Experience-Based Swedish TTO and VAS Value Sets for EQ-5D-5L Health States

Abstract

Background and Objective Although value sets for the five-level version of the generic health-related quality-of-life instrument EQ-5D are emerging, there is still no value set available in the literature based on time trade-off valuations made by individuals experiencing the valued health states. The aim of this study was to estimate experience-based value sets for the EQ-5D-5L for Sweden using time trade-off and visual analogue scale valuation methods. Methods In a large, cross-sectional, population-based, self-administered postal health survey, the EQ-5D-5L descriptive system, EQ visual analogue scale and a time trade-off question were included. Time trade-off and visual analogue scale valuations of the respondent's current health status were used in statistical modelling to estimate a single-index value of health for each of the 3125 health states. Ordinary least-squares and generalised linear models were estimated with the main effect within each of the five dimensions represented by 20 dummy variables reflecting the additional decrement in value for levels 2-5 when the severity increases by one level sequentially beginning from having no problem. Interaction variables representing the occurrence of severity levels in at least one of the dimensions were tested: severity level 2 or worse (N2); severity level 3 or worse (N3); severity level 4 or worse (N4); severity level 5 (N5). Results A total of 896 health states (28.7% of the 3125 possible EQ-5D-5L health states) were reported by the 25,867 respondents. Visual analogue scale (n = 23,899) and time trade-off (n = 13,381) responders reported valuations of their currently experienced health state. The preferred regression models used ordinary least-squares estimation for both time trade-off and visual analogue scale values and showed consistency in all coefficients after combining certain levels. Levels 4 and 5 for the dimensions of mobility, self-care and usual activities were combined in the time trade-off model. Including the interaction variable N5, indicating severity level 5 in at least one of the five dimensions, made it possible to distinguish between the two worst severity levels where no other dimension is at level 5 as this coefficient is applied only once. In the visual analogue scale regression model, levels 4 and 5 of the mobility dimension were combined. The interaction variables N2-N4 were included, indicating that each of these terms reflect a statistically significant decrement in visual analogue scale value if any of the dimensions is at severity level 2, 3 or 4, respectively. Conclusions Time trade-off and visual analogue scale value sets for the EQ-5D-5L are now available for Sweden. The time trade-off value set is the first such value set based on experience-based time trade-off valuation. For decision makers with a preference for experience-based valuations of health states from a representative population-based sample, the reported value sets may be considered fit for purpose to support resource allocation decision as well as evaluating...

Properties of the EQ-5D-5L when prospective longitudinal data from 28,902 total hip arthroplasty procedures are applied to different European EQ-5D-5L value sets

“…A possible confounder is that the Swedish TTO cohort, in contrast to the Swedish and German VAS cohorts, had an upper age limit of 69 years. Nevertheless, we agree with Burström et al [21] that value sets based on VAS and TTO may yield different health outcomes in practical evaluations.…”

“…Furthermore, our correlation analysis suggests an association between QALY gain and the value set range. The smaller ranges, and consequently the smaller possible QALY gains, of the experience-based value sets are expected since experience-based value sets are based on ratings on the 0–1 scale [12] (Sweden 0-100) [21] not allowing for values less than zero. This illustrates that experience-based and hypothetical value sets are inherently different and that QALY gains derived with different value sets are not comparable.…”

“…At the time of our study (Spring 2021), the valuations of 13 European value sets were completed. We used these 13 value sets for our investigation: Denmark [9] , England [10] , France [11] , Germany (2 value sets) [ 12 , 13 ], Hungary [14] , Ireland [15] , the Netherlands [16] , Poland [17] , Portugal [18] , Spain [ 19 , 20 ], Sweden Time Trade-off (TTO) and Visual Analogue Scale (VAS) [21] . One of the German value sets and the Swedish value sets are experience-based (respondents value their own current health state) whereas the other value sets are derived using hypothetical valuation (members of the general public are asked to value hypothetical health states).…”

The impact of community-based prevention on quality of life—The necessity to control for general health trends the Northern Sweden MONICA study in 2014

“…The HRQoL levels in both NB and VB in the 2014 MONICA survey are higher than what was found in a recent national Swedish study. Burström et al [ 19 ], report average EQ-VAS score on a national basis to be 0.76 while it was 0.79 (VB) and 0.80 (NB) in the MONICA data. These differences can to some extent be a result of different age groups; Burström et al included ages above 95 years while the results presented here are restricted to participants between 40–85.…”

Reporting and valuing one’s own health: a think aloud study using EQ-5D-5L, EQ VAS and a time trade-off question among patients with a chronic condition

“…Below the line, there was an additional sentence in parenthesis: 'if you think that you currently have full health, you should mark 10 years' . This open-ended TTO question has been used in the development of experience-based value sets for EQ-5D-3L [31] and EQ-5D-5L [32], and similar versions have been included in other studies [33][34][35].…”