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Wang Y, Xu Y, Shan H, Pan H, Chen J, Yang J. Health state utility values of type 2 diabetes mellitus and related complications: a systematic review and meta-regression. Health Qual Life Outcomes 2024; 22:74. [PMID: 39244536 DOI: 10.1186/s12955-024-02288-1] [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: 05/17/2024] [Accepted: 08/26/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND This study aimed to synthesize and quantitatively examine Health State Utility Values (HSUVs) for Type 2 Diabetes Mellitus (T2DM) and its complications, providing a robust meta-regression framework for selecting appropriate HSUV estimates. METHOD We conducted a systematic review to extract HSUVs for T2DM and its complications, encompassing various influencing factors. Relevant literature was sourced from a review spanning 2000-2020, supplemented by literature from PubMed, Embase, and the Web of Science (up to March 2024). Multivariate meta-regression was performed to evaluate the impact of measurement tools, tariffs, health status, and clinical and demographic variables on HSUVs. RESULTS Our search yielded 118 studies, contributing 1044 HSUVs. The HSUVs for T2DM with complications varied, from 0.65 for cerebrovascular disease to 0.77 for neuropathy. The EQ-5D-3L emerged as the most frequently employed valuation method. HSUV differences across instruments were observed; 15-D had the highest (0.89), while HUI-3 had the lowest (0.70) values. Regression analysis elucidated the significant effects of instrument and tariff choice on HSUVs. Complication-related utility decrement, especially in diabetic foot, was quantified. Age <70 was linked to increased HSUVs, while longer illness duration, hypertension, overweight and obesity correlated with reduced HSUVs. CONCLUSION Accurate HSUVs are vital for the optimization of T2DM management strategies. This study provided a comprehensive data pool for HSUVs selection, and quantified the influence of various factors on HSUVs, informing analysts and policymakers in understanding the utility variations associated with T2DM and its complications.
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Affiliation(s)
- Yubo Wang
- Department of Pharmacy, 1/F, Science and Technology Building, The First Affiliated Hospital of Xinjiang Medical University, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
- Xinjiang Key Laboratory of Clinical Drug Research, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Yueru Xu
- School of Pharmacy, Xinjiang Medical University, No.393 XinYi Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Huiting Shan
- Department of Pharmacy, 1/F, Science and Technology Building, The First Affiliated Hospital of Xinjiang Medical University, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
- Xinjiang Key Laboratory of Clinical Drug Research, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Huimin Pan
- Department of Pharmacy, 1/F, Science and Technology Building, The First Affiliated Hospital of Xinjiang Medical University, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
- Xinjiang Key Laboratory of Clinical Drug Research, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Ji Chen
- Department of Pharmacy, 1/F, Science and Technology Building, The First Affiliated Hospital of Xinjiang Medical University, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China.
- Xinjiang Key Laboratory of Clinical Drug Research, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China.
| | - Jianhua Yang
- Department of Pharmacy, 1/F, Science and Technology Building, The First Affiliated Hospital of Xinjiang Medical University, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China.
- Xinjiang Key Laboratory of Clinical Drug Research, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China.
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Kiadaliri A, Cronström A, Dahlberg LE, Lohmander LS. Patient acceptable symptom state and treatment failure threshold values for work productivity and activity Impairment and EQ-5D-5L in osteoarthritis. Qual Life Res 2024; 33:1257-1266. [PMID: 38409279 PMCID: PMC11045603 DOI: 10.1007/s11136-024-03602-6] [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] [Accepted: 01/06/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To estimate patient acceptable symptom state (PASS) and treatment failure (TF) threshold values for Work Productivity and Activity Impairment (WPAI) measure and EQ-5D-5L among people with hip or knee osteoarthritis (OA) 3 and 12 months following participation in a digital self-management intervention (Joint Academy®). METHODS Among the participants, we computed work and activity impairments scores (both 0-100, with a higher value reflecting higher impairment) and the Swedish hypothetical- (range: - 0.314 to 1) and experience-based (range: 0.243-0.976) EQ-5D-5L index scores (a higher score indicates better health status) at 3- (n = 14,607) and 12-month (n = 2707) follow-ups. Threshold values for PASS and TF were calculated using anchor-based adjusted predictive modeling. We also explored the baseline dependency of threshold values according to pain severity at baseline. RESULTS Around 42.0% and 48.3% of the participants rated their current state as acceptable, while 4.2% and 2.8% considered the treatment had failed at 3 and 12 months, respectively. The 3-month PASS/TF thresholds were 16/29 (work impairment), 26/50 (activity impairment), 0.92/0.77 (hypothetical EQ-5D-5L), and 0.87/0.77 (the experience-based EQ-5D-5L). The thresholds at 12 months were generally comparable to those estimated at 3 months. There were baseline dependencies in PASS/TF thresholds with participants with more severe baseline pain considering poorer (more severe) level of WPAI/EQ-5D-5L as satisfactory. CONCLUSION PASS and TF threshold values for WPAI and EQ-5D-5L might be useful for meaningful interpretation of these measures among people with OA. The observed baseline dependency of estimated thresholds limits their generalizability and values should be applied with great caution in other settings/populations.
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Affiliation(s)
- Ali Kiadaliri
- Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.
- Arthro Therapeutics, Malmö, Sweden.
- Clinical Epidemiology Unit, Skåne University Hospital, Remissgatan 4, 221 85, Lund, Sweden.
| | - Anna Cronström
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Leif E Dahlberg
- Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
- Arthro Therapeutics, Malmö, Sweden
| | - L Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
- Arthro Therapeutics, Malmö, Sweden
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Zhang Y, Li J, Yang L. Health-related quality of life of Chinese patients with chronic kidney disease: a study based on four EQ-5D-3L value sets. Sci Rep 2023; 13:7863. [PMID: 37188868 DOI: 10.1038/s41598-023-35002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/11/2023] [Indexed: 05/17/2023] Open
Abstract
Provide reference data on which EQ-5D-3L value set should be used with Chinese patients with chronic kidney disease (CKD); assess differences in health-related quality of life (HRQoL) based on the use of the Chinese (from 2014 and 2018), the UK, and the Japanese value sets; and examine differences in utility scores for key preventive influencing factors. Data from 373 patients with CKD recruited for a cross-sectional multicenter HRQoL survey were used. Differences among utility scores based on the four value sets were determined using Wilcoxon signed rank test. Intra-class correlation coefficient (ICCs) and Bland-Altman plots were used to evaluate consistency among utility scores and Tobit regression model was used to analyze the influencing factors of utility scores. There were significant differences between utility scores based on the four value sets, with the Chinese 2018 value set yielding the highest utility (0.957). ICCs between the value sets for China 2014, the UK, and Japan were all greater than 0.9, whereas the ICCs between the value sets for China 2018 and the other three were all less than 0.7. The influencing factors of utility scores included CKD stages, age, education level, city, and primary renal disease. This was the first study to report findings on the health utility of patients with CKD based on the two Chinese EQ-5D-3L value sets. Overall, the Chinese value sets performed similarly to the other two value sets (UK and Japan) commonly used in the Chinese population; however, value sets for different countries were not interchangeable. In Chinese contexts, the two value sets for China were recommended and the choice of which one should consider whether the value set of choice was established with a sample that is consistent with the targeted population.
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Affiliation(s)
- Ye Zhang
- Population Development Studies Center, Renmin University of China, Beijing, 100872, People's Republic of China
- School of Sociology and Population Studies, Renmin University of China, Beijing, 100872, People's Republic of China
| | - Jinyue Li
- School of Statistics, Renmin University of China, Beijing, 100872, People's Republic of China
| | - Li Yang
- School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, People's Republic of China.
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Svedbom A, Borgstöm F, Hernlund E, Alekna V, Bianchi ML, Clark P, Diaz-Curiel M, Dimai HP, Jürisson M, Lesnyak O, McCloskey E, Sanders KM, Silverman S, Tamulaitiene M, Thomas T, Tosteson ANA, Jönsson B, Kanis JA. An experience- and preference-based EQ-5D-3L value set derived using 18 months of longitudinal data in patients who sustained a fracture: results from the ICUROS. Qual Life Res 2023; 32:1199-1208. [PMID: 36495384 PMCID: PMC10063467 DOI: 10.1007/s11136-022-03303-y] [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] [Accepted: 11/12/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION EQ-5D-3L preference-based value sets are predominately based on hypothetical health states and derived in cross-sectional settings. Therefore, we derived an experience-based value set from a prospective observational study. METHODS The International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) was a multinational study on fragility fractures, prospectively collecting EQ-5D-3L and Time trade-off (TTO) within two weeks after fracture (including pre-fracture recall), and at 4, 12, and 18 months thereafter. We derived an EQ-5D-3L value set by regressing the TTO values on the ten impairment levels in the EQ-5D-3L. We explored the potential for response shift and whether preferences for domains vary systematically with prior impairment in that domain. Finally, we compared the value set to 25 other EQ-5D-3L preference-based value sets. RESULTS TTO data were available for 12,954 EQ-5D-3L health states in 4683 patients. All coefficients in the value set had the expected sign, were statistically significant, and increased monotonically with severity of impairment. We found evidence for response shift in mobility, self-care, and usual activities. The value set had good agreement with the only other experience- and preference-based value set, but poor agreement with all hypothetical value sets. CONCLUSIONS We present an experience- and preference-based value set with high face validity. The study indicates that response shift may be important to account for when deriving value sets. Furthermore, the study suggests that perspective (experienced versus hypothetical) is more important than country setting or demographics for valuation of EQ-5D-3L health states.
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Affiliation(s)
- Axel Svedbom
- ICON, Stockholm, Sweden.
