EQ-5D-5L versus EQ-5D-3L: The Impact on Cost Effectiveness in the United Kingdom

Alava, Mónica Hernández; Wailoo, Allan; Grimm, Sabine; Pudney, Stephen; Gomes, Manuel; Sadique, Zia; Meads, David; O’Dwyer, John; Barton, Garry; Irvine, Lisa

doi:10.1016/j.jval.2017.09.004

Cited by 77 publications

(83 citation statements)

References 23 publications

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“…By contrast, the Devlin et al distribution was unlike the EQ-5D-3L distribution or mapped EQ-5D-5L distribution, displaying a large shift upwards in utility values combined with a narrowing of the overall distribution. We suggest that the Devlin et al distribution is a function of both a response shift and a change in the valuation system, and therefore is similar to the findings reported by Hernandez Alava et al [26] when exploring the impact of switching from the EQ-5D-3L to the EQ-5D-5L Devlin et al tariff on cost-effectiveness results. Overall, the distributional findings in this study validate those previously reported by Mulhern et al [25] on a smaller sample for England and those reported by Janssen et al [22] for EQ-5D-3L and EQ-5D-5L values across seven countries.…”

Section: Discussionsupporting

confidence: 85%

“…Overall, the distributional findings in this study validate those previously reported by Mulhern et al [25] on a smaller sample for England and those reported by Janssen et al [22] for EQ-5D-3L and EQ-5D-5L values across seven countries. Given the recent NICE position statement recommending the use of the van Hout et al mapping algorithm for studies that have collected 5L data, we suggest the implications of our results for cost-effectiveness analysis conducted in the near future could be similar (but smaller in magnitude) to those outlined by Hernandez Alava et al [26]. Due to the upwards shift in utility values that we observed for the 5L respondents using the van Hout et al algorithm, primarily driven by a response shift, there is less utility space for potential gains to occur versus identical EQ-5D-3L respondents scored using the Dolan EQ-5D-3L tariff.…”

Section: Discussionsupporting

confidence: 53%

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A Comparison of the EQ-5D-3L and EQ-5D-5L

Thompson

Turner

2020

PharmacoEconomics

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Introduction The EQ-5D-3L (3L) and EQ-5D-5L (5L) are both frequently used measures of health status. Previous studies have found the EQ-5D-5L to have superior measurement properties but no study has compared the two measures in a large general population survey using matched respondents. Methods Using data from the GP Patient Survey, coarsened exact matching was used to match individuals completing the 3L in 2011 with those completing the 5L in 2012. Measurement properties were assessed for a general population and multimorbid population (chronic conditions ≥ 2), with ceiling effects, informativity and distribution of response compared. Changes in the direction of response, as well as the impact on utility distributions, were quantified. Results Matching resulted in a cohort of 1, 023,218 respondents (2011: 511,609; 2012: 511,609) for analysis. Ceiling effects for the 5L were lower than the 3L (43.8% vs. 54.4%). The 5L had improved informativity and broader spread of responses than the 3L (5L top 50 profiles: 77.4% vs. 3L: 98.8%). Overall, there was an upwards shift in utility values for the 5L versus the 3L as respondents using the 5L reported ill health more frequently but with less severity. Measurement improvements and effects on utility values were more pronounced for the multimorbid population. Conclusion The 5L had superior measurement properties than the 3L and should be preferred in general population surveys and for use in individuals with multimorbidity. At increasing levels of morbidity, the 5L is currently associated with higher utility values than the 3L. Electronic supplementary material The online version of this article (https ://doi.The EQ-5D-5L has superior measurement properties to the EQ-5D-3L and should be preferred in general population and multimorbid populations.The EQ-5D-5L leads respondents to report more illhealth. However, it is less severe than when using the EQ-5D-3L.For higher-levels of multimorbidity, use of the EQ-5D-5L in England will currently lead to higher utility values than the EQ-5D-3L, irrespective of the tariff used.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 53%

A Comparison of the EQ-5D-3L and EQ-5D-5L

Thompson

Turner

2020

PharmacoEconomics

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“…Both measures had good completion rates, however a noteable difference was that the DEMQOL scores tended to be higher, but cover a smaller range. This suggests that there is potential for different utility measures to give different results, as has been found previously [51] [52].…”

