The document summarizes the development of an EQ-5D-5L value set for England based on stated preference data collected from 1000 members of the general public. Researchers aimed to generate a value set that reflects public preferences using time trade-off (TTO) and discrete choice experiment (DCE) data. A hybrid statistical model was developed to combine the TTO and DCE data and account for heterogeneity in individual preferences. The final model produced utility values for all 3,125 EQ-5D-5L health states based on the combined dataset.

1. Nancy Devlin & Ben van Hout
on behalf of the OHE & ScHARR research team
OHE seminar
London • 30 October 2014
An EQ-5D-5L value set for England

2. An EQ-5D-5L value set for England
30 October 2014
This project is independent research commissioned and funded by
the NIHR / Department of Health Policy Research Programme (‘EQ-
5D-5L Value Set for England’ - 070/0073). Additional funding was
also received from the EuroQol Research Foundation.
The views expressed in this presentation are those of the authors,
and not necessarily those of the funding bodies.
Note: The value set reported here has ‘interim’ status, until such
point as it is accepted for publication in a peer reviewed journal.
Please do not quote from or circulate these slides without
permission of the presenting authors.
Note: There are a small number of differences between the content
of these slides and of those presented at the OHE lunchtime seminar
in October 2014. The latest analyses are presented in this version.
Disclaimer

3. An EQ-5D-5L value set for England
30 October 2014
Content
1. Background
2. Aims
3. Study design
4. Data
5. Modelling
6. Key results and implications
7. Remaining research questions

4. An EQ-5D-5L value set for England
30 October 2014
Background
• EQ-5D-5L: 3,125 states cf. 243 in the EQ-5D
• An important instrument: requests for 5L use now
supersede requests for 3L
• Interim utilities available by mapping 5L states to 3L
states, and using existing 3L value sets
• But ultimately, bespoke value sets required for 5L states
• Values are generally required to be based on the stated
preferences of the general public (e.g. NICE 2013)

5. An EQ-5D-5L value set for England
30 October 2014
3L 5L Would we
expect
underlying
values to be the
same?
11111 11111 Yes
33333 55555 Not necessarily –
mobility ‘extreme’
vs. ‘confined to
bed’
22222 33333 Not necessarily –
‘some’ vs.
‘moderate’

6. An EQ-5D-5L value set for England
30 October 2014
Aims
Aim: To produce a set of values for the EQ-5D-5L health state
descriptive system, based on the preferences of the general public
in England, for use in decisions based on EQ-5D-5L data
We investigated the following questions:
• What is the best method to generate an EQ-5D-5L Value Set
which reflects the stated preferences of the English general
public?
• How can conceptually different types of preference data – Time
Trade Off (TTO) and Discrete Choice Experiment (DCE) – be
combined in modelling health state values?
• How are extreme negative opinions about health states best
handled?
• How do people differ in their stated preferences for quality of life;
and life and death?

7. An EQ-5D-5L value set for England
30 October 2014
Study design
• Research protocol developed by the EuroQol Research Foundation
• Stated preference data collected in face-to-face computer-
assisted personal interviews
• n = 1000 members of the adult general public of England,
selected at random from residential postcodes
• Sample recruitment sub-contracted to Ipsos MORI
• Each respondent valued 10 health states using TTO, randomly
assigned from 86 health states in an underlying design; and
seven DCE tasks, randomly assigned from 196 pairs of states
• ‘Composite’ TTO approach: conventional TTO for values > 0 and
‘lead time’ TTO for values < 0
• The EuroQol Valuation Technology software (EQ-VT) was used to
present the tasks and to capture respondents’ responses

8. An EQ-5D-5L value set for England
30 October 2014

9. An EQ-5D-5L value set for England
30 October 2014
TTO for values > 0
(states better than dead)
Example shown:
U(hi) = 5/10 = 0.5
U(hi) = (x/t)
where x is the time in
full health and t is the
time in health state hi at
the respondent’s point of
indifference