- Division of Dermatology and Venereology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
| | | | | | | | | | - Patricia Clark
- Clinical Epidemiology Unit, Hospital Infantil Federico Gómez and Faculty of Medicine UNAM, Ciudad de Mexico, Mexico
| | - Manuel Diaz-Curiel
- Servicio de Medicina Interna/Enfermedades Metabolicas Oseas, Fundacion Jimenez Diaz, Madrid, Spain
- Catedra de Enfermedades Metabolicas Óseas, Universidad Autonoma, Madrid, Spain
| | - Hans Peter Dimai
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Mikk Jürisson
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Olga Lesnyak
- North-West State Medical University Named After I.I.Mechnikov, St.Petersburg, Russian Federation
| | - Eugene McCloskey
- Academic Unit of Bone Metabolism, Metabolic Bone and Centre for Integrated Research in Musculoskeletal Ageing University of Sheffield, Sheffield, UK
| | - Kerrie M Sanders
- Department of Clinical Medicine, Western Health and Sunshine Campus Melbourne University, Victoria, Australia
| | | | | | - Thierry Thomas
- Department of Rheumatology, Hôpital Nord, Centre Hospitalier Universitaire (CHU) Saint-Etienne, INSERM U1059, Lyon University, Saint-Etienne, France
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, USA
| | | | - John A Kanis
- Department of Clinical Medicine, Western Health and Sunshine Campus Melbourne University, Victoria, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
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Balázs PG, Erdősi D, Zemplényi A, Brodszky V. Time trade-off health state utility values for depression: a systematic review and meta-analysis. Qual Life Res 2023; 32:923-937. [PMID: 36178658 PMCID: PMC10063515 DOI: 10.1007/s11136-022-03253-5] [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] [Accepted: 09/03/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aims to systematically review the literature on health utility in depression generated by time trade-off (TTO) method and to compare health state vignettes. METHODS Systematic literature search was conducted following PRISMA guideline in 2020 November (updated in 2022 March) in Pubmed, Web of Science, PsycInfo, and Cochrane Database of Systematic Reviews. Random effect meta-analysis was conducted to pool vignette-based utility values of mild, moderate, and severe depression and to compare the preferences of depressed and nondepressed population. RESULTS Overall, 264 records were found, 143 screened by title and abstract after removing duplicates, 18 assessed full text, and 14 original publications included. Majority of the studies (n = 9) used conventional TTO method, and most of the studies (n = 8) applied 10-year timeframe. Eight studies evaluated self-experienced health (own-current depression). Six studies assessed vignette-based health states of remitted, mild, moderate, and severe depression, half of them applied McSad measure based health description. Altogether, 61 different utility values have been cataloged, mean utility of self-experienced depression states (n = 33) ranged between 0.89 (current-own depression) and 0.24 (worst experienced depression). Pooled utility estimates for vignette-based mild, moderate, and severe depression was 0.75, 0.66 and 0.50, respectively. Meta-regression showed that severe depression (β = -0.16) and depressed sample populations (β = -0.13) significantly decrease vignette-based utility scores. CONCLUSION Our review revealed extent heterogeneity both in TTO methodology and health state vignette development. Patient's perception of depression health states was worse than healthy respondents.
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Affiliation(s)
- Péter György Balázs
- Doctoral School of Business and Management, Corvinus University of Budapest, Budapest, Hungary
- Institute of Social and Political Sciences, Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary
| | - Dalma Erdősi
- Center for Health Technology Assessment and Pharmacoeconomic Research, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Antal Zemplényi
- Center for Health Technology Assessment and Pharmacoeconomic Research, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Valentin Brodszky
- Institute of Social and Political Sciences, Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary
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Dixon PR, Shapiro J, Tomlinson G, Cottrell J, Lui JT, Falk L, Chen JM. Health State Utility Values Associated with Cochlear Implants in Adults: A Systematic Review and Network Meta-Analysis. Ear Hear 2023; 44:244-253. [PMID: 36303282 DOI: 10.1097/aud.0000000000001287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The cost-effectiveness of bilateral cochlear implants in adults remains uncertain despite established clinical benefits. In cost-effectiveness studies, benefit is often measured by change in health state utility value (HSUV), a single number summary of health-related quality of life anchored at 0 (state of being dead) and 1 (perfect health). Small differences in bilateral cochlear implant HSUV change conclusions of published models, and invalid estimates can therefore mislead policy and funding decisions. As such, we aimed to review and synthesize published HSUV estimates associated with cochlear implants. DESIGN We included observational or experimental studies reporting HSUV for adult patients (age ≥18 years) with at least moderate-profound sensorineural hearing loss in both ears who received unilateral or bilateral cochlear implants. We searched MEDLINE, EMBASE, PsycINFO, and Cochrane Library databases up to May 1, 2021. Study and participant characteristics and HSUV outcomes were extracted. Narrative synthesis is reported for all studies. A Bayesian network meta-analysis was conducted to generate pooled estimates for the mean difference in HSUV for three comparisons: (1) unilateral cochlear implant versus preimplant, (2) bilateral cochlear implants versus preimplant, (3) bilateral versus unilateral cochlear implants. Our principal measure was pooled mean difference in HSUV. RESULTS Thirty-six studies reporting unique patient cohorts were identified. Health Utilities Index, 3 (HUI-3) was the most common HSUV elicitation method. HSUV from 19 preimplant mean estimates (1402 patients), 19 unilateral cochlear implant mean estimates (1701 patients), and 5 bilateral cochlear implants mean estimates (83 patients) were pooled to estimate mean differences in HUI-3 HSUV by network meta-analysis. Compared with preimplant, a unilateral cochlear implant was associated with a mean change in HSUV of +0.17 (95% credible interval [CrI] +0.12 to +0.23) and bilateral cochlear implants were associated with a mean change of +0.25 (95% CrI +0.12 to +0.37). No significant difference in HSUV was detected for bilateral compared with unilateral cochlear implants (+0.08 [95% CrI -0.06 to +0.21]). Overall study quality was moderate. CONCLUSIONS The findings of this review and network meta-analysis comprise the best-available resource for parameterization of cost-utility models of cochlear implantation in adults and highlight the need to critically evaluate the validity of available HSUV instruments for bilateral cochlear implant populations.Protocol registration: PROSPERO (CRD42018091838).
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Affiliation(s)
- Peter R Dixon
- Department of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, California
| | - Justin Shapiro
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto
| | - George Tomlinson
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, Canada
| | - Justin Cottrell
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Justin T Lui
- Section of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Calgary, Calgary, Canada
| | - Lindsey Falk
- Evidence, Development and Standards, Health Quality Ontario
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Joseph M Chen
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
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Chalet FX, Bujaroska T, Germeni E, Ghandri N, Maddalena ET, Modi K, Olopoenia A, Thompson J, Togninalli M, Briggs AH. Mapping the Insomnia Severity Index Instrument to EQ-5D Health State Utilities: A United Kingdom Perspective. PHARMACOECONOMICS - OPEN 2023; 7:149-161. [PMID: 36703022 PMCID: PMC9928998 DOI: 10.1007/s41669-023-00388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE This study aimed to map the Insomnia Severity Index (ISI) to the EQ-5D-3L utility values from a UK perspective. METHODS Source data were derived from the 2020 National Health and Wellness Survey (NHWS) for France, Germany, Italy, Spain, the UK and the US. Ordinary least squares regression, generalised linear model (GLM), censored least absolute deviation, and adjusted limited dependent variable mixture model (ALDVMM) were employed to explore the relationship between ISI total summary score and EQ-5D utility while accounting for adjustment covariates derived from the NHWS. Fitting performance was assessed using standard metrics, including mean-squared error (MSE) and coefficient of determination (R2). RESULTS A total of 17,955 respondent observations were included, with a mean ISI score of 12.12 ± 5.32 and a mean EQ-5D-3L utility (UK tariff) of 0.71 ± 0.23. GLM gamma-log and ALDVMM were the two best performing models. The ALDVMM had better fitting performance (R2 = 0.320, MSE 0.0347) than the GLM gamma-log (R2 = 0.303, MSE 0.0353); in train-test split-sample validation, ALDVMM also slightly outperformed the GLM gamma-log model, with an MSE of 0.0351 versus 0.0355. Based on fitting performance, ALDVMM and GLM gamma-log were the preferred models. CONCLUSIONS In the absence of preference-based measures, this study provides an updated mapping algorithm for estimating EQ-5D-3L utilities from the ISI summary total score. This new mapping not only draws its strengths from the use of a large international dataset but also the incorporation of adjustment variables (including sociodemographic and general health characteristics) to reduce the effects of confounders.
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Affiliation(s)
| | - Teodora Bujaroska
- Visium, EPFL Innovation Park, Rte Cantonale, 1015, Lausanne, Switzerland
| | - Evi Germeni
- Health Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Nizar Ghandri
- Visium, EPFL Innovation Park, Rte Cantonale, 1015, Lausanne, Switzerland
| | - Emilio T Maddalena
- Visium, EPFL Innovation Park, Rte Cantonale, 1015, Lausanne, Switzerland
| | - Kushal Modi
- Cerner Enviza, 2800 Rockcreek Parkway, North Kansas City, MO, 64117, USA
| | - Abisola Olopoenia
- Cerner Enviza, 2800 Rockcreek Parkway, North Kansas City, MO, 64117, USA
| | - Jeffrey Thompson
- Cerner Enviza, 2800 Rockcreek Parkway, North Kansas City, MO, 64117, USA
| | - Matteo Togninalli
- Visium, EPFL Innovation Park, Rte Cantonale, 1015, Lausanne, Switzerland
| | - Andrew H Briggs
- Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
- Avalon Health Economics LLC, 119 Washington St, Morristown, NJ, 07960, USA
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Nakamura CA, Mitchell PM, Peters TJ, Moreno-Agostino D, Araya R, Scazufca M, Hollingworth W. A Validation Study of the EQ-5D-5L and ICEpop Capability Measure for Older People Among Older Individuals With Depressive Symptoms in Brazil. Value Health Reg Issues 2022; 30:91-99. [PMID: 35325703 DOI: 10.1016/j.vhri.2021.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/03/2021] [Accepted: 11/30/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study aimed to assess the known-groups validity of the EQ-5D-5L and the ICEpop Capability Measure for Older People (ICECAP-O), 2 outcome measures used in economic evaluation, among older adults with depressive symptoms in socioeconomically deprived areas of Brazil. We also explored the role of education and income on responses to these measures. METHODS This cross-sectional study used baseline data from PROACTIVE, a cluster randomized controlled trial to evaluate a psychosocial intervention for late-life depression among older adults. Participants aged ≥60 years with a 9-item Patient Health Questionnaire score ≥10 were recruited from 20 primary healthcare clinics. Ordered logistic regression models assessed the association between depressive symptoms severity, income, and education and dimension-level responses on the EQ-5D-5L and ICECAP-O. Multivariable regression models investigated the ability of EQ-5D-5L and ICECAP-O scores to discriminate between depressive symptoms severity levels and other characteristics, including education level and household income. RESULTS A total of 715 participants were included in the study. Depressive symptoms severity was associated with all EQ-5D-5L and ICECAP-O dimensions, except the ICECAP-O enjoyment attribute. In contrast, household income was only associated with the ICECAP-O security attribute. Higher severity of depressive symptoms (9-item Patient Health Questionnaire scores) was also strongly associated with lower (ie, worse) scores on both measures in all models. Education level and household income showed no association with either EQ-5D-5L or ICECAP-O scores. CONCLUSIONS To best of our knowledge, this is the first study that investigated the validity of these 2 measures among older adults in Brazil. Both EQ-5D-5L and ICECAP-O showed evidence of validity in differentiating depressive symptom severity.
