Comparing the Incomparable? A Systematic Review of Competing Techniques for Converting Descriptive Measures of Health Status into QALY-Weights

Mortimer, Duncan; Segal, Leonie

doi:10.1177/0272989x07309642

Cited by 137 publications

(157 citation statements)

References 61 publications

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“…In a review of crosswalk studies and methodology, Mortimer and Segal [8] addressed the methodological and conceptual concerns with regression crosswalk methodology and found large variation in the explanatory power of regression models. A broad overview of study results indicates that the explanatory power of the regression models is lower when converting scores with disparate constructs and measurement scales [6].…”

Section: Discussionmentioning

confidence: 99%

“…Much of this type of mapping, or crosswalk, methodology has been previously conducted using other outcome measurement tools with the purpose of predicting a generic, preference-based healthy utility measure from a diseasespecific measure or two generic health-related quality-of-life instruments [2,4,8]. To our knowledge, there are no equivalent studies in arthroplasty that offer a direct comparison to our results.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, there are no equivalent studies in arthroplasty that offer a direct comparison to our results. Although the use of regression models to map, or crosswalk, values from disease-specific health measurement instruments to utilities derived from generic health measurement instruments is increasing, there have been few studies related to osteoarthritis and total joint arthroplasty [1,4,8,9,17]. Furthermore, the WOMAC is the only disease-specific instrument that has been mapped to predict a preference-based health utility.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Can Original Knee Society Scores Be Used to Estimate New 2011 Knee Society Scores?

Odum

Fehring

2017

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Can Original Knee Society Scores Be Used to Estimate New 2011 Knee Society Scores?

Odum

Fehring

2017

Clinical Orthopaedics &Amp; Related Research

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“…Head-to-head comparisons were identified in 392 studies, suggesting low level of agreement, and hence a need for developing algorithms to compare utility scores across the various instruments used. Crosswalks or 'mappings' between a disease specific instrument and a HSU-instruments are commonly used to enable QALY estimations [6,7]. However, while such crosswalks between HSU-instruments are rare [8][9][10][11], previous studies have indicated non-linear relationships [8,9,11].…”

Section: Introductionmentioning

confidence: 99%

Health state utility instruments compared: inquiring into nonlinearity across EQ-5D-5L, SF-6D, HUI-3 and 15D

et al. 2015

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2 AbstractPurpose Different health state utility (HSU) instruments produce different utilities for the same individuals, thereby compromising the intended comparability of economic evaluations of health care interventions. When developing crosswalks, previous studies have indicated non-linear relationships. This paper inquires into the degree of non-linearity across the four most widely used HSUinstruments, and proposes exchange rates that differ depending on the severity levels of the health state utility scale.Method Overall, 7933 respondents from six countries; 1760 in a non-diagnosed healthy group and 6173 in seven disease groups, reported their health states using four different instruments: EQ-5D-5L, SF-6D, HUI-3 and 15D. Quantile regressions investigate the degree of non-linear relationships between these instruments. To compare the instruments across different disease severities, we split the health state utility scale into utility intervals with 0.2 successive decrements in utility starting from perfect health at 1.00. Exchange Rates (ERs) are calculated as the mean utility difference between two utility intervals on one HSU-instrument divided by the difference in mean utility on another HSU-instrument.Result Quantile regressions reveal significant non-linear relationships across all four HSUinstruments. The degrees of non-linearities differ, with a maximum degree of difference in the coefficients along the health state utility scale of 3.34 when SF-6D is regressed on EQ-5D. At the lower end of the health state utility scale, the exchange rate from SF-6D to EQ-5D is 2.19, whilst at the upper end it is 0.35. ConclusionComparisons at different utility levels illustrates the fallacy of using linear functions as crosswalks between HSU-instruments. The existence of non-linear relationships between different HSU-instruments suggests that level-specific exchange rates should be used when converting a change in utility on the instrument used, onto a corresponding utility change had another instrument 3 been used. Accounting for non-linearities will increase the validity of the comparison for decision makers when faced with a choice between interventions whose calculations of QALY-gains have been based on different HSU-instruments.

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“…Mortimer and Segal [7] aimed to compare four methods for estimating QALY weights from non-PBMs, including derivation of a PBM from an existing measure, and to determine what effect the choice of method may have on the values generated. Their review included generic and conditionspecific measures.…”

mentioning

confidence: 99%

A Systematic Review of the Literature on the Development of Condition-Specific Preference-Based Measures of Health

Goodwin

Green

2016

Appl Health Econ Health Policy

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Background. Health state utility values (HSUVs) are required to calculate quality-adjusted life-years (QALYs). They are frequently derived from generic preference-based measures of health. However, such generic measures may not capture health attributes of relevance to specific conditions. In such cases, a condition-specific preference-based measure (CSPBM) may be more appropriate.Objective. This systematic review aimed to identify all published accounts of developing CSPBMs, to describe and appraise the methods used. Results. Eighty-six publications were identified, describing 51 CSPBMs. Around two-thirds of these were QALY measures; the remainder were designed for clinical decision-making only. Classification systems for 33 CSPBMs were derived from existing instruments; 18 were developed de novo. HSUVs for 34 instruments were estimated using a 'composite' approach, involving statistical modelling; the remainder used a 'decomposed' approach based on multi-attribute utility theory. Half of the papers that described the estimation of HSUVs did not report validating their measures.Conclusion. Various methods have been used at all stages of CSPBM development. The choice between developing a classification system de novo or from an existing instrument may depend on the availability of a suitable existing measure, while the choice between a decomposed or composite approach appears to be determined primarily by the purpose for which the instrument is designed. The validation of CSPBMs remains an area for further development. 3 Key Points for Decision MakersThere are two main approaches to developing a classification system (derivation from an existing instrument or de novo) and two main approaches to estimating health state utility values (using statistical regression or multi-attribute utility theory) for a condition-specific preference based measure.There is more evidence available to support the validity of classification systems that were derived from existing measures of health-related quality of life than there is for classification systems developed de novo.

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Comparing the Incomparable? A Systematic Review of Competing Techniques for Converting Descriptive Measures of Health Status into QALY-Weights

Cited by 137 publications

References 61 publications

Can Original Knee Society Scores Be Used to Estimate New 2011 Knee Society Scores?

Can Original Knee Society Scores Be Used to Estimate New 2011 Knee Society Scores?

Health state utility instruments compared: inquiring into nonlinearity across EQ-5D-5L, SF-6D, HUI-3 and 15D

A Systematic Review of the Literature on the Development of Condition-Specific Preference-Based Measures of Health

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