Comparing the EQ‐5D‐5L crosswalks and value sets for England, the Netherlands and Spain: Exploring their impact on cost‐utility results

Abstract

This study compares the five-level EuroQol five-dimension questionnaire (EQ-5D-5L) crosswalks and the 5L value sets for England, the Netherlands, and Spain and explores the implication of using one or the other for the results of cost-utility analyses. Data from two randomized controlled trials in depression and diabetes were used. Utility value distributions were compared, and mean differences in utility values between the EQ-5D-5L crosswalk and the 5L value set were described by country. Quality-adjusted life years (QALYs) were calculated using the area-under-the-curve method. Incremental cost-effectiveness ratios (ICERs) were calculated, and uncertainty around ICERs was estimated using bootstrapping and graphically shown in cost-effectiveness acceptability curves. For all countries investigated, utility value distributions differed between the EQ-5D-5L crosswalk and 5L value set. In both case studies, mean utility values were lower for the EQ-5D-5L crosswalk compared with the 5L value set in England and Spain, but higher in the Netherlands. However, these differences in utility values did not translate into relevant differences across utility estimation methods in incremental QALYs and the interventions' probability of cost-effectiveness. Thus, our results suggest that EQ-5D-5L crosswalks and 5L value sets can be used interchangeably in patients affected by mild or moderate conditions. Further research is needed to establish whether these findings are generalizable to economic evaluations among severely ill patients. K E Y W O R D SEuroQol, utility, EQ-5D, EQ-5D-5L, crosswalk, value set, quality of life Ângela J. Ben, PhD, and Aureliano P. Finch, PhD, contributed equally to this work.

The impact of multimorbidity patterns on health-related quality of life in the general population: results of the Belgian Health Interview Survey

“…These results are not unexpected because similar findings were found in other countries (e.g. England, The Netherlands, Spain) with higher utility values for the EQ-5D-5L value set compared to the crosswalk value set [ 49 – 51 ]. In addition, the new value set generates 12 additional significant interaction effects for dyad disease combinations (Online Appendix 2).…”

“…As such, we can conclude that there will always be an synergistic/negative HRQoL effect, making multimorbidity even more important than initially thought. Possible reasons for the observed differences may be attributed to changes in for example population demographics, preferences over time, descriptive system of the EQ-5D, and valuation method used [ 49 , 51 ]. The magnitude of differences between value sets may however have important implications for decision-making as they can greatly impact estimates (e.g.…”

Can EQ-5D-3L utility values of low back pain patients be validly predicted by the Oswestry Disability Index for use in cost-effectiveness analyses?

“…This is true, when the bias surrounding the predicted utility values does not translate into relevant differences in incremental QALYs and the probability of the intervention being cost-effective compared to the control group (i.e., decision-based validity) [ 58 ]. This may be explained by the fact that the bias is likely to be similar in the intervention and control groups, thereby not affecting incremental QALYs and CEACs [ 59 ].…”

To what extent does the use of crosswalks instead of EQ-5D value sets impact reimbursement decisions?: a simulation study

“…Given that healthcare decision-makers can be confronted with scientific evidence that is based on EQ-5D value sets or mapping approaches, guidance on choosing the most appropriate utility scoring method is urgently needed [ 23 ]. So far, literature suggests that EQ-5D scoring methods might result in different utility values, but inconsistent results have been found on the extent to which these differences affect differences in QALY between treatment groups (i.e., incremental QALY) and impact reimbursement decisions [ 18 , 24 – 29 ]. Camacho et al (2018), for example, concluded that the use of crosswalks instead of England 5L value sets may increase the likelihood of mental health interventions being cost-effective, while Ben et al (2020) found that the probability of interventions for mental health and diabetes being cost-effective was not significantly affected using crosswalks compared to 5L value sets for England, the Netherlands, and Spain.…”