictive accuracy for out-of-sample health states than the conventional additive main-effects model in cross-validation analysis of the 5-level version of EQ-5D (EQ-5D-5L) composite time trade-off (cTTO) datasets. In this study, we aimed to further test the performance of CALE model using a different design and modified EQ-5D-5L states. METHODS A total of 29 EQ-5D-5L self-care bolt-off states, 30 EQ-5D-5L states, and 31 EQ-5D-5L vision bolt-on states were selected from the same orthogonal array. A total of 600 university students were interviewed face-to-face to value a subset of these health states using the cTTO method. For each type of health state, we fitted both the conventional main-effects model and the CALE model. Predictive accuracy was assessed in a series of cross-validation analysis using the leave-one-state-out method. RESULTS Overall, the CALE model outperformed the conventional model for each of the 3 types of health states in predicting the cTTO values of out-of-sample health states. The prediction accuracy of using the CALE model improved with the number of dimensions in health states, for example, the MAE decreased about 24%, 67%, and 77% for the EQ-5D-5L self-care bolt-off, EQ-5D-5L, and EQ-5D-5L vision bolt-on states, respectively, when using CALE models. CONCLUSION Our study supported the strengths of the CALE model for modelling the utility values of both original and modified EQ-5D-5L health states. Investigators with limited resources may consider using the CALE model to lower the costs for their valuation studies for EQ-5D-5L or similar health state descriptive systems.
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Affiliation(s)
- Zhihao Yang
- Health Services Management Department, Guizhou Medical University, Guiyang, China; Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, China
| | - Kim Rand
- Health Services Research Center, Akershus University Hospital, Lørenskog, Norway; Math in Health B.V., Rotterdam, the Netherlands
| | - Jan Busschbach
- Medical Psychiatry and Psychotherapy, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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Yang Z, Rand K, Luo N. 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? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:685-693. [PMID: 36375679 DOI: 10.1016/j.jval.2022.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVES A 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. METHODS We 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. RESULTS When 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. CONCLUSIONS Censoring 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.
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Affiliation(s)
- Zhihao Yang
- Health Services Management Department, Guizhou Medical University, Guiyang, China; College of Pharmacy, Jinan University, Guangzhou, China.
| | - Kim Rand
- Health Services Research Center, Akershus University Hospital, Lørenskog, Norway; Maths in Health B.V., Rotterdam, The Netherlands
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Che M, Pullenayegum E. Efficient Designs for Valuation Studies That Use Time Tradeoff (TTO) Tasks to Map Latent Utilities from Discrete Choice Experiments to the Interval Scale: Selection of Health States for TTO Tasks. Med Decis Making 2023; 43:387-396. [PMID: 36866604 DOI: 10.1177/0272989x231159381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND In eliciting utilities to value multiattribute utility instruments, discrete choice experiments (DCEs) administered online are less costly than interviewer-facilitated time tradeoff (TTO) tasks. DCEs capture utilities on a latent scale and are often coupled with a small number of TTO tasks to anchor utilities to the interval scale. Given the costly nature of TTO data, design strategies that maximize value set precision per TTO response are critical. METHODS Under simplifying assumptions, we expressed the mean square prediction error (MSE) of the final value set as a function of the number J of TTO-valued health states and the variance VJ of the states' latent utilities. We hypothesized that even when these assumptions do not hold, the MSE 1) decreases as VJ increases while holding J fixed and 2) decreases as J increases while holding VJ fixed. We used simulation to examine whether there was empirical support for our hypotheses a) assuming an underlying linear relationship between TTO and DCE utilities and b) using published results from the Dutch, US, and Indonesian EQ-5D-5L valuation studies. RESULTS Simulation set (a) supported the hypotheses, as did simulations parameterized using valuation data from Indonesia, which showed a linear relationship between TTO and DCE utilities. The US and Dutch valuation data showed nonlinear relationships between TTO and DCE utilities and did not support the hypotheses. Specifically, for fixed J, smaller values of VJ reduced rather than increased the MSE. CONCLUSIONS Given that, in practice, the underlying relationship between TTO and DCE utilities may be nonlinear, health states for TTO valuation should be placed evenly across the latent utility scale to avoid systematic bias in some regions of the scale. HIGHLIGHTS Valuation studies may feature a large number of respondents completing discrete choice tasks online, with a smaller number of respondents completing time tradeoff (TTO) tasks to anchor the discrete choice utilities to an interval scale.We show that having each TTO respondent complete multiple tasks rather than a single task improves value set precision.Keeping the total number of TTO respondents and the number of tasks per respondent fixed, having 20 health states directly valued through TTO leads to better predictive precision than valuing 10 health states directly.If DCE latent utilities and TTO utilities follow a perfect linear relationship, choosing the TTO states to be valued by weighting on the 2 ends of the latent utility scale leads to better predictive precision than choosing states evenly across the latent utility scale.Conversely, if DCE latent utilities and TTO utilities do not follow a linear relationship, choosing the states to be valued using TTO evenly across the latent utility scale leads to better predictive precision than weighted selection does.In the context of valuation of the EQ-5D-Y-3L, we recommend valuing 20 or more health states using TTO and placing them evenly across the latent utility scale.