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Affiliation(s)
- Carina A Nakamura
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.
| | - Paul M Mitchell
- Health Economics Bristol, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Tim J Peters
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Darío Moreno-Agostino
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
| | - Ricardo Araya
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
| | - Marcia Scazufca
- Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - William Hollingworth
- Health Economics Bristol, Bristol Medical School, University of Bristol, Bristol, England, UK
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Tan XW, Lim KWK, Martin D, Tor PC. Effects of electroconvulsive therapy on cognition and quality of life in schizophrenia. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:400-408. [PMID: 35906939 DOI: 10.47102/annals-acadmedsg.202292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The effects of electroconvulsive therapy (ECT) on quality of life (QoL), and its relationship with symptom and cognitive change remains unclear. We aim to examine the association of QoL changes with psychiatric symptom and cognitive changes among patients with schizophrenia who underwent ECT. METHODS This is a retrospective cohort study of 132 patients who received ECT from July 2017 to December 2019. Sociodemographic and clinical characteristics were obtained from medical records. Changes in QoL, psychiatric symptoms and cognition function were examined after 6 sessions of ECT. Generalised linear regression was used to examine the associations of Brief Psychiatric Rating Scale (BPRS) scores and Montreal Cognitive Assessment (MoCA) scores with QoL as measured by EQ-5D scores. RESULTS The mean (standard error) improvements after ECT were statistically significant for the assessment scales of EQ-5D utility score: 0.77 (0.02) to 0.89 (0.02), P<0.001; EuroQol-5-Dimension (EQ-5D) visual analogue scale score: 66.82 (2.61) to 73.05 (1.93), P=0.012; and EQ-5D subdomain scores. Both improvement in BPRS (adjusted β coefficient -0.446, 95% confidence interval [CI] -0.840 to -0.052) and MoCA (adjusted β 12.068, 95% CI 0.865 to 12.271) scores were significantly associated with improvement in EQ-5D utility scores after adjustment for sociodemographic and clinical characteristics. Improvement of BPRS scores (psychiatric symptoms) was significantly associated with improvement of the patients' mental health that was assessed by EQ-5D subdomain scores of pain (adjusted β coefficient 0.012, 95% CI 0.004 to 0.021) and anxiety (adjusted β coefficient 0.013, 95% CI 0.002 to 0.024). Improvement of MoCA scores (cognitive function) was significantly associated with patients' physical health as assessed by EQ-5D subdomain score of usual activity (adjusted β coefficient -0.349, 95% CI -0.607 to -0.09). CONCLUSION ECT was associated with an overall improvement of QoL among patients with schizophrenia. The improvement of psychiatric symptoms was found to be significantly associated with better mental health while the improvement of cognitive function was associated with better physical health.
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Affiliation(s)
- Xiao Wei Tan
- Department of Mood and Anxiety, Institute of Mental Health, Singapore
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Kim J, Lee HJ, Jo MW. Health-related Quality of Life INsTrument with 8 Items for Use in Patients with Type 2 Diabetes Mellitus: A Validation Study. J Prev Med Public Health 2022; 55:234-242. [PMID: 35677997 PMCID: PMC9201088 DOI: 10.3961/jpmph.22.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/03/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives This study assessed the validity and reliability of the Health-related Quality of Life Instrument with 8 Items (HINT-8) in patients with diabetes. HINT-8 is a newly-developed, generic health-related quality of life (HRQoL) instrument. Methods Three HRQoL instruments—HINT-8, EuroQoL 5-Dimension 5-Level (EQ-5D-5L), and Short Form Health Survey version 2.0 (SF-36v2)—were provided to 300 patients with diabetes visiting a tertiary hospital for follow-up visits in Korea. The HRQoL scores obtained using the HINT-8 were evaluated for subgroups with known differences based on demographics and diabetes-related characteristics (known-group validity). The mean scores of the instruments were compared between groups segmented by their responses to the HINT-8 (discriminatory ability). Correlation coefficients of the HINT-8 with other instruments were calculated (convergent and divergent validity). The Cohen kappa and intra-class correlation coefficient (ICC) were also evaluated (test-retest reliability). Results The average HINT-8 indexes were lower among women, older, and less-educated subjects. Subjects who did not list any problems on the HINT-8 had significantly higher HRQoL scores than those who did. The correlation coefficients of the HINT-8 with the EQ-5D-5L index and EuroQoL visual analogue scale were 0.715 (p<0.001) and 0.517 (p<0.001), respectively. The correlation coefficients between the HINT-8 index and the scores of 8 domains of the SF-36v2 ranged from 0.478 (p<0.001) to 0.669 (p<0.001). The Cohen kappa values for the HINT-8 ranged from 0.268 to 0.601, and the ICC of the HINT-8 index was 0.800 (95% confidence interval [CI], 0.720 to 0.860). Conclusions This study showed that the HINT-8 is a valid and reliable HRQoL instrument for patients with diabetes.
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Affiliation(s)
- Juyoung Kim
- Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul,
Korea
| | - Hyeon-Jeong Lee
- National Evidence-based Healthcare Collaborating Agency, Seoul,
Korea
| | - Min-Woo Jo
- Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul,
Korea
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11
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Rohrbach PJ, Dingemans AE, Groothuis-Oudshoorn CGM, Van Til JA, Essers BA, Van Furth EF, Van den Akker-Van Marle ME. The ICEpop Capability Measure for Adults Instrument for Capabilities: Development of a Tariff for the Dutch General Population. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:125-132. [PMID: 35031091 DOI: 10.1016/j.jval.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/31/2021] [Accepted: 07/21/2021] [Indexed: 05/26/2023]
Abstract
OBJECTIVES The ICEpop Capability Measure for Adults (ICECAP-A) assesses 5 capabilities (stability, attachment, autonomy, achievement, and enjoyment) that are important to one's quality of life and might be an important addition to generic health questionnaires currently used in economic evaluations. This study aimed to develop a Dutch tariff of the Dutch translation of the ICECAP-A. METHODS The methods used are similar to those used in the development of the UK tariff. A profile case best-worst scaling task was presented to 1002 participants from the general Dutch population. A scale-adjusted latent class analysis was performed to test for preferences of ICECAP-A capabilities and scale heterogeneity. RESULTS A 3-preference class 2-scale class model with worst choice as scale predictor was considered optimal and was used to calculate the resulting tariff. Results indicated that the capabilities stability, attachment, and enjoyment were considered more important aspects of quality of life than autonomy and achievement. Additionally, improving capabilities from low to moderate levels had a larger effect on quality of life than improving capabilities that were already at a higher level. CONCLUSIONS The ICECAP-A tariffs found in this study could be used in economic evaluations of healthcare interventions in The Netherlands.
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Affiliation(s)
- Pieter J Rohrbach
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; GGZ Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands.
| | | | | | - Janine A Van Til
- Technical Medical Centre, Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Brigitte A Essers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Eric F Van Furth
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; GGZ Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
| | - M Elske Van den Akker-Van Marle
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
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12
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Norlin JM, Kellerborg K, Odin P. Patient Utilities in Health States Based on Hoehn and Yahr and Off-Time in Parkinson's Disease: A Swedish Register-Based Study in 1823 Observations. PHARMACOECONOMICS 2021; 39:1141-1149. [PMID: 34231134 DOI: 10.1007/s40273-021-01056-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Cost-effectiveness models in Parkinson's disease often include health states based on Hoehn and Yahr (H&Y) and time in 'off'. Few studies have investigated utilities in these health states. OBJECTIVE The aim of this study was firstly to explore utilities in health states based on H&Y and off-time, and secondly to investigate to what extent H&Y and off-time correlated with EQ-5D dimensions. METHODS Patients with idiopathic Parkinson's disease in the National Parkinson's Disease Patient Registry (PARKreg) in Sweden with observations of EQ-5D-3L, H&Y and off-time were included. Correlations with EQ-5D dimensions were analyzed. The relationship between the EQ-5D-3L and H&Y and off-time were estimated by a linear mixed-model with random intercept. RESULTS Among patients in PARKreg, 1823 observations fulfilled inclusion criteria. The dimensions 'self-care', 'mobility' and 'usual activities' correlated moderately with H&Y (rs = 0.45, rs = 0.46, rs = 0.45). Weak correlations were found for 'anxiety/depression' and 'pain/discomfort' (rs = 0.24, rs = 0.22) (p values < 0.001). All dimensions correlated weakly with off-time. The fitted model included H&Y, time in 'off', and sex. All H&Y stages were found to be significant and had large and monotonous impact on EQ-5D. Off-time was not significant, but improved the model goodness of fit. Predicted values ranged from 0.733 to - 0.106. CONCLUSION This study provides utilities for health states reflecting the current modeling practice of interventions targeting motor symptoms in Parkinson's disease. Future research should investigate patient utilities in health states that also capture non-motor symptoms of the disease, as the management of and options for treatments targeting these symptoms increases.
