Slides from a presentation given by OHE's Patricia Cubi-Molla and Paula Lorgelly on a EQ-5D-3L and EQ-5D-5L longitudinal study of cancer patients: do they capture the same changes in quality of life over time?

1. Do EQ-5D-3L and EQ-5D-5L capture the same
changes in quality of life over time?
A longitudinal study of cancer patients
Patricia Cubi-Molla, Paula Lorgelly (OHE, KCL), Mark
Pennington (KCL), Richard Norman (CurtinU)
XXXVIII Jornadas de Economia de la Salud
Las Palmas de Gran Canaria
20-22 June 2018

2. Presentation at the XXXVIII Jornadas AES
Preliminary results – Please do not cite
3L vs 5L in cancer patients
Background
• How the EQ-5D-3L and EQ-5D-5L capture changes in
quality of life is a key issue for health technology
assessment.
• NICE’s position statement:
• The 3L value set to be used for reference case analyses
• Where 5L data have been collected, reference case
analyses should calculate utilities by mapping the 5L
descriptive system data onto the 3L value set (crosswalk
mapping function by van Hout et al. (2012))
• NICE supports sponsors of prospective clinical studies
continuing to use 5L to collect data on quality of life.

3. Presentation at the XXXVIII Jornadas AES
Preliminary results – Please do not cite
3L vs 5L in cancer patients
Background
• Early econometric modelling implies that the 3L and the
5L will produce substantially different estimates of cost
effectiveness [1-4]. Two-step procedure:
1. External data  mapping algorithm between 3L and 5L
utilities  formula to predict 5L responses from 3L
2. Cost-effectiveness (CE) case studies (3L version) 
apply formula  translate CE results into 5L  compare
• A critique of the mapping methods:
 Individuals’ unobserved characteristics?
 Different impact across the distribution of health
 Reduction of the sensitivity
[1] Hernández-Alava and Pudney JHE 2017 | [2] Hernandez-Alava et al. VinH 2018 |
[3] Knott et al. HE 2017 | [4] Khan et al. HQoLO 2016

4. Presentation at the XXXVIII Jornadas AES
Preliminary results – Please do not cite
3L vs 5L in cancer patients
Objectives / Aim
Our paper contributes to the literature in two main aspects:
1. We compare 3L and 5L results at an individual patient-
level by quantifying changes in health assessed by the
3L and 5L instruments
2. this paper compares the performance of the 3L and 5L
versions of the EQ-5D in capturing changes in quality of
life over time in a cohort of cancer patients.

5. Presentation at the XXXVIII Jornadas AES
Preliminary results – Please do not cite
3L vs 5L in cancer patients
Data: Cancer 2015
• Cancer 2015 is a longitudinal prospective population-
based genomic cancer cohort in Australia.
• EQ-5D, VAS and EORTC QLQ-C30 were asked at baseline
(diagnosis) and at various follow-up points (in our sample
max of seven times/4 years follow-up).
• The 3L was used from 2012 to October 2015, since
October 2015 the 5L has been used.
• Some (earlier) patients only completed the 3L, some
(later) patients only completed the 5L, while some started
on the 3L and moved to the 5L
• We use UK 3L tariffs, English 5L tariffs, 5L crosswalk
• Responses to the EORTC QLQ-C30 were used to generate
EORTC-8D and QLU-C10D values.

6. Presentation at the XXXVIII Jornadas AES
Preliminary results – Please do not cite
3L vs 5L in cancer patients
Method: GenMatch

7. Presentation at the XXXVIII Jornadas AES
Preliminary results – Please do not cite
3L vs 5L in cancer patients
Results (preliminary)
-0.084
-0.019
0.002
0.006
0.025
0.019
0.008
-0.007 -0.007
-0.017
-0.046
-0.010
0.007
-0.003
0.003
-0.100
-0.080
-0.060
-0.040
-0.020
0.000
0.020
0.040
LARGE INCREASE
(0.101 OR
HIGHER)
SMALL INCREASE
(0.021 TO 0.10)
LITTLE CHANGE
(0.02 TO -0.02)
SMALL DECREASE
(-0.021 TO -0.1)
LARGE DECREASE
(-0.101 OR
LOWER)
Tariff 8D CW

8. Presentation at the XXXVIII Jornadas AES
Preliminary results – Please do not cite
3L vs 5L in cancer patients
Summary of main results
• Improvements in HRQoL as measured by the QLU-C10D
(which is derived from the condition specific EORTC QLQ-
C30 instrument) appear to be associated with smaller
changes in utility quantified by the EQ-5D-5L compared
to the EQ-5D-3L. This is consistent with previous
literature.
• When HRQoL is deteriorating between observations then
the 5L tariff is found to produce bigger utility losses.
• The crosswalk (a) loses the increased sensitivity of the 5L
(if it detects more change) but (b) it stretches out utility
values across a larger range (the 3L range), and hence
gains or losses are larger and more in line with the 3L
tariffs.

9. Presentation at the XXXVIII Jornadas AES
Preliminary results – Please do not cite
3L vs 5L in cancer patients
Discussion/Limitations
• 3L potentially leading to more attractive incremental
cost-effectiveness ratios for interventions that
improve quality of life?
• Some limitations:
• If patients differed over time, result validity may be
affected.
• Results are not necessarily generalisable to a non-
cancer setting.
• Patients were relatively ‘healthy’ on enrolment into the
cohort

10. Presentation at the XXXVIII Jornadas AES
Preliminary results – Please do not cite
3L vs 5L in cancer patients
To enquire about additional information and analyses, please contact
pcubi-molla@ohe.org
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This study was supported by the EuroQol Foundation (EQ Project 20170410). Cancer
2015 was funded by the Victorian Government through the Victorian Cancer Agency
Translational Research Program.
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