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Affiliation(s)
- Menglu Che
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
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Olariu E, Mohammed W, Oluboyede Y, Caplescu R, Niculescu-Aron IG, Paveliu MS, Vale L. EQ-5D-5L: a value set for Romania. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:399-412. [PMID: 35688994 PMCID: PMC10060331 DOI: 10.1007/s10198-022-01481-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/12/2022] [Indexed: 05/16/2023]
Abstract
OBJECTIVE We aimed to develop an EQ-5D-5L value set for Romania. METHODS In line with the EuroQoL standardized valuation protocol, computer-assisted interviews were conducted face-to-face in a representative sample in Romania (November 2018-November 2019). Valuation methods included composite time trade-off and discrete choice experiment tasks. Several models were tested, including models that accounted for data censoring, panel structure of the data, heteroscedasticity, conditional logit, and hybrid models. The final model was selected based on logical consistency, theoretical considerations, and use of all available data. We compared our value set with other value sets from Central and Eastern Europe region. RESULTS Data from 1493 respondents was used to estimate the value set. A censored hybrid model corrected for heteroscedasticity was selected to represent the value set. The highest decrements in utility were observed for the pain/discomfort dimension (0.375), followed by the mobility dimension (0.293). Health utilities ranged from 1.000 to - 0.323 and 1.3% of the values were negative. The model was corrected with survey weights to better reflect the representativeness of the sample, but the first two coefficients of the self-care dimension stopped being logically consistent. Differences were found between the Romanian, Hungarian and Polish EQ-5D-5L value sets. Good agreement was noted with the Romanian EQ-5D-3L value set, with a swap between pain/discomfort and mobility in ranking of dimensions. CONCLUSION A value set for EQ-5D-5L is now available for Romania. This will push one-step further the development of health technology assessment and encourage more health-related quality-of-life research to be conducted locally.
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Affiliation(s)
- Elena Olariu
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
| | - Wael Mohammed
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Yemi Oluboyede
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Raluca Caplescu
- Department of Statistics and Econometrics, Faculty of Economic Cybernetics, Statistics and Informatics, Bucharest University of Economic Studies, Bucharest, Romania
| | - Ileana Gabriela Niculescu-Aron
- Department of Statistics and Econometrics, Faculty of Economic Cybernetics, Statistics and Informatics, Bucharest University of Economic Studies, Bucharest, Romania
| | - Marian Sorin Paveliu
- Department of Pharmacology and Pharmaeconomics, Faculty of General Medicine, Titu Maiorescu University, Bucharest, Romania
| | - Luke Vale
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
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Liao M, Luo N, Rand K, Yang Z. Urban/rural differences in preferences for EQ-5D-5L health states: a study of a multi-ethnic region in China. Qual Life Res 2023:10.1007/s11136-023-03394-1. [PMID: 36944783 DOI: 10.1007/s11136-023-03394-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVES This study aimed to compare health preferences for EQ-5D-5L health states between urban and rural populations in China. METHODS This study used pooled secondary data from two EQ-5D-5L valuation studies. Participants were recruited from Guizhou province and Chongqing municipality, China using quota sampling. Each participant was interviewed face-to-face to value a set of 15 or 16 out of 30 EQ-5D-5L health states using time trade-off (TTO) methods including composite TTO and other two variants. Regression analysis was used to compare health state preferences between urban and rural participants. RESULTS A total of 597 participants (urban: 55.44%; rural: 44.56%) completed the valuation interviews. Both univariate and multivariable linear regression analyses showed that rural participants tended to value health states lower than urban participants regardless of severity of health states. The unadjusted and adjusted overall mean differences between the two groups were - 0.041 (95% confidence interval [CI] - 0.077, - 0.004, p-value = 0.031) and - 0.040 (95% CI - 0.078, - 0.002, p-value = 0.038), respectively. Predictions for the 3125 health states based on rural participants' health preferences were lower than those based on urban participants' health preferences. CONCLUSION There were small, yet statistically significant, differences in EQ-5D-5L health states preferences between urban and rural populations in China. Future study aiming at establishing a national value set should pay more attention to the sample representativeness.
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Affiliation(s)
- Meixia Liao
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Nan Luo
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Kim Rand
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Maths in Health B.V., Rotterdam, The Netherlands
| | - Zhihao Yang
- Health Services Management Department, Guizhou Medical University, Guiyang, China.
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Murata T, Morimoto K, Matsuyama F, Yamada M, Feliciano J, Hassan M. Health state utility estimation of Mycobacterium Avium complex pulmonary disease using a time trade-off approach. J Med Econ 2023; 26:477-487. [PMID: 36896886 DOI: 10.1080/13696998.2023.2189858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
AIMS To obtain appropriate health state utility values for cost-effectiveness analyses of new Mycobacterium avium complex pulmonary disease (MAC-PD) treatments. The impact of MAC-PD severity and symptoms on quality of life (QoL) also were quantified. METHODS A questionnaire describing four health states, MAC-positive severe, MAC-positive moderate, MAC-positive mild, and MAC-negative, was developed based on St. George's Respiratory Questionnaire (SGRQ) Symptom and Activity scores from the CONVERT trial. The time trade-off (TTO) method with ping-pong titration procedure was used to estimated health state utilities. Regression analyses assessed impacts of covariates. RESULTS Of 319 Japanese adults (49.8% female, mean age 44.8 years), mean (95% CI) health state utility scores (MAC-positive severe, MAC-positive moderate, MAC-positive mild, and MAC-negative) were 0.252 (0.194-0.310), 0.535 (0.488-0.582), 0.816 (0.793-0.839), and 0.881 (0.866-0.896), respectively. MAC-negative state utility scores were significantly higher than MAC-positive severe (mean difference [95% CI], 0.629 [0.574-0.684]), MAC-positive moderate (0.346 [0.304-0.389]), and MAC-positive mild (0.065 [0.048-0.082]) scores (p < 0.001 each). Most participants would trade survival duration to avoid MAC-positive states (97.5% to avoid MAC-positive severe; 88.7% MAC-positive moderate; 61.4% MAC-positive mild). Regression analyses to investigate the impact of background characteristics showed similar utility differences between health states when not adjusted for covariates. LIMITATIONS Some participant demographics differed from the general population; however, this did not impact utility differences among health states as regression analyses adjusting for demographics did not affect these differences. Similar investigations are needed among patients with MAC-PD and in other countries. CONCLUSIONS This study evaluating the impact of MAC-PD on utilities using the TTO method demonstrates that differences in utilities are dependent on the severity of respiratory symptoms and their impacts on daily activities and QoL. These results could contribute to better quantification of the value of MAC-PD treatments and improve assessments of cost-effectiveness.
