Comparison of health state values derived from patients and individuals from the general population

Gandhi, Mihir; Tan, Ru San; Ng, Raymond; Choo, Su Pin; Chia, Whay Kuang; Toh, Chee-Keong; Lam, Carolyn S.P.; Lee, Phong Teck; Latt, Nang; Rand‐Hendriksen, Kim; Cheung, Yin Bun; Luo, Nan

doi:10.1007/s11136-017-1683-5

Cited by 11 publications

(7 citation statements)

References 29 publications

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“…Our results provide evidence that own experience with HRQoL impairments could have led to the different relative importance of the dimensions, because both patient samples self-reported more problems across all EQ-5D-5L dimensions than the general population in Germany and Spain. The influence of present disease experience on health state preferences has been shown in previous research 14,23 and is confirmed in this study. Accordingly, the higher level of impairments in German patients could have resulted in larger differences in health state preferences than Spain.…”

Section: Discussionsupporting

confidence: 89%

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To What Extent Do Patient Preferences Differ From General Population Preferences?

Ludwig

Ramos-Goñi

Oppe³

et al. 2021

Value in Health

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In some countries including Germany, value sets based on general population preferences are not acceptable for decision-makers in healthcare because the impact of the reference group-general population versus patients-on utility decrements is questioned. The objective of this study was to explore potential differences in patient versus general population health preferences and a way of combining both preferences in economic evaluation.Methods: EQ-5D-5L general population preferences were available from national value sets in Germany and Spain. Patient preferences were obtained by conducting discrete choice experiments with patients with rheumatism and patients with diabetes mellitus in Germany and Spain using an online panel. The econometric approach was based on the conditional logit framework. Latent values were anchored using the national value sets.Results: A total of 1700 patients (Germany, n = 937; Spain, n = 763) were included in the analysis. In both countries, patients gave more importance to mobility, self-care, or usual activities and less importance to pain/discomfort and anxiety/ depression than the general population. The size of these differences was larger in Germany than in Spain. In Germany, preferences reported by both patient groups were more similar than in Spain. Conclusion:Patient preferences differ from preferences derived from the general population. In contrast to the general population, patients gave more importance to the functional dimensions than to symptoms in both countries. The extent of the differences depends on the disease and the country. For countries preferring patient preferences, a possible way of incorporating the patient perspective in health state valuation was suggested and needs to be further explored.

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Section: Discussionsupporting

confidence: 89%

“…1,13 Previous empirical work has highlighted that patient preferences differ from general population preferences and that these differences have an impact on utilities and cost-effectiveness. 1,12,14,15 Nevertheless, research in this area is still scarce.…”

Section: Introductionmentioning

confidence: 99%

To What Extent Do Patient Preferences Differ From General Population Preferences?

Ludwig

Ramos-Goñi

Oppe³

et al. 2021

Value in Health

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“…Our findings are consistent with studies of disease state adaptation reported in haemophilia and other chronic conditions, where patients have reported higher health states than otherwise healthy peers 23‐25 . A recent patient preference study by Carlsson et al (2017) 25 showed that patients with haemophilia A consistently rated their health states higher than their peers in the GP (score range, 0.67–0.73 for PwHA vs 0.54–0.60 for the GP).…”

Section: Discussionsupporting

confidence: 90%

“…Our application of the composite DCE TTO method to include consideration of the duration of health states offers a robust approach not only to test for the existence of the disability paradox, but also to quantify its impact. Gandhi and colleagues (2017) 23 observed that patients with heart disease or cancer reported similar health state utility values as the general population when adjusted for sociodemographic characteristics. Peeters and Stiggelbout (2010) 24 conducted a meta‐analysis showing that patients across a variety of conditions generally provided higher health state valuations than ‘non‐patients’ from the GP.…”

Section: Discussionmentioning

confidence: 99%

Evidence of a disability paradox in patient‐reported outcomes in haemophilia

et al. 2021

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Introduction People with inherited and long‐term conditions such as haemophilia have been shown to adapt to their levels of disability, often reporting better quality of life (QoL) than expected from the general population (the disability paradox). Aim To investigate the disability paradox in people with haemophilia in the United States by examining preference differences in health state valuations versus the general population. Methods We conducted a discrete choice experiment including duration to capture valuations of health states based on patient‐reported preferences. Participants indicated their preferences for hypothetical health states using the EQ‐5D‐5L, where each participant completed 15 of the 120 choice tasks. Response inconsistencies were evaluated with dominated and repeated scenarios. Conditional‐logit regressions with random sampling of the general population responses were used to match the sample of patients with haemophilia. We compared model estimates and derived preferences associated with EQ‐5D‐5L health states. Results After removing respondents with response inconsistencies, 1327/2138 (62%) participants remained (177/283 haemophilia; 1150/1900 general population). Patients with haemophilia indicated higher preference value for 99% of EQ‐5D‐5L health states compared to the general population (when matched on age and gender). The mean health state valuation difference of 0.17 indicated a meaningful difference compared to a minimal clinically important difference threshold of 0.07. Results were consistent by haemophilia type and severity. Conclusion Our findings indicated the presence of a disability paradox among patients with haemophilia, who reported higher health states than the general population, suggesting the impact of haemophilia may be underestimated if general population value sets are used.

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“…Previous research has shown many cases in which preference estimates derived from specific patient populations differ systematically from those derived from the general population, [6][7][8][9][10] although some studies find no differences. 11,12 The current practice therefore raises normative concerns and could be inconsistent with the notion of patient sovereignty if it leads to a mismatch between the decisions patients make based on official published data and those they would have made had the information reflected their own preferences more closely.…”

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confidence: 99%

Using EQ-5D Data to Measure Hospital Performance: Are General Population Values Distorting Patients’ Choices?

et al. 2020

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Background. The English National Health Service publishes hospital performance indicators based on average postoperative EQ-5D index scores after hip replacement surgery to inform prospective patients’ choices of hospital. Unidimensional index scores are derived from multidimensional health-related quality-of-life data using preference weights estimated from a sample of the UK general population. This raises normative concerns if general population preferences differ from those of the patients who are to be informed. This study explores how the source of valuation affects hospital performance estimates. Methods. Four different value sets reflecting source of valuation (general population v. patients), valuation technique (visual analog scale [VAS] v. time tradeoff [TTO]), and experience with health states (currently experienced vs. experimentally estimated) were used to derive and compare performance estimates for 243 hospitals. Two value sets were newly estimated from EQ-5D-3L data on 122,921 hip replacement patients and 3381 members of the UK general public. Changes in hospital ranking (nationally) and performance outlier status (nationally; among patients’ 5 closest hospitals) were compared across valuations. Results. National rankings were stable under different valuations (rank correlations >0.92). Twenty-three (9.5%) hospitals changed outlier status when using patient VAS valuations instead of general population TTO valuations, the current approach. Outlier status also changed substantially at the local level. This was explained mostly by the valuation technique, not the source of valuations or experience with the health states. Limitations. No patient TTO valuations were available. The effect of value set characteristics could be established only through indirect comparisons. Conclusion. Different value sets may lead to prospective patients choosing different hospitals. Normative concerns about the use of general population valuations are not supported by empirical evidence based on VAS valuations.

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Comparison of health state values derived from patients and individuals from the general population

Cited by 11 publications

References 29 publications

To What Extent Do Patient Preferences Differ From General Population Preferences?

To What Extent Do Patient Preferences Differ From General Population Preferences?

Evidence of a disability paradox in patient‐reported outcomes in haemophilia

Using EQ-5D Data to Measure Hospital Performance: Are General Population Values Distorting Patients’ Choices?

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