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Long C, Mao Z, Yang Z. A Head-to-Head Comparison of EQ-HWB and EQ-5D-5L in Patients, Carers, and General Public in China. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:848-856. [PMID: 38447744 DOI: 10.1016/j.jval.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/04/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES This study aimed to understand the psychometric properties of EQ Health and Wellbeing (EQ-HWB) and to examine its relationship with EQ-5D-5L in a sample covering patients, carers, and general public. METHODS A cross-sectional study was conducted in Guizhou Province, China. The acceptability, convergent validity (using Spearman correlation coefficients), internal structure (using exploratory factor analysis), and known-group validity of EQ-HWB, EQ-HWB-Short (EQ-HWB-S), and EQ-5D-5L were reported and compared. RESULTS A total of 323 participants completed the survey, including 106 patients, 101 carers, and 116 individuals from the general public. Approximately 7.4% of participants had at least 1 missing response. In the EQ-HWB and EQ-5D-5L items related to activities, there were more level 1 responses. The correlations between EQ-HWB and EQ-5D-5L items ranged from low to high, confirming the convergent validity of similar aspects between the 2 instruments. Notably, EQ-HWB measures 2 additional factors compared with EQ-5D-5L or EQ-HWB-S, both of which share 3 common factors. When the patient group was included, EQ-5D-5L had the largest effect size, but it failed to differentiate between the groups of general public and carers. Both EQ-HWB and EQ-HWB-S demonstrated better known-group validity results when carers were included. CONCLUSIONS EQ-HWB measures a broader quality of life construct that goes beyond health measured by EQ-5D-5L. By encompassing a broader scope, the impact of healthcare interventions may become diluted, given that other factors can influence well-being outcomes as significantly as health conditions do.
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Affiliation(s)
- Chen Long
- Department of Health Services Management, Guizhou Medical University, Guiyang, China
| | - Zhuxin Mao
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Zhihao Yang
- Department of Health Services Management, Guizhou Medical University, Guiyang, China; Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, China.
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Whitty JA, Littlejohns P, Ratcliffe J, Rixon K, Wilson A, Kendall E, Burton P, Chalkidou K, Scuffham PA. Impact of information and deliberation on the consistency of preferences for prioritization in health care - evidence from discrete choice experiments undertaken alongside citizens' juries. J Med Econ 2023; 26:1237-1249. [PMID: 37738383 DOI: 10.1080/13696998.2023.2262329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/20/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Public preferences are an important consideration for priority-setting. Critics suggest preferences of the public who are potentially naïve to the issue under consideration may lead to sub-optimal decisions. We assessed the impact of information and deliberation via a Citizens' Jury (CJ) or preference elicitation methods (Discrete Choice Experiment, DCE) on preferences for prioritizing access to bariatric surgery. METHODS Preferences for seven prioritization criteria (e.g. obesity level, obesity-related comorbidities) were elicited from three groups who completed a DCE: (i) participants from two CJs (n = 28); (ii) controls who did not participate in the jury (n = 21); (iii) population sample (n = 1,994). Participants in the jury and control groups completed the DCE pre- and post-jury. DCE data were analyzed using multinomial logit models to derive "priority weights" for criteria for access to surgery. The rank order of criteria was compared across groups, time points and CJ recommendations. RESULTS The extent to which the criteria were considered important were broadly consistent across groups and were similar to jury recommendations but with variation in the rank order. Preferences of jurors but not controls were more differentiated (that is, criteria were assigned a greater range of priority weights) after than before the jury. Juror preferences pre-jury were similar to that of the public but appeared to change during the course of the jury with greater priority given to a person with comorbidity. Conversely, controls appeared to give a lower priority to those with comorbidity and higher priority to treating very severe obesity after than before the jury. CONCLUSION Being informed and undertaking deliberation had little impact on the criteria that were considered to be relevant for prioritizing access to bariatric surgery but may have a small impact on the relative importance of criteria. CJs may clarify underlying rationale but may not provide substantially different prioritization recommendations compared to a DCE.
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Affiliation(s)
- Jennifer A Whitty
- Health Economics Group, Norwich Medical School, Faculty of Medicine and Health Sciences, The University of East Anglia, Norwich, UK
- NIHR Applied Research Collaboration (ARC), East of England, UK
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Patient Centered Research, Evidera, London, UK
| | | | - Julie Ratcliffe
- Menzies Centre for Health Policy and Economics, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Kylie Rixon
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Andrew Wilson
- Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
| | - Elizabeth Kendall
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Paul Burton
- Cities Research Institute, Griffith University, Queensland, Australia
| | - Kalipso Chalkidou
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Piscitello J, Altszuler AR, Mazzant JR, Babinski DE, Gnagy EM, Page TF, Molina BSG, Pelham WE. The Impact of ADHD on Maternal Quality of Life. Res Child Adolesc Psychopathol 2022; 50:1275-1288. [PMID: 35648330 PMCID: PMC9613519 DOI: 10.1007/s10802-022-00935-z] [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: 05/11/2022] [Indexed: 11/24/2022]
Abstract
Childhood attention-deficit/hyperactivity disorder (ADHD) is associated with substantial burden to caregiver quality of life (QoL). However, a paucity of work has focused on quantifying QoL among caregivers of adolescents with a history of ADHD. The purpose of the current study was (1) to quantify maternal QoL in a sample of mothers of adolescents with and without childhood ADHD; and (2) to examine predictors (i.e., parent and child characteristics and behavior) associated with maternal QoL. Participants included mothers of adolescents with (N = 110) and without ADHD (N = 90) ranging in age from 13 to 18 (M = 16.09, 92% male). The Quality Adjusted Life-Year (QALY) was used to calculate maternal QoL using two health domains (i.e., anxiety/depression and disruption in daily activities) commonly impacted by raising youth with ADHD. QALYs are valued monetarily to estimate disease burden. Mothers of adolescents with childhood ADHD experienced significantly worse QoL relative to mothers in the comparison group. Maternal depression, as well as adolescent age, ADHD status, and discipline problems significantly predicted lower levels of maternal QALY health status index, with ADHD being the strongest predictor. This is equal to a reduction in 1.96 QALYs when summed over the course of a child's lifetime and is associated with a loss of $98,000 to $196,000. Results of the investigation help to further elucidate the health impacts incurred by families of adolescents with ADHD and have important public health implications. Further, parental QoL should be considered when conceptualizing the financial and negative health impact of ADHD.
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Affiliation(s)
- Jennifer Piscitello
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US.
| | - Amy R Altszuler
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US
| | - Jessica Robb Mazzant
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US
| | - Dara E Babinski
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, US
| | - Elizabeth M Gnagy
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US
| | - Timothy F Page
- Department of Management, H. Wayne Huizenga College of College of Business and Entrepreneurship, Nova Southeastern University, Davie, FL, US
| | - Brooke S G Molina
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, US
| | - William E Pelham
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US
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Gamper EM, King MT, Norman R, Loth FLC, Holzner B, Kemmler G. The EORTC QLU-C10D discrete choice experiment for cancer patients: a first step towards patient utility weights. J Patient Rep Outcomes 2022; 6:42. [PMID: 35507194 PMCID: PMC9068836 DOI: 10.1186/s41687-022-00430-5] [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: 11/12/2021] [Accepted: 02/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Utility-Core 10 Dimensions (QLU-C10D) is a novel cancer-specific preference-based measure (PBM) for which value sets are being developed for an increasing number of countries. This is done by obtaining health preferences from the respective general population. There is an ongoing discussion if instead patients suffering from the disease in question should be asked for their preferences. We used the QLU-C10D valuation survey, originally designed for use in the general population, in a sample of cancer patients in Austria to assess the methodology’s acceptability and applicability in this target group before obtaining QLU-C10D patient preferences. Methods The core of the QLU-C10D valuation survey is a discrete choice experiment in which respondents are asked to give preferences for certain health states (described by a relatively large number of 10 quality of life domains) and an associated survival time. They therewith are asked to trade off quality of life against life time. As this might be a very burdensome task for cancer patients undergoing treatment, a cognitive interview was conducted in a pilot sample to assess burden and potential additional needs for explanation in order to be able to use the DCE for the development of QLU-C10D patient preferences. In addition, responses to general feedback questions on the survey were compared against responses from a matched control group from the already completed Austrian general population valuation survey. Results We included 48 patients (mean age 59.9 years; 46% female). In the cognitive interview, the majority indicated that their experience with the survey was positive (85%) and overall clarity as good (90%). In response to the general feedback questions, patients rated the presentation of the health states less clear than matched controls (p = 0.008). There was no difference between patients and the general population concerning the difficulty in choosing between the health states (p = 0.344). Conclusion Despite the relatively large number of DCE domains the survey was manageable for patients and allows going on with the QLU-C10D patient valuation study. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00430-5.