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Affiliation(s)
- Jenny M Norlin
- The Swedish Institute for Health Economics, Råbygatan 2, 223 61, Lund, Sweden.
| | - Klas Kellerborg
- The Swedish Institute for Health Economics, Råbygatan 2, 223 61, Lund, Sweden
| | - Per Odin
- Department of Neurology, Rehabilitation Medicine, Memory Disorders, and Geriatrics, Skåne University Hospital, Malmö, Sweden
- Restorative Parkinson Unit, Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- SWEPAR-net, Lund, Sweden
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13
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Joelson A, Wildeman P, Sigmundsson FG, Rolfson O, Karlsson J. Properties of the EQ-5D-5L when prospective longitudinal data from 28,902 total hip arthroplasty procedures are applied to different European EQ-5D-5L value sets. LANCET REGIONAL HEALTH-EUROPE 2021; 8:100165. [PMID: 34557854 PMCID: PMC8454852 DOI: 10.1016/j.lanepe.2021.100165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background The purpose of this study was to evaluate the impact of using different country-specific value sets in EQ-5D-5L based outcome analyses. Methods We obtained data on patients surgically treated with total hip arthroplasty (THA) between 2017 and 2019 from the national Swedish Hip Arthroplasty Register. Preoperative and one-year postoperative data on a total of 28,902 procedures were available for analysis. The EQ-5D-5L health states were coded to the EQ-5D-5L preference indices using 13 European value sets. The EQ-5D-5L index distributions were then estimated with kernel density estimation. The change in EQ-5D-5L index before and one year after treatment was evaluated with the standardized response mean (SRM). The lifetime gain in quality-adjusted life years (QALYs) was estimated with a 3.5% annual QALY discount rate. Findings There was a marked variability in means and shapes of the resulting EQ-5D-5L index distributions. There were also considerable differences in the EQ-5D-5L index distribution shape before and after the treatment using the same value set. The effect sizes of one-year change (SRM) were similar for all value sets. However, the differences in estimated QALY gains were substantial. Interpretation The EQ-5D-5L index distributions varied considerably when a single large data set was applied to different European EQ-5D-5L value sets. The most pronounced differences were between the value sets based on experience-based valuation and the value sets based on hypothetical valuation. This illustrates that experience-based and hypothetical value sets are inherently different and also that QALY gains derived with different value sets are not comparable. Our findings are of importance in study planning since the results and conclusions of a study depend on the choice of value set. Funding None.
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Affiliation(s)
- Anders Joelson
- Orebro University School of Medical Sciences, Orebro, Sweden.,Department of Orthopedics, Orebro University Hospital, Orebro, Sweden
| | - Peter Wildeman
- Orebro University School of Medical Sciences, Orebro, Sweden.,Department of Orthopedics, Orebro University Hospital, Orebro, Sweden
| | - Freyr Gauti Sigmundsson
- Orebro University School of Medical Sciences, Orebro, Sweden.,Department of Orthopedics, Orebro University Hospital, Orebro, Sweden
| | - Ola Rolfson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Jan Karlsson
- University Health Care Research Center, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
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Concordance among Swedish, German, Danish, and UK EQ-5D-3L Value Sets: Analyses of Patient-Reported Outcomes in the Swedish Hip Arthroplasty Register. J Clin Med 2021; 10:jcm10184205. [PMID: 34575317 PMCID: PMC8471757 DOI: 10.3390/jcm10184205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Application of different value sets to health-related quality of life (HRQoL) measured with the EQ-5D-3L may lead to different results due to differences in methods, perspectives, and countries used. Focusing on concordance, this study aimed at understanding the implications of applying EQ-5D-3L value sets from Sweden, Germany, Denmark, and the UK to evaluate HRQoL of patients undergoing total hip replacement (THR) in Sweden before and after surgery. Methods: We performed a longitudinal study of patients in the Swedish Hip Arthroplasty Register from preoperative stage to 1-year follow-up (n = 73,523) using data collected from 2008 to 2016. Eight EQ-5D-3L value sets from the four countries were compared based on a valuation method (visual analogue scale (VAS) or time trade-off (TTO)), perspective (experience-based or hypothetical), and country. Concordance among the value sets with patient-reported EQ VAS score was also assessed. Longitudinal changes in EQ-5D-3L index over the 1-year follow-up were compared across value sets by method, perspective, and country. Results: Value sets based on the same method and perspective showed higher concordance in EQ-5D-3L index at both measurement time points than other comparisons. In the comparisons by perspective, VAS value sets showed higher concordance than TTO value sets. The Swedish VAS and the Danish TTO value sets showed the highest levels of concordance with patient-reported EQ VAS scores. Generally, value sets based on the same method and perspective had the smallest mean differences between changes in EQ-5D-3L indices from preoperative to 1-year postoperative follow-up. Conclusion: Among THR patients value sets based on the same method and perspective, a direct transfer of results across countries could be meaningful. In cases of differences in methods and perspectives among value sets, transfer of value sets across settings would have to consider conversion through crosswalk.
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Teni FS, Rolfson O, Devlin N, Parkin D, Nauclér E, Burström K. Variations in Patients' Overall Assessment of Their Health Across and Within Disease Groups Using the EQ-5D Questionnaire: Protocol for a Longitudinal Study in the Swedish National Quality Registers. JMIR Res Protoc 2021; 10:e27669. [PMID: 34448726 PMCID: PMC8433865 DOI: 10.2196/27669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/19/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND EQ-5D is one of the most commonly used questionnaires to measure health-related quality of life. It is included in many of the Swedish National Quality Registers (NQRs). EQ-5D health states are usually summarized using "values" obtained from members of the general public, a majority of whom are healthy. However, an alternative, which remains to be studied in detail, is the potential to use patients' self-reported overall health on the visual analog scale (VAS) as a means of capturing experience-based perspective. OBJECTIVE The aim of this study is to assess EQ VAS as a valuation method with an experience-based perspective through comparison of its performance across and within patient groups, and with that of the general population in Sweden. METHODS Data on nearly 700,000 patients from 12 NQRs covering a variety of diseases/conditions and nearly 50,000 individuals from the general population will be analyzed. The EQ-5D-3L data from the 12 registers and EQ-5D-5L data from 2 registers will be used in the analyses. Longitudinal studies of patient-reported outcomes among different patient groups will be conducted in the period from baseline to 1-year follow-up. Descriptive statistics and analyses comparing EQ-5D dimensions and observed self-assessed EQ VAS values across and within patient groups will be performed. Comparisons of the change in health state and observed EQ VAS values at 1-year follow-up will also be undertaken. Regression models will be used to assess whether EQ-5D dimensions predict observed EQ VAS values to investigate patient value sets in each patient group. These will be compared across the patient groups and with the existing Swedish experience-based VAS and time trade-off value sets obtained from the general population. RESULTS Data retrieval started in May 2019 and data of patients in the 12 NQRs and from the survey conducted among the general population have been retrieved. Data analysis is ongoing on the retrieved data. CONCLUSIONS This research project will provide information on the differences across and within patient groups in terms of self-reported health status through EQ VAS and comparison with the general population. The findings of the study will contribute to the literature by exploring the potential of self-assessed EQ VAS values to develop value sets using an experience-based perspective. TRIAL REGISTRATION ClinicalTrials.gov NCT04359628; https://clinicaltrials.gov/ct2/show/NCT04359628. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/27669.
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Affiliation(s)
- Fitsum Sebsibe Teni
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Ola Rolfson
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Nancy Devlin
- Centre for Health Policy, University of Melbourne, Melbourne, Australia
- Office of Health Economics, London, United Kingdom
| | - David Parkin
- Office of Health Economics, London, United Kingdom
- City, University of London, London, United Kingdom
| | - Emma Nauclér
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Kristina Burström
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Health Care Services, Region Stockholm, Stockholm, Sweden
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Tejada RA, Gibbons L, Belizán M, Gutierrez EL, Reyes N, Augustovski FA. Comparison of EQ-5D Values Sets Among South American Countries. Value Health Reg Issues 2021; 26:56-65. [PMID: 34023752 DOI: 10.1016/j.vhri.2021.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 01/26/2021] [Accepted: 02/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Social health preference sets are necessary for conducting health economic evaluations. Values from other countries are often used when local sets are not available, which may alter the results. We aimed to evaluate the degree of variability of currently available country-specific value sets of the EuroQol EQ-5D instrument from South American countries (SAC). METHODS We selected EQ-5D value sets from SAC and 2 reference countries. We obtained crosswalk value sets for the countries that use the EQ-5D-3L instrument. We compared the value sets with the Kruskal-Wallis test and then carried out pairwise comparisons with the Sign test. We also assessed correlations among the countries' value sets using the Spearman test. We calculated the absolute difference across countries for each health state, considering a difference of greater than 0.05 relevant. RESULTS The range of value sets varied greatly. The Peruvian value set had the widest range (1 to -1.076) and the lowest values (median: 0.055; interquartile range: -0.171 to 0.275). The Ecuadorian set had the highest values (median: 0.587; interquartile range: 0.443-0.704). The Peruvian value set also had the greatest proportion of health states (43.6%) with a negative value, and the Uruguayan set had the smallest proportion (0.9%). Differences among countries were significant in all cases, with the greatest difference between Ecuador and Peru (median difference: 0.495; 95% confidence interval: 0.515-0.528). CONCLUSION Social health preference sets varied greatly among SAC. Using non-local values could distort resource allocation decisions; hence, we recommend that countries obtain and use local value sets.