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A national survey of Iranian general population to estimate a value set for the EQ-5D-5L. Qual Life Res 2023:10.1007/s11136-023-03378-1. [PMID: 36897530 DOI: 10.1007/s11136-023-03378-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES The main aim of this study is to estimate a national value set of the EQ-5D-5L questionnaire for Iran. METHODS The composite time trade-off (cTTO) and discrete choice experiment (DCE) methods; and the protocol for EuroQol Portable Valuation Technology (EQ-PVT) were used to estimate the Iran national value set. 1179 face-to-face computer-assisted interviews were conducted with adults that were recruited from five Iran major cities in 2021. Generalized least squares, Tobit, heteroskedastic, logit, and hybrid models were used to analyze the data and to identify the best fitting model. RESULTS According to the logical consistency of the parameters, significance levels and prediction accuracy indices of the MAE; a heteroscedastic censored Tobit hybrid model combining cTTO and DCE responses was considered as the best fitting model to estimate the final value set. The predicted values ranged from - 1.19 for the worst health state (55555) to 1 for full health (11111), with 53.6% of the predicted values being negative. Mobility was the most influential dimension on health state preference values. CONCLUSIONS The present study estimated a national EQ-5D-5L value set for Iranian policy makers and researchers. The value set enables the EQ-5D-5L questionnaire to use to calculate QALYs to assist the priority setting and efficient allocation of limited healthcare resources.
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Peasgood T, Bourke M, Devlin N, Rowen D, Yang Y, Dalziel K. Randomised comparison of online interviews versus face-to-face interviews to value health states. Soc Sci Med 2023; 323:115818. [PMID: 36940582 PMCID: PMC9993735 DOI: 10.1016/j.socscimed.2023.115818] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/23/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Health state valuation studies using composite time trade-off (cTTO) interviews have historically been conducted face-to-face. The COVID-19 pandemic forced disruptive innovation meaning a number of valuation studies conducted interviews via videoconference. These studies found online interviews feasible and acceptable; however, studies were not constructed to test the impact of online versus face-to-face interviews. This study builds on its sister study from the UK and aims to assess the acceptability and equivalence of in person face-to-face interviews with online interviews on cTTO valuation outcomes and on data quality. METHODS Participants were recruited into a randomised equivalence study via an external research company. Consenting participants were randomly allocated to complete a cTTO interview face-to-face or online, using the same 10 EQ-5D-5L health states. Mean and distribution of the cTTO values, participant understanding, data quality, demographic characteristics, participant preference, participant engagement and participant feedback were all compared across interview mode. Statistical equivalence for cTTO values for each state was tested using two one-sided t-tests by mode. Finally, regression analysis was completed to assess the impacts of interview mode on cTTO value while controlling for demographic characteristics of the participants. RESULTS Mean cTTO values were shown to be equivalent for mild health states and showed no significant difference for serious health states. The proportion of individuals who expressed an interest in the study but declined to arrange an interview after finding out their randomisation was significantly higher for the face-to-face (21.6%) than the online group (1.8%). No significant difference was found between groups for participant engagement, understanding or feedback nor for any indicators of data quality. CONCLUSION Administrating interviews face to face or online did not appear to have a statistically significant impact on mean cTTO values. Offering both online and face-to-face interviews routinely allows all participants to select the most convenient option.
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Affiliation(s)
- Tessa Peasgood
- Health Economics Unit, Centre for Health Policy | Melbourne School of Population and Global Health, The University of Melbourne, Australia.