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Affiliation(s)
- Eva-Maria Gamper
- Innsbruck Institute of Patient-Centered Outcome Research (IIPCOR), Dr. Stumpf Straße 47, 6020, Innsbruck, Austria.
| | - Madeleine T King
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, 2006, Australia
| | - Richard Norman
- School of Public Health, Curtin University, Perth, Australia
| | - Fanny L C Loth
- Faculty of Philosophy and Education, Catholic University of Eichstätt-Ingolstadt, Eichtstätt, Germany
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Kemmler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
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Monteiro AL, Kuharic M, Pickard AS. A Comparison of a Preliminary Version of the EQ-HWB Short and the 5-Level Version EQ-5D. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:534-543. [PMID: 35279371 DOI: 10.1016/j.jval.2022.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/15/2021] [Accepted: 01/03/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The EQ Health and Wellbeing Short (EQ-HWB-S) is a new broad generic measure of health and wellbeing for use in economic evaluations of interventions across healthcare, social care, and public health. This measure conceptually overlaps with the 5-level version EQ-5D (EQ-5D-5L), while expanding on the coverage of health and social care related dimensions. This study aims to examine the extent to which the EQ-HWB-S and EQ-5D-5L overlap and are different. METHODS A sample of US-based respondents (n = 903; n = 400 cancer survivors and n = 503 general population) completed a survey administered via an online panel. The survey included the EQ-HWB item pool (62 items, including 11 items used in this analysis), EQ-5D-5L, and questions about sociodemographic and health characteristics. The analysis included (Spearman's) correlations, the comparison of patterns of response (distributions and ceiling effects), and the ability to discriminate between known groups. RESULTS Moderate to strong associations were found between conceptually overlapping dimensions of the EQ-5D-5L and the EQ-HWB-S (rs > 0.5, P < .001). Among respondents reporting full health on the EQ-5D-5L (n = 161, 18.23%), the EQ-HWB-S identified ceiling effects, particularly with the item "feeling exhausted." Most EQ-5D-5L and EQ-HWB-S items demonstrated discriminative ability among those with and without physical and mental conditions, yielding medium (> 0.5) to large effect sizes (> 0.8). Nevertheless, only EQ-HWB-S items distinguished between caregivers and noncaregivers and those with low and high caregiver burden, albeit with small effect sizes (0.2-0.5). CONCLUSIONS Results indicate a convergence between the measures, especially between overlapping dimensions, lending support to the validity of the EQ-HWB-S. The EQ-HWB-S performed similarly or better than the EQ-5D-5L among patient groups and is better able to differentiate among caregivers and respondents closer to full health.
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Affiliation(s)
- Andrea L Monteiro
- Department of Pharmacy Systems, Outcomes and Policy. College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Maja Kuharic
- Department of Pharmacy Systems, Outcomes and Policy. College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy. College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.
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Erku D, Schneider J, Scuffham P. A framework for economic evaluation of therapeutic drug monitoring-guided dosing in oncology. Pharmacol Res Perspect 2021; 9:e00862. [PMID: 34546005 PMCID: PMC8453491 DOI: 10.1002/prp2.862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022] Open
Abstract
The standard approach for dose individualization of chemotherapy in the oncology setting has long been based on body surface area (BSA) as a measure of body size. However, for many anticancer drugs, administration of dosages based on BSA may result in some patients receiving supratherapeutic or subtherapeutic concentrations due to substantial interindividual pharmacokinetic variability. Therapeutic drug monitoring (TDM)-guided dosing aims to ensure that the patient's serum drug concentration is in a target range which has been shown to produce optimal clinical outcomes. The management of several malignancies is now moving away from using traditional intravenous chemotherapy to longer-term treatment with targeted molecular therapies. These targeted anticancer drugs are currently dosed based on a fixed dose for all patients. The pharmacokinetic characteristics of most of these drugs (e.g., tyrosine-kinase inhibitors) support implementation of individualized dosing via TDM. However, prior to adopting TDM-guided dosing in oncology settings, the economic efficiency and value for money of introducing TDM interventions should be critically and systematically examined along with the impacts on patient care and outcomes. Yet, current evidence in this area is limited, and more generally, there is lack of methodological guidance on how to identify, estimate and value clinical and cost information necessary to conduct economic evaluations of TDM interventions. In this paper, we propose a coherent framework for conducting economic evaluation of TDM interventions in oncology settings and discuss some practical challenges of conducting economic evaluations of TDM.
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Affiliation(s)
- Daniel Erku
- Centre for Applied Health EconomicsGriffith UniversityNathanQueenslandAustralia
- Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
| | - Jennifer Schneider
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
| | - Paul Scuffham
- Centre for Applied Health EconomicsGriffith UniversityNathanQueenslandAustralia
- Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
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Santos M, Monteiro AL, Santos B. EQ-5D Brazilian population norms. Health Qual Life Outcomes 2021; 19:162. [PMID: 34112207 PMCID: PMC8190837 DOI: 10.1186/s12955-021-01671-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/06/2021] [Indexed: 01/22/2023] Open
Abstract
Background The EQ-5D-3L is a widely used generic health-related quality of life measure commonly applied to describe health outcomes and to measure disease burden. The aim of this study was to generate Brazilian population norms, stratified by age and gender, based on Brazilian preference weights for EQ-5D-3L.
Methods A multicenter cross-sectional study was conducted in three Brazilian urban areas. The final sample consisted of 5774 respondents, aged from 18 to 64 years. Amongst other information, respondents were asked to self-report their health status using the EQ-5D-3L descriptive system and visual analog scale (EQ-VAS). Data on socio-demographic characteristics was obtained through specific questionnaires. The Brazilian TTO scoring algorithm was used to derive the utility values. Multivariate logistic regression models were fitted to analyze the influence of age, sex, education status and sample site on the presence of any problem for each dimension of EQ5D. Results Mean values were computed for both weighted index scores and self-rated health status (EQ-VAS), and stratified by gender and age groups. Health status declines with age, ranging between 0.87 for the youngest group 18–29 year-olds and 0.76 for 60–64-year-old. Men reported higher scores (0.85) than the woman (0.79). Lower education levels were associated with lower EQ-5D index score in most age groups. Conclusion This study provides EQ-5D reference values for the Brazilian population. These values can be used by local decision-makers and researchers in economic evaluations and population health studies.
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Affiliation(s)
- Marisa Santos
- Nucleo de Avaliacao de Tecnologias Em Saude, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - Andrea L Monteiro
- Nucleo de Avaliacao de Tecnologias Em Saude, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil. .,Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.
| | - Bráulio Santos
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
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Prichard RA, Zhao FL, Mcdonagh J, Goodall S, Davidson PM, Newton PJ, Farr-Wharton B, Hayward CS. Discrepancies between proxy estimates and patient reported, health related, quality of life: minding the gap between patient and clinician perceptions in heart failure. Qual Life Res 2021; 30:1049-1059. [PMID: 33387292 DOI: 10.1007/s11136-020-02722-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Health related quality of life (HRQoL) is rarely routinely measured in the clinical setting. In the absence of patient reported data, clinicians rely on proxy and informal estimates to support clinical decisions. This study compares clinician estimates (proxy) with patient reported HRQoL in patients with advanced heart failure and examines factors influencing discrepancies. METHODS Seventy-five patients with heart failure, (22 females, 53 males) completed the EQ-5D-5L questionnaire. Thirty-nine clinicians (11 medical, 23 nursing, 5 allied health) completed the proxy version (V1) producing 194 dyads. Correlation was assessed using Spearman's rank tests, systematic bias was examined with Bland-Altman analyses. Inter-rater agreement at the domain level, was investigated using linear weighted Kappa statistics while factors influencing the IRG were explored using independent student t-tests, analysis of variance and regression. RESULTS There was a moderate positive correlation between clinician HRQoL estimates and patient reported utility (r = 0.38; p < .0005). Mean clinician estimates were higher than patient reported utility (0.60 vs 0.54; p = 0.008), with significant underestimation of reported problems apparent in three of the five EQ-5D-5L domains. Patient sex (female), depressed mood and frailty were all associated with an increased inter-rater gap. CONCLUSION Clinicians in this sample overestimated HRQoL. Factors affecting the inter-rater gap, including sex and depression, support formal HRQoL screening to enhance clinical conversations and decision making. The discrepancy also supports regulatory restriction on the use of expert opinion in the development of QALYs in health economic analysis.
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Affiliation(s)
- Roslyn A Prichard
- Faculty of Health, University of Technology, Ultimo, NSW, Australia.
| | - Fei-Li Zhao
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, Australia
| | - Julee Mcdonagh
- Faculty of Health, University of Technology, Ultimo, NSW, Australia
| | - Stephen Goodall
- Centre for Health Economic Research and Evaluation, University of Technology Sydney, Ultimo, Australia
| | | | - Phillip J Newton
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
| | - Ben Farr-Wharton
- School of Business and Law, Edith Cowan University, Joondalup, WA, Australia
| | - Christopher S Hayward
- Faculty of Health, University of Technology, Ultimo, NSW, Australia
- Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
- St Vincent's Hospital Heart and Lung Clinic, St Vincent's Hospital Sydney, Darlinghurst, Australia
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Bahrampour M, Byrnes J, Norman R, Scuffham PA, Downes M. Discrete choice experiments to generate utility values for multi-attribute utility instruments: a systematic review of methods. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:983-992. [PMID: 32367379 DOI: 10.1007/s10198-020-01189-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 04/15/2020] [Indexed: 05/19/2023]
Abstract
OBJECTIVES In recent years, discrete choice experiments (DCEs) have become frequently used to generate utility values, but there are a diverse range of approaches to do this. The primary focus of this systematic review is to summarise the methods used for the design and analysis of DCEs when estimating utility values in both generic and condition-specific preference-based measures. METHODS Published literature using DCEs to estimate utility values from preference-based instruments were identified from MEDLINE, Embase, Cochrane Library and CINAHL using PRISMA guidelines. To assess the different DCE methods, standardised information was extracted from the articles including the DCE design method, the number of choice sets, the number of DCE pairs per person, randomisation of questions, analysis method, logical consistency tests and techniques for anchoring utilities. The CREATE checklist was used to assess the quality of the studies. RESULTS A total of 38 studies with samples from the general population, students and patients were included. Values for health states described using generic multi attribute instruments (MAUIs) (especially the EQ-5D) were the most commonly explored using DCEs. The studies showed considerable methodology and design diversity (number of alternatives, attributes, sample size, choice task presentation and analysis). Despite these differences, the quality of articles reporting the methods used for the DCE was generally high. CONCLUSION DCEs are an important approach to measure utility values for both generic and condition-specific instruments. However, a gold standard method cannot yet be recommended.