10. An EQ-5D-5L value set for England
30 October 2014
Example shown:
U(hi) = (5-10)/10
= -0.5
t = 20 years
lead time (LT) = 10 years
U(hi) = (x-LT)/(t-LT)
= (x-10)/10
Min value = -1
TTO for values < 0
(states worse than dead)

11. An EQ-5D-5L value set for England
30 October 2014
DCE task

12. An EQ-5D-5L value set for England
30 October 2014
Data
• Interviews conducted between Nov 2012 and May 2013
• 996 completed the valuation questionnaire (response rate
approx. 40%)
• Close attention paid to data quality: daily monitoring of
uploaded data and follow-up with interviewers
• Sample broadly representative of English adult general
public, although a somewhat larger proportion of retired
individuals and a smaller proportion of younger individuals

13. An EQ-5D-5L value set for England
30 October 2014
DCE data
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
-10 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9
Misery index of state A minus misery index of state B
Proportions choosing A and B based on relative
severities of A and B
% B
% A
0 1
-10-50510
delta sum of scores
difinmisery

14. An EQ-5D-5L value set for England
30 October 2014
TTO data
• Fewer values < 0 (worse than dead) compared to Dolan
(1997) value set – as expected
• Clusters of values at -1, 0, 0.5 and 1
• Logical inconsistencies (e.g. 55555 > than other states)
• ‘Unusual’ valuations e.g. mild states being valued < 0
• Interviewer effects apparent

15. An EQ-5D-5L value set for England
30 October 2014
1 3 4 5 6 7 8
-0.10-0.050.00
misery coefficient
group
TTO groups
group N
all at 1 18
0<all<1 217
-1<all<1 113
-1=<all<1 53
0<all<=1 194
-1<all<=1 55
-1=<all<=1 52

16. An EQ-5D-5L value set for England
30 October 2014
11121 mean= 0.876
value
density
-1.0 0.0 0.5 1.002040
12111 mean= 0.868
value
density
-1.0 0.0 0.5 1.0
02040
11211 mean= 0.866
value
density
-1.0 0.0 0.5 1.0
02040
11221 mean= 0.862
value
density
-1.0 0.0 0.5 1.0
01020
21111 mean= 0.83
value
density
-1.0 0.0 0.5 1.002040
12121 mean= 0.823
value
density
-1.0 0.0 0.5 1.0
0515
11112 mean= 0.815
value
density
-1.0 0.0 0.5 1.0
02040
11122 mean= 0.806
value
density
-1.0 0.0 0.5 1.0
0515
11212 mean= 0.801
value
density
-1.0 0.0 0.5 1.0
0515
Distributions, by state

17. An EQ-5D-5L value set for England
30 October 2014
54231 mean= 0.473
value
density
-1.0 0.0 0.5 1.004812
33253 mean= 0.465
value
density
-1.0 0.0 0.5 1.0
0515
12334 mean= 0.463
value
density
-1.0 0.0 0.5 1.0
048
23514 mean= 0.46
value
density
-1.0 0.0 0.5 1.0
04812
43514 mean= 0.443
value
density
-1.0 0.0 0.5 1.0048
15151 mean= 0.436
value
density
-1.0 0.0 0.5 1.0
051015
23152 mean= 0.435
value
density
-1.0 0.0 0.5 1.0
0515
31525 mean= 0.428
value
density
-1.0 0.0 0.5 1.0
0510
31524 mean= 0.423
value
density
-1.0 0.0 0.5 1.002468
Distributions, by state

18. An EQ-5D-5L value set for England
30 October 2014
21444 mean= 0.148
value
density
-1.0 -0.5 0.0 0.5 1.0
01020
53244 mean= 0.148
value
density
-1.0 -0.5 0.0 0.5 1.0
0515
52455 mean= 0.12
value
density
-1.0 -0.5 0.0 0.5 1.0
0510
43555 mean= 0.119
value
density
-1.0 -0.5 0.0 0.5 1.0
051015
55555 mean= 0.016
value
density
-1.0 -0.5 0.0 0.5 1.0
0100
NA mean= NA
value
density
-1.0 -0.5 0.0 0.5 1.0
-1.00.01.0
Distributions, by state