| | - Mackenzie Bourke
- Health Economics Unit, Centre for Health Policy | Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Nancy Devlin
- Health Economics Unit, Centre for Health Policy | Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Donna Rowen
- School of Health and Related Research, University of Sheffield, UK
| | - Yaling Yang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Kim Dalziel
- Health Economics Unit, Centre for Health Policy | Melbourne School of Population and Global Health, The University of Melbourne, Australia
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Meregaglia M, Malandrini F, Finch AP, Ciani O, Jommi C. EQ-5D-5L Population Norms for Italy. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:289-303. [PMID: 36434410 PMCID: PMC9702834 DOI: 10.1007/s40258-022-00772-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES This study aimed to provide normative data obtained in response to the EQ-5D-5L questionnaire in Italy and compare this with data from other countries. METHODS A sample of the Italian adult population (aged ≥ 18 years) was recruited and interviewed online using videoconferencing software (Zoom) between November 2020 and February 2021. The distribution of answers was estimated as per the descriptive system of the EQ-5D-5L, and descriptive statistics were calculated for the EQ VAS score and EQ-5D-5L index value in the whole sample and relevant subgroups. An ordinary least square (OLS) regression was performed to evaluate the impact of sociodemographic variables on EQ-5D-5L results. Lastly, a comparison was made with EQ-5D-5L population norms of other countries. Data analysis was performed using Microsoft Excel and Stata 13. RESULTS Overall, 1182 people representative of the Italian population (2020) in terms of sex and geographical area responded to the survey. Of the 3125 potential EQ-5D-5L health states, only 106 (3.4%) were selected, and the '11111' and '11112' states were chosen by half of the participants. In terms of EQ-5D-5L dimensions, the frequency of any problems (from slight to extreme) associated with anxiety and depression was high among the very young (18-24 years, 56.0%) and in women of all ages (49.7%). The mean index value (± standard deviation [SD]) was 0.93 (± 0.11) for the entire sample and gradually decreased with age, moving from 0.95 (± 0.06) in the youngest group (18-24 years) to 0.91 (± 0.13) in the oldest age group (≥ 75 years). Similarly, the mean EQ VAS score (± SD) was 81.8 (± 13.5), and decreased from 87.0 (± 8.9) in the 18-24 years age group to 75.1 (± 16.4) among participants > 75 years of age. The existence of self-reported chronic conditions (e.g., cardiovascular disease), female sex, and social assistance recipiency were negatively associated with the EQ-5D index value, while the EQ VAS score was significantly lower in people with chronic conditions and aged > 55 years. Conversely, higher income levels had a positive impact on both the EQ-5D index value and the EQ VAS score. Lastly, both the EQ-5D index value and EQ VAS score in Italy were, on average, higher than in most European countries. CONCLUSIONS EQ-5D-5L population norms provide useful insights into the health status of the Italian population and can be used as a reference for other surveys using the same instrument.
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Affiliation(s)
| | | | - Aureliano Paolo Finch
- EuroQol Office, EuroQol Research Foundation, Rotterdam, The Netherlands
- Health Values Research and Consultancy, Amsterdam, The Netherlands
| | - Oriana Ciani
- CERGAS, SDA Bocconi School of Management, Milan, Italy
| | - Claudio Jommi
- CERGAS, SDA Bocconi School of Management, Milan, Italy
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Al Shabasy S, Roudijk B, Abbassi M, Finch A, Stolk E, Farid S. The Egyptian EQ-5D-5L Extensive Pilot Study: Lessons Learned. PHARMACOECONOMICS 2023; 41:329-338. [PMID: 36434416 PMCID: PMC9928797 DOI: 10.1007/s40273-022-01208-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To investigate the effect of an extensive pilot phase in improving protocol compliance, face validity, reduction of interviewer effect and prediction errors in the composite time trade-off (cTTO) data elicited as part of the EQ-5D-5L valuation study in Egypt. METHODS This study used the cTTO data and quality control (QC) reports from the Egyptian EQ-5D-5L valuation study. Three-level mixed models were estimated to test whether interviewer effects were reduced during the pilot phase and subsequent rounds of collected cTTO data. Ordinary least square (OLS) regression analysis was conducted for each interviewer separately to test whether the mean absolute error (MAE) improved as interviewers completed more interviews. Moreover, improvement in protocol compliance, face validity and reduction of prediction errors in the cTTO data were tested. RESULTS 1180 interviews were conducted by nine interviewers and included in the final analysis, of which 206 interviews were pilot and 974 interviews were actual. There was substantial improvement in the face validity and reduction of prediction errors in the cTTO data where the MAE of the actual data was 0.37, which is much lower than that of the pilot data, which was 0.44. However, there was an initial high level of protocol compliance in terms of the four indicators of the QC tool and the variance attributed to the interviewers was small throughout the whole study. CONCLUSIONS This study clarified the benefits of the pilot phase and the strict implementation of the QC tool in improving the face validity and the prediction accuracy of the cTTO data. However, a more extensive pilot phase may be more beneficial in EQ-5D-5L valuation studies that have issues initially with protocol compliance and interviewer effects.
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Affiliation(s)
- Sahar Al Shabasy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini St., Cairo, 11562, Egypt
| | - Bram Roudijk
- EuroQol Research Foundation, Rotterdam, The Netherlands
| | - Maggie Abbassi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini St., Cairo, 11562, Egypt
| | | | - Elly Stolk
- EuroQol Research Foundation, Rotterdam, The Netherlands
| | - Samar Farid
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini St., Cairo, 11562, Egypt.