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Affiliation(s)
- Romina A Tejada
- Unidad de Análisis y Generación de Evidencias en Salud Pública, Instituto Nacional de la Salud, Lima, Peru; Division of Cancer Epidemiology, McGill University, Montreal, Canada.
| | - Luz Gibbons
- Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - María Belizán
- Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - Ericson L Gutierrez
- Unidad de Análisis y Generación de Evidencias en Salud Pública, Instituto Nacional de la Salud, Lima, Peru
| | - Nora Reyes
- Unidad de Análisis y Generación de Evidencias en Salud Pública, Instituto Nacional de la Salud, Lima, Peru
| | - Federico Ariel Augustovski
- Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina; School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
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Poteet S, Craig BM. QALYs for COVID-19: A Comparison of US EQ-5D-5L Value Sets. THE PATIENT 2021; 14:339-345. [PMID: 33782840 PMCID: PMC8007385 DOI: 10.1007/s40271-021-00509-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND In economic evaluations, quality-adjusted life-years (QALYs) can serve as a unit of measurement for disease burden. Obtaining QALY values for COVID-19 presents a challenge owing to the availability of two US EQ-5D-5L value sets and the potentially asymptomatic presentation of the disease. The first value set was completed allowing for the discounting of future health outcomes while the second value set is undiscounted. OBJECTIVE The objective of this study was to compare the distribution of QALY values using a national survey and the two published value sets; and to estimate the association between COVID-19 outcomes and QALY losses. METHODS Between 9 and 11 November, 2020, 1153 US adults completed the EQ-5D-5L instrument (five items and a visual analog scale) as well as self-reported their demographics, COVID-19 symptoms, and memberships to populations that are at risk of COVID-19 infection. The two US value sets were applied to the EQ-5D-5L responses to produce QALY values. We estimated the mean QALYs by visual analog scale decile and a generalized linear model of COVID-19 outcomes. RESULTS The discounted values are higher than the undiscounted values for each visual analog scale decile owing to methodological differences. Persons at increased risk, with a fever in the past day, and with one or more other symptoms have significantly greater QALY losses (p < 0.01). Overall, non-institutionalized individuals at risk of symptomatic clinical COVID-19 equal 0.68 for the 2016 value set (95% confidence interval 0.49-0.87) and 0.10 for the 2017 value set (95% confidence interval - 0.31 to 0.51) QALYs. CONCLUSIONS Multiple studies have shown that decision makers discount future health outcomes, which increase QALY values. This study confronts the practical implications of these methodological advances for use in COVID-19 economic evaluations. Health economists will be able to use the QALY values in this study to better evaluate health interventions against COVID-19.
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Affiliation(s)
- Stephen Poteet
- Department of Social/Behavioral Sciences, St. Petersburg College, 2465 Drew St, ES313D, Clearwater, FL 33765 USA
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18
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Feng YS, Kohlmann T, Janssen MF, Buchholz I. Psychometric properties of the EQ-5D-5L: a systematic review of the literature. Qual Life Res 2021; 30:647-673. [PMID: 33284428 PMCID: PMC7952346 DOI: 10.1007/s11136-020-02688-y] [Citation(s) in RCA: 291] [Impact Index Per Article: 97.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Although the EQ-5D has a long history of use in a wide range of populations, the newer five-level version (EQ-5D-5L) has not yet had such extensive experience. This systematic review summarizes the available published scientific evidence on the psychometric properties of the EQ-5D-5L. METHODS Pre-determined key words and exclusion criteria were used to systematically search publications from 2011 to 2019. Information on study characteristics and psychometric properties were extracted: specifically, EQ-5D-5L distribution (including ceiling and floor), missing values, reliability (test-retest), validity (convergent, known-groups, discriminate) and responsiveness (distribution, anchor-based). EQ-5D-5L index value means, ceiling and correlation coefficients (convergent validity) were pooled across the studies using random-effects models. RESULTS Of the 889 identified publications, 99 were included for review, representing 32 countries. Musculoskeletal/orthopedic problems and cancer (n = 8 each) were most often studied. Most papers found missing values (17 of 17 papers) and floor effects (43 of 48 papers) to be unproblematic. While the index was found to be reliable (9 of 9 papers), individual dimensions exhibited instability over time. Index values and dimensions demonstrated moderate to strong correlations with global health measures, other multi-attribute utility instruments, physical/functional health, pain, activities of daily living, and clinical/biological measures. The instrument was not correlated with life satisfaction and cognition/communication measures. Responsiveness was addressed by 15 studies, finding moderate effect sizes when confined to studied subgroups with improvements in health. CONCLUSIONS The EQ-5D-5L exhibits excellent psychometric properties across a broad range of populations, conditions and settings. Rigorous exploration of its responsiveness is needed.
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Affiliation(s)
- You-Shan Feng
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany.
- Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany.
| | - Thomas Kohlmann
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
| | - Mathieu F Janssen
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Erasmus University, Rotterdam, The Netherlands
| | - Ines Buchholz
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
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Abstract
PURPOSE To assess the impact of EQ-5D country-specific value sets on cost-utility outcomes. METHODS Data from 2 randomized controlled trials on low back pain (LBP) and depression were used. 3L value sets were identified from the EuroQol Web site. A nonparametric crosswalk was employed for each tariff to obtain the likely 5L values. Differences in quality-adjusted life years (QALYs) between countries were tested using paired t tests, with United Kingdom as reference. Cost-utility outcomes were estimated for both studies and both EQ-5D versions, including differences in QALYs and cost-effectiveness acceptability curves. RESULTS For the 3L, QALYs ranged between 0.650 (Taiwan) and 0.892 (United States) in the LBP study and between 0.619 (Taiwan) and 0.879 (United States) in the depression study. In both studies, most country-specific QALY estimates differed statistically significantly from that of the United Kingdom. Incremental cost-effectiveness ratios ranged between &OV0556;2044/QALY (Taiwan) and &OV0556;5897/QALY (Zimbabwe) in the LBP study and between &OV0556;38,287/QALY (Singapore) and &OV0556;96,550/QALY (Japan) in the depression study. At the NICE threshold of &OV0556;23,300/QALY (≈£20,000/QALY), the intervention's probability of being cost-effective versus control ranged between 0.751 (Zimbabwe) and 0.952 (Taiwan) and between 0.230 (Canada) and 0.396 (Singapore) in the LBP study and depression study, respectively. Similar results were found for the 5L, with extensive differences in ICERs and moderate differences in the probability of cost-effectiveness. CONCLUSIONS This study indicates that the use of different EQ-5D country-specific value sets impacts on cost-utility outcomes. Therefore, to account for the fact that health state preferences are affected by sociocultural differences, relevant country-specific value sets should be used.
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Joelson A, Sigmundsson FG, Karlsson J. Properties of the EQ-5D-3L index distribution when longitudinal data from 27,328 spine surgery procedures are applied to nine national EQ-5D-3L value sets. Qual Life Res 2021; 30:1467-1475. [PMID: 33449340 DOI: 10.1007/s11136-020-02749-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the current study was to apply a single large longitudinal EQ-5D-3L data set to several national EQ-5D-3L value sets and explore differences in EQ-5D-3L index density functions and effect sizes before and after treatment. METHODS Patients, surgically treated for lumbar spinal stenosis or lumbar disk herniation between 2007 and 2017, were recruited from the national Swedish spine register. A total of 27,328 procedures were eligible for analysis. The EQ-5D health states were coded to EQ-5D-3L summary indices using value sets for 9 countries: Argentina, Australia, Canada, China, Germany, Italy, Sweden, the UK, and the US. The EQ-5D-3L summary index distributions were then estimated with kernel density estimation. The change in EQ-5D-3L index before and after treatment was evaluated with the standardized response mean (SRM). RESULTS There was a high variability in the resulting EQ-5D-3L index density functions. There were also considerable differences in EQ-5D-3L index density functions before and after treatment using the same value set. Effect sizes of 2-year change (SRM), however, were similar when the 9 value sets were applied on pre- and post-treatment data. CONCLUSIONS We found a marked variability in EQ-5D-3L index density functions when a single large data set was applied to 9 national EQ-5D-3L value sets. Consequently, studies that aggregate international data, e.g. meta-analyses, may produce misleading results if the underlying differences in EQ-5D-3L index density functions are inadequately handled. On the basis of the results of our study, we recommend against pooling of different national EQ-5D-3L index data.
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Affiliation(s)
- Anders Joelson
- Department of Orthopedics, Orebro University School of Medical Sciences and Orebro University Hospital, Orebro, Sweden.
| | - Freyr Gauti Sigmundsson
- Department of Orthopedics, Orebro University School of Medical Sciences and Orebro University Hospital, Orebro, Sweden
| | - Jan Karlsson
- University Health Care Research Center, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
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Claessens AKM, Ramaekers BLT, Lobbezoo DJA, van Kampen RJW, de Boer M, van de Wouw AJ, Dercksen MW, Geurts SME, Joore MA, Tjan-Heijnen VCG. Quality of life in a real-world cohort of advanced breast cancer patients: a study of the SONABRE Registry. Qual Life Res 2020; 29:3363-3374. [PMID: 32816222 PMCID: PMC7686224 DOI: 10.1007/s11136-020-02604-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE We aimed to evaluate quality of life (QoL) using the European Quality of Life Five-Dimensions questionnaire (EQ-5D-3L) in a real-world cohort of Dutch advanced breast cancer (ABC) patients. Secondary, we reported differences in QoL between subgroups of patients based on age, comorbidity, tumor-, and treatment characteristics, and assessed the association of duration of metastatic disease and time to death with QoL. METHODS ABC patients who attended the outpatient clinic between October 2010 and May 2011 were asked to fill out the EQ-5D-3L questionnaire. Patient-, disease-, and treatment characteristics were obtained from the medical files. Health-utility scores were calculated. Subgroups were described and compared for utility scores by parametric and non-parametric methods. RESULTS A total of 92 patients were included with a median utility score of 0.691 (Interquartile range [IQR] 0.244). Patients ≥ 65 years had significantly worse median utility scores than younger patients; 0.638 versus 0.743, respectively (p = 0.017). Moreover, scores were significantly worse for patients with versus those without comorbidity (medians 0.620 versus 0.725, p = 0.005). Utility scores did not significantly differ between subgroups of tumor type, type of systemic treatment, number of previous palliative treatment(s), or number or location of metastatic site(s). The remaining survival was correlated with utility scores (correlation coefficient (r) = 0.260, p = 0.0252), especially in the subgroup < 65 years (r = 0.340, p = 0.0169), whereas there was no significant correlation with time since metastatic diagnosis (r = - 0.106, p = 0.3136). CONCLUSION Within this real-world cross-sectional study, QoL was significantly associated with age, comorbidity, and remaining survival duration. The observation of a lower QoL in ABC patients, possibly indicating the last period of life, may assist clinical decision-making on timing of cessation of systemic antitumor therapy.
