Results from an exploratory study to test the performance of EQ-5D-3L valuation subsets based on orthogonal designs, and an investigation into some modeling and transformation alternatives for the utility function

Background: EQ-5D-3L valuation studies continue to employ the MVH protocol or variants of MVH. One issue that has received attention is the selection of the states for direct valuation by respondents. Changes in the valuation subset have been found to change the coefficients of the utility function. The purpose of this study was to test the performance of valuation subsets based on orthogonal experiment designs. The design of the study also allowed a comparison of models based on raw or untransformed VAS values with values transformed at the level of the respondent and at the aggregate level. Methods: Two different valuation subsets were developed based on orthogonal arrays. A VAS elicitation was undertaken with two groups of similar respondents and the resulting utility functions based on the valuations of the two different valuation subsets were compared using mean absolute errors between model and observed values, and by correlation with values in and out of sample. The impact of using untransformed versus VAS values transformed at the level of the individual and at aggregate level and the inclusion of a constant term in the utility functions were also investigated. Results: The utility functions obtained from the two valuation subsets were very similar. The models that included a constant and based on raw VAS values from the two valuation studies returned rank correlation coefficients of 0.994 and 0.995 when compared with respective observed values. MAEs of model values with observed values were 2.4% or lower for all models that included a constant term. Several models were developed and evaluated for the combined data (from both valuation subsets). The model that included the N3 term performed best. Conclusions: The finding that two very different valuation subsets can produce strikingly similar utility functions suggests that orthogonal designs should be given some attention in further studies. The impact of rescaling VAS values at the level of the individual versus at aggregate level had minimal impact on the performance of the models when compared to models based on the raw VAS values

HIV policy in Jamaica: good form and substance but inadequate application and accountability

The HIV epidemic and response in Jamaica was reviewed in April–November 2019 as part of the preparation of a National Strategic Plan for 2020-25. The National HIV Programme, which includes multi-sectoral partners, has made substantial achievements in reducing the spread of HIV in the population. Mortality due to HIV in Jamaica has decreased from 25 deaths/100,000 population in 2004 to 13 deaths/100,000 population in 2016. Jamaica has committed to the UNAIDS fast track strategy for ending the AIDS epidemic, but HIV incidence rates remain too high, (1,600/100,000 in 2018). This paper reviews key national policies that have guided Jamaica’s HIV response. We discuss challenges and gaps in policy application and development that impede Jamaica’s efforts to achieve universal access to HIV prevention, treatment and care services

Health-Related Quality of Life Population Norms for Belize Using EQ-5D-5L

Objectives: There has been a growing interest in the use of EQ-5D health outcomes measures in Latin America and the Caribbean. Population norms data provide a benchmark against which clinicians, researchers, and policy makers can compare the health status of patient, treatment, or demographic groups. This study aimed to provide EQ-5D-5L population norms for Belize. Methods: The EQ-5D-5L questionnaire was included in a national survey in Belize in 2014. The survey also captured key demographic variables. EQ-5D-5L health states, EQ-5D visual analog scale (EQ VAS) scores, and EQ-5D-5L index values (based on the Trinidad and Tobago value set) were obtained for key demographic groups in Belize. Results: A representative sample of 2078 respondents completed the survey. The mean index value, EQ VAS score, and ceiling level for Belize were 0.947, 82.6, and 67.8%, respectively. Similar to other Caribbean countries, Belizeans self-reported relatively high EQ VAS scores and ceiling levels compared with non-Caribbean regions. Men reported generally higher health status than women, health status declined as age rises, and the dimensions with the highest burden were pain/discomfort and mobility. Conclusions: This study provides researchers and practitioners in Belize with tools to use EQ-5D-5L. Users can apply the EQ VAS scores and EQ-5D-5L states presented herein as reference values. Until an EQ-5D-5L value set is created for Belize, the Trinidad and Tobago index values can be applied to Belizean-reported EQ-5D-5L states, which can then be compared with the index values presented in this study

Evaluating Health Inequality in Five Caribbean Basin Countries Using EQ-5D-5L

Background EQ-5D-5L is a standardized health outcomes instrument that can be added to national surveys to measure inequality in health outcomes. The aim of this study was to produce baseline values of health inequality using EQ-5D-5L for five countries in the Caribbean Basin region based on national surveys in 2012-2014. Methods The EQ-5D-5L questionnaire was included in adult population surveys of Barbados, Belize, Colombia, Jamaica and Trinidad and Tobago. EQ-5D-5L measures were calculated for demographic groups using stratifiers from the World Health Organization's PROGRESS-Plus framework, and generalized linear models were used to test for association between EQ-5D-5L and the PROGRESS-Plus variables. Ordered logit models were used to obtain odds ratios for the effect of the PROGRESS-Plus variables on reporting problems on the EQ-5D-5L dimensions. The Kakwani index was calculated for each country. Results Data were obtained for representative samples in each country, giving a combined total of 11,284 respondents. Different patterns of inequality were observed among the five countries. The biggest drivers of inequality were age and gender, and the biggest EQ-5D factors were self-care in Belize and pain/discomfort in the other four countries. Conclusion This study demonstrated that the EQ-5D-5L instrument can easily be added to national surveys. Inequality measures from this study can be used as baseline values for comparisons with future similar surveys in these five countries to infer changes in health inequality as measured by EQ-5D outcomes. These can be used to track the performance of policy initiatives aimed at specific demographic groups

The anatomy of a deep intracontinental orogen

The crustal architecture of central Australia has been profoundly affected by protracted periods of intracontinental deformation. In the northwestern Musgrave Block, the Ediacaran–Cambrian (600–530 Ma) Petermann Orogeny resulted in pervasive mylonitic reworking of Mesoproterozoic granites and granitic gneisses at deep crustal levels (P = 10–14 kbar and T = 700–800°C). SHRIMP and LA-ICPMS dating of zircon indicate that peak metamorphic conditions were attained at circa 570 Ma, followed by slow cooling to ∼600–660°C at circa 540 Ma driven by exhumation along the Woodroffe Thrust. Strong links between regional kinematic partitioning, pervasive high shear strains and partial melting in the orogenic core, and an anomalous lobate thrust trace geometry suggest that north vergent shortening was accompanied by the gravitational collapse and lateral escape of a broad thrust sheet. Like the present-day Himalayan-Tibetan system, the macroscopic structural, metamorphic, and kinematic architecture of the Petermann Orogen appears to be dominantly shaped by large-scale ductile flow of lower crustal material. We thus argue that the anatomy of this deep intracontinental orogen is comparable to collisional orogens, suggesting that the deformational response of continental crust is remarkably similar in different tectonic settings.Tom Raimondo, Alan S. Collins, Martin Hand, Althea Walker-Hallam, R. Hugh Smithies, Paul M. Evins, and Heather M. Howar