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Jyani G, Prinja S, Garg B, Kaur M, Grover S, Sharma A, Goyal A. Health-related quality of life among Indian population: The EQ-5D population norms for India. J Glob Health 2023; 13:04018. [PMID: 36799239 PMCID: PMC9936451 DOI: 10.7189/jogh.13.04018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Background The EuroQol 5 dimensions (EQ-5D) is the most used generic health-related quality of life (HRQoL) instrument for measuring population health and health outcomes. Since there are no EuroQol 5 dimensions 5 levels (EQ-5D-5L) population norms available for India, this study developed the Indian population norms for the EQ-5D-5L. The potential influencing factors of HRQoL of the Indian population have been identified. Methods The data was collected alongside the Indian EQ-5D-5L valuation study (Development of an EQ-5D Value Set for India Using an Extended Design: DEVINE Study). A cross-sectional survey of 3548 adult respondents was conducted across five states of India, in which respondents were asked to report their own health states using the EQ-5D-5L descriptive system and the EuroQol Visual Analog Scale (EQ VAS). The utility score was calculated using the EQ-5D-5L value set based on the preferences of the Indian population. Norm scores were generated for age, sex, and other important socio-demographic variables. The proportion of patients reporting problems in different dimensions of EQ-5D-5L was assessed. The impact of socio-economic determinants on health-related quality of life was evaluated using multiple linear regression. Results The mean EQ VAS score of the Indian population is 75.18 (95% confidence interval (CI) = 74.50-75.90), whereas mean utility score is 0.848 (95% CI = 0.840-0.857). The EQ VAS scores, and utility scores decreased with age. Males reported higher EQ VAS values than females. The highest mean utility score was observed for males of <20 years (0.936), whereas the lowest mean score was observed for females of >70 years (0.488). The mean VAS score ranged between 85.24 for females of <20 years and 50.67 for females of >70 years. Highest problems were reported in the dimension of "pain / discomfort", closely followed by "anxiety / depression". Age, educational qualification, marital status, substance abuse, presence of ailments, state / region of residence, number of dependent members in the household, and time spent on mobile are the significant determinants of HRQoL of Indian population. Conclusions These population norms will be used as reference values for comparative purposes in future Indian studies. Economic evaluations can use these average age-specific HRQoL population norms to value the health-state of not having the specific disease under investigation.
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Affiliation(s)
- Gaurav Jyani
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Basant Garg
- National Health Authority, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Atul Sharma
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aarti Goyal
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Martin AP, Ferri Grazzi E, Mighiu C, Chevli M, Shah F, Maher L, Shaikh A, Sagar A, Hubberstey H, Franks B, Ramos-Goñi JM, Oppe M, Tang D. Health state utilities for beta-thalassemia: a time trade-off study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:27-38. [PMID: 35347553 PMCID: PMC9876862 DOI: 10.1007/s10198-022-01449-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Beta-thalassemia (BT) is an inherited blood disorder characterized by reduced levels of functional hemoglobin resulting in phenotypes ranging from clinically asymptomatic to severely anemic. Patients with BT may require lifelong regular blood transfusions supported by appropriate iron chelation therapy (ICT). This study aimed to determine how the UK general population values BT health states associated with differing transfusion burden and ICT. METHODS Composite time trade-off (cTTO) methodology was employed to elicit health state utilities in BT. Relevant BT literature related to symptom and quality-of-life impact, including physical, functional, and emotional well-being, and safety profiles of BT treatments were considered when drafting health state descriptions. Eleven health state descriptions were developed and validated by hematologists and patient advocates for clinical accuracy and completeness. 200 individuals from the UK general population participated in the cTTO interviews. RESULTS The mean age of participants was 41.50 years (SD 16.01, range 18-81); 88 (46.8%) were female. Utility values ranged from 0.78 (SD 0.34) for non-transfusion dependent BT with oral ICT to 0.37 (SD 0.50) for high transfusion burden with subcutaneous ICT in transfusion-dependent BT. CONCLUSIONS This study provides health utilities for a range of BT health states from the UK general population perspective. Importantly, lower transfusion burden and lower burden of anemia were associated with higher utilities. To a lesser extent, differential modes of ICT were found to impact utility valuations in patients with BT. The utilities obtained in this study can be employed as inputs in cost-effectiveness analyses of BT therapies.
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Affiliation(s)
| | | | | | - Manoj Chevli
- Celgene Ltd, a Bristol-Myers Squibb Company, Uxbridge, UK
| | | | - Louise Maher
- Celgene Ltd, a Bristol-Myers Squibb Company, Uxbridge, UK
| | | | | | | | | | - Juan M Ramos-Goñi
- Formerly Axentiva Solutions, Tacoronte, Santa Cruz de Tenerife, Spain
| | - Mark Oppe
- Formerly Axentiva Solutions, Tacoronte, Santa Cruz de Tenerife, Spain
| | - Derek Tang
- Bristol Myers Squibb, Princeton, NJ, USA
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Jakubczyk M, Lipman SA, Roudijk B, Norman R, Pullenayegum E, Yang Y, Gu NY, Stolk E. Modifying the Composite Time Trade-Off Method to Improve Its Discriminatory Power. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:280-291. [PMID: 36244905 DOI: 10.1016/j.jval.2022.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/20/2022] [Accepted: 08/16/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES In cost-effectiveness analysis of health technologies, health state utilities are needed. They are often elicited with a composite time trade-off (cTTO) method, particularly for the widely used EQ-5D-5L. Unfortunately, cTTO discriminatory power is hindered by (1) respondents' nontrading (NT) of time for quality, (2) censoring of utilities at -1, and (3) poor correlation of negative utilities with state severity. We investigated whether modifying cTTO can mitigate these effects. METHODS We interviewed online 478 students (February to April, 2021) who each valued the same 10 EQ-5D-5L health states in 1 of 3 arms. Arm A used a standard cTTO, expanded with 2 questions to explore reasons for NT and censoring. Arms B and C used a time trade-off with modified alternatives offered to overcome loss aversion, to unify the tasks for positive and negative utilities, and to enable eliciting utilities < -1. RESULTS In arms B and C, we observed less NT than in A (respectively, 4% and 4% vs 10%), more strictly negative utilities (38% and 40% vs 25%), and more utilities ≤ -1 (18% and 30% vs 10%). The average utility of state 55555 dropped to -2.15 and -2.52 from -0.53. Enabling finer trades in arm A reduced NT by 70%. Arms B and C yielded an intuitive association between negative utilities and state severity. These arms were considered more difficult and resulted in more inconsistencies. CONCLUSIONS The discriminatory power of cTTO can be improved, but it may require increasing the difficulty of the task. The standard cTTO may overestimate the utilities, especially of severe states.