Section: Discussionsupporting

confidence: 57%

MEDREV (pharmacy-health psychology intervention in people living with dementia with behaviour that challenges): the feasibility of measuring clinical outcomes and costs of the intervention

Maidment

Barton

Campbell

et al. 2020

BMC Health Serv Res

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Background: People living with dementia in care homes frequently exhibit "behaviour that challenges". Anti-psychotics are used to treat such behaviour, but are associated with significant morbidity. This study researched the feasibility of conducting a trial of a full clinical medication review for care home residents with behaviour that challenges, combined with staff training. This paper focusses on the feasibility of measuring clinical outcomes and intervention costs. Methods: People living with moderate to severe dementia, receiving psychotropics for behaviour that challenges, in care homes were recruited for a medication review by a specialist pharmacist. Care home and primary care staff received training on the management of challenging behaviour. Data were collected at 8 weeks, and 3 and 6 months. Measures were Neuropsychiatric Inventory-Nursing Home version (NPI-NH), cognition (sMMSE), quality of life (EQ-5D-5 L/DEMQoL) and costs (Client Services Receipt Inventory). Response rates, for clinical, quality of life and health economic measures, including the levels of resource-use associated with the medication review and other non-intervention costs were calculated. Results: Twenty-nine of 34 participants recruited received a medication review. It was feasible to measure the effects of the complex intervention on the management of behaviour that challenges with the NPI-NH. There was valid NPI-NH data at each time point (response rate = 100%). The sMMSE response rate was 18.2%. Levels of resource-use associated with the medication review were estimated for all 29 participants who received a medication review. Good response levels were achieved for other non-intervention costs (100% completion rate), and the EQ-5D-5 L and DEMQoL (≥88% at each of the time points where data was collected). Conclusions: It is feasible to measure the clinical and cost effectiveness of a complex intervention for behaviour that challenges using the NPI-NH and quality of life measures.

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“…The 5L version appears to capture small changes in health-related quality of life. Nevertheless, according to Hernandez et al [31], in the UK the shift to the right, and the higher concentration of high utility values, could lead to lower QALY increments and higher incremental cost-effectiveness ratios (ICERs), except for treatments with high lifeyear gains, which may raise issues of historical consistency between past (with 3L) and future decisions. Continuing to use the crosswalk as an interim solution would not lead to major changes versus the 3L.…”

Section: Discussionmentioning

confidence: 99%

A French Value Set for the EQ-5D-5L

et al. 2020

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Objective The objective of this study was to develop a French value set for the EQ-5D-5L, for academic and clinical research, and for regulatory requirements for price-setting of drugs and medical devices. Method This study used the standardized valuation protocol developed by EuroQol, using computer-assisted personal interview software. A representative sample of 1048 French residents were interviewed by a market research company, under the supervision of the research team. Health states were valued using composite time trade-off and a discrete choice experiment. Modeling was used to create values for the 3125 possible health states. The composite time trade-off data were modeled using a Tobit model with censored observations at −1 and correcting for heteroscedasticity. A conditional logit model was used for the discrete choice results, and both models were combined using a hybrid model. An adjusted hybrid model was tested to correct for imbalance in the sample on age and sex compared with the general population. A comparison with the 3-level (3L) value set was performed. Results The adjusted model was preferred to comply with the representativeness of the general population. It provided a value set for which all coefficients were logically consistent. Values ranged from − 0.525 to 1. The distribution of values presented a shift towards higher values versus the 3L value set. Ranking of dimensions changed. Pain and discomfort and mobility were the dimensions with the highest potential for disutility compared with mobility and self-care for the 3L instrument. Conclusions This study provides a value set based on societal preferences of the French population, using an improved descriptive instrument of health-related quality-of-life health states. It will contribute to improve the quality of cost-effectiveness analysis in the French context and help stimulate disease-specific quality-of-life references for academic-, institutional-, and industry-promoted studies.

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EQ-5D-5L versus EQ-5D-3L: The Impact on Cost Effectiveness in the United Kingdom

Cited by 77 publications

References 23 publications

A Comparison of the EQ-5D-3L and EQ-5D-5L

A Comparison of the EQ-5D-3L and EQ-5D-5L

MEDREV (pharmacy-health psychology intervention in people living with dementia with behaviour that challenges): the feasibility of measuring clinical outcomes and costs of the intervention

A French Value Set for the EQ-5D-5L

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