A hybrid modelling approach for eliciting health state preferences: the Portuguese EQ-5D-5L value set

Ferreira, Pedro Lopes; Antunes, Patrícia; Ferreira, Lara Noronha; Pereira, Luìs Nobre; Ramos-Goñi, Juan Manuel

doi:10.1007/s11136-019-02226-5

Cited by 62 publications

(59 citation statements)

References 48 publications

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“…This approach has been used in several national EQ-5D-5L valuation studies. [25][26][27][28][29][30][31][32][33] The hybrid model will combine the likelihood functions of a linear model for the c-TTO data and a logit model for the DCE data. As the coefficients will be estimated from a conditional logit and expressed on a latent arbitrary utility scale, we will use a rescaled parameter θ, which will assume that the c-TTO model coefficients are proportional to DCE model coefficients.…”

Section: Modellingmentioning

confidence: 99%

Valuing health-related quality of life among the Indian population: a protocol for the Development of an EQ-5D Value set for India using an Extended design (DEVINE) Study

et al. 2020

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IntroductionQuality-adjusted life year (QALY) has been recommended by the government as preferred outcome measure for Health Technology Assessment (HTA) in India. As country-specific health-related quality of life tariff values are essential for accurate measurement of QALYs, the government of India has commissioned the present study. The aim of this paper is to describe the methods for the Development of an EQ-5D Value set for India using an Extended design (DEVINE) Study. Additionally, this study aspires to establish if the design of 10-time trade-off (TTO) blocks is enough to generate valid value sets.Methods and analysisA cross-sectional survey using the EuroQol Group’s Valuation Technology (EQ-VT) will be undertaken in a sample of 2700 respondents selected from six different states of India using a multistage stratified random sampling technique. The participants will be interviewed using computer-assisted personal interviewing technique. The TTO valuation will be done using 10 composite TTO (c-TTO) tasks and 7 discrete choice experiment (DCE) tasks. Hybrid modelling approach using both c-TTO and DCE data to estimate the potential value set will be applied. Values of all 3125 health states will be predicted using both the conventional EQ-VT design of 10 blocks of 10 TTO tasks, and an extended design of 18 blocks of 10 TTO tasks. The potential added value of the eight additional blocks in overall validity will be tested. The study will deliver value set for India and assess the adequacy of existing 10-blocks design to be able to correctly predict the values of all 3125 health states.Ethics and disseminationThe ethical approval has been obtained from Institutional Ethics Committee of PGIMER, Chandigarh, India. The anonymised EQ-5D-5L value set will be available for general use and in the HTAs commissioned by India’s central HTA Agency.

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Section: Modellingmentioning

confidence: 99%

Valuing health-related quality of life among the Indian population: a protocol for the Development of an EQ-5D Value set for India using an Extended design (DEVINE) Study

et al. 2020

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“…To do this, analysts have assumed that β DCE = θ β TTO for some scalar θ . 6–15 The usual hybrid model then multiples the likelihoods for the Tobit and conditional logit and maximizes it over β TTO , σ 2 , and θ . 32…”

Section: Methodsmentioning

confidence: 99%

“…TTO EQ-5D-5L data tend to exhibit heteroscedasticity, with larger variances at more severe health states. [8][9][10]14,15,18 In models that assume independence between all responses (i.e., not mixed or latent class models), we allowed for conditionally log-linear heteroscedasticity as follows:…”

Section: Heteroscedasticity In Censored Tto Responsesmentioning

confidence: 99%

“…However, of the 18 countries with published value sets, 10 used both types of data. [6][7][8][9][10][11][12][13][14][15] One motivation for this is the possibility of a more accurate value set on including more data. If the latent DCE utilities are a linear transform of the TTO utilities, then using both types of data should improve predictive precision.…”

mentioning

confidence: 99%

“…Furthermore, a number of studies have noted that TTO data display heteroscedasticity. 8,10,11,[13][14][15][16][17][18] In valuation studies of the original version of the EQ-5D (EQ-5D-3L), ignoring heteroscedasticity did not lead to bias because these studies employed linear regression models. It is well known in the statistical literature that ordinary least squares (i.e., linear regression modeling ignoring correlation) leads to unbiased estimates of the regression coefficients 19 regardless of the distribution of the error term.…”