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Affiliation(s)
- Michał Jakubczyk
- Decision Analysis and Support Unit, SGH Warsaw School of Economics, Warsaw, Poland.
| | - Stefan A Lipman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Bram Roudijk
- EuroQol Research Foundation, Rotterdam, the Netherlands
| | - Richard Norman
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Eleanor Pullenayegum
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
| | - Yaling Yang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK
| | - Ning Yan Gu
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Elly Stolk
- EuroQol Research Foundation, Rotterdam, the Netherlands
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Fitriana TS, Roudijk B, Purba FD, Busschbach JJV, Stolk E. Estimating an EQ-5D-Y-3L Value Set for Indonesia by Mapping the DCE onto TTO Values. PHARMACOECONOMICS 2022; 40:157-167. [PMID: 36348155 PMCID: PMC9758088 DOI: 10.1007/s40273-022-01210-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Methods for estimating health values in adult populations are well developed, but lag behind in children. The EuroQol standard protocol to arrive at value sets for the youth version of the EQ-5D-Y-3L combines discrete choice experiments with ten composite time trade-off values. Whether ten composite time trade-off values are sufficient remains to be seen and this is one of the reasons the protocol allows for experimental expansion. In this study, 23 health states were administered for the composite time trade-off. This methodological research is embedded in a study aimed at generating a representative value set for EQ-5D-Y-3L in Indonesia. METHODS A representative sample of 1072 Indonesian adults each completed 15 discrete choice experiment choice pairs via face-to-face interviews. The discrete choice experiment responses were analysed using a mixed-logit model. To anchor the discrete choice experiment values onto the full health-dead quality-adjusted life-year scale, composite time trade-off values were separately obtained from 222 adults living in Java for 23 EQ-5D-Y-3L states. The derived latent discrete choice experiment values were mapped onto the mean observed composite time trade-off values to create a value set for the EQ-5D-Y-3L. Linear and non-linear mapping models were explored to estimate the most efficient and valid model for the value set. RESULTS Coefficients obtained from the choice model were consistent with the monotonic structure of the EQ-5D-Y-3L instrument. The composite time trade-off data showed non-linearity, as the values for the two worst states being evaluated were much lower than predicted by a standard linear model estimated over all composite time trade-off data. Thus, the non-linear mapping strategies with a power term outperformed the linear mapping in terms of mean absolute error. The final model gave a value range from 1.000 for full health (11111) to - 0.086 for the worst health state (33333). Values were most affected by pain/discomfort and least by self-care. CONCLUSIONS This article presents the first EQ-5D-Y-3L value set for Indonesia based on the stated preferences of adults asked to consider their views about a 10-year-old child. Mapping the mixed-logit discrete choice experiment model with the inclusion of a power term (without a constant) allowed us to generate a consistent value set for Indonesian youth. Our findings support the expansion of the composite time trade-off part of the EQ-5D-Y valuation study design and show that it would be wise to account for possible non-linearities in updates of the design.
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Affiliation(s)
- Titi Sahidah Fitriana
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
- Faculty of Psychology, YARSI University, Jakarta, Indonesia.
| | - Bram Roudijk
- EuroQol Research Foundation, Rotterdam, The Netherlands
| | - Fredrick Dermawan Purba
- Department of Developmental Psychology, Faculty of Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Jan J V Busschbach
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Elly Stolk
- EuroQol Research Foundation, Rotterdam, The Netherlands
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Łaszewska A, Sajjad A, Busschbach J, Simon J, Hakkaart-van Roijen L. Conceptual Framework for Optimised Proxy Value Set Selection Through Supra-National Value Set Development for the EQ-5D Instruments. PHARMACOECONOMICS 2022; 40:1221-1234. [PMID: 36201130 PMCID: PMC9534733 DOI: 10.1007/s40273-022-01194-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Preference differences between countries and populations justify the use of country-specific value sets for the EQ-5D instruments. There are no clear criteria based on which the selection of value sets for countries without a national value set should be made. As part of the European PECUNIA project, this study aimed to identify factors contributing to differences in preference-based valuations and develop supra-national value sets for homogenous country clusters in Europe. METHODS A literature review was conducted to identify factors relevant to variations in the EQ-5D-3L/5L health state valuations across countries. Factors fulfilling the pre-specified criteria of validity, reliability, international feasibility and comparability were used to group 27 European Union member states, the European Free Trade Association countries and the UK. Clusters of countries were developed based on the frequency of their appearance in the same grouping. The supra-national value sets were estimated for these clusters from the coefficients of existing published valuation studies using the ordinary least-squares model. RESULTS Ten factors were identified from 69 studies. From these, five grouping variables: (1) culture and religion; (2) linguistics; (3) healthcare system typology; (4) healthcare system financing; and (5) sociodemographic aspects were derived to define the groups of homogenous countries. Frequency-based grouping revealed five cohesive clusters: English-speaking, Nordic, Central-Western, Southern and Eastern European. CONCLUSIONS European countries were clustered considering variables that may relate to differences in health state valuations. Supra-national value sets provide optimised proxy value set selection in the lack of a national value set and/or for regional decision making.
