A Comparison of PROPr and EQ-5D-5L Value Sets

Abstract

Objectives The EQ-5D-5L and its value sets are widely used internationally. However, in the US and elsewhere, there is growing use of PROMIS, which has a value set (PROPr) based on the stated preferences of the US population. This paper aims to compare the characteristics of EQ-5D-5L and PROPr value sets and to highlight potential implications for users. Methods US, Australian and English value sets were used for EQ-5D-5L. PROPr utilities were calculated based on PROMIS-29 + 2. We examined, in each case, (i) the characteristics (e.g. range of values, number of unique values) and distribution of all possible ‘theoretical’ utilities; (ii) dimension/domain importance ranking by the utility of corner states (i.e. health states with the worst level in one domain and the best in all others); (iii) comparisons of utilities for health states hypothesised to be comparable in terms of severity across EQ-5D-5L descriptive systems and PROMIS-29 + 2 domain scores; (iv) the changes in values of adjacent states (i.e. a one-level change in one dimension for EQ-5D-5L and a four-point change in raw scores for PROMIS-29 + 2, with the other dimensions held constant) for dimensions hypothesised to overlap conceptually or be correlated between the two instruments. Results EQ-5D-5L and PROPr utilities differ systematically. First, the US EQ-5D-5L utilities range from − 0.573 to 1, whereas PROPr values for PROMIS-29 + 2 range from − 0.022 to 0.954. Second, in the US (and English) EQ-5D-5L value sets, pain is the most important dimension whereas in PROPr pain is one of the least important (apart from sleep disturbance). Third, classified based on severity across EQ-5D-5L descriptive systems and PROMIS-29 + 2 domain scores, PROPr has substantially lower values than EQ-5D-5L values for comparable ‘mild’ health states, but higher values for more ‘severe’ health states. Last, when one dimension is considered across its best to worst levels and all other dimensions are held constant at their best or moderate level, in EQ-5D-5L value sets, the greatest changes in utility occur between levels 3 and 4 (moderate and severe) problems; in PROPr that occurred between the most severe states and their descriptively adjacent health states. Conclusion There are very considerable differences between US EQ-5D-5L and PROPr utilities, despite both in principle representing utility on the same scale anchored at 0 and 1 and both representing the preferences of the US general public. It is important for decision makers and clinical triallists to be aware of these differences. Further work is needed to assess the impact of these differences in value sets using population and patient data, and in longitudinal settings. Supplementary Information The online version contains supplementary material available at 10.1007/s40273-021-01109-3.

Population Norms for the EQ-5D-5L, PROPr and SF-6D in Hungary

“…Considering the EQ-5D-5L’s wider utility range (− 0.848 to 1) compared with PROPr (−0.022–0.954) and SF-6D (0.301–1), one may initially anticipate a specific order of sample means: SF-6D > PROPr > EQ-5D. However, value set characteristics, such as the theoretical density distribution of values along the utility scale, also impact mean values [ 68 ]. Theoretical EQ-5D-5L and SF-6D values exhibit a symmetric distribution, with EQ-5D-5L having a wider range.…”

“…These encompass issues with the validity of positively worded items (e.g. ‘Refreshing sleep’), the valuation methods and design employed in developing the value set, and face validity, particularly in relation to mean utilities around 0.50 (the midpoint of the QALY scale) in general population samples [ 26 , 68 , 80 ]. As for the SF-6D, it is important to note that we used the SF-36v1, enabling the estimation of SF-6Dv1 utilities.…”

Decomposing income-related inequality in health-related quality of life in mainland China: a national cross-sectional study

“…The outcome indicator, HRQoL, was assessed using the EQ-5D-5L developed by the European Society for Quality of Life (EuroQol), which is the most widely used instrument for assessing HRQoL of general populations across the world 33. Its Chinese version has been validated,28 including a population value set for estimating utility index (UI) 29.…”

A head-to-head comparison of the EQ-5D-3L index scores derived from the two EQ-5D-3L value sets for China

“…Moreover, in order to help understand how a single-level change in severity of descriptive systems would result in different utility change between the two value sets, we computed changes in utility values between pairs of adjacent health states for each value set. We called them “adjacent” when two health states are exactly the same except for one dimension where the severity level differs by one only [ 15 , 34 – 36 ]. For example, health states “21111” and “11111” were considered adjacent.…”