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Affiliation(s)
- Mina Bahrampour
- Centre for Applied Health Economics, School of Medicine and Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia.
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - Richard Norman
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Paul A Scuffham
- Centre for Applied Health Economics, School of Medicine and Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - Martin Downes
- Centre for Applied Health Economics, School of Medicine and Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
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Valuing health-related quality of life in heart failure: a systematic review of methods to derive quality-adjusted life years (QALYs) in trial-based cost-utility analyses. Heart Fail Rev 2020; 24:549-563. [PMID: 30903357 PMCID: PMC6560006 DOI: 10.1007/s10741-019-09780-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The accurate measurement of health-related quality of life (HRQoL) and the value of improving it for patients are essential for deriving quality-adjusted life years (QALYs) to inform treatment choice and resource allocation. The objective of this review was to identify and describe the approaches used to measure and value change in HRQoL in trial-based economic evaluations of heart failure interventions which derive QALYs as an outcome. Three databases (PubMed, CINAHL, Cochrane) were systematically searched. Twenty studies reporting economic evaluations based on 18 individual trials were identified. Most studies (n = 17) utilised generic preference-based measures to describe HRQoL and derive QALYs, commonly the EQ-5D-3L. Of these, three studies (from the same trial) also used mapping from a condition-specific to a generic measure. The remaining three studies used patients’ direct valuation of their own health or physician-reported outcomes to derive QALYs. Only 7 of the 20 studies reported significant incremental QALY gains. Most interventions were reported as being likely to be cost-effective at specified willingness to pay thresholds. The substantial variation in the approach applied to derive QALYs in the measurement of and value attributed to HRQoL in heart failure requires further investigation.
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Gamper EM, Holzner B, King MT, Norman R, Viney R, Nerich V, Kemmler G. Test-Retest Reliability of Discrete Choice Experiment for Valuations of QLU-C10D Health States. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:958-966. [PMID: 30098674 DOI: 10.1016/j.jval.2017.11.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/08/2017] [Accepted: 11/28/2017] [Indexed: 05/17/2023]
Abstract
BACKGROUND Recently, a newly developed cancer-specific multiattribute utility instrument based on the widely used health-related quality of life instrument, the European Organisation for Research and Treatment of Cancer QLQ-C30, was introduced: the QLU-C10D. For the elicitation of utility weights, a discrete choice experiment (DCE) was designed. Our aim was to investigate the DCE in terms of individual choice consistency and utility estimate consistency by applying a test-retest design. METHODS We conducted the study in general population samples in Germany and France. The DCE was administered via a web-based self-complete survey using online panels. Respondents were presented 16 choice sets comprising 11 attributes with 4 levels each. Retest was conducted 4 to 6 weeks after first assessment. We used kappa and percentage agreement as measures of choice consistency and both intraclass correlations and mean utility differences as measures of utility estimate consistency. RESULTS A total of 300 German respondents (31% female, mean age 48 years [SD 14]) and 305 French respondents (46% female, mean age 47 years [SD 16]) completed test and retest assessments. Individual choice consistency was moderate to high (Germany: κ = 0.605, percentage agreement = 80.2%; France: κ = 0.411, percentage agreement = 70.6%). Utility estimate consistency was high when considering intraclass correlations (all >0.79). Mean utility differences were 0.08 in the German sample and 0.05 in the French sample. CONCLUSIONS Results indicate that the designed DCE elicits stable health state preferences rather than guesses or mood-specific or condition-specific judgments. Nevertheless, the identified mean utility differences between test and retest need to be taken into account when determining minimal important differences for the QLU-C10D in future research.
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Affiliation(s)
- Eva-Maria Gamper
- Department for Psychiatry and Psychotherapy, Medical University of Innsbruck, Innsbruck, Austria.
| | - Bernhard Holzner
- Department for Psychiatry and Psychotherapy, Medical University of Innsbruck, Innsbruck, Austria
| | - Madeleine T King
- Psycho-Oncology Cooperative Research Group, Cancer Australia Chair in Cancer Quality of Life School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
| | - Richard Norman
- School of Public Health, Department of Health Policy and Management, Curtin University, Perth, Australia
| | - Rosalie Viney
- Center of Health Economics and Research Evaluation, University of Technology Sydney, Sydney, Australia
| | | | - Georg Kemmler
- Department for Psychiatry and Psychotherapy, Medical University of Innsbruck, Innsbruck, Austria
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12
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Nerich V, Saing S, Gamper EM, Holzner B, Pivot X, Viney R, Kemmler G. Critical appraisal of health-state utility values used in breast cancer-related cost–utility analyses. Breast Cancer Res Treat 2017; 164:527-536. [DOI: 10.1007/s10549-017-4283-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
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Hamers FF, Ghabri S, Le Gales C. Health-state utility estimates for health technology assessment: a review of the manufacturers' submissions to the French National Authority for Health. Expert Rev Pharmacoecon Outcomes Res 2017; 17:489-494. [PMID: 28133977 DOI: 10.1080/14737167.2017.1289088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Our aim was to review the selection and methods used for deriving health state utility (HSU) estimates included in the cost-utility analyses (CUA) submitted by manufacturers to the National Authority for Health (HAS) during the first 2 years after the introduction of the economic evaluation for price setting in France. METHODS We reviewed all manufacturers' submissions that included a CUA and were assessed by HAS by the end of October 2015 (N = 34). We reviewed the identification, selection, and methods used to estimate HSU and compared them with those recommended by HAS. RESULTS A literature review to identify HSU was reported in only 13 (38%) submissions. The instruments for describing HSU were a preference-based generic instrument in 20 (59%) submissions; vignettes in five (15%); a condition-specific instrument in three (9%); and a combination of instruments in six (18%). The valuation perspective was the general population in 26 (76%) submissions; in only nine (26%) submissions, the valuation set was derived from the French general population. CONCLUSIONS We identified numerous concerns in the selection, valuation and use of HSU, as well as a frequent lack of clarity in the methods used. Most submissions (79%) included HSU that did not meet HAS recommendations.
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Affiliation(s)
- Françoise F Hamers
- a Department of Economic and Public Health Evaluation , Haute Autorité de Santé (French National Authority for Health, HAS) , Saint-Denis La Plaine , France
| | - Salah Ghabri
- a Department of Economic and Public Health Evaluation , Haute Autorité de Santé (French National Authority for Health, HAS) , Saint-Denis La Plaine , France
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Snoswell C, Smith AC, Scuffham PA, Whitty JA. Economic evaluation strategies in telehealth: Obtaining a more holistic valuation of telehealth interventions. J Telemed Telecare 2016; 23:792-796. [DOI: 10.1177/1357633x16671407] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Telehealth is an emerging area of medical research. Its translation from conception, to research and into practice requires tailored research and economic evaluation methods. Due to their nature telehealth interventions exhibit a number of extra-clinical benefits that are relevant when valuing their costs and outcomes. By incorporating methods to measure societal values such as patient preference and willingness-to-pay, a more holistic value can be placed on the extra-clinical outcomes associated with telehealth and evaluations can represent new interventions more effectively. Cost-benefit analysis is a method by which relevant costs and outcomes in telehealth can be succinctly valued and compared. When health economic methods are conducted using holistic approaches such as cost-benefit analysis they can facilitate the translation of telehealth research into policy and practice.
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Affiliation(s)
- Centaine Snoswell
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| | - Paul A Scuffham
- School of Medicine & the Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Jennifer A Whitty
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- School of Medicine & the Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
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Kularatna S, Whitty JA, Johnson NW, Jayasinghe R, Scuffham PA. A comparison of health state utility values associated with oral potentially malignant disorders and oral cancer in Sri Lanka assessed using the EQ-5D-3 L and the EORTC-8D. Health Qual Life Outcomes 2016; 14:101. [PMID: 27402015 PMCID: PMC4940840 DOI: 10.1186/s12955-016-0502-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 06/29/2016] [Indexed: 11/22/2022] Open
Abstract
Background It has been suggested that the EQ-5D-3 L preference-based measure of health outcome lacks sensitivity to discriminate between health states in cancer patients. An alternative approach is to use a disease (cancer) specific preference-based measure, such as the EORTC-8D. A limited number of comparisons have been made between generic and disease specific preference-based measures. The aim of this study was to compare the utility scores from the EQ-5D-3 L and the EORTC-8D in a group of patients with oral cancer or with oral potentially malignant disorders (OPMD). Methods Patients (n = 151) with OPMD or oral cancer were recruited consecutively from six hospitals in Sri Lanka. All participants completed both the EQ-5D-3 L and the EORTC's QLQC-30 instrument. The Sri Lankan EQ-5D-3 L and EORTC-8D scoring algorithms were employed to estimate utility scores. The utility scores from the two instruments were compared for discrimination, responsiveness and correlation. Results There were significant differences across the two utility scores. The EQ-5D-3 L showed better discrimination than EORTC-8D with higher effect sizes. There were higher ceiling effects observed in the EQ-5D-3 L. There was poor correlation between the dimensions of the two instruments except for the mobility and physical functions. Conclusion The two instruments captured different aspects of quality of life. The EQ-5D-3 L demonstrated better discrimination than the EORTC-8D. In mild conditions EORTC-8D was more responsive and we recommend further validation of this instrument in diverse cancer conditions.
