EuroQol Agenda and Developing the New EQ-5D-5L Value Sets
An Overview of the EuroQol Group’s Scientific Agenda and Value Sets for EQ-5D-5L Professor Nancy J. Devlin Office of Health Economics Pharmaceutical Oncology Initiative (POI) Meeting London • 18 January 2013
Contents1. Recent developments with the EQ-5D2. EuroQol Group: new scientific agenda & Working Groups3. Valuation of EQ-5D-5L4. Overview of 5L value set studies5. Points for discussion
1. EuroQol Group: recent developments Developments over recent years have focused on: • Development of a new 5-level version: EQ-5D-5L • 94 languages; PDA/tablet/web • Development of a version of EQ-5D for children: EQ-5D-Y • Provision of an interim value set for the 5L (based on a crosswalk study) • Preparation for valuation of the EQ-5D-5L: new methods for administering, eliciting and modelling values.
Final version: UK EnglishHerdman, M., Gudex, C., Lloyd, A., Janssen, M.F., Kind, P., Parkin, D., Bonsel, G. and Badia, X. Development andpreliminary testing of the new EQ-5D-5L. Quality of Life Research.
Final 5L version EQ VAS3L VAS instructions 5L VAS instructions
Interim value set: study populations COPD/asthma (n=342)6 Countries Diabetes (n=275) Liver disease (n=426) Italy Rheumatoid arthritis/arthritis (n=372) United Kingdom (Scotland, Engla Cardiovascular disease (n=251) nd) Patient study population Stroke (n=614) Netherlands Depression (n=250) Poland Personality disorders (n=384) Students (n=443) Denmark Other (n=334)
A comparison of the distribution of responseson the 3L and 5L
Mobility 5L No Slight Moderate Severe3L problems problems problems problems Unable toNo problems 1782 119 16 1 4 Van Hout et al (2012) InterimSome problems 29 552 586 386 23Confined to bed 1 1 4 30 112 scoring for the EQ-5D-5L:Self-Care 5L No Slight Moderate Severe Mapping the EQ-5D-5L to EQ-3L problems problems problems problems Unable toNo problems 2468 82 13 5 0 5D-3L value sets Value inSome problems 43 408 313 109 6 Health. 15(5), 708-715.Unable to 3 5 6 35 140Usual Activities 5L No Slight Moderate Severe3L problems problems problems problems Unable toNo problems 1382 163 20 9 0Some problems 42 661 656 274 15 Note: problems withUnable to 5 7 23 134 239 inconsistencies in self-Pain/Discomfort 5L3L None Slight Moderate Severe Extreme reported health in parallelNone 1126 211 21 6 2Moderate 65 850 837 239 8 fielding pose challenges forExtreme 1 4 19 159 82 modelling the relationshipAnxiety/Depression 5L3L None Slight Moderate Severe Extreme between 5L and 3L healthNone 1352 219 30 10 3 statesModerate 45 841 692 164 6Extreme 1 3 17 158 93
Modelling approachFor each 5L dimension, calculateprobability of response on 3-levelsystem. Given those probabilities, calculate probability of being in each of the 243 (3L) states for a given 5L health state vector. This facilitates a 5L “utility” score for each of the 3125 health states, calculated as the average utility score weighted by the probabilities to be in one of the 243 health states.
Interim 5L scores• 5L value calculator available from the EuroQol Group website
2. EuroQol Group: new scientific agenda • Value Sets WG • Implement valuation protocol for 5L studies internationally • Valuation methodology • Innovative methods for future protocols • Conceptual basis for ‘bolt on’ dimensions • Methods for valuation of EQ-5D-Y • EQ Data Archive • EQ-5D in Children • Large scale health applications (PROMs and pops) • EQ-5D beyond health care
3. Valuation of EQ-5D-5L• 5L Value set studies underway/planned: England China UK Singapore Ireland Japan Netherlands South Korea Spain Taiwan Germany Middle East Canada US Uruguay Nigeria New Zealand
Challenges valuing EQ-5D-5L• 55 = 3,125 states to value (cf. 243 in EQ-5D)• Differences between EQ-5D-5L Is 55555(5L) states more subtle than EQ-5D = 33333(3L)?• Potentially, a greater cognitive (hopefully, ye s) burden in differentiating between/imagining the states Is 11111• The 5L more sensitive PRO, but (5L) = 11111 (3L)? (yes) how does the general public view How does 51111 the decrements in utility? (5L) cf. 31111 (3L)? (unable to How much ‘milder’ is walk about vs. 12111(5L) cf. 12111 (3L)? confined to bed) How does 33333 (5L) cf. 22222 (3L)?
EQ-5D-5L valuation protocol 1. General welcome 2. Introduction • Self reported health on the EQ-5D-5L descriptive system • Self reported health on the EQ-VAS • Background questions 3. Composite Time Trade-Off • Instructions and example of TTO task • TTO valuation of 10 EQ-5D-5L states • TTO debriefing/structured feedback 4. Discrete Choice • Instructions and example of DC task • DC valuation of 10 pairs of EQ-5D-5L states • DC debriefing/structured feedback 5. General thank you and goodbye
EQ-VT (‘valuation technology’)• EQ-VT software developed to display the tasks; automate the questioning process; and capture and timestamp responses• Administered in face to face interviews, ie computer assisted personal interviews (CAPI) – not online.
Choice of valuation methods• TTO: widely used and accepted (eg by NICE), so forms the basis for 5L valuations.• But problems with conventional approach to TTO in valuation of states worse than dead.• Lead time TTO a uniform method that can yield values < 0 and > 0 – but also not without its problems!• EuroQol Group has opted for a composite approach: conventional TTO for > 0; lead time TTO for < 0• DC: without duration; preferences data used to supplement TTO.
5L value sets for England & UK• ‘An EQ-5D-5L Value set for England’: funded by DH via the NIHR PRP• Research led by OHE/Sheffield: N Devlin, B van Hout, K Shah, B Mulhern, Y Feng• Commenced November 2012; to report July 2013• ‘An EQ-5D-5L value set for the UK’: additional data collection in NI, Wales and Scotland funded by Office of the Chief Scientist, Scotland and the EuroQol Foundation• Data collection to commence March 2013; to report by December 2013• Sample recruitment/interviews for both studies undertaken by Ipsos Mori
What might the value sets look like?• Too early to tell (< a third of final sample)But…• TTO values have a good relationship with the ‘misery score’ for states.• Likely that the minimum value (55555) will be higher than that for 33333 in the MVH• Improved approaches to modelling will effect the characteristics of the value set – no N3 term
5. For discussion with POI • Will the 5L improve the sensitivity of EQ-5D in measuring QoL for cancer patients? • Are there any aspects of QoL which might be potential candidates for exploration of ‘bolt ons’? • How will the new values effect estimates of QoL improvement for cancer medicines?