19. An EQ-5D-5L value set for England
30 October 2014
minimum value
minv
Frequency
-1.0 -0.5 0.0 0.5 1.0
050100150
maximum value
maxv
Frequency
0.0 0.2 0.4 0.6 0.8 1.0
0200400
standard deviation of values
(varv^0.5)
Frequency
0.0 0.2 0.4 0.6 0.8 1.0
050100150
range of values used
range
Frequency
0.0 0.5 1.0 1.5 2.0
050100150
Descriptive statistics

20. An EQ-5D-5L value set for England
30 October 2014
• Overall, English 5L valuation data have acceptable ‘face validity’:
the worse the health state, the lower the mean and median value
TTO data

21. An EQ-5D-5L value set for England
30 October 2014
Interpretation of the data
• Evidence from this study suggests that it is harder to imagine,
differentiate between, and value health states described in
terms of 5L rather than 3L
• More subtle differences between states
• Cognitive burden
• Initial model results suggested respondents did not
differentiate between ‘severe’ (level 4) and ‘extreme’ (level 5)
problems on the dimension anxiety/depression

22. An EQ-5D-5L value set for England
30 October 2014
• Our process for examining the individual-level
data:
• Let’s look at all our respondents
• Put expected value according to DCE on x axis
• Put values on Y axis
• And stare at 1,000 graphs
Interpretation of the data

23. An EQ-5D-5L value set for England
30 October 2014
Examination of individual-level data

24. An EQ-5D-5L value set for England
30 October 2014
Examination of individual-level data

25. An EQ-5D-5L value set for England
30 October 2014
Real or censored???

26. An EQ-5D-5L value set for England
30 October 2014
Interviewer effects
Interviewer
Completed
interviews
Exhaust lead time
(value = -1)
State worse than dead
(value < 0)
State equal to dead
(value = 0)
Non-trade
(value = 1)
UK15354 33 6% 14% 15% 15%
UK12790 30 1% 5% 22% 3%
UK05524 29 0% 1% 6% 8%
UK03958 28 3% 10% 25% 10%
UK04526 28 1% 16% 8% 2%
UK04512 26 6% 20% 10% 3%
UK13185 25 0% 3% 24% 8%
UK14661 25 4% 12% 14% 36%
UK04523 24 2% 10% 9% 20%
UK02515 22 1% 7% 6% 5%
UK15247 20 5% 12% 27% 13%
UK12648 19 5% 14% 17% 27%
UK15835 19 12% 19% 2% 42%
UK02957 18 3% 6% 12% 2%
UK03921 16 0% 0% 4% 20%
UK04405 16 13% 33% 13% 4%
UK06347 16 6% 11% 27% 19%
UK12499 16 0% 2% 6% 17%
UK04587 15 2% 5% 7% 13%

27. An EQ-5D-5L value set for England
30 October 2014
Decisions regarding the data
• Excluded 23 respondents who gave all 10 health states
the same value; and 61 respondents who valued 55555
(misery score = 25) no lower than the value they gave to
the mildest health state included in their block (misery
score = 6)
• The core modelling dataset includes 912 respondents,
with 10 TTO observations for each
• Censored 105 individuals/477 zeros with >2 states at
zero (that is out of 1,315 zeros)
• Censored 68 individuals/142 data points with inconsistent
negative data

28. An EQ-5D-5L value set for England
30 October 2014
• The main specifications included models with 5, 9, 10 and
20 parameters (four parameters for each of the five
dimensions reflecting a utility decrement for each severity
level).
• 20 parameter preferred on prior grounds
• All models were estimated for both TTO and DCE data, and
‘hybrids’ of the these
• Final model based on the hybrid
• Heterogeneity explored via random coefficient models,
which estimate value functions for every individual
member of the sample
• Values at -1 treated as censored
• Truncation of the error distribution at 1 is addressed
Key aspects of the modelling