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Affiliation(s)
- Sanjeewa Kularatna
- Centre for Applied Health Economics, School of Medicine, Nathan Campus, Griffith University , 170 Kessels Road, Nathan, 4111, Queensland, Australia. .,Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
| | - Jennifer A Whitty
- Centre for Applied Health Economics, School of Medicine, Nathan Campus, Griffith University , 170 Kessels Road, Nathan, 4111, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Queensland, Australia.,School of Pharmacy, The University of Queensland, Queensland, Australia
| | - Newell W Johnson
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Ruwan Jayasinghe
- Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Paul A Scuffham
- Centre for Applied Health Economics, School of Medicine, Nathan Campus, Griffith University , 170 Kessels Road, Nathan, 4111, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Queensland, Australia
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17
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Khan I, Morris S, Pashayan N, Matata B, Bashir Z, Maguirre J. Comparing the mapping between EQ-5D-5L, EQ-5D-3L and the EORTC-QLQ-C30 in non-small cell lung cancer patients. Health Qual Life Outcomes 2016; 14:60. [PMID: 27072351 PMCID: PMC4830017 DOI: 10.1186/s12955-016-0455-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 03/23/2016] [Indexed: 01/01/2023] Open
Abstract
Background Several mapping algorithms have been published with the EORTC-QLQ-C30 for estimating EQ-5D-3L utilities. However, none are available with EQ-5D-5L. Moreover, a comparison between mapping algorithms in the same set of patients has not been performed for these two instruments simultaneously. In this prospective data set of 100 non-small cell lung cancer (NSCLC) patients, we investigate three mapping algorithms using the EQ-5D-3L and EQ-5D-5L and compare their performance. Methods A prospective non-interventional cohort of 100 NSCLC patients were followed up for 12 months. EQ-5D-3L, EQ-5D-5L and EORTC-QLQ-C30 were assessed monthly. EQ-5D-5L was completed at least 1 week after EQ-5D-3L. A random effects linear regression model, a beta-binomial (BB) and a Limited Variable Dependent Mixture (LVDM) model were used to determine a mapping algorithm between EQ-5D-3L, EQ-5D-5L and QLQ-C30. Simulation and cross validation and other statistical measures were used to compare the performances of the algorithms. Results Mapping from the EQ-5D-5L was better: lower AIC, RMSE, MAE and higher R2 were reported with the EQ-5D-5L than with EQ-5D-3L regardless of the functional form of the algorithm. The BB model proved to be more useful for both instruments: for the EQ-5D-5L, AIC was –485, R2 of 75 %, MAE of 0.075 and RMSE was 0.092. This was –385, 69 %, 0.099 and 0.113 for EQ-5D-3L respectively. The mean observed vs. predicted utilities were 0.572 vs. 0.577 and 0.515 vs. 0.523 for EQ-5D-5L and EQ-5D-3L respectively, for OLS; for BB, these were 0.572 vs. 0.575 and 0.515 vs. 0.518 respectively and for LVDMM 0.532 vs 0.515 and 0.569 vs 0.572 respectively. Less over-prediction at poorer health states was observed with EQ-5D-5L. Conclusions The BB mapping algorithm is confirmed to offer a better fit for both EQ-5D-3L and EQ-5D-5L. The results confirm previous and more recent results on the use of BB type modelling approaches for mapping. It is recommended that in studies where EQ-5D utilities have not been collected, an EQ-5D-5L mapping algorithm is used.
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Affiliation(s)
- Iftekhar Khan
- Clinical Trials Unit & Department of Health Economics, University of Surrey, Guilford, UK. .,Department of Applied Health Research, University College London, London, UK.
| | - Steve Morris
- Department of Applied Health Research, University College London, London, UK
| | - Nora Pashayan
- Department of Applied Health Research, University College London, London, UK
| | | | - Zahid Bashir
- University of Birmingham, Cancer School, Birmingham, UK
| | - Joe Maguirre
- Liverpool Heart and Chest Hospital, Liverpool, UK
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18
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King MT, Costa DSJ, Aaronson NK, Brazier JE, Cella DF, Fayers PM, Grimison P, Janda M, Kemmler G, Norman R, Pickard AS, Rowen D, Velikova G, Young TA, Viney R. QLU-C10D: a health state classification system for a multi-attribute utility measure based on the EORTC QLQ-C30. Qual Life Res 2016; 25:625-36. [PMID: 26790428 DOI: 10.1007/s11136-015-1217-y] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To derive a health state classification system (HSCS) from the cancer-specific quality of life questionnaire, the EORTC QLQ-C30, as the basis for a multi-attribute utility instrument. METHODS The conceptual model for the HSCS was based on the established domain structure of the QLQ-C30. Several criteria were considered to select a subset of dimensions and items for the HSCS. Expert opinion and patient input informed a priori selection of key dimensions. Psychometric criteria were assessed via secondary analysis of a pooled dataset comprising HRQOL and clinical data from 2616 patients from eight countries and a range of primary cancer sites, disease stages, and treatments. We used confirmatory factor analysis (CFA) to assess the conceptual model's robustness and generalisability. We assessed item floor effects (>75 % observations at lowest score), disordered item response thresholds, coverage of the latent variable and differential item function using Rasch analysis. We calculated effect sizes for known group comparisons based on disease stage and responsiveness to change. Seventy-nine cancer patients assessed the relative importance of items within dimensions. RESULTS CFA supported the conceptual model and its generalisability across primary cancer sites. After considering all criteria, 12 items were selected representing 10 dimensions: physical functioning (mobility), role functioning, social functioning, emotional functioning, pain, fatigue, sleep, appetite, nausea, bowel problems. CONCLUSIONS The HSCS created from QLQ-C30 items is known as the EORTC Quality of Life Utility Measure-Core 10 dimensions (QLU-C10D). The next phase of the QLU-C10D's development involves valuation studies, currently planned or being conducted across the globe.
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Affiliation(s)
- M T King
- Psycho-Oncology Cooperative Research Group (PoCoG), School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.
- Central Clinical School, Sydney Medical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
| | - D S J Costa
- Psycho-Oncology Cooperative Research Group (PoCoG), School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - N K Aaronson
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J E Brazier
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK
| | - D F Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - P M Fayers
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - P Grimison
- Chris O'Brien Lifehouse, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - M Janda
- School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - G Kemmler
- Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria
| | - R Norman
- School of Public Health, Curtin University, Perth, WA, Australia
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - A S Pickard
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - D Rowen
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK
| | - G Velikova
- Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital, Leeds, UK
| | - T A Young
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK
| | - R Viney
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney (UTS), Sydney, NSW, Australia
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Hayes A, Arima H, Woodward M, Chalmers J, Poulter N, Hamet P, Clarke P. Changes in Quality of Life Associated with Complications of Diabetes: Results from the ADVANCE Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:36-41. [PMID: 26797234 DOI: 10.1016/j.jval.2015.10.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 10/11/2015] [Accepted: 10/18/2015] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To measure the impact of complications on summary measures of health-related quality of life among people with type 2 diabetes. METHODS Patients participating in the Action in Diabetes and Vascular Disease:Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial were administered a health-related quality-of-life questionnaire, the three-level EuroQol five-dimensional questionnaire (EQ-5D-3L), on four occasions over a 5-year period. We used two-way fixed-effects longitudinal regression models to investigate the impact of incident diabetes complications (stroke, heart failure, myocardial infarction, ischemic heart disease, renal failure, blindness, and amputation) on EQ-5D-3L utility score (where 1 = perfect health), while controlling for characteristics of individuals that do not vary over time. RESULTS The effect of having any one of the seven complications was to reduce the EQ-5D-3L utility score by 0.054 (95% confidence interval 0.044-0.064), and this was not significantly affected by baseline age, sex, economic region, or the value set used to derive utilities. The complication with the largest disutility was amputation (0.122), followed by stroke (0.099), blindness (0.083), renal failure (0.049), heart failure (0.045), and myocardial infarction (0.026). Ischemic heart disease did not significantly reduce the utility score. Quality of life also declined with elapsed time-by an average of 0.006 per year, in addition to the effect of complications. CONCLUSIONS Common complications significantly reduce health-related quality of life. Utility scores derived from the EQ-5D-3L provide a potential measure that can be used to summarize patient-reported outcomes and inform health economic models. Prevention of complications is critical to reduce the progressive burden of declining quality of life for people with diabetes.