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Affiliation(s)
- Agata Łaszewska
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria.
| | - Ayesha Sajjad
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jan Busschbach
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Leona Hakkaart-van Roijen
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Roudijk B, Sajjad A, Essers B, Lipman S, Stalmeier P, Finch AP. A Value Set for the EQ-5D-Y-3L in the Netherlands. PHARMACOECONOMICS 2022; 40:193-203. [PMID: 36216977 PMCID: PMC9549846 DOI: 10.1007/s40273-022-01192-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 05/05/2023]
Abstract
BACKGROUND AND OBJECTIVE There is increasing interest in preference-accompanied measures of health for paediatric populations. The child-friendly EQ-5D version, EQ-5D-Y-3L, is one such instrument, but the lack of a Dutch value set prevents its use in economic evaluations of healthcare interventions in the Netherlands. This study aims at covering this gap by collecting preferences using a standardised protocol for deriving EQ-5D-Y-3L value sets. METHODS Composite time trade-off data were collected using videoconferencing interviews, with each respondent completing ten composite time trade-off tasks. Discrete choice experiment data were collected using an online survey, with respondents each completing 15 paired comparisons. Respondents completed these tasks considering what they prefer for a hypothetical 10-year-old child. Discrete choice experiment data were analysed using a ten-parameter mixed-logit model and anchored to the quality-adjusted life-year scale using the mean observed composite time trade-off values. RESULTS The study collected preferences for 197 respondents using composite time trade-off and for 959 respondents using a discrete choice experiment. The discrete choice experiment sample was representative for the Dutch population in terms of age and sex. The level 3 weight for pain/discomfort was the largest, followed by feeling worried, sad or unhappy, usual activities, mobility and self-care. Health state values ranged between -0.218 and 1. CONCLUSIONS This study generated a Dutch value set for the EQ-5D-Y-3L, which can be used for the computation of quality-adjusted life-years for economic evaluations of healthcare interventions in paediatric populations.
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Affiliation(s)
- Bram Roudijk
- EuroQol Research Foundation, Rotterdam, The Netherlands.
| | - Ayesha Sajjad
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Brigitte Essers
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Stefan Lipman
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Peep Stalmeier
- Radboud University Medical Center, Nijmegen, The Netherlands
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Dewilde S, Roudijk B, Tollenaar NH, Ramos-Goñi JM. An EQ-5D-Y-3L Value Set for Belgium. PHARMACOECONOMICS 2022; 40:169-180. [PMID: 36316544 PMCID: PMC9628592 DOI: 10.1007/s40273-022-01187-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND In Belgium, a value set for children and adolescents for a generic health-related quality-of-life measure is not available. To inform drug pricing and make resource allocation decisions for children and adolescents, national tax-payers' preferences for youth health states should be known. OBJECTIVE We aimed to obtain a value set for EQ-5D-Y-3L in Belgium, following the international youth valuation protocol for data collection. METHODS Composite Time Trade-Off interviews were conducted in a sample of 200 adults, either face to face or via video conferencing. Another sample of 1000 adults completed an online discrete choice experiment survey. All adults were asked to take the perspective of a 10-year-old child for both methods. Both samples were representative for Belgium in terms of age, sex and region. A latent class analysis was selected to obtain the relative importance of the five dimensions and their levels based on the discrete choice experiment data, which were anchored with the composite Time Trade-Off censored value for the worst health state (33333). RESULTS Preferences from Belgian adults revealed a mean censored value for 33333 for children and adolescents of - 0.475. All the estimated coefficients of the model with 4 latent classes were statistically significant and showed higher disutility as severity levels increase. The most important health dimension was pain/discomfort, followed by feeling sad/worried/unhappy. CONCLUSIONS This study presents the Belgian EQ-5D-Y-3L value set, which will be included in the Belgian pharmacoeconomic guidelines. The value set enables the calculation of quality-adjusted life-years in children and adolescents, allowing a cost-effectiveness evaluation of health technologies and their youth-specific price setting.
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Affiliation(s)
- Sarah Dewilde
- Services in Health Economics, Rue des Eburons 55, 1000, Brussels, Belgium.
| | - Bram Roudijk
- EuroQol Research Foundation, Rotterdam, The Netherlands
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Lipman SA, Essers BAB, Finch AP, Sajjad A, Stalmeier PFM, Roudijk B. In a Child's Shoes: Composite Time Trade-Off Valuations for EQ-5D-Y-3L with Different Proxy Perspectives. PHARMACOECONOMICS 2022; 40:181-192. [PMID: 36255560 PMCID: PMC9579618 DOI: 10.1007/s40273-022-01202-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 05/04/2023]
Abstract
BACKGROUND AND OBJECTIVES EQ-5D-Y-3L health states are commonly valued by asking adults to complete stated preference tasks, 'given their views about a 10-year-old child' (hereafter referred to as proxy 1). The use of this perspective has been a source of debate. In this paper, we investigated an alternative proxy perspective: i.e. adults considered what they think a 10-year old-child would decide for itself (hereafter, proxy 2 (substitute)]. Our main objective was to explore how the outcomes, dispersion and response patterns of a composite time trade-off valuation differ between proxy 1 and proxy 2. METHODS A team of four trained interviewers completed 402 composite time trade-off interviews following the EQ-5D-Y-3L protocol. Respondents were randomly allocated to value health states in either the proxy 1 or proxy 2 (substitute) perspective. Each respondent valued ten health states with the perspective they were assigned to, as well as one health state with the alternative perspective (33333). RESULTS The use of different proxy perspectives yielded differences in EQ-5D-Y-3L valuation. For states in which children had considerable pain and were very worried, sad or unhappy, respondents' valuations were lower in proxy 1 than in proxy 2 (substitute) perspectives, by about 0.2. Within-subject variation across health states was lower for proxy 2 (substitute) than proxy 1 perspectives. Analyses of response patterns suggest that data for proxy 2 (substitute) perspectives were less clustered. CONCLUSIONS There are systematic differences between composite time trade-off responses given by adults deciding for children and adults considering what children would want for themselves. In addition to warranting further qualitative exploration, such differences contribute to the ongoing normative discussion surrounding the source and perspective used for valuation of child and adolescent health.
