Exploring The Impact of Adding A Respiratory Dimension to The EQ-5D-5L

Abstract

Objectives. To evaluate the impact of adding a respiratory dimension (a bolt-on dimension) to the EQ-5D-5L health state valuations. Methods. Based on extensive regression and principal component analyses, 2 respiratory bolt-on candidates were formulated: R1, limitations in physical activities due to shortness of breath, and R2, breathing problems. Valuation interviews for the selected bolt-ons were performed with a representative sample from the Dutch general public using the standardized interview protocol and software of the EuroQol group. Hybrid models based on the combined time-tradeoff (TTO) and discrete choice experiment (DCE) data were estimated to assess whether the 5 levels of the respiratory bolt-on led to significant changes in utility values. Results. For each bolt-on candidate, slightly more than 200 valuation interviews were conducted. Mean TTO values and DCE choice probabilities for health states with a level 4 or 5 for the respiratory dimension were significantly lower compared with the same health states in the Dutch EQ-5D-5L valuation study without the respiratory dimension. Results of hybrid models showed that for the bolt-on ''limitations in physical activities,'' the utility decrements were significant for level 3 (-0.055), level 4 (-0.087), and level 5 (-0.135). For ''breathing problems,'' the utility decrements for the same levels were greater (-0.086,-0.219, and-0.327, respectively). Conclusions. The addition of each of the 2 respiratory bolt-ons to the EQ-5D-5L had a significant effect on the valuation of health states with severe levels for the bolt-on. The bolt-on dimension ''breathing problems'' showed the greatest utility decrements and therefore seems the most appropriate respiratory bolt-on dimension.

Psychometric Validation of the EQ-5D-3L in Patients with Nontuberculous Mycobacterial (NTM) Lung Disease Caused by Mycobacterium avium Complex (MAC)

“… 34 Hoogendoorn et al proposed another potential solution for future consideration, which involved the addition of a respiratory dimension to the EQ-5D (3L or 5L). 44 They found that addition of a “breathing problem” dimension significantly improved the responsiveness of the EQ-5D to clinically significant changes in chronic lung disease patients. 44 However, such an approach would require valuation of the new dimension in order to obtain preference-based utility scores, which can be burdensome in terms of time and resources.…”

“… 44 They found that addition of a “breathing problem” dimension significantly improved the responsiveness of the EQ-5D to clinically significant changes in chronic lung disease patients. 44 However, such an approach would require valuation of the new dimension in order to obtain preference-based utility scores, which can be burdensome in terms of time and resources. Additionally, the comparability of the utilities obtained using this instrument with established national tariffs may also be questionable.…”

Methods Used to Identify, Test, and Assess Impact on Preferences of Bolt-Ons: A Systematic Review

“…Of the 28 articles that were included, 3 articles were studies that identified possible bolt-ons (category A "identification or development of possible suitable bolt-ons"), [23][24][25] 13 articles were psychometric performance studies (category B "psychometric performance studies"), 8,26-37 and 6 articles were valuation studies of EQ-5D 1 bolt-on (category C "health state valuation studies"). 19,20,[38][39][40][41][42] Furthermore, 3 articles were categorized as both categories A and B, [43][44][45] and 3 articles as both categories A and C. 13,21,38 Study populations consisted of a healthy population (n = 17 articles: general public, 13,[19][20][21]24,25,27,30,36,38,[40][41][42][43] random households, 44,45 faculty members 39 ) and patients (n = 11 articles: individuals with a chronic condition, 23 visitors of an outpatient eye clinic, 26 cognitive impaired elderly patients, 18 patients with diabetes, 28 general injury patients, 29,31,35 patients listed for cataract surgery, 32,34 stroke patients, …”

“…Overall, only 1 study scored "doubtful" on the COSMIN Risk of Bias checklist, whereas all other studies scored "inadequate." Considering the quality of studies per subject, 1 study scored "adequate" on PROM development, 38 3 studies scored doubtful, 21,28,42 and 24 studies scored inadequate. Furthermore, content validity was found to be inadequate again in 25 studies and doubtful in the remaining 3 studies.…”

“…Based on the self-developed checklist for bolt-on studies, 3 studies in category A1 ("studies that identified possible suitable bolt-ons") scored doubtful, 23,24,44 and 3 studies adequate, 25,43,45 whereas for category A2 ("studies that developed possible suitable bolt-ons") 1 study was inadequate 40 and 2 studies were very good. 21,38 For category B, 3 studies scored inadequate, 26,34,36 6 studies doubtful, 18,27,28,30,32,33 and 4 studies adequate. 29,31,35,37 Furthermore, 1 study in category C was judged inadequate, 19 3 studies doubtful, 21,38,39 1 study adequate, 41 and 4 studies very good.…”