29. An EQ-5D-5L value set for England
30 October 2014
The hybrid likelihood
General
• You have a statistical model
that generates the data,
holding unknown
parameters
• You have the data
• You calculate for every set
of parameters the
probability that the data
occur
• The likelihood is the product
of all probabilities
• You calculate the
parameters at which this
product of probabilities
(likelihood) is highest
Specific
• There is a likelihood for the
DCE-data
– Assuming normal errors
• There is a likelihood for the
TTO-data
– Assuming normal errors
• The combined likelihood is
the product of both
likelihoods

30. An EQ-5D-5L value set for England
30 October 2014
Initial model results, DCE only
mobility 0.337 (0.306 - 0.369) 1.574 (0.884 -2.334) 0.278 (0.185 - 0.398) slight 0.349 (0.235 - 0.460)
self-care 0.241 (0.214 - 0.268) 1.222 (0.689 -1.805) 0.217 (0.144 - 0.315) moderate 0.441 (0.310 - 0.577)
usual activities 0.203 (0.175 - 0.232) 0.994 (0.555 -1.474) 0.176 (0.117 - 0.257) severe 1.132 (1.002 - 1.269)
pain/discomfort 0.406 (0.377 - 0.436) 1.793 (1.017 -2.655) 0.312 (0.208 - 0.446) unable 1.441 (1.298 - 1.590)
anxiety/depression 0.394 (0.364 - 0.424) 1.777 (1.002 -2.619) 0.309 (0.205 - 0.442) slight 0.268 (0.145 - 0.388)
slight 0.214 (0.132 -0.358) 1.187 (0.758 - 1.753) moderate 0.406 (0.272 - 0.541)
moderate 0.256 (0.159 -0.426) 1.425 (0.929 - 2.106) severe 1.007 (0.874 - 1.145)
severe 0.788 (0.503 -1.294) 4.385 (2.961 - 6.234) unable 1.049 (0.920 - 1.180)
unable/extreme 0.912 (0.583 -1.496) 5.006 (3.357 - 7.127) slight 0.213 (0.102 - 0.326)
extreme 5.134 (3.450 - 7.351) moderate 0.216 (0.096 - 0.335)
severe 0.796 (0.672 - 0.923)
unable 0.816 (0.689 - 0.949)
slight 0.328 (0.212 - 0.446)
moderate 0.376 (0.248 - 0.499)
severe 1.198 (1.065 - 1.331)
extreme 1.587 (1.449 - 1.731)
slight 0.331 (0.205 - 0.454)
moderate 0.376 (0.252 - 0.506)
severe 1.355 (1.220 - 1.494)
extreme 1.470 (1.329 - 1.611)
Deviance 7750 (7745 -7757) 7516 (7510 -7525) 7516 (7510 -7527) Deviance 7502 (7492 -7516)
DIC 7755 7517 7523 DIC 7522
5 parameters 9 parameters 10 parameters 20 parameters
self-care
usual activities
pain/discomfort
anxiety/
depression
mobility