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Affiliation(s)
- Alison Hayes
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Hisatomi Arima
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - Mark Woodward
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - John Chalmers
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Neil Poulter
- Imperial College and St. Mary's Hospital, London, UK
| | - Pavel Hamet
- Montreal Diabetes Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Philip Clarke
- School of Population and Global health, University of Melbourne, Melbourne, Victoria, Australia
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20
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Lopes E, Carter D, Street J. Power relations and contrasting conceptions of evidence in patient-involvement processes used to inform health funding decisions in Australia. Soc Sci Med 2015; 135:84-91. [DOI: 10.1016/j.socscimed.2015.04.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Whitty JA, Lancsar E, Rixon K, Golenko X, Ratcliffe J. A systematic review of stated preference studies reporting public preferences for healthcare priority setting. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2015; 7:365-86. [PMID: 24872225 DOI: 10.1007/s40271-014-0063-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is current interest in incorporating weights based on public preferences for health and healthcare into priority-setting decisions. OBJECTIVE The aim of this systematic review was to explore the extent to which public preferences and trade-offs for priority-setting criteria have been quantified, and to describe the study contexts and preference elicitation methods employed. METHODS A systematic review was performed in April 2013 to identify empirical studies eliciting the stated preferences of the public for the provision of healthcare in a priority-setting context. Studies are described in terms of (i) the stated preference approaches used, (ii) the priority-setting levels and contexts, and (iii) the criteria identified as important and their relative importance. RESULTS Thirty-nine studies applying 40 elicitation methods reported in 41 papers met the inclusion criteria. The discrete choice experiment method was most commonly applied (n = 18, 45.0 %), but other approaches, including contingent valuation and the person trade-off, were also used. Studies prioritised health systems (n = 4, 10.2 %), policies/programmes/services/interventions (n = 16, 41.0 %), or patient groups (n = 19, 48.7 %). Studies generally confirmed the importance of a wide range of process, non-health and patient-related characteristics in priority setting in selected contexts, alongside health outcomes. However, inconsistencies were observed for the relative importance of some prioritisation criteria, suggesting context and/or elicitation approach matter. CONCLUSIONS Overall, findings suggest caution in directly incorporating public preferences as weights for priority setting unless the methods used to elicit the weights can be shown to be appropriate and robust in the priority-setting context.
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Affiliation(s)
- Jennifer A Whitty
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD, 4102, Australia,
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Kularatna S, Whitty JA, Johnson NW, Jayasinghe R, Scuffham PA. Valuing EQ-5D health states for Sri Lanka. Qual Life Res 2014; 24:1785-93. [PMID: 25543271 DOI: 10.1007/s11136-014-0906-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to derive an algorithm to estimate utility values for the EQ-5D-3L health states based on the preferences of a population sample from Sri Lanka. METHODS The time trade-off method was used to directly value 198 EQ-5D-3L health states in a general population sample (n = 780) from Sri Lanka. Stratified cluster sampling with random selection within clusters was used to select the sample from four districts. Each participant valued 15 health states via face-to-face interviews. The best fit model was selected using consistency, parsimony, and goodness of fit. Based on logical inconsistency, numerous sub-samples were also used for model specification. For each model, the numbers of illogical orderings in the resulting value set were also examined. RESULTS Generalised least squares with random effects were found to be the best specification. The sub-sample consisting of participants with less than seven logical inconsistent observations produced no illogical ordering in the final value set and is considered the preferred model. Compared to value sets in other countries, a high disutility is associated with level 3 deficits in the mobility dimension. More than 50 % of health states in the Sri Lankan value set are deemed worse than death health states. CONCLUSIONS Sri Lankan utility values for EQ-5D-3L states deviate markedly from existing values for upper middle and high-income countries. It is important to have country-specific utility values to conduct cost-utility analysis.
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Affiliation(s)
- Sanjeewa Kularatna
- Centre for Applied Health Economics, School of Medicine, Logan Campus, Griffith University, University Drive, Meadowbrook, Brisbane, QLD, 4131, Australia,
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Lopert R, Viney R. Revolution then evolution: the advance of health economic evaluation in Australia. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2014; 108:360-6. [PMID: 25444293 DOI: 10.1016/j.zefq.2014.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/26/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022]
Abstract
All governments face immense challenges in providing affordable healthcare for their citizens, and the diffusion of novel health technologies is a key driver of growth in expenditure for many. Although important methodological and process variations exist around the world, health economic evaluation is increasingly seen as an important tool to support decision-making around the introduction of new health technologies, interventions and programmes in countries of varying stages of economic development. In Australia, the assessment of the comparative cost-effectiveness of new medicines proposed for subsidy under the country's national drug subsidy programme, the Pharmaceutical Benefits Scheme, was introduced in the late 1980s and became mandatory in 1993, making Australia the first country to introduce such a requirement nationally. Since then the use of health economic evaluation has expanded and been applied to support decision-making across a broader range of health technologies, as well as to programmes in public health.
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Affiliation(s)
- Ruth Lopert
- LWC Health Pty Ltd, Canberra, Australia; Department of Health Policy, George Washington University, Washington DC.
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney and Chair, Economics Subcommittee, Pharmaceutical Benefits Advisory Committee
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Kularatna S, Whitty JA, Johnson NW, Jayasinghe R, Scuffham PA. Development of an EORTC-8D utility algorithm for Sri Lanka. Med Decis Making 2014; 35:361-70. [PMID: 25403654 DOI: 10.1177/0272989x14559274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Currently there are no reported cancer-specific health state valuations in low- and middle-income countries using a validated preference-based measure. The EORTC-8D, a cancer-specific preference-based measure, has 81,920 health states and is useful for economic evaluations in cancer care. The aim of this study was to develop a utility algorithm to value EORTC-8D health states using preferences derived from a representative population sample in Sri Lanka. METHODS The time-tradeoff method was used to elicit preferences from a general population sample of 780 in Sri Lanka. A block design of 85 health states, with a time horizon of 10 years, was used for the direct valuation. Data were analyzed using generalized least squares with random effects. All respondents with at least one logical inconsistency were excluded from the analysis. RESULTS After logical inconsistencies were excluded, 4520 observations were available from 717 respondents for the analysis. The preferred model specified main effects with an interaction term for any level 4 or worse descriptor within a health state. Worsening of physical functioning had a substantially greater utility decrement than any other dimension in this population. Limitations are that the data collection could not include the whole country and that females formed a large part of the sample. CONCLUSIONS Preference weights for EORTC-8D health states for Sri Lanka have been derived: These will be very useful in economic evaluations of cancer-related interventions in a range of low- and middle-income countries.
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Affiliation(s)
- Sanjeewa Kularatna
- Centre for Applied Health Economics, School of Medicine, Griffith University, Queensland, Australia (SK, PAS)
| | | | - Newell W Johnson
- Population and Social Health Research Programme, Griffith Health Institute, Griffith University, Queensland, Australia (SK, NWJ, PAS)
| | - Ruwan Jayasinghe
- Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka (RJ)
| | - Paul A Scuffham
- Centre for Applied Health Economics, School of Medicine, Griffith University, Queensland, Australia (SK, PAS),Population and Social Health Research Programme, Griffith Health Institute, Griffith University, Queensland, Australia (SK, NWJ, PAS)
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Khan I, Morris S. A non-linear beta-binomial regression model for mapping EORTC QLQ- C30 to the EQ-5D-3L in lung cancer patients: a comparison with existing approaches. Health Qual Life Outcomes 2014; 12:163. [PMID: 25388439 PMCID: PMC4234877 DOI: 10.1186/s12955-014-0163-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 10/15/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The performance of the Beta Binomial (BB) model is compared with several existing models for mapping the EORTC QLQ-C30 (QLQ-C30) on to the EQ-5D-3L using data from lung cancer trials. METHODS Data from 2 separate non small cell lung cancer clinical trials (TOPICAL and SOCCAR) are used to develop and validate the BB model. Comparisons with Linear, TOBIT, Quantile, Quadratic and CLAD models are carried out. The mean prediction error, R(2), proportion predicted outside the valid range, clinical interpretation of coefficients, model fit and estimation of Quality Adjusted Life Years (QALY) are reported and compared. Monte-Carlo simulation is also used. RESULTS The Beta-Binomial regression model performed 'best' among all models. For TOPICAL and SOCCAR trials, respectively, residual mean square error (RMSE) was 0.09 and 0.11; R(2) was 0.75 and 0.71; observed vs. predicted means were 0.612 vs. 0.608 and 0.750 vs. 0.749. Mean difference in QALY's (observed vs. predicted) were 0.051 vs. 0.053 and 0.164 vs. 0.162 for TOPICAL and SOCCAR respectively. Models tested on independent data show simulated 95% confidence from the BB model containing the observed mean more often (77% and 59% for TOPICAL and SOCCAR respectively) compared to the other models. All algorithms over-predict at poorer health states but the BB model was relatively better, particularly for the SOCCAR data. CONCLUSION The BB model may offer superior predictive properties amongst mapping algorithms considered and may be more useful when predicting EQ-5D-3L at poorer health states. We recommend the algorithm derived from the TOPICAL data due to better predictive properties and less uncertainty.