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Affiliation(s)
- Anouk K. M. Claessens
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, PO BOX 5800, 6202 AZ Maastricht, The Netherlands
- Department of Medical Oncology, Zuyderland Medical Center, PO BOX 5500, 6130 MB Sittard-Geleen, The Netherlands
| | - Bram L. T. Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, PO BOX 5800, 6202 AZ Maastricht, The Netherlands
| | - Dorien J. A. Lobbezoo
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, PO BOX 5800, 6202 AZ Maastricht, The Netherlands
| | - Roel J. W. van Kampen
- Department of Medical Oncology, Zuyderland Medical Center, PO BOX 5500, 6130 MB Sittard-Geleen, The Netherlands
| | - Maaike de Boer
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, PO BOX 5800, 6202 AZ Maastricht, The Netherlands
| | - Agnes J. van de Wouw
- Department of Internal Medicine, VieCuri Medical Center, PO BOX 1926, 5900 BX Venlo, The Netherlands
| | - M. Wouter Dercksen
- Department of Internal Medicine, Máxima Medical Center, PO BOX 90052, 5600 PD Eindhoven, The Netherlands
| | - Sandra M. E. Geurts
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, PO BOX 5800, 6202 AZ Maastricht, The Netherlands
| | - Manuela A. Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, PO BOX 5800, 6202 AZ Maastricht, The Netherlands
| | - Vivianne C. G. Tjan-Heijnen
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, PO BOX 5800, 6202 AZ Maastricht, The Netherlands
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Duarte RV, Soliday N, Leitner A, Taylor RS. Health-Related Quality of Life Associated With Pain Health States in Spinal Cord Stimulation for Chronic Neuropathic Pain. Neuromodulation 2020; 24:142-149. [PMID: 32940398 DOI: 10.1111/ner.13267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES A substantial proportion of patients have recently reported pain reduction levels of ≥80% following treatment with Evoked Compound Action Potential (ECAP) spinal cord stimulation (SCS). The additional health-related quality of life (HRQoL) utility gain that can be achieved in this patient group is unclear. The aim of this study is to quantify the HRQoL utility values seen in a remission health state (defined as ≥80% pain reduction) and contrast with more traditional health states of <50% and ≥50% pain relief. MATERIALS AND METHODS Pain intensity assessed using a 100 mm visual analogue scale (VAS) and EQ-5D-5L questionnaires were collected from 204 patients treated with ECAP SCS for chronic back and leg pain and followed up to 12 months. Utility values were derived using EQ-5D-5L responses crosswalked to EQ-5D-3L. Linear regression models adjusted for baseline utility values and patient demographics were used to compare differences in utility values across health states. RESULTS Patients in the remission health state (i.e., ≥80% pain reduction) consistently reported statistically significant greater utility values (+0.09 to +0.15, all p < 0.003) compared to patients reporting ≥50% pain relief at 3- and 12-month follow-up for overall, back, and leg VAS pain. The gain in utility values per percent unit of pain reduction was statistically significant at 3- and 12-month follow-up with a mean increase in HRQoL utility score between 0.003 and 0.005 observed for each percent of pain reduction. CONCLUSION Our analyses show that patients in a remission health state report statistically and clinically significant better HRQoL than patients experiencing lesser pain relief.
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Affiliation(s)
- Rui V Duarte
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | | | | | - Rod S Taylor
- Institute of Health and Well Being, University of Glasgow, Glasgow, UK.,College of Medicine and Health, University of Exeter, Exeter, UK
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Wang H, Cao C, Guo C, He Y, Li F, Xu R, Liu M, Liu Z, Pan Y, Liu F, Liu Y, Li J, Cai H, He Z, Ke Y. An evaluation of EQ-5D-3L health utility scores using five country-specific tariffs in a rural population aged 45-69 years in Hua county, Henan province, China. Health Qual Life Outcomes 2020; 18:228. [PMID: 32660494 PMCID: PMC7359608 DOI: 10.1186/s12955-020-01476-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to compare the performance of the recently developed Chinese (city) tariff of the EQ-5D-3L against the UK, US, Japanese and Korean tariffs in a general rural population in China. METHODS From November 2015 to September 2016, 12,085 permanent residents aged 45-69 from 257 villages randomly selected from Hua County, Henan Province, China, were interviewed using EQ-5D-3L, and a one-on-one questionnaire investigation was used to collect data on factors associated with HRQOL. The health utility scores were calculated using the UK, US, Japanese, Korean and Chinese (city) tariffs. The agreement, known-groups validity and sensitivity of these five tariffs were evaluated. Transition scores for pairs of observed EQ-5D-3L health states were calculated and compared. RESULTS The Korean tariff yielded the highest mean health utility score (0.963), followed by the Chinese (city) (0.948), US (0.943), UK (0.930) and Japanese (0.921) tariffs, but the differences in the scores of any two tariffs did not exceed the MCID. The Chinese (city) tariff showed higher ICC values (ICCs> 0.89, 95% CI:0.755-0.964) and narrower limits of agreement (0.099-0.167) than the Korean tariff [(ICCs> 0.71, 95% CI:0.451-0.955); (0.146-0.253)]. The Chinese (city) tariff had a higher relative efficiency and effect size statistics in 10 out of 11 variables as compared to the UK, US and Japanese tariffs. The Chinese (city) tariff (0.215) was associated with moderate mean absolute transition scores compared with the UK (0.342), US (0.230), Japanese (0.149) and Korean (0.189) tariffs for 1485 observed pairs of the EQ-5D-3L health states. CONCLUSIONS Health utility scores derived from the five tariffs differed. The Chinese (city) tariff was the most suitable of these tariffs and was without obvious weakness. We recommend adopting the Chinese (city) tariff when applying EQ-5D-3L to assess quality of life among the elderly in China's agricultural region with socio-economic status similar to Hua County. Results of this study had provided a crucial basis for health surveys, health promotion projects, health intervention trials, and health economic evaluation taking HRQOL as a target in rural areas of China.
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Affiliation(s)
- Hui Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Changqi Cao
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Endoscopy Center, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Chuanhai Guo
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Yu He
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Fenglei Li
- Hua County People's Hospital, Anyang, Henan Province, People's Republic of China
| | - Ruiping Xu
- Anyang Cancer Hospital, Anyang, Henan Province, People's Republic of China
| | - Mengfei Liu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Zhen Liu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Yaqi Pan
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Fangfang Liu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Ying Liu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Jingjing Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Hong Cai
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Zhonghu He
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China.
| | - Yang Ke
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China.
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Michaels JA. Potential for epistemic injustice in evidence-based healthcare policy and guidance. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106171. [PMID: 32461243 DOI: 10.1136/medethics-2020-106171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/12/2020] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Abstract
The rapid development in healthcare technologies in recent years has resulted in the need for health services, whether publicly funded or insurance based, to identify means to maximise the benefits and provide equitable distribution of limited resources. This has resulted in the need for rationing decisions, and there has been considerable debate regarding the substantive and procedural ethical principles that promote distributive justice when making such decisions. In this paper, I argue that while the scientifically rigorous approaches of evidence-based healthcare are claimed as aspects of procedural justice that legitimise such guidance, there are biases and distortions in all aspects of the process that may lead to epistemic injustices. Regardless of adherence to principles of distributive justice in the decision-making process, evidential failings may undermine the fairness and legitimacy of such decisions. In particular, I identify epistemic exclusion that denies certain patient and professional groups the opportunity to contribute to the epistemic endeavour. This occurs at all stages of the process, from the generation, analysis and reporting of the underlying evidence, through the interpretation of such evidence, to the decision-making that determines access to healthcare resources. I further argue that this is compounded by processes which confer unwarranted epistemic privilege on experts in relation to explicit or implicit value judgements, which are not within their remit. I suggest a number of areas in which changes to the processes for developing, regulating, reporting and evaluating evidence may improve the legitimacy of such processes.
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Affiliation(s)
- Jonathan Anthony Michaels
- Health Economics and Decision Science, The University of Sheffield School of Health and Related Research, Sheffield, UK
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25
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Surendra NK, Abdul Manaf MR, Hooi LS, Bavanandan S, Mohamad Nor FS, Shah Firdaus Khan S, Ong LM, Abdul Gafor AH. Health related quality of life of dialysis patients in Malaysia: Haemodialysis versus continuous ambulatory peritoneal dialysis. BMC Nephrol 2019; 20:151. [PMID: 31039745 PMCID: PMC6492391 DOI: 10.1186/s12882-019-1326-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 04/02/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Health related quality of life (HRQOL) is an important predictor of clinical outcomes for End Stage Renal Disease (ESRD) patients and to establish quality adjusted life years (QALYs) for economic evaluation studies. This study aims to measure the health utilities and to identify socio-demographic and clinical factors associated with HRQOL for haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) in Malaysia. METHODS A total of 141 patients (77 HD and 64 CAPD) from 1 federal and four state hospitals participated in this cross-sectional study. Patients were randomly selected from the National Renal Registry (NRR) using a stratified random sampling. The EQ-5D-3 L questionnaire was used to measure HRQOL. Variables investigated include dialysis modalities, sociodemographic characteristics, co-morbidities and biochemical markers. Utilities are measured on an ordinal scale of 0-1, where 1 indicates full health and 0 indicates death. RESULTS The mean utility scores were 0.854 ± 0.181 and 0.905 ± 0.124 (p > 0.05) and the mean Visual Analogue Scale (VAS) scores were 76.2 ± 12.90 and 77.1 ± 10.26 (p > 0.05) for HD and CAPD patients respectively. There was a significant difference in problems reported between HD (35.1%) and CAPD (15.6%) on usual activities dimension (p = 0.009). The proportion of patients having problems in the pain/discomfort domain in both modalities was high (34.0%). Haemoglobin (< 10 g/dL) (p = 0.003), number of co-morbidities ≥3 (p = 0.004) and wheelchair-bound status (p < 0.001) were significant predictors of poor HRQOL. CONCLUSIONS The present cross-sectional study shows that CAPD patients have a higher utility index score than HD patients but this was not statistically significant. The utilities index score may be used to calculate QALYs.