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confidence: 99%

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Using Both Time Tradeoff and Discrete Choice Experiments in Valuing the EQ-5D: Impact of Model Misspecification on Value Sets

et al. 2020

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Introduction. The EQ-5D-5L valuation protocol contains both time tradeoff (TTO) tasks and discrete choice experiments (DCE), raising the question of how to best use these in creating a value set. The hybrid model, which combines TTO and DCE data, has emerged as a commonly used approach. However, this model assumes independence among responses from the same individual, a linear relationship between TTO and DCE utilities, and, in many implementations, homoscedastic residuals. The aims of this study are to examine alternatives to these assumptions and determine the impact of misspecification on value sets. Methods. We performed a simulation study, parameterized using the US EQ-5D-5L valuation study, to assess the impact of model misspecification. We simulated TTO and DCE data with nonlinear relationships between TTO and DCE utilities, heteroscedastic errors, and correlated responses. Simulated data were analyzed using hybrid models with and without heteroscedasticity, Tobit models with and without heteroscedasticity, a latent class model, and a mixed model. Results. Mean absolute errors (MAEs) for correctly specified models were <0.05, whereas models that incorrectly assumed a linear relationship between TTO and DCE utilities or homoscedasticity of TTO responses featured states with an MAE >0.1. When a linear relationship between TTO and DCE utilities held, using both TTO and DCE data under correct specification yielded smaller MAEs compared with using TTO data alone but yielded larger MAEs when a linear relationship did not hold. Mistakenly assuming homoscedasticity led to increased MAEs, whereas ignoring dependence did not. Conclusions. Because heteroscedasticity in TTO utilities and nonlinear associations between DCE and TTO utilities have been noted, we recommend careful assessment of scedasticity and linearity to ascertain the suitability of a hybrid model.

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Cardio-Oncology Rehabilitation for Cancer Survivors With High Cardiovascular Risk

Viamonte,

Joaquim,

Alves

et al. 2023

JAMA Cardiol

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ImportanceCardiovascular disease is a leading cause of morbidity in cancer survivors, which makes strategies aimed at mitigating cardiovascular risk a subject of major contemporary importance.ObjectiveTo assess whether a center-based cardiac rehabilitation (CBCR) framework compared with usual care encompassing community-based exercise training (CBET) is superior for cardiorespiratory fitness improvement and cardiovascular risk factor control among cancer survivors with high cardiovascular risk.Design, Setting, and ParticipantsThis prospective, single-center, randomized clinical trial (CORE trial) included adult cancer survivors who had exposure to cardiotoxic cancer treatment and/or previous cardiovascular disease. Enrollment took place from March 1, 2021, to March 31, 2022. End points were assessed at baseline and after the 8-week intervention.InterventionsParticipants were randomly assigned in a 1:1 ratio to 8 weeks of CBCR or CBET. The combined aerobic and resistance exercise sessions were performed twice a week.Main Outcomes and MeasuresThe powered primary efficacy measure was change in peak oxygen consumption (V̇o2) at 2 months. Secondary outcomes included handgrip maximal strength, functional performance, blood pressure (BP), body composition, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), lipid profile, plasma biomarker levels, physical activity (PA) levels, psychological distress, quality of life (QOL), and health literacy.ResultsA total of 75 participants completed the study (mean [SD] age, 53.6 [12.3] years; 58 [77.3%] female), with 38 in the CBCR group and 37 in the CBET group. Participants in CBCR achieved a greater mean (SD) increase in peak V̇o2 than those in CBET (2.1 [2.8] mL/kg/min vs 0.8 [2.5] mL/kg/min), with a between-group mean difference of 1.3 mL/kg/min (95% CI, 0.1-2.6 mL/kg/min; P = .03). Compared with the CBET group, the CBCR group also attained a greater mean (SD) reduction in systolic BP (−12.3 [11.8] mm Hg vs −1.9 [12.9] mm Hg; P &lt; .001), diastolic BP (−5.0 [5.7] mm Hg vs −0.5 [7.0] mm Hg; P = .003), and BMI (−1.2 [0.9] vs 0.2 [0.7]; P &lt; .001) and greater mean (SD) improvements in PA levels (1035.2 [735.7] metabolic equivalents [METs]/min/wk vs 34.1 [424.4] METs/min/wk; P &lt; .001), QOL (14.0 [10.0] points vs 0.4 [12.9] points; P &lt; .001), and health literacy scores (2.7 [1.6] points vs 0.1 [1.4] points; P &lt; .001). Exercise adherence was significantly higher in the CBCR group than in the CBET group (mean [SD] sessions completed, 90.3% [11.8%] vs 68.4% [22.1%]; P &lt; .001).Conclusion and RelevanceThe CORE trial showed that a cardio-oncology rehabilitation model among cancer survivors with high cardiovascular risk was associated with greater improvements in peak V̇o2 compared with usual care encompassing an exercise intervention in a community setting. The CBCR also showed superior results in exercise adherence, cardiovascular risk factor control, QOL, and health literacy.Trial RegistrationClinicalTrials.gov Identifier: NCT05132998

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A hybrid modelling approach for eliciting health state preferences: the Portuguese EQ-5D-5L value set

Cited by 62 publications

References 48 publications

Valuing health-related quality of life among the Indian population: a protocol for the Development of an EQ-5D Value set for India using an Extended design (DEVINE) Study

Valuing health-related quality of life among the Indian population: a protocol for the Development of an EQ-5D Value set for India using an Extended design (DEVINE) Study

Using Both Time Tradeoff and Discrete Choice Experiments in Valuing the EQ-5D: Impact of Model Misspecification on Value Sets

Cardio-Oncology Rehabilitation for Cancer Survivors With High Cardiovascular Risk

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