In search of a common currency: A comparison of seven EQ‐5D‐5L value sets

This is the peer reviewed version of the following article: Olsen, J.A., Lamu, A.N. & Cairns, J. (2018). In search of a common currency: A comparison of seven EQ‐5D‐5L value sets. Health Economics, 27(1), 39-49, which has been published in final form at https://doi.org/10.1002/hec.3606. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.The recently published EQ‐5D‐5L value sets from Canada, England, Japan, Korea, the Netherlands, Spain, and Uruguay are compared with an aim to identify any similarities in preference pattern. We identify some striking similarities for Canada, England, the Netherlands, and Spain in terms of (a) the relative importance of the 5 dimensions; (b) the relative utility decrements across the 5 levels; and (c) the scale length. On the basis of the observed similarities across these 4 Western countries, we develop an amalgam model, WePP (western preference pattern), and compare it with these 4 value sets. The values generated by this model show a high degree of concordance with those of England, Canada, and Spain. Patient level data were obtained from the Multi‐Instrument Comparison project, which includes participants from 6 countries in 7 disease groups (N = 7,933): The WePP values lie within the confidence intervals for the value sets in Canada, England, and Spain across the whole severity distribution. We suggest that the WePP model represents a useful “common currency” for (Western) countries that have not yet developed their own value sets. Further research is needed to disentangle the differences between value sets due to preference heterogeneity from those stemming from methodological differences

Condition-specific or generic preference-based measures in oncology? A comparison of the EORTC-8D and the EQ-5D-3L.

PURPOSE: It has been argued that generic health-related quality of life measures are not sensitive to certain disease-specific improvements; condition-specific preference-based measures may offer a better alternative. This paper assesses the validity, responsiveness and sensitivity of a cancer-specific preference-based measure, the EORTC-8D, relative to the EQ-5D-3L. METHODS: A longitudinal prospective population-based cancer genomic cohort, Cancer 2015, was utilised in the analysis. EQ-5D-3L and the EORTC QLQ-C30 (which gives EORTC-8D values) were asked at baseline (diagnosis) and at various follow-up points (3 months, 6 months, 12 months). Baseline values were assessed for convergent validity, ceiling effects, agreement and sensitivity. Quality-adjusted life-years (QALYs) were estimated and similarly assessed. Multivariate regression analyses were employed to understand the determinants of the difference in QALYs. RESULTS: Complete case analysis of 1678 patients found that the EQ-5D-3L values at baseline were significantly lower than the EORTC-8D values (0.748 vs 0.829, p < 0.001). While the correlation between the instruments was high, agreement between the instruments was poor. The baseline health state values using both instruments were found to be sensitive to a number of patient and disease characteristics, and discrimination between disease states was found to be similar. Mean generic QALYs (estimated using the EQ-5D-3L) were significantly lower than condition-specific QALYs (estimated using the EORTC-8D) (0.860 vs 0.909, p < 0.001). The discriminatory power of both QALYs was similar. CONCLUSIONS: When comparing a generic and condition-specific preference-based instrument, divergences are apparent in both baseline health state values and in the estimated QALYs over time for cancer patients. The variability in sensitivity between the baseline values and the QALY estimations means researchers and decision makers are advised to be cautious if using the instruments interchangeably

Validity of Quality of Life Measurement in Economic Evaluations in Total Joint Replacement: Agreement between Western Ontario and McMasters\u27 Osteoarthritis Index (WOMAC) and the EuroQOL 5D (EQ-5D) Utility scores

Health economic evaluations are commonly conducted through a cost-utility analysis, where health benefits are measured using utility scores. A common utility measure is the European Quality of Life (EQ-5D). Osteoarthritis (OA) research studies commonly use disease-specific quality of life tools such as the Western Ontario and McMaster’s Universities Osteoarthritis Index (WOMAC) to derive utility scores, but the validity of this method is unknown. This research aims to determine the agreement between utility scores derived from WOMAC and the EQ-5D surveys among patients who have undergone Total Joint Replacement (TJR). To estimate the agreement, we calculated an intraclass correlation coefficient (ICC) and its 95% confidence interval (CI) and produced Bland Altman plots. Our results indicate good agreement between the two scores, as seen with the ICC value of 0.85, 95% CI (0.82 - 0.87)

The Cost-Effectiveness of a Midvastus Versus Standard Medial Parapatellar Surgical Approach for Total Knee Arthroplasty

The minimally invasive midvastus (MMV) surgical approach for total knee arthroplasty (TKA) is a less invasive technique that has been proposed to accelerate recovery over standard TKA, however, advantages are not yet definitively established. We investigated the cost-effectiveness of MMV TKA versus the standard medial parapatellar (MPP) approach for TKA alongside a randomized controlled trial in patients with knee osteoarthritis. Patients reported resource use as well as indirect costs, and health outcomes were measured using the EQ-5D-5L and the Western Ontario and McMaster Universities Osteoarthritis Index over the 12-month study period. The results of our net benefit regression analysis suggest MMV TKA may be cost-effective compared to MPP TKA from the payer perspective at willingness-to-pay (WTP) values between $1000 and$2000, and WTP values between $2000 and$20,000 from the societal perspective

Decisions about Health Behavioral Experiments in Health with Applications to Understand and Improve Health State Valuation

How do individuals and societies make such decisions about health in practice, and does economic research provide the right tools to inform and study such decision-making? In his dissertation, Stefan Lipman tries to answer these questions. In economics, decisions about health are typically studied assuming they are made rationally. However, over the past decades the traditional economic view of rationality has been suggested to be highly unrealistic. As most work challenging this view is based on financial decision-making, in the first part of his dissertation, Lipman extend

Derivation of preliminary preference-based valuation sets for the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) to allow calculation of mental well-being adjusted life years (MWALY)

Concerns have been raised regarding the sensitivity of widely used preference-based instruments (e.g. EQ-5D) to value mental health benefits. An alternative outcome measure other than QALY is required due to an increasing interest in the promotion of mental well-being. The aim of this thesis is to develop preliminary U.K. preference-based valuation sets for the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS), to allow estimation of Mental Well-being Adjusted Life Years (MWALYs). Given that this was the first attempt at valuing SWEMWBS states, a series of stages were followed to ensure the robustness of the derived valuation sets. Firstly, alternative valuation techniques were analysed to justify the appropriate valuation strategy for mental well-being states. A sample of manageable mental well-being states for valuation was also identified through alternative experimental designs. Next, a qualitative piloting study with the application of think-aloud interviewing technique was conducted to investigate the cognitive process of completing the valuation tasks. The modified valuation protocol informed by the qualitative study was then validated within a larger sample in a quantitative study. The valuation responses of the quantitative study were modelled to produce utility values for all mental well-being states. The qualitative and quantitative studies suggested the feasibility, practicality and face validity of the SWEMWBS valuation. A total of 225 participants provided valuation responses to allow estimation of valuation sets based on composite time trade-off (C-TTO), Discrete choice experiment (DCE) and Inverse Variance Weighting (IVW) hybrid model. The first and second models generated illuminating differences with the hybrid approach giving an arguably desirable blend of the two. The valuation sets for mental well-being states can be used for indicative cost-utility analyses of mental well-being interventions and have the potential to inform the practicality of applying the proposed valuation protocol in the full national valuation study