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Affiliation(s)
- Naren Kumar Surendra
- Department of Community Health, Faculty of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Cheras Malaysia
| | - Mohd Rizal Abdul Manaf
- Department of Community Health, Faculty of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Cheras Malaysia
| | - Lai Seong Hooi
- Hospital Sultanah Aminah, Jalan Persiaran Abu Bakar Sultan, 80100 Johor Bahru, Johor Malaysia
| | | | | | | | - Loke Meng Ong
- Hospital Pulau Pinang, Residency Road, 10990 Penang, Malaysia
| | - Abdul Halim Abdul Gafor
- Nephrology Unit, Faculty of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
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Nyberg A, Tistad M, Wadell K. Can the COPD web be used to promote self-management in patients with COPD in swedish primary care: a controlled pragmatic pilot trial with 3 month- and 12 month follow-up. Scand J Prim Health Care 2019; 37:69-82. [PMID: 30700230 PMCID: PMC6452803 DOI: 10.1080/02813432.2019.1569415] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Evaluate the feasibility of the COPD Web and its study design and study procedures and to increase the understanding of the potential effect of the tool in order to provide guidance for a future large scale trial. DESIGN Parallel-group controlled pragmatic pilot trial. SUBJECTS There was a total of 83 patients with COPD (mean age 70 ± 8 years with a forced expiratory volume in first second percent predicted of 60 ± 17%). The intervention group (n = 43) was introduced to and had access to the COPD Web in addition to usual care, while the control group (n = 40) received usual care alone. MAIN OUTCOME MEASURES The feasibility of the COPD Web (i.e., if and how the COPD Web was used) was automatically collected through the website, while outcomes on health, conceptual knowledge, and physical activity (PA) were collected through questionnaires at baseline, 3 months and 12 months. RESULTS At 3 months, 77% of the intervention group was considered users, and the majority of time spent on the site was related to PA and exercises and was spent during the first month (>80%). In addition, the intervention group reported increased PA (odds ratio [OR] = 4.4, P < .001), increased conceptual knowledge in five domains (OR = 2.6-4.2, all P < .05), and altered disease management strategies (e.g., increased PA) (OR ≥ 2.7 P < .05) in comparison to the control group. The latter was also different between groups at 12 months (OR = 3.7, P = .044). Knowledge of PA was correlated with level of PA (ρ = .425-.512, P < .05) as well as to the use of PA as a strategy to manage their disease (χ2 = 11.2-32.9, P < .05). CONCLUSION Giving patients with COPD access to the COPD Web in addition to their ordinary primary care might be an effective shorter term (3 month) strategy to promote self-management. However, these results needs to be confirmed in a definitive large-scale trial. Key points Even though self-management strategies are an important part of chronic obstructive pulmonary disease (COPD) management, access to support for such strategies are limited for a large part of the COPD-population. Promoting self-management through the COPD Web might increase short-term levels of physical activity, promote conceptual knowledge and alter disease management strategies. The primary care COPD population in this study experienced limited impact of the disease in daily life, limited exertional dyspnea, and high generic quality-of-life, but vastly reduced levels of physical activity. A future large scale study should include strategies to encourage greater exposures to the COPD Web, including an extended analysis of factors associated with using or not using the tool over time and its impact on outcome measures, objective measures of conceptual knowledge, and physical activity, and it should include a large enough sample size to enable sub-group analyses and strategies to enhance recruitment.
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Affiliation(s)
- Andre Nyberg
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
- CONTACT Andre Nyberg Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, 90187Umeå, Sweden
| | - Malin Tistad
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
- School of Education Health and Social studies, Dalarna University, Falun, Sweden
| | - Karin Wadell
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
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Eriksson J, Kobelt G, Gannedahl M, Berg J. Association between Disability, Cognition, Fatigue, EQ-5D-3L Domains, and Utilities Estimated with Different Western European Value Sets in Patients with Multiple Sclerosis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:231-238. [PMID: 30711069 DOI: 10.1016/j.jval.2018.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 04/27/2018] [Accepted: 08/07/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To assess the association between fatigue, cognition, domains of the EuroQol five-dimensional questionnaire (EQ-5D-3L), disability, and utilities estimated with several Western European value sets in patients with multiple sclerosis (MS). METHODS Data from a multinational, cross-sectional, observational study of patients with MS (N = 16,808) conducted in 16 European countries were used. Health-related quality of life data were collected through the EQ-5D-3L, and fatigue and cognitive difficulties were self-assessed on a 10-point visual analogue scale. Associations were assessed using Pearson correlation and multivariate regression model. RESULTS Symptoms of fatigue and cognitive difficulties were present in 90% and 70% of patients at all levels of disability, respectively, and thus only weakly correlated to disability. Problems in the EQ-5D-3L domains were common even at mild disability levels. Mobility, usual activities, and pain issues were experienced by 80% to 90% of patients with moderate and high levels of disability. Mobility, usual activities, and self-care were strongly correlated to disability. Disability, MS type, fatigue, and cognition were associated with utility in regression models, although the coefficients of fatigue and cognition were small. CONCLUSIONS The strong relationship of disability with utility was confirmed. Despite this, fatigue and cognitive difficulties were associated with utility estimated with different European value sets.
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Bernfort L, Gerdle B, Husberg M, Levin LÅ. People in states worse than dead according to the EQ-5D UK value set: would they rather be dead? Qual Life Res 2018; 27:1827-1833. [PMID: 29616427 PMCID: PMC5997722 DOI: 10.1007/s11136-018-1848-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2018] [Indexed: 11/22/2022]
Abstract
Purpose Quality-adjusted life years (QALYs) measure health by combining length and quality of life. QALYs constitute the effect side of incremental cost-effectiveness ratios, describing the results of health economic evaluations. The objectives of this study were to (1) investigate the prevalence of states worse than dead (SWD) when using the EuroQol-5D UK value set, and (2) to study to what extent SWDs are reasonable with a starting point in experience-based valuations of health states. Methods Data from a Swedish cross-sectional population survey were used. The survey was directed to 10,000 persons 65 years and older and its primary aim was to investigate the prevalence and consequences of chronic pain. The survey included questions reflecting life situation and well-being. Some of these were used in order to characterise people in SWD. Results SWD were found in 1.8% of the 6611 respondents. The prevalence of SWD increased with advancing age and was more common among women than men. The control questions used indicated that most of the persons being in SWD according to the EQ-5D UK value set most probably would not judge themselves to be in a SWD. Conclusions Though negative QALY-weights are not very common, they constitute a non-negligible part of health states in a Swedish population 65 years and older. Prevalence of SWD is higher among women than men and increases with age. From responses to other questions on well-being and life situation, there is reason to doubt the reasonableness of experience-based negative QALY-weights in many cases.
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Affiliation(s)
- Lars Bernfort
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, 58183, Linköping, Sweden.
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Magnus Husberg
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, 58183, Linköping, Sweden
| | - Lars-Åke Levin
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, 58183, Linköping, Sweden
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Endarti D, Riewpaiboon A, Thavorncharoensap M, Praditsitthikorn N, Hutubessy R, Kristina SA. A Comparison of EQ-5D-3L Index Scores Using Malaysian, Singaporean, Thai, and UK Value Sets in Indonesian Cervical Cancer Patients. Value Health Reg Issues 2017; 15:50-55. [PMID: 29474178 DOI: 10.1016/j.vhri.2017.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 05/30/2017] [Accepted: 07/27/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To gain insight into the most suitable foreign value set among Malaysian, Singaporean, Thai, and UK value sets for calculating the EuroQol five-dimensional questionnaire index score (utility) among patients with cervical cancer in Indonesia. METHODS Data from 87 patients with cervical cancer recruited from a referral hospital in Yogyakarta province, Indonesia, from an earlier study of health-related quality of life were used in this study. The differences among the utility scores derived from the four value sets were determined using the Friedman test. Performance of the psychometric properties of the four value sets versus visual analogue scale (VAS) was assessed. Intraclass correlation coefficients and Bland-Altman plots were used to test the agreement among the utility scores. Spearman ρ correlation coefficients were used to assess convergent validity between utility scores and patients' sociodemographic and clinical characteristics. With respect to known-group validity, the Kruskal-Wallis test was used to examine the differences in utility according to the stages of cancer. RESULTS There was significant difference among utility scores derived from the four value sets, among which the Malaysian value set yielded higher utility than the other three value sets. Utility obtained from the Malaysian value set had more agreements with VAS than the other value sets versus VAS (intraclass correlation coefficients and Bland-Altman plot tests results). As for the validity, the four value sets showed equivalent psychometric properties as those that resulted from convergent and known-group validity tests. CONCLUSIONS In the absence of an Indonesian value set, the Malaysian value set was more preferable to be used compared with the other value sets. Further studies on the development of an Indonesian value set need to be conducted.