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Affiliation(s)
- Iftekhar Khan
- Cancer Research UK & UCL Cancer Trials Centre, Cancer Institute, University College London, 90 Tottenham Court Road (5th floor), London, W1T 4TJ, UK.
| | - Stephen Morris
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
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Whitty JA, Littlejohns P. Social values and health priority setting in Australia: an analysis applied to the context of health technology assessment. Health Policy 2014; 119:127-36. [PMID: 25267072 DOI: 10.1016/j.healthpol.2014.09.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 09/01/2014] [Accepted: 09/07/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the role of social values in priority setting related to health technology assessment processes and decision-making in Australia. APPROACH The processes and decision criteria of the Pharmaceutical and Medical Benefits Advisory Committees are described based on literature and policy sources, and analysed using a framework for identifying social values in priority-setting. FINDINGS Transparency and accountability of processes are apparent. Participation balances inclusiveness and effectiveness of decision-making, but presents an opportunity to enhance priority setting processes. Clinical and cost-effectiveness are important content considerations. Social values related to justice/equity are considered, without quantification of criteria weights for equity relative to other factors. HTA processes support solidarity through subsidising approved technologies for all Australians, whilst retaining autonomy by permitting non-subsidised technologies to be accessed privately, leading to possible tension between the values of solidarity, autonomy and equity. CONCLUSIONS Priority setting related to health technology subsidy incorporates a range of inter-related social values in the processes and content of decision-making. Participation in decision-making could arguably be improved if a patient and public engagement policy were to be formulated alongside more widespread changes across processes to assess social values using approaches such as the Citizens' Jury.
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Affiliation(s)
- Jennifer A Whitty
- School of Pharmacy, The University of Queensland, St Lucia, Brisbane, Queensland, Australia; Population and Social Health Research Program, Griffith Health Institute, Griffith University, Logan, Queensland, Australia.
| | - Peter Littlejohns
- Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King's College London, UK
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Whitty JA, Burton P, Kendall E, Ratcliffe J, Wilson A, Littlejohns P, Scuffham PA. Harnessing the potential to quantify public preferences for healthcare priorities through citizens' juries. Int J Health Policy Manag 2014; 3:57-62. [PMID: 25114943 PMCID: PMC4122074 DOI: 10.15171/ijhpm.2014.61] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 06/12/2014] [Indexed: 11/09/2022] Open
Abstract
Despite progress towards greater public engagement, questions about the optimal approach to access public preferences remain unanswered. We review two increasingly popular methods for engaging the public in healthcare priority-setting and determining their preferences; the Citizens' Jury (CJ) and Discrete Choice Experiment (DCE). We discuss the theoretical framework from which each method is derived, its application in healthcare, and critique the information it can provide for decision-makers. We conclude that combining deliberation of an informed public via CJs and quantification of preferences using DCE methods, whilst it remains to be tested as an approach to engaging the public in priority-setting, could potentially achieve much richer information than the application of either method in isolation.
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Affiliation(s)
- Jennifer A Whitty
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia; and Population and Social Health Research Program, Griffith Health Institute, Griffith University, Logan campus, University Drive, Meadowbrook, Queensland, Australia
| | - Paul Burton
- Urban Research Program, Griffith School of Environment, Griffith University, Gold Coast campus, Southport, Queensland, Australia
| | - Elizabeth Kendall
- Centre of National Research on Disability and Rehabilitation, Population and Social Health Research Program, Griffith Health Institute, Griffith University, Logan campus, University Drive, Meadowbrook, Queensland, Australia
| | - Julie Ratcliffe
- Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, Australia
| | - Andrew Wilson
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, New South Wales, Australia
| | - Peter Littlejohns
- Division of Health and Social Care Research, King’s College School of Medicine, London, UK
| | - Paul A Scuffham
- Centre for Applied Health Economics, Population and Social Health Research Program, Griffith Health Institute, Griffith University, Logan campus, University Drive, Meadowbrook, Queensland, Australia
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Wisløff T, Hagen G, Hamidi V, Movik E, Klemp M, Olsen JA. Estimating QALY gains in applied studies: a review of cost-utility analyses published in 2010. PHARMACOECONOMICS 2014; 32:367-75. [PMID: 24477679 PMCID: PMC3964297 DOI: 10.1007/s40273-014-0136-z] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Reimbursement agencies in several countries now require health outcomes to be measured in terms of quality-adjusted life-years (QALYs), leading to an immense increase in publications reporting QALY gains. However, there is a growing concern that the various 'multi-attribute utility' (MAU) instruments designed to measure the Q in the QALY yield disparate values, implying that results from different instruments are incommensurable. By reviewing cost-utility analyses published in 2010, we aim to contribute to improved knowledge on how QALYs are currently calculated in applied analyses; how transparently QALY measurement is presented; and how large the expected incremental QALY gains are. We searched Embase, MEDLINE and NHS EED for all cost-utility analyses published in 2010. All analyses that had estimated QALYs gained from health interventions were included. Of the 370 studies included in this review, 48% were pharmacoeconomic evaluations. Active comparators were used in 71% of studies. The median incremental QALY gain was 0.06, which translates to 3 weeks in best imaginable health. The EQ-5D-3L is the dominant instrument used. However, reporting of how QALY gains are estimated is generally inadequate. In 55% of the studies there was no reference to which MAU instrument or direct valuation method QALY data came from. The methods used for estimating expected QALY gains are not transparently reported in published papers. Given the wide variation in utility scores that different methodologies may assign to an identical health state, it is important for journal editors to require a more transparent way of reporting the estimation of incremental QALY gains.
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Affiliation(s)
- Torbjørn Wisløff
- Norwegian Knowledge Centre for the Health Services, Postboks 7004 St. Olavs plass, 0130, Oslo, Norway,
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Clemens S, Begum N, Harper C, Whitty JA, Scuffham PA. A comparison of EQ-5D-3L population norms in Queensland, Australia, estimated using utility value sets from Australia, the UK and USA. Qual Life Res 2014; 23:2375-81. [DOI: 10.1007/s11136-014-0676-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2014] [Indexed: 11/30/2022]
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Teckle P, McTaggart-Cowan H, Van der Hoek K, Chia S, Melosky B, Gelmon K, Peacock S. Mapping the FACT-G cancer-specific quality of life instrument to the EQ-5D and SF-6D. Health Qual Life Outcomes 2013; 11:203. [PMID: 24289488 PMCID: PMC4220776 DOI: 10.1186/1477-7525-11-203] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 11/11/2013] [Indexed: 11/18/2022] Open
Abstract
Objective To help facilitate economic evaluations of oncology treatments, we mapped responses on cancer-specific instrument to generic preference-based measures. Methods Cancer patients (n = 367) completed one cancer-specific instrument, the FACT-G, and two preference-based measures, the EQ-5D and SF-6D. Responses were randomly divided to form development (n = 184) and cross-validation (n = 183) samples. Relationships between the instruments were estimated using ordinary least squares (OLS), generalized linear models (GLM), and censored least absolute deviations (CLAD) regression approaches. The performance of each model was assessed in terms of how well the responses to the cancer-specific instrument predicted EQ-5D and SF-6D utilities using mean absolute error (MAE) and root mean squared error (RMSE). Results Physical, functional, and emotional well-being domain scores of the FACT-G best explained the EQ-5D and SF-6D. In terms of accuracy of prediction as measured in RMSE, the CLAD model performed best for the EQ-5D (RMSE = 0.095) whereas the GLM model performed best for the SF-6D (RMSE = 0.061). The GLM predicted SF-6D scores matched the observed values more closely than the CLAD and OLS. Conclusion Our results demonstrate that the estimation of both EQ-5D and SF-6D utility indices using the FACT-G responses can be achieved. The CLAD model for the EQ-5D and the GLM model for the SF-6D are recommended. Thus, it is possible to estimate quality-adjusted life years for economic evaluation from studies where only cancer-specific instrument have been administered.
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Affiliation(s)
- Paulos Teckle
- Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Agency, Vancouver, BC, Canada.
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Riedel BC, Ducharme JK, Geldmacher DS. Family composition and expressions of family-focused care needs at an academic memory disorders clinic. Int J Alzheimers Dis 2013; 2013:436271. [PMID: 24251066 PMCID: PMC3819762 DOI: 10.1155/2013/436271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 09/26/2013] [Accepted: 09/29/2013] [Indexed: 11/17/2022] Open
Abstract
Objective. To understand who dementia patients identify as their family and how dementia affects family life. Background. Dementia care is often delivered in family settings, so understanding the constituency and needs of the family unit involved in care is important for determining contributors to family quality of life. Design/Methods. Seventy-seven families receiving care at an academic dementia clinic completed questionnaires regarding the affected person and the family. Responses were categorized as focused on an individual's needs or the family's needs. Results. Respondents identified a mean of 3.77 family members involved in care. Spouse (80.5%), daughter (58.4%), son (46.8%), and stepchild or child-in-law (37.7%) were the most frequently listed family members. Questions regarding the effect of dementia-related changes in cognition and mood were most likely to elicit a family-focused response. Questionnaire items that inquired about specific medical questions and strategies to improve family function were least likely to elicit a family-focused response. Conclusions. Both caregivers and persons with dementia frequently provided family-focused responses, supporting the construct of dementia as an illness that affects life in the family unit. This finding reinforces the potential utility of family-centered quality of life measures in assessing treatment success for people with dementia.