31. An EQ-5D-5L value set for England
30 October 2014
Initial model results, TTO only
• DIC lowest for 10-parameter model
• Unexpected coefficient for level 5 on anxiety/depression
constant 1.109 (1.086 - 1.131) 0.874 (0.858 - 0.889) 0.884 (0.870 - 0.899) constant 0.832 (0.816 - 0.837)
mobility 0.037 (0.030 - 0.045) 0.266 (0.215 - 0.323) 0.209 (0.176 - 0.257) slight -0.021 -(0.039 - -0.015)
self-care 0.035 (0.028 - 0.042) 0.273 (0.222 - 0.337) 0.208 (0.175 - 0.255) moderate 0.008 -(0.018 - 0.017)
usual activities 0.040 (0.033 - 0.048) 0.252 (0.208 - 0.308) 0.194 (0.162 - 0.241) severe 0.141 (0.108 - 0.153)
pain/discomfort 0.072 (0.063 - 0.081) 0.401 (0.334 - 0.485) 0.323 (0.275 - 0.392) unable 0.210 (0.175 - 0.221)
anxiety/depression 0.057 (0.049 - 0.065) 0.312 (0.253 - 0.382) 0.261 (0.223 - 0.317) slight -0.005 -(0.027 - 0.002)
slight 0.111 (0.080 - 0.150) 0.159 (0.120 - 0.202) moderate 0.031 (0.003 - 0.041)
moderate 0.225 (0.175 - 0.279) 0.282 (0.221 - 0.344) severe 0.102 (0.068 - 0.114)
severe 0.644 (0.539 - 0.756) 0.838 (0.678 - 0.953) unable 0.196 (0.166 - 0.207)
unable/extreme 0.802 (0.670 - 0.935) 1.094 (0.901 - 1.258) slight 0.000 -(0.019 - 0.007)
extreme 0.981 (0.789 - 1.125) moderate 0.020 -(0.006 - 0.029)
severe 0.123 (0.093 - 0.134)
unable 0.158 (0.124 - 0.170)
slight -0.004 -(0.022 - 0.002)
moderate 0.047 (0.022 - 0.056)
severe 0.269 (0.233 - 0.282)
extreme 0.304 (0.260 - 0.320)
slight 0.016 -(0.003 - 0.022)
moderate 0.060 (0.031 - 0.072)
severe 0.246 (0.211 - 0.259)
extreme 0.235 (0.202 - 0.247)
sigma 1.510 (1.235 - 1.775) 3.074 (2.659 - 3.567) 3.131 (2.664 - 3.650) sigma 0.931 (0.805 - 1.073)
Deviance 3153 (2914 - 3422) -3448 -(3967 - -2970) -4673 -(5200 - -4104) Deviance -11006 -(11860 - -10200)
DIC 4534 -989 -2704 DIC -4951
anxiety/
depression
5 parameters 9 parameters 10 parameters 20 parameters
mobility
self-care
usual activities
pain/
discomfort

32. An EQ-5D-5L value set for England
30 October 2014
Initial results from the hybrid model
• Before addressing censoring at 1
constant 1.180 (1.150 -1.209) 0.890 (0.863 -0.913) 0.892 (0.866 -0.917) constant 0.881 (0.853 -0.912)
mobility -0.054 -(0.059 --0.050) 0.249 (0.154 -0.333) 0.157 (0.097 -0.271) slight -0.051 -(0.068 --0.035)
self-care -0.038 -(0.043 --0.032) 0.191 (0.117 -0.256) 0.118 (0.073 -0.205) moderate -0.065 -(0.085 --0.047)
usual activities -0.035 -(0.040 --0.029) 0.163 (0.100 -0.222) 0.101 (0.062 -0.175) severe -0.180 -(0.198 --0.162)
pain/discomfort -0.070 -(0.076 --0.065) 0.301 (0.186 -0.399) 0.198 (0.121 -0.338) unable -0.228 -(0.248 --0.210)
anxiety/depression -0.067 -(0.073 --0.063) 0.287 (0.177 -0.382) 0.188 (0.116 -0.326) slight -0.041 -(0.058 --0.025)
slight -0.201 -(0.310 --0.138) -0.323 -(0.504 --0.174) moderate -0.063 -(0.082 --0.045)
moderate -0.267 -(0.407 --0.188) -0.428 -(0.658 --0.234) severe -0.150 -(0.168 --0.131)
severe -0.800 -(1.216 --0.574) -1.276 -(1.932 --0.696) unable -0.169 -(0.187 --0.152)
unable/extreme -0.914 -(1.388 --0.658) -1.522 -(2.308 --0.822) slight -0.038 -(0.054 --0.021)
extreme -1.414 -(2.138 --0.775) moderate -0.039 -(0.058 --0.021)
severe -0.132 -(0.150 --0.114)
unable -0.136 -(0.154 --0.117)
slight -0.050 -(0.067 --0.032)
moderate -0.062 -(0.080 --0.044)
severe -0.206 -(0.225 --0.186)
extreme -0.258 -(0.279 --0.239)
slight -0.057 -(0.075 --0.039)
moderate -0.075 -(0.094 --0.056)
severe -0.230 -(0.252 --0.209)
extreme -0.238 -(0.259 --0.219)
constant DCE 0.023 -(0.077 -0.096) -0.119 -(0.174 --0.063) -0.120 -(0.170 --0.066) constant DCE -0.119 -(0.175 --0.064)
slope DCE 5.535 (4.223 -7.404) -5.936 -(6.325 --5.558) -5.935 -(6.324 --5.542) slope DCE -6.055 -(6.497 --5.632)
Deviance 21241 (21230 -21250) 20934 (20930 -20950) 20932 (20920 -20940) Deviance 17806 (17790 -17820)
DIC 21249 20917 20877 DIC 17830
mobility
self-care
usual
activities
pain/
discomfort
anxiety/
depression
5 parameters 9 parameters 10 parameters 20 parameters

