Estimating an EQ-5D-5L Value Set for China
TL;DR: The 8-parameter multiplicative model performed the best in the study and therefore was used to generate the EQ-5D-5L value set for China and is recommend using rescaled values whereby 1 represents the value of instrument-defined full health in economic evaluation of health technologies in China whenever the EQ/5D/5L data are available.
About: This article is published in Value in Health.The article was published on 2017-04-01 and is currently open access. It has received 280 citations till now. The article focuses on the topics: EQ-5D & Regression analysis.
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TL;DR: 5L provides more precise measurement at individual and group levels, both in terms of descriptive system data and utilities, which is likely to be generalisable to longitudinal studies, including economic evaluation, clinical and public health studies.
Abstract: Objective: This study describes the first empirical head-to-head comparison of EQ-5D-3L (3L) and EQ-5D-5L (5L) value sets for multiple countries. Methods: A large multinational dataset, including 3L and 5L data for eight patient groups and a student cohort, was used to compare 3L versus 5L value sets for Canada, China, England/UK (5L/3L, respectively), Japan, The Netherlands, South Korea and Spain. We used distributional analyses and two methods exploring discriminatory power: relative efficiency as assessed by the F statistic, and an area under the curve for the receiver-operating characteristics approach. Differences in outcomes were explored by separating descriptive system effects from valuation effects, and by exploring distributional location effects. Results: In terms of distributional evenness, efficiency of scale use and the face validity of the resulting distributions, 5L was superior, leading to an increase in sensitivity and precision in health status measurement. When compared with 5L, 3L systematically overestimated health problems and consequently underestimated utilities. This led to bias, i.e. over- or underestimations of discriminatory power. Conclusion: We conclude that 5L provides more precise measurement at individual and group levels, both in terms of descriptive system data and utilities. The increased sensitivity and precision of 5L is likely to be generalisable to longitudinal studies, such as in intervention designs. Hence, we recommend the use of the 5L across applications, including economic evaluation, clinical and public health studies. The evaluative framework proved to be useful in assessing preference-based instruments and might be useful for future work in the development of descriptive systems or health classifications.
200 citations
TL;DR: The challenges faced in EQ-5D-5L valuation since 2012 are presented and how these were resolved and a set of new challenges that have become central in currently ongoing research on how EQ-4D-4L health states should be valued and modeled are described.
151 citations
TL;DR: In a trial involving Chinese patients with basilar-artery occlusion, approximately one third of whom received intravenous thrombolysis, endovascular thrombectomy within 12 hours after stroke onset led to better functional outcomes at 90 days than best medical care but was associated with procedural complