At an OHE seminar on October 30th, OHE’s Professor Devlin and Professor van Hout from University of Sheffield jointly presented the key results from their study ‘An EQ-5D-5L value set for England’. The seminar was well attended, with participants from the Department of Health, NICE, NHS England, the EuroQol Group, academia and pharmaceutical industry.
The EQ-5D is widely used to measure and value changes in health-related quality of life. Respondents self-report their health in terms of five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) with three response levels in each (no, some or extreme problems). A new version of the instrument (EQ-5D-5L) with five response levels (no, slight, moderate, severe or extreme problems) is now available.
A value set is required to link the health states described by the EQ-5D-5L to utility values used in calculating quality-adjusted life years (QALYs). The aim of this project was both to explore theoretical issues relating to how best to elicit and model preferences, and to produce an EQ-5D-5L value set for England.
Professors Devlin and van Hout were awarded a research grant from the Policy Research Programme (PRP) of the National Institute for Health Research (NIHR) for this research. The project team also included Koonal Shah and Yan Feng from OHE and Brendan Mulhern from the University of Sheffield.
Members of the general public in England (n=996), selected at random from residential post codes, were interviewed by Ipsos MORI between November 2012 and March 2013 using a protocol developed by the EuroQol Group. Each respondent was asked to complete 10 health state valuations using a composite Time Trade Off (TTO) approach, and seven paired comparisons of health states via Discrete Choice Experiment (DCE) tasks. Extensive work was undertaken in modelling the data in alternative ways. The final model selected for the EQ-5D-5L value set for England was a 20 parameter hybrid model (i.e. using both TTO and DCE data) with censored errors/opinions.
The seminar highlighted a number of characteristics of the resulting value set. For example, compared with the EQ-5D value set currently used in the UK, the EQ-5D-5L value set for England:
- contains a smaller proportion of states with negative values: 3% of health states have negative values (are ‘worse than being dead’), compared to over a third of the health states in the current EQ-5D value set;
- has a higher minimum value, -0.208, compared to -0.594 in the current EQ-5D UK value set;
- shows that pain/discomfort and anxiety/depression were the aspects of health people placed most importance on, compared with pain/discomfort and mobility in the current EQ-5D value set;
- has values which are normally distributed, rather than the ‘bi-modal’ characteristic of the current EQ-5D value set.
Overall, the valuation data have good ‘face validity’. However, it was notable that the responses did not always suggest the respondents saw a difference between ‘level 4’ and ‘level 5’ problems. This is reflected in the corresponding values for anxiety/depression.
Slides from the seminar are available on Slideshare.
Papers providing details of the methods and results will be released during the coming months.
Further information on the research protocol is available in:
Oppe, M., Devlin, N.., van Hout, B., Krabbe, P. and de Charro, F. (2014) A Program of Methodological Research to Arrive at the New International EQ-5D-5L Valuation Protocol. Value in Health, 17(4), 445 – 453.
The research reported in this seminar is independent research commissioned and funded by the NIHR/ Department of Health Policy Research Programme (‘EQ-5D-5L Value Set for England’ – 070/0073), with additional funding provided by the EuroQol Group. The views expressed in this publication are those of the author(s) and not necessarily those of the Department of Health or the EuroQol Group.