33. An EQ-5D-5L value set for England
30 October 2014
Issues with the TTO results
• Lower parameter for anxiety-depression level
5 than for anxiety/depression level 4
• Brute force
• Heterogeneity
• Latent distributions
• Low value of the intercept
• Error distributions

34. An EQ-5D-5L value set for England
30 October 2014
• The coefficients beta which reflect weights for
dimensions and levels are normally distributed
over the population
• The shape of the value as a function of x’beta
follows a:
– Normal distribution
– Lognomal distribution
– Multinomial distribution
– (3 latent classes)
Heterogeneity
-1.5
-1
-0.5
0
0.5
1
value
x'beta

35. An EQ-5D-5L value set for England
30 October 2014
Parameter estimates
-0.050
0.000
0.050
0.100
0.150
0.200
0.250
0.300
0.350
slope ~ normal
slight moderate severe unable/extreme
-0.100
0.000
0.100
0.200
0.300
0.400
0.500
0.600
slope ~ lognormal
slight moderate severe unable/extreme
-0.500
0.000
0.500
1.000
1.500
2.000
2.500
3.000
3.500
slope ~ multinomial
slight moderate severe unable/extreme
-0.050
0.000
0.050
0.100
0.150
0.200
0.250
0.300
homogeneous TTO
slight moderate severe unable/extreme

36. An EQ-5D-5L value set for England
30 October 2014
The low value of the constant

37. An EQ-5D-5L value set for England
30 October 2014
• Variation is caused by:
• Differences of opinion
• Errors
• You can value at 0.5 or 0, but you can’t value
at 1.5 or 2
• If it is errors, and not opinions, which are
driving the lower values, the mean may not be
the right measure to reflect ‘average’ opinion
• There is error-censoring at 1
Are (have) we (been) doing this
correctly?