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Affiliation(s)
- Stefan A Lipman
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
| | - Brigitte A B Essers
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Ayesha Sajjad
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Peep F M Stalmeier
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bram Roudijk
- EuroQol Research Foundation, Rotterdam, The Netherlands
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Rencz F, Ruzsa G, Bató A, Yang Z, Finch AP, Brodszky V. Value Set for the EQ-5D-Y-3L in Hungary. PHARMACOECONOMICS 2022; 40:205-215. [PMID: 36123448 PMCID: PMC9485017 DOI: 10.1007/s40273-022-01190-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 05/19/2023]
Abstract
BACKGROUND The Hungarian health technology assessment guidelines recommend the use of the EuroQol instrument family in quality-adjusted life-year calculations. However, no national value set exists for the EQ-5D-Y-3L or any other youth-specific instrument. OBJECTIVE This study aims to develop a national value set of the EQ-5D-Y-3L for Hungary based on preferences of the general adult population. METHODS This study followed the international valuation protocol for the EQ-5D-Y-3L. Two independent samples, representative of the Hungarian general adult population in terms of age and sex were recruited to complete online discrete choice experiment (DCE) tasks and composite time trade-off (cTTO) tasks by computer-assisted personal interviews. Adults valued hypothetical EQ-5D-Y-3L health states considering the health of a 10-year-old child. DCE data were modelled using a mixed logit model with random-correlated coefficients. Latent DCE utility estimates were mapped onto mean observed cTTO utilities using ordinary least squares regression. RESULTS Overall, 996 and 200 respondents completed the DCE and cTTO surveys, respectively. For each domain, the value set resulted in larger utility decrements with more severe response levels. The relative importance of domains by level 3 coefficients was as follows: having pain or discomfort > feeling worried, sad or unhappy > mobility > doing usual activities > looking after myself. Overall, 12.3% of all health states had negative utilities in the value set, with the worst health state having the lowest predicted utility of - 0.485. CONCLUSION This study developed a national value set of the EQ-5D-Y-3L for Hungary. The value set enables to evaluate the cost utility of health technologies for children and adolescents based on societal preferences in Hungary.
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Affiliation(s)
- Fanni Rencz
- Department of Health Policy, Corvinus University of Budapest, 8 Fővám tér, 1093, Budapest, Hungary.
| | - Gábor Ruzsa
- Department of Statistics, Corvinus University of Budapest, Budapest, Hungary
- Doctoral School of Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Alex Bató
- Department of Health Policy, Corvinus University of Budapest, 8 Fővám tér, 1093, Budapest, Hungary
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, Budapest, Hungary
| | - Zhihao Yang
- Health Services Management Department, Guizhou Medical University, Guiyang, China
| | | | - Valentin Brodszky
- Department of Health Policy, Corvinus University of Budapest, 8 Fővám tér, 1093, Budapest, Hungary
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Kreimeier S, Mott D, Ludwig K, Greiner W. EQ-5D-Y Value Set for Germany. PHARMACOECONOMICS 2022; 40:217-229. [PMID: 35604633 PMCID: PMC9124748 DOI: 10.1007/s40273-022-01143-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 05/19/2023]
Abstract
BACKGROUND Demand is increasing for youth-specific preference-based health-related quality-of-life measures for inclusion in evaluations of healthcare interventions for children and adolescents. The EQ-5D-Youth (EQ-5D-Y) has the potential to become such a preference-based measure. OBJECTIVE This study applied the recently published EQ-5D-Y valuation protocol to develop a German EQ-5D-Y value set and explored the differences between values given to youth health by parents and non-parents. METHODS To elicit EQ-5D-Y health state preferences, a representative sample of 1030 adults of the general population completed a discrete choice experiment (DCE) online survey, and 215 adults participated in face-to-face interviews applying composite time trade-off (cTTO). Respondents were asked to consider a 10-year-old child living in the health states. DCE data were modelled using a mixed logit model. To derive the value set, DCE latent scale values were anchored onto adjusted mean cTTO values using a linear mapping approach. RESULTS Adult respondents considered pain/discomfort and feeling worried/sad/unhappy as the two most important dimensions in terms of youth health. Adjusted mean cTTO values ranged from - 0.350 for health state 33333 to 0.970 for health state 21111. The EQ-5D-Y value set showed a logical order for all parameter estimates, and predicted values ranged from - 0.283 to 1. Differences in preferences by parental status were mainly observed for cTTO results, where mean values were larger for parents than for non-parents. CONCLUSIONS Applying the valuation protocol, a German EQ-5D-Y value set with internally consistent coefficients was developed. This enables the instrument to be used in economic evaluations of paediatric healthcare interventions.
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Affiliation(s)
- Simone Kreimeier
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany.
| | | | - Kristina Ludwig
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
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