The Impact of Moving from EQ-5D-3L to -5L in NICE Technology Appraisals

Background: The EuroQol-5 Dimension (EQ-5D) instrument is the National Institute for Health and Care Excellence (NICE)’s preferred measure of health-related quality of life (QoL) in adults. The three-level (3L) value set is currently recommended for use, but the five-level (5L) set is increasingly being used in practice. Objective: We aimed to explore the impact of moving from 3L to 5L in NICE appraisals. Methods: We adapted our existing mapping for use with health state utility values derived from a population where the original distribution of utilities was unknown. We used this mapping to estimate 5L utilities for 21 comparisons of interventions from models used in NICE technology appraisal decision making, covering a range of disease areas. Results: All utilities increased using 5L, and the differences between highest and lowest utilities decreased. In ten oncology comparisons, using 5L generally increased the incremental quality-adjusted life-years (QALYs) as the benefit from improving survival increased. In four non-oncology comparisons where the intervention improved QoL only, the incremental QALYs decreased as the benefit of improving QoL was reduced. In seven non-oncology comparisons where interventions improved survival and QoL, there was a trade-off between increasing the benefit from survival and decreasing the benefit from improving QoL. Conclusion: 3L and 5L lead to substantially different estimates of incremental QALYs and cost effectiveness. The direction and magnitude of the change is not consistent across case studies. Using 5L instead of 3L may lead to different reimbursement decisions. NICE will face inconsistencies in decision making if it uses 3L and 5L concurrently

Design, synthesis, and molecular modeling of a novel amide-linked cyclic GnRH analogue cyclo(4-9)[Lys(4),D-Trp(6),Glu(9)]GnRH: Stimulation of gonadotropin gene expression

Journal URL: http://pubs.acs.org/journals/jmcmar/index.htm

Heat increment of feeding and its thermoregulatory benefit in the muskrat (Ondatra zibethicus

in the muskrat (Ondatra zibethicus

Local political leadership: Nordic style

In a context where changes brought about by globalization and Europeanization, and where local governments increasingly operate in a governance mode, different countries place increasing stress on the importance of strong local leadership. This article reviews local political leadership in Denmark, Finland, Norway and Sweden. Outside of a few major (mainly capital) cities, local government in the Nordic area remains small scale and frequently rural, is strongly partisan, yet relies on a strong tradition of consensual, corporatist style of decision-making. Furthermore, this social democratic consensus places a stress on the continued production and delivery of high quality welfare state services. This domestic environment produces a style of local leadership which is essentially collective in nature and in which the strong mayor concept is alien. The article reviews the experience of local political leadership in the four Nordic countries and concludes that, though there is some small country variation and without many examples of strong mayors, local political leaders play an important role, especially in managing and maintaining the consensual style of politics