38. An EQ-5D-5L value set for England
30 October 2014
The low value of the constant

39. An EQ-5D-5L value set for England
30 October 2014
TTO value by number of moves
-1 -0.95 -0.9 -0.85 -0.8 -0.7 -0.65 -0.6 -0.55 -0.5 -0.5 -0.4 -0.4 -0.3 -0.3 -0.2 -0.2 -0.1 -0.1 0 0.1 0.1 0.2 0.2 0.3 0.3 0.4 0.4 0.5 0.5 0.6 0.6 0.7 0.7 0.8 0.8 0.9 0.9 1 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 223
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 596 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 222 0 0 0 0 0 0 0 0 0 865 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 123 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 275 0 0 0 279 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 48 0 0 0 14 0 0 0 0 0 0 0 6 0 2 0 0 0 242 0 0 44 0 48 0 0 337 0 0 0 0 0 0
0 0 0 0 0 55 0 0 10 0 5 0 0 8 0 0 0 0 0 0 1 0 0 187 0 0 43 2 0 67 0 5 52 0 0 385 0 0 0 0
0 0 0 0 20 0 5 2 0 7 0 0 6 0 0 17 0 0 0 1 0 89 1 0 20 4 0 33 7 0 6 37 0 17 36 0 0 313 0 0
0 0 30 0 0 1 0 3 1 0 0 3 0 1 2 0 0 11 0 0 71 0 18 7 1 19 4 2 3 28 3 1 5 18 0 16 42 0 457 0
0 71 0 1 0 2 2 0 0 2 0 0 1 0 0 0 2 0 11 45 0 13 0 20 1 1 2 8 5 13 0 7 3 3 5 19 0 40 0 645
305 0 1 0 1 0 0 1 0 0 0 2 0 0 0 2 0 4 0 29 7 7 1 2 0 5 2 1 0 11 0 4 1 7 2 7 2 4 105 0
0 1 0 0 0 1 1 0 0 2 0 0 0 2 0 1 0 0 2 1 3 3 1 0 1 2 0 2 1 5 3 2 1 5 0 3 1 12 2 18
4 0 2 0 0 0 0 1 0 1 0 1 0 0 0 1 0 0 2 6 0 2 1 3 1 3 0 1 1 3 0 3 0 0 0 7 0 4 12 8
2 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 1 0 0 5 0 2 0 0 0 1 1 2 1 2 0 0 0 1 0 0 0 5 6 4
0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 1 3 1 0 0 0 0 3 0 1 0 0 1 2 0 1 1 1 0 4 3 2
0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 2 0 1 1 1 1 1 0 1 0 6 0 2 0 2 0 0 0 0 2 15
0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 2 0 2 0 0 1 1 0 0 0 0 4 0
6 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 3 0 1 0 1 0 0 0 0 0 1 0 1 0 0 1 0 0 0 1 0
0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 2
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1
1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 1 0 0 0 2 0 0 0 0 0 2 0 0 1 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1
0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0
1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

40. An EQ-5D-5L value set for England
30 October 2014
The
resulting
EQ-5D-
5L value
set
model
England EQ-5D-5L values 95% CIs
constant 1.003 (0.983 - 1.019)
Mobility slight 0.057 (0.043 - 0.075)
moderate 0.075 (0.057 - 0.093)
severe 0.208 (0.190 - 0.227)
unable 0.255 (0.237 - 0.275)
Self-care slight 0.058 (0.045 - 0.074)
moderate 0.083 (0.061 - 0.101)
severe 0.176 (0.157 - 0.197)
unable 0.208 (0.189 - 0.225)
Usual activities slight 0.048 (0.033 - 0.066)
moderate 0.067 (0.047 - 0.086)
severe 0.165 (0.147 - 0.180)
unable 0.165 (0.152 - 0.184)
Pain/discomfort slight 0.059 (0.042 - 0.075)
moderate 0.080 (0.059 - 0.098)
severe 0.245 (0.225 - 0.264)
extreme 0.298 (0.278 - 0.317)
Anxiety/depression slight 0.073 (0.058 - 0.089)
moderate 0.099 (0.079 - 0.119)
severe 0.282 (0.263 - 0.298)
extreme 0.282 (0.267 - 0.300)

41. An EQ-5D-5L value set for England
30 October 2014
EQ-5D-5L value set for England Example: the value for health state 23245
constant 1.003 Constant =1.003
Mobility = 2 0.057 Minus MO level 2 -0.057
Mobility = 3 0.075
Mobility = 4 0.208
Mobility = 5 0.255
Self-care = 2 0.058
Self-care = 3 0.083 Minus SC level 3 -0.083
Self-care = 4 0.176
Self-care = 5 0.208
Usual activities = 2 0.048 Minus UA level 2 -0.048
Usual activities = 3 0.067
Usual activities = 4 0.165
Usual activities = 5 0.165
Pain/discomfort = 2 0.059
Pain/discomfort = 3 0.080
Pain/discomfort = 4 0.245 Minus PD level 4 -0.245
Pain/discomfort = 5 0.298
Anxiety/depression = 2 0.073
Anxiety/depression = 3 0.099
Anxiety/depression = 4 0.282
Anxiety/depression = 5 0.282 Minus AD level 5 -0.282
State 23245 = 0.288
EQ-5D-5L
values for
England:
a worked
example

