Using the EQ-5D as a performance measurement tool in the NHS

In a landmark move, the UK Department of Health (DH) is introducing the routine use of Patient Reported Outcome Measures (PROMs) as a means of measuring the performance of health care providers in improving patient health. From April 2009 all patients will be asked to complete both generic (EQ-5D) and condition specific PROMs before and after surgery for four elective procedures; the intention is to extend this to a wide range of other NHS services. The aim of this paper is to report analysis of the EQ-5D data generated from a pilot study commissioned by the DH, and to consider the implications of the results for their use as performance indicators and measures of patient benefit. The EQ-5D has the potential advantage in the context of PROMs of enabling comparisons of performance across services as well as between providers; and in facilitating assessments of the cost effectiveness of NHS services. We present two new methods we have developed for analysing and displaying EQ-5D profile data: a Paretian Classification of Health Change, and a Health Profile Grid. Using these methods, we show that EQ-5D data can readily be used to generate useful insights into differences between providers in improving overall changes in health; results are also suggestive of striking differences in changes in health between surgical procedures. We conclude by noting a number of issues that remain to be addressed in the use of PROMs data as a basis for performance indicators

A Study of the Relationship Between Health and Subjective Well-being in Parkinson’s Disease Patients

Objectives: In light of the apparent disconnect between traditional measures of societal well-being such as GDP and reported levels of happiness, governments globally are turning their attention to alternative subjective measures of well-being (SWB) to aid policy decisions. In the context of health, there is therefore growing interest in understanding how measures of health-related quality of life (HRQoL), widely used in health technology appraisal, relates to SWB, and whether SWB could provide a sound basis for resource allocation decisions in health and other sectors in the future. This study investigates the relationship between HRQoL, as measured by EQ-5D, and SWB in Parkinson’s disease (PD) and the extent to which patients’ self-reported health can explain (part of) their SWB. Methods: A paper questionnaire including EQ-5D, four key SWB questions taken from the Office for National Statistics Integrated Household Survey in England and other demographic details was distributed to people with PD in the UK. Responses were used to estimate multiple regression models explaining SWB using each of the EQ-5D Index (UK weights), EQ-5D dimensions and EQ-VAS and patient socio-demographic characteristics. Results: 276 questionnaires were distributed and 183 responses received. The EQ-5D Index was a moderate predictor of SWB (adjusted R2 range 0.19-0.38 in OLS models), but EQ-VAS performed better (adjusted R2 range 0.32-0.49). Combining EQ-VAS and EQ-5D dimensions, especially anxiety/depression and mobility, and household status in some cases, yielded the best-fitting models (adjusted R2 range 0.40-0.52). Conclusions: The findings imply that EQ-VAS and some dimensions of the EQ-5D, together with key demographic data, could potentially be used to predict SWB, e.g. via mapping. However, further empirical research into the relationship between SWB and EQ-5D longitudinally, and in different disease areas, is required to corroborate these findings, and further standardisation of SWB measures is recommended

The health state preferences and logistical inconsistencies of New Zealanders: a tale of two tariffs

Notwithstanding the proposed use of Cost-Utility Analysis (CUA) to inform health care priority setting in New Zealand, to date there has been no research into New Zealanders’ valuations of health-related quality of life. This paper reports the results of a study of the health state preferences of adult New Zealanders generated from a postal survey to which 1360 people responded (a 50% response rate). The survey employed a self-completed questionnaire in which a selection of health states were described using the EQ-5D health state classification system and respondents’ valuations were sought using a visual analogue scale (VAS). Close attention is paid to the quality of the data, in particular to the ‘logical inconsistencies’ in respondents’ valuations. Regression analysis is used to interpolate values over the 245 possible EQ-5D states. Two tariffs of health state preferences, arising from contrasting treatments of the logical inconsistencies, are reported.New Zealand, EuroQol, EQ-5D

Opportunity costs and local health service spending decisions:a qualitative study from Wales

Background: All health care systems face the need to find the resources to meet new demands such as a new, cost-increasing health technology. In England and Wales, when a health technology is recommended by the National Institute for Health and Care Excellence (NICE), the National Health Service (NHS) is mandated to provide the funding to accommodate it within three months of publication of the recommendation. Identifying what, in practice, is foregone when new cost-increasing technologies are introduced is important for understanding the effects of health technology assessment (HTA) decisions on the NHS or any other health care system. Our objective was to investigate how in practice local NHS commissioners in Wales accommodated financial �shocks� arising from technology appraisals (TAs) issued by NICE and from other cost pressures

Supporting urban planning of low-carbon precincts: Integrated demand forecasting

Waste is a symbol of inefficiency in modern society and represents misallocated resources. This paper outlines an on-going interdisciplinary research project entitled "Integrated ETWW demand forecasting and scenario planning for low-carbon precincts" and reports on first findings and a literature review. This large multi-stakeholder research project develops a shared platform for integrated ETWW (energy, transport, waste and water) planning in a low-carbon urban future, focusing on synergies and alternative approaches to urban planning. The aim of the project is to develop a holistic integrated software tool for demand forecasting and scenario evaluation for residential precincts, covering the four domains, ETWW, using identified commonalities in data requirements and model formulation. The authors of this paper are overseeing the waste domain. A major component of the project will be developing a method for including the impacts of household behavior change in demand forecasting, as well as assessing the overall carbon impacts of urban developments or redevelopments of existing precincts. The resulting tool will allow urban planners, municipalities and developers to assess the future total demands for energy, transport, waste and water whilst in the planning phase. The tool will also help to assess waste management performance and materials flow in relation to energy and water consumption and travel behavior, supporting the design and management of urban systems in different city contexts. © 2013 by the authors