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Affiliation(s)
- Dwi Endarti
- Department of Pharmaceutics, Faculty of Pharmacy, Gadjah Mada University, Yogyakarta, Indonesia.
| | - Arthorn Riewpaiboon
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Montarat Thavorncharoensap
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Naiyana Praditsitthikorn
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Bangkok, Thailand; Bureau of AIDS, TB and STIs, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Raymond Hutubessy
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Susi Ari Kristina
- Department of Pharmaceutics, Faculty of Pharmacy, Gadjah Mada University, Yogyakarta, Indonesia
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Leidl R, Reitmeir P. An Experience-Based Value Set for the EQ-5D-5L in Germany. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:1150-1156. [PMID: 28964448 DOI: 10.1016/j.jval.2017.04.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 03/02/2017] [Accepted: 04/21/2017] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Valuation of health states provides a summary measure useful to health care decision makers. Results may depend on whether the currently experienced health state or a hypothetical health state is being evaluated. This study derives a value set for the EuroQoL Five-Dimensional Five-Level Questionnaire (EQ-5D-5L) by focusing on the individual's current experience. DATA AND METHODS Data include four pooled population surveys of the general German population in 2012-2015 (N = 8114). For valuation, a visual analogue scale (VAS) was used. Six specifications of a generalized linear model with binomial error distribution and constraint parameter estimation were analyzed. In each 1000 simulation runs, models were cross-validated after splitting the sample into an estimation part and a validation part. Predictive accuracy was measured by mean absolute error and sum of squared errors. RESULTS The models rendered a consistent set of parameters. With regard to predictive accuracy, the model considering all problem levels within the five dimensions and the highest problem level reached performed best overall. DISCUSSION Estimation proved to be feasible. Predictive accuracy exceeded that of a similar, experience-based value set for the EQ-5D-3L. Compared with a Dutch value set for the EQ-5D-5L derived for hypothetical health states, experienced values tended to be slightly lower for mild health states and substantially higher for severe health states. Clinical relevance and usefulness of the value set remain to be determined in future studies. CONCLUSIONS For decision makers who prioritize patient-relevant benefit, the experience-based value set provides a novel option to summarize health states, reflecting how health states experienced are valued in a population.
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Affiliation(s)
- Reiner Leidl
- Institute for Health Economics and Health Care Management, HelmholtzZentrum München, Neuherberg, Germany; Munich Center of Health Sciences, Ludwig-Maximilians University, Munich, Germany.
| | - Peter Reitmeir
- Institute for Health Economics and Health Care Management, HelmholtzZentrum München, Neuherberg, Germany
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Wein B, Coslovsky M, Jabbari R, Galatius S, Pfisterer M, Kaiser C. Prasugrel vs. clopidogrel in contemporary Western European patients with acute coronary syndromes receiving drug-eluting stents: Comparative cost-effectiveness analysis from the BASKET-PROVE cohorts. Int J Cardiol 2017; 248:20-27. [PMID: 28823409 DOI: 10.1016/j.ijcard.2017.07.102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 07/06/2017] [Accepted: 07/24/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Clinical and cost-effectiveness of prasugrel vs. clopidogrel in acute coronary syndrome (ACS) was only evaluated using TRITON-TIMI 38 event rates. A comparative analysis of both drugs in contemporary European ACS patients is lacking. METHODS To address this issue, cardiac and bleeding events of 2 "sister" multicenter stent trials, BASKET-PROVE (BP) I with clopidogrel and BPII with prasugrel (for 12months each) were used in a hybrid analysis. Medication costs were 2015 sales prices, event costs modelled for Denmark (DNK), Germany (GER) and Switzerland (SUI) and quality adjusted life years (QALY) by EQ-5D-3L questionnaire. RESULTS In BPI and II, 1012 and 985 ACS-patients received drug eluting stents, respectively, followed-up for 2years. Compared to clopidogrel, prasugrel-treated patients had no more major cardiac events (5.2% vs. 6.4%, p=0.422) nor cardiac deaths (1.6% vs. 1.0%, p=0.255), but more major bleedings (4.0% vs. 1.7%, p<0.001) and altogether no difference in QALYs (-0.027 (95%CI: -0.064/0.011)). Prasugrel caused higher total expenditures per patient: 1116.3 (DNK), 1063.5 (GER) and 880.8 (SUI) EURO, respectively. Accordingly, incremental cost-effectiveness was negative for prasugrel vs. clopidogrel with ratios of -45,907 (DNK), -39,909 (GER) and -33,435 (SUI) EURO/QALY gained, making clopidogrel an economically dominant strategy, even after accounting for the non-randomized comparison. CONCLUSION Findings of this contemporary European ACS-cohort showed markedly lower cardiac event rates than TRITON-TIMI 38 and no significant difference in 2-year QALYs between prasugrel and clopidogrel-treated patients. At current drug prices, clopidogrel use resulted in an economically dominant treatment strategy in Western European patients.
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Affiliation(s)
- Bastian Wein
- Elisabeth-Hospital, Department of Cardiology and Angiology, Essen, Germany; University Hospital of Basel, Department of Cardiology, Switzerland.
| | | | - Reza Jabbari
- Bispebjerg Hospital, Copenhagen University, Department of Cardiology, Copenhagen, Denmark
| | - Søren Galatius
- Bispebjerg Hospital, Copenhagen University, Department of Cardiology, Copenhagen, Denmark
| | | | - Christoph Kaiser
- University Hospital of Basel, Department of Cardiology, Switzerland
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32
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Heijink R, Reitmeir P, Leidl R. International comparison of experience-based health state values at the population level. Health Qual Life Outcomes 2017; 15:138. [PMID: 28683747 PMCID: PMC5501450 DOI: 10.1186/s12955-017-0694-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 05/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Decision makers need to know whether health state values, an important component of summary measures of health, are valid for their target population. A key outcome is the individuals' valuation of their current health. This experience-based perspective is increasingly used to derive health state values. This study is the first to compare such experience-based valuations at the population level across countries. METHODS We examined the relationship between respondents' self-rated health as measured by the EQ-VAS, and the different dimensions and levels of the EQ-5D-3 L. The dataset included almost 32,000 survey respondents from 15 countries. We estimated generalized linear models with logit link function, including country-specific models and pooled-data models with country effects. RESULTS The results showed significant and meaningful differences in the valuation of health states and individual health dimensions between countries, even though similarities were present too. Between countries, coefficients correlated positively for the values of mobility, self-care and usual activities, but not for the values of pain and anxiety, thus underlining structural differences. CONCLUSIONS The findings indicate that, ideally, population-specific experience-based value sets are developed and used for the calculation of health outcomes. Otherwise, sensitivity analyses are needed. Furthermore, transferring the results of foreign studies into the national context should be performed with caution. We recommend future studies to investigate the causes of differences in experience-based health state values through a single international study possibly complemented with qualitative research on the determinants of valuation.
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Affiliation(s)
- Richard Heijink
- National Institute for Public Health and the Environment, P.O. Box 1, 3720, BA, Bilthoven, the Netherlands. .,Dutch Healthcare Authority, Utrecht, the Netherlands.
| | - Peter Reitmeir
- Institute for Health Economic and Healthcare Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Reiner Leidl
- Institute for Health Economic and Healthcare Management, Helmholtz Zentrum München, Neuherberg, Germany.,Munich Center of Health Sciences, Ludwig-Maximilians-University, Munich, Germany
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33
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Kiadaliri AA. A Comparison of Iran and UK EQ-5D-3L Value Sets Based on Visual Analogue Scale. Int J Health Policy Manag 2017; 6:267-272. [PMID: 28812814 PMCID: PMC5417148 DOI: 10.15171/ijhpm.2016.131] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 09/25/2016] [Indexed: 11/22/2022] Open
Abstract
Background: Preference weights for EQ-5D-3L based on visual analogue scale (VAS) has recently been developed in Iran. The aim of the current study was to compare performance of this value set against the UK VAS-based value set.
Methods: The mean scores for all possible 243 health states were compared using Student t test. Absolute agreement and consistency were investigated using concordance correlation coefficient (CCC) and Bland-Altman plot. Health gains for 29 403 possible transitions between pairs of EQ-5D-3L health states were compared. Responsiveness to change and discriminative ability across subgroups of health transitions were assessed.
Results: The mean EQ-5D-3L scores were similar for two value sets (mean = 0.31, P = 1.00). For 36% of health states, the absolute differences were greater than 0.10. There were three pairwise logical inconsistencies in the Iranian value set. The Iranian scores were lower (higher) for severe (mild) health states than the United Kingdom. The CCC (95% CI) was 0.85 (0.81 to 0.88) and Bland-Altman plot showed good agreement. The mean health gain for all possible transitions predicted by the Iranian value set was higher (0.22 vs. 0.20, P < .001) and two value sets predicted opposite transitions in 15% of transitions. The responsiveness of these two value sets were similar with lower discriminative ability for Iranian value set.
Conclusion: The Iranian value set attribute lower values to most severe health states and higher values to mild health states compared with the UK value set. Such systematic differences might translate into discrepant health gains and cost-effectiveness which should be taking into account for informed decision-making.
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Affiliation(s)
- Aliasghar A Kiadaliri
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences-Lund, Lund University, Lund, Sweden.,Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Hinde S, Wade R, Palmer S, Woolacott N, Spackman E. Apremilast for the Treatment of Moderate to Severe Plaque Psoriasis: A Critique of the Evidence. PHARMACOECONOMICS 2016; 34:587-596. [PMID: 26820148 DOI: 10.1007/s40273-016-0382-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
As part of the National Institute for Health and Care Excellence's (NICE) single technology appraisal (STA) process, apremilast was assessed to determine the clinical and cost effectiveness of its use in the treatment of moderate to severe plaque psoriasis in two patient populations, differentiated by the severity of the patient's Psoriasis Area Severity Index (PASI) score. The Centre for Reviews and Dissemination (CRD) and the Centre for Health Economics (CHE) Technology Appraisal Group at the University of York was commissioned to act as the evidence review group (ERG). This article provides a summary of the company's submission, the ERG report and NICE's subsequent guidance. In the company's initial submission, a sequence of treatments including apremilast was found to be both more effective and cheaper than a comparator sequence without it in both populations considered. However, this result was found to be highly sensitive to a series of assumptions made by the company, primarily reflecting the costs of best supportive care once no further treatments are available, and the source of utility estimates. A re-estimation of the cost effectiveness of apremilast by the ERG suggested that the apremilast sequence in the two populations was more effective, but due to high additional costs was not indicative of a cost-effective use of NHS resources. As such, in the final appraisal decision NICE concluded that apremilast was not cost effective in either population.
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Affiliation(s)
- Sebastian Hinde
- Centre for Health Economics (CHE), University of York, York, YO10 5DD, UK.
| | - Ros Wade
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Stephen Palmer
- Centre for Health Economics (CHE), University of York, York, YO10 5DD, UK
| | - Nerys Woolacott
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Eldon Spackman
- Centre for Health Economics (CHE), University of York, York, YO10 5DD, UK
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