42. An EQ-5D-5L value set for England
30 October 2014
Comparison with 3L and crosswalk
5L value set Crosswalk value set 3L value set
% health states
worse than dead
3.2% (100 out of
3,125)
26.66% (833 out of
3,125)
34.57% (84 out of
243)
Preferences
regarding
dimensions (from
the most important
to the least
important)
Pain/Discomfort Pain/Discomfort Pain/Discomfort
Anxiety/Depression Mobility Mobility
Mobility Anxiety/Depression Anxiety/Depression
Self-care Self-care Self-care
Usual Activities Usual Activities Usual Activities
Value of 55555
(33333)
-0.205 -0.49 -0.594
Value of 11112* 0.927 0.879 0.848
Value of 11121* 0.941 0.837 0.796
Value of 11211* 0.952 0.906 0.883
Value of 12111* 0.942 0.846 0.815
Value of 21111* 0.943 0.877 0.850
Minimum value -0.205 -0.49 -0.594
Maximum value 1 1 1
Range of values [-0.205, 1] [-0.594, 1] [-0.594, 1]

43. An EQ-5D-5L value set for England
30 October 2014
Distributions of values
0
.5
1
1.5
Density
-.5 0 .5 1
value
0
.5
1
1.5
2
Density
-.5 0 .5 1
value
0
.5
1
1.5
2
Density
-.5 0 .5 1
value
3L crosswalk
5L

44. An EQ-5D-5L value set for England
30 October 2014
Values and ‘misery scores’
-.5
0
.5
1
5 10 15
misery
eq5d3l Fitted values
-.5
0
.5
1
5 10 15 20 25
misery
eq5d5l Fitted values
-.5
0
.5
1
5 10 15 20 25
misery
eq5d5l Fitted values
3L crosswalk
5L

45. An EQ-5D-5L value set for England
30 October 2014
Comparing 3L and 5L data
3L value set 5L value set
% logical
inconsistencies
4.89%
(166 out of 3,395)
8.43%
(84 out of 996)
% who do not give
their lowest value to
the worst health state
29.19%
(991 out of 3,395)
28.92%
(288 out of 996)

46. An EQ-5D-5L value set for England
30 October 2014
Implications of the results
• The 5L Value set for England has a lower range of values than
the current UK EQ-5D value set
• Higher minimum value for 55555 (5L) (-0.205) than 33333
(3L) (-0.56): as expected, given known issues with the Dolan
(1997) value set
• The proportion of health states with negative values is
considerably lower
• No ‘N3’ term – it did not improve the model
• Implies treatments for very severe conditions may have lower
QALY gains than at present
• The greater descriptive sensitivity of the EQ-5D-5L will be
somewhat counteracted by the nature of the 5L value set
compared to the previous 3L value set

47. An EQ-5D-5L value set for England
30 October 2014
Implications of the results
• For two dimensions, anxiety/depression and usual
activities, the TTO results did not differentiate between
levels 4 and 5
• e.g. interventions that reduce the level of
anxiety/depression from extreme to severe will show few
QALY gains
• Potential implications for other applications of the value
set e.g. in the PROMs programme, where it is used to
measure hospital performance

48. An EQ-5D-5L value set for England
30 October 2014
Remaining research questions
• This presentation has focussed on the value set for
England – we have also collected data for Scotland, Wales
and NI, and will be estimating a UK value set
• How do values compare with other countries? Over a
dozen 5L value set studies underway internationally, using
a consistent methodology
• Many remaining methodological issues…for example,
– the effect of valuation full health vs. 11111 in the TTO
– Describing health states ‘in context’ of the full health
state descriptive system
– DCE with duration
– Remodelling the 3L value set with the new methods