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Affiliation(s)
- Brandalyn C. Riedel
- Department of Gerontology, Virginia Commonwealth University, Richmond, VA 23298, USA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA 90089, USA
| | - Jamie K. Ducharme
- Department of Neurology, University of Virginia, Charlottesville, VA 22908, USA
| | - David S. Geldmacher
- Department of Neurology, University of Virginia, Charlottesville, VA 22908, USA
- University of Alabama-Birmingham, Birmingham, AL 35294, USA
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Kularatna S, Whitty JA, Johnson NW, Scuffham PA. Health state valuation in low- and middle-income countries: a systematic review of the literature. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:1091-1099. [PMID: 24041360 DOI: 10.1016/j.jval.2013.05.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 04/17/2013] [Accepted: 05/13/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Cost-utility analysis is widely used in high-income countries to inform decisions on efficient health care resource allocation. Cost-utility analysis uses the quality-adjusted life-year as the outcome measure of health. High-income countries have undertaken health state valuation (HSV) studies to determine country-specific utility weights to facilitate valuation of health-related quality of life. Despite an evident need, however, the extent of HSVs in low- and middle-income countries (LMICs) is unclear. METHODS The literature was searched systematically by using four databases and additional Web searches to identify HSV studies carried out in LMICs. The Preferred Reporting System for Systematic Reviews and Meta-Analysis (PRISMA) strategy was followed to ensure systematic selection of the articles. RESULTS The review identified 17 HSV studies from LMICs. Twelve studies were undertaken in upper middle-income countries, while lower middle- and low-income countries contributed three and two studies, respectively. There were 7 generic HSV and 10 disease-specific HSV studies. The seven generic HSVs included five EuroQol five-dimensional questionnaire, one six-dimensional health state short form (derived from short-form 36 health survey), and one Assessment of Quality of Life valuations. Time trade-off was the predominant valuation method used across all studies. CONCLUSIONS This review found that health state valuations from LMICs are uncommon and utility weights are generally unavailable for these countries to carry out health economic evaluation. More HSV studies need to be undertaken in LMICs to facilitate efficient resource allocation in their respective health systems.
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Affiliation(s)
- Sanjeewa Kularatna
- Centre for Applied Health Economics, School of Medicine, Griffith University, Queensland, Australia; Population and Social Health Research Programme, Griffith Health Institute, Griffith University, Queensland, Australia.
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Bae S, Lee S, Bae EY, Jang S. Korean guidelines for pharmacoeconomic evaluation (second and updated version) : consensus and compromise. PHARMACOECONOMICS 2013; 31:257-67. [PMID: 23322587 DOI: 10.1007/s40273-012-0021-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The first version of the Korean guidelines for pharmacoeconomic evaluation was published by Health Insurance Review and Assessment Service (HIRA) in 2006. Since the introduction of the first version, domestic experience with the application of the recommendations has accumulated, and methodologies in certain areas have progressed considerably. Based on these experiences, HIRA initiated a guidelines revision project to address the need for revisions. The purpose of this study is to share the process used to complete these guideline revisions and to provide the contents of the revised guidelines. In developing the current revision, meetings with the advisory committee and working-level meetings with pharmaceutical companies were held several times to reach as much of a consensus as possible, and the results of a survey of pharmaceutical companies and decision makers regarding the existing guidelines were considered. The second version of the guidelines clarified the level of data requirement ('must', 'recommended', 'preferred') based on the data availability, the information needs of the decision makers and the strength of the evidence. The recommended perspective economic studies should take has been modified and additional guidance has been provided on QALY measurement. Manuals for systematic reviews and indirect comparisons have been published, and a standardized reporting format for expert opinions has been added. Sections on preferred methods for evaluations, sensitivity analysis, modelling and time horizon have been elucidated. The revised guidelines clarify the expression of the recommendations, making them more user-friendly, and provide more specific guidance to improve the quality and comparability across submissions.
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Affiliation(s)
- Seungjin Bae
- Health Insurance Review and Assessment Service, Research and Development Center, 1451-34, Seocho-3dong, Seocho-gu, Seoul, 137-926, The Republic of Korea.
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Whitty JA. An international survey of the public engagement practices of health technology assessment organizations. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:155-163. [PMID: 23337227 DOI: 10.1016/j.jval.2012.09.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 07/22/2012] [Accepted: 09/30/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Many jurisdictions are moving toward greater public involvement in health technology assessment (HTA) processes. This study aims to provide a broad, cross-sectional indication of the extent and methods of public engagement in HTA, with a focus on which public are engaged, by what mechanisms, and the purpose of public engagement. METHODS An international Web-based survey of 217 organizations involved in HTA was undertaken. Contact e-mail addresses for targeted organizations were identified from the Internet. RESULTS Individuals from 39 (18%) of the contacted organizations completed a survey. The majority (67%) of responding HTA organizations undertake public engagement activities, predominantly involving lay representatives of organized groups (81%), and to a lesser extent individual patients/consumers (54%) or citizens/community members (54%). For organizations undertaking public engagement, mechanisms based on communication or consultation were the most common, although some organizations have used or intend to use participatory approaches, particularly the Citizens' Jury (8%) or Consensus Council (20%) methods. Respondents identified with a number of rationales and barriers for undertaking public engagement. CONCLUSIONS This survey provides further insight into the public engagement approaches that are used by HTA organizations in practice. In particular, it suggests a limited adoption of participatory methods to date, and interest in the use of social media. Study findings require further confirmation, due to limitations related to survey response. There is considerable opportunity for further research into pragmatic, robust, and meaningful approaches to public engagement to strengthen HTA policy and decision-making frameworks. An agenda for future research evolving from the survey responses is proposed.
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Affiliation(s)
- Jennifer A Whitty
- Centre for Applied Health Economics, School of Medicine, and Griffith Health Institute, Griffith University, Queensland, Australia.
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Fischer KE. A systematic review of coverage decision-making on health technologies-evidence from the real world. Health Policy 2012; 107:218-30. [PMID: 22867939 DOI: 10.1016/j.healthpol.2012.07.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 05/30/2012] [Accepted: 07/09/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Quantitative analysis of real-world coverage decision-making offers insights into the revealed preferences of appraisal committees. Aim of this review was to structure empirical evidence of coverage decisions made in practice based on the components 'methods and evidence', 'criteria and standards', 'decision outcome' and 'processes'. METHODS Several electronic databases, key journals and decision committees' websites were searched for publications between 1993 and June 2011. Inclusion criteria were the analysis of past decisions and application of quantitative methods. Each study was categorized by the scope of decision-making and the components covered by the variables used in quantitative analysis. RESULTS Thirty-two studies were identified. Many focused on pharmaceuticals, the UK NICE or the Australian PBAC. The components were covered comprehensively, but heterogeneously. Seventy-two variables were identified of which the following were more prevalent: specifications of the decision outcome; the indications considered for appraisal, identification of incremental cost-effectiveness ratios, appropriateness of evaluation methods, type of economic or clinical evidence used for assessment, and the decision date. CONCLUSIONS Research was dominated by analysis of decision outcomes and appraisal criteria. Although common approaches were identified, the complexity of coverage decision-making - reflected by the heterogeneity of identified variables - will continue to challenge empirical research.
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Affiliation(s)
- Katharina Elisabeth Fischer
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; University of Hamburg, Hamburg Center for Health Economics, Esplanade 36, 20354 Hamburg, Germany.
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Kularatna S, Whitty JA, Scuffham PA. Comment on the use of vignettes and the EQ-5D to value disease-specific health states. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:592; author reply 591-2. [PMID: 22583473 DOI: 10.1016/j.jval.2011.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 12/09/2011] [Indexed: 05/31/2023]
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Whitty JA, Rundle-Thiele SR, Scuffham PA. Insights from triangulation of two purchase choice elicitation methods to predict social decision making in healthcare. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2012; 10:113-126. [PMID: 22201266 DOI: 10.2165/11597100-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Discrete choice experiments (DCEs) and the Juster scale are accepted methods for the prediction of individual purchase probabilities. Nevertheless, these methods have seldom been applied to a social decision-making context. OBJECTIVE To gain an overview of social decisions for a decision-making population through data triangulation, these two methods were used to understand purchase probability in a social decision-making context. METHODS We report an exploratory social decision-making study of pharmaceutical subsidy in Australia. A DCE and selected Juster scale profiles were presented to current and past members of the Australian Pharmaceutical Benefits Advisory Committee and its Economic Subcommittee. RESULTS Across 66 observations derived from 11 respondents for 6 different pharmaceutical profiles, there was a small overall median difference of 0.024 in the predicted probability of public subsidy (p = 0.003), with the Juster scale predicting the higher likelihood. While consistency was observed at the extremes of the probability scale, the funding probability differed over the mid-range of profiles. There was larger variability in the DCE than Juster predictions within each individual respondent, suggesting the DCE is better able to discriminate between profiles. However, large variation was observed between individuals in the Juster scale but not DCE predictions. CONCLUSIONS It is important to use multiple methods to obtain a complete picture of the probability of purchase or public subsidy in a social decision-making context until further research can elaborate on our findings. This exploratory analysis supports the suggestion that the mixed logit model, which was used for the DCE analysis, may fail to adequately account for preference heterogeneity in some contexts.
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Affiliation(s)
- Jennifer A Whitty
- School of Medicine, Griffith Health Institute, Griffith University, Logan Campus, Meadowbrook, QLD, Australia.
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Tongsiri S, Cairns J. Estimating population-based values for EQ-5D health states in Thailand. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:1142-5. [PMID: 22152185 DOI: 10.1016/j.jval.2011.06.005] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 05/09/2011] [Accepted: 06/09/2011] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To derive EuroQol five-dimensional (EQ-5D) health states values from the Thai general population. METHODS Forty-eight trained individuals successfully conducted interviews with a representative sample of 1409 respondents in 2007. A total of 12 sets of health states were used with one set allocated to each respondent. A respondent was requested to assign values for 11 states using the ranking and visual analogue scale methods and 10 states using the time trade-off method. The variables from the three existing models were used in model specifications and the best model was chosen on the basis of the extent of logical inconsistency in the estimated scores, predictive performance, parsimony, and sensitivity to changes in health. RESULTS Eighty-six health states were valued. The mean age of respondents was 44.6 years old. The highly consistent respondents tend to give higher scores for mild states and lower scores for severe states, compared with those given by the highly inconsistent respondents. The best model used variables from the Dolan 1997 study and estimated from the scores given by the respondents with fewer than 11 inconsistencies. The estimated scores are completely consistent, R(2) is 0.448. The second highest score was 0.766 given to state 11112 and the lowest score was -0.454 for state 33333. CONCLUSION Values for EQ-5D health states were estimated from the Thai general population. This is the first Thai generic health state value results to be used in evaluating health interventions in Thailand.
