Predicting the EQ-5D utilities from the Kansas City Cardiomyopathy Questionnaire in patients with heart failure

Abstract

Introduction Evaluation of health status benefits, cost-effectiveness, and value of new heart failure therapies is critical for supporting their use. The Kansas City Cardiomyopathy Questionnaire (KCCQ) measures patients’ heart failure-specific health status, but does not provide utilities needed for cost-effectiveness analyses. We mapped the KCCQ scores to EQ-5D scores so that estimates of societal-based utilities can be generated to support economic analyses. Methods Using data from two U.S. cohort studies, we developed models for predicting EQ-5D utilities (3L and 5L versions) from the KCCQ (23- and 12-item versions). In addition to predicting scores directly, we considered predicting the five EQ-5D health state items and deriving utilities from the predicted responses, allowing different countries’ health state valuations to be used. Model validation was performed internally via bootstrap and externally using data from two clinical trials. Model performance was assessed using R2, mean prediction error, mean absolute prediction error, and calibration of observed versus predicted values. Results The EQ-5D-3L models were developed from 1,000 health status assessments in 547 patients with heart failure and reduced ejection fraction (HFrEF), while the EQ-5D-5L model was developed from 3,925 patients with HFrEF. For both versions, models predicting individual EQ-5D items performed as well as those predicting utilities directly. The selected models for the 3L had internally validated R-squares of 48.4-50.5% and 33.7-45.6% on external validation. The 5L version had validated R-square of 57.7%. Conclusion Mappings from the KCCQ to the EQ-5D can yield estimates of societal-based utilities to support cost-effectiveness analyses when EQ-5D data are not available.

Cost-effectiveness of Dapagliflozin for Treatment of Patients With Heart Failure With Reduced Ejection Fraction

“…We estimated the mean baseline utility of the DAPA-HF population using the KCCQ-TSS (eMethods 11 and eTable 8 in the Supplement). We used an algorithm that maps KCCQ-TSS scores to utility estimates . The utility estimates are based on a US time trade-off valuation of EQ-5D-3L scores.…”

“…We estimated subgroup-specific differences for patients with and without diabetes . For the heart failure health status subgroups, we estimated overall KCCQ scores based on subgroup KCCQ-TSS values and mapped these scores to estimated utilities . We estimated the effect of dapagliflozin on utility based on the change in KCCQ observed in DAPA-HF (annual utility change of 0.008) (eMethods 12 in the Supplement).…”

Cost-effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors for the Treatment of Heart Failure With Preserved Ejection Fraction

“…As in prior analyses, we mapped the KCCQ to quality-of-life weights using a published regression formula. 3,4,21,[25][26][27] During the first year of the analysis, we assumed the KCCQ captured all components of quality of life, including quality-of-life reductions for HF hospitalizations. During subsequent years, quality-of-life reductions due to HF hospitalizations, HF urgent care visits, and aging were modeled separately as these were not captured in the trial.…”

Correspondence to European Heart Journal—Quality of Care and Clinical Outcomes in response to paper by Thomas, M. et al. 2021: Predicting the EQ-5D from the Kansas City Cardiomyopathy Questionnaire (KCCQ) in patients with heart failures

“…We congratulate Thomas et al 1 for developing algorithms mapping Kansas CityCardiomyopathy Questionnaire (KCCQ) toEQ-5D health-utility scores for patients with heart failure (HF). EQ-5D is a standard tool for assessing cost-effectiveness (QALYs) across disease areas.…”

“…Mapping disease-specific, patient-reported outcomes like KCCQ to EQ-5D has limitations, as the authors acknowledge. 1 However, the potential insensitivity of EQ-5D to changes in health state should be considered. 2–4 EQ-5D may be sensitive to the effects of interventions in advanced heart failure (New York Heart Association (NYHA) III–IV), but perhaps less so for milder disease.…”