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Affiliation(s)
- Sirinart Tongsiri
- Faculty of Medicine, Mahasarakham University, Tambon Talad, Muang, Mahasarakham, Thailand.
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Ducharme JK, Geldmacher DS. Family quality of life in dementia: a qualitative approach to family-identified care priorities. Qual Life Res 2011; 20:1331-5. [PMID: 21279738 DOI: 10.1007/s11136-011-9852-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To characterize factors contributing to quality of life (QOL) in families providing care to people with dementia. BACKGROUND Assessing QOL in dementia has proved difficult. Individuals with dementia often possess limited insight, leading them to self-rate QOL differently from those who provide care for them. A majority of people with dementia receive care in the context of family units, but measures of whole-family QOL have not been previously described in the literature on dementia. The concept of family quality of life (FQOL) was developed and validated among families caring for children with developmental disabilities. FQOL measures have the potential to improve determinations of effectiveness in dementia care. DESIGN/METHODS Fifty-four questionnaires requesting information on priorities for care were collected from families of patients obtaining care at an academic dementia clinic. Forms were completed by family members, patients, or both. The mean age of the patients was 73.6 years; 61% were women. Qualitative analyses of the responses were conducted by two evaluators. Comments from 54 questionnaires were assigned by consensus to five categories based on domains validated for FQOL in families of individuals with developmental disabilities. Eleven cases from the 54 were rated by both evaluators to assess inter-rater reliability. RESULTS Five domains were identified as follows: (1) family interactions, (2) direct care/activities of daily living support, (3) emotional/behavioral well-being, (4) physical and cognitive well-being, and (5) disability-related support/medical care. Not surprisingly for clinic encounters, medical care requests and inquiries were expressed by a high proportion of families. Concerns about physical and cognitive well-being were expressed nearly as often. Issues regarding family interactions and emotional well-being were less frequently raised. CONCLUSIONS/RELEVANCE A FQOL model developed for developmental disability provided useful information for qualitative characterization of priorities among families receiving dementia care. Ongoing research will be useful to explore the validity and utility of the FQOL concept in dementia, especially in domains not well addressed by the current questionnaire.
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Affiliation(s)
- Jamie K Ducharme
- Department of Neurology, University of Virginia, Charlottesville, VA 22908, USA
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Abstract
Abstract The growing number of biosimilars presents challenges to regulatory and health technology assessment (HTA) systems. This paper illustrates these challenges by focusing on biosimilars used in the oncological setting. In particular, discordances between data required by regulatory and HTA authorities potentially deprive patients of effective treatments and hinder optimal resource allocation. Regulatory and HTA authorities need to harmonize requirements to foster the development and widespread use of biosimilars, which potentially release considerable resources. The authors believe that often-inappropriate methodology creates a very real chance that HTA authorities will reject some biosimilars. This would effectively extend patent protection and, in the absence of competitor pressure from biosimilars, result in prices remaining unnecessarily high. The authors propose that HTA organizations should accept pharmacokinetic and pharmacodynamic equivalence between the brand and the biosimilar as a proxy of biological comparability. HTA organizations should then adopt, in the absence of compelling reasons otherwise, cost-minimization analysis (CMA) as the basis of the cost-effectiveness deliberations. In the absence of adequate studies demonstrating equivalent efficacy, a prerequisite of CMA, HTA organizations should require threshold analysis. Once approved, biosimilar manufacturers and regulators should maintain rigorous pharmacovigilance to exclude immunoreactivity or other rare adverse events. Furthermore, cancer centres and trusts should regularly audit and publish the impact of biosimilars on clinical outcomes and resource use. When appropriate, regulatory and HTA authorities should demand revised cost-effectiveness analyses from biosimilar manufacturers. This approach would hone the accuracy of the cost-effectiveness analyses, protect patients and allow health services rapid access to low cost treatments.
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Virgili G, Koleva D, Garattini L, Banzi R, Gensini GF. Utilities and QALYs in health economic evaluations: glossary and introduction. Intern Emerg Med 2010; 5:349-52. [PMID: 20607453 DOI: 10.1007/s11739-010-0420-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 06/16/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Gianni Virgili
- Department of Specialised Surgical Sciences, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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Lee HY, Chen YH, Chiu WT, Hwang JS, Wang JD. Quality-adjusted life-years and helmet use among motorcyclists sustaining head injuries. Am J Public Health 2010; 100:165-70. [PMID: 19910346 DOI: 10.2105/ajph.2008.159004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We estimated loss of quality-adjusted life expectancy (QALE) among motorcyclists in Taiwan who sustained head injuries while wearing or not wearing a helmet. METHODS Patients with head injuries (n=3328) were grouped into categories representing good and poor outcomes (moderate disability or death) at discharge. After linkage with the National Mortality Registry, survival functions were determined and extrapolated over a 50-year period on the basis of the survival ratio between patients and age- and gender-matched reference populations, as calculated from available Taiwan vital statistics. Survival functions were then multiplied by scores from quality-of-life measures. RESULTS Percentages of good and poor outcomes were 87.2% and 12.8%, respectively, in the helmeted group and 66.4% and 33.6% in the nonhelmeted group. The mean QALE for helmeted motorcyclists, calculated by weighting percentages of good and poor outcomes, was 31.7 quality-adjusted life-years (QALYs), with an average loss of 5.8 QALYs. For nonhelmeted motorcyclists, the mean QALE was 25.9 QALYs, with a loss of 10.7 QALYs. CONCLUSIONS Helmet use could save approximately 5 QALYs among motorcyclists sustaining head injuries. Future cost-effectiveness analysis can calculate the incremental cost-effectiveness ratio for regulation of helmet use.
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Affiliation(s)
- Hsin-Yi Lee
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Room 719, No. 17, Xu-Zhou Road, Taipei 10055, Taiwan
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Abstract
With improvements in patient and graft survival after liver transplantation, recipient quality of life (QOL) has become an important focus of patient care and clinical outcomes research. To provide a better understanding of the instruments used to assess QOL in the adult liver transplant population, we conducted a systematic review of the MEDLINE database and Cochrane library. Our review identified 128 relevant articles utilizing more than 50 different QOL instruments. Generic health status instruments are the most commonly used, and among them the Medical Outcomes Study Short Form-36 (SF-36), the Hospital Anxiety and Depression Scale (HADS), and the Beck Depression Inventory (BDI) are the most prevalent. Few studies (16%) included targeted, disease-specific instruments. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Quality of Life questionnaire, the Liver Disease Quality of Life questionnaire, and the Chronic Liver Disease questionnaire are the most frequently employed targeted instruments; however, these instruments have been designed to assess QOL in patients with chronic liver disease rather than patients after liver transplantation. The present review focuses on the psychometric properties of the existing QOL instruments and discusses their individual strengths and limitations in evaluating liver transplantation recipients. The lack of a gold-standard QOL instrument for liver transplant recipients is an impediment to cross-study comparisons. We conclude that the development of a QOL instrument specifically for liver transplant recipients will improve QOL assessment in this population leading to a more nuanced understanding of the factors that influence transplant recipients' well-being.
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Affiliation(s)
- Colleen L. Jay
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL 60611, USA
| | - Zeeshan Butt
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL 60611, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniela P. Ladner
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL 60611, USA
| | - Anton I. Skaro
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL 60611, USA
| | - Michael M. Abecassis
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL 60611, USA
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Newall AT, Kelly H, Harsley S, Scuffham PA. Cost effectiveness of influenza vaccination in older adults: a critical review of economic evaluations for the 50- to 64-year age group. PHARMACOECONOMICS 2009; 27:439-450. [PMID: 19640008 DOI: 10.2165/00019053-200927060-00001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Several recent studies have assessed the benefits of extending influenza vaccination programmes, which are currently targeted primarily at those aged over 65 years, to those aged 50-64 years. We identified and reviewed all cost-effectiveness studies of influenza vaccination in those aged 50-64 years published before July 2008. While the studies suggest that vaccination in this age-group is likely to be cost effective, these results were dependent on several key assumptions. The estimates of serious outcomes due to influenza and the estimates of vaccine effectiveness (VE) against these outcomes were found to have the most influence on cost effectiveness. However, due to factors including mismatches between the measure of VE and the outcome under consideration, as well as various other data limitations, there is significant uncertainty around these key assumptions that was not well explored. There was a failure in some studies to report fundamental inputs such as discount rates. Overall, there was a general lack of transparency in the studies and, consequently, the conclusions around the cost effectiveness of influenza vaccine in those aged 50-64 years must be interpreted with caution.
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Affiliation(s)
- Anthony T Newall
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Whitty JA, Rundle‐Thiele SR, Scuffham PA. Insights into public preferences for pharmaceutical funding. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2008. [DOI: 10.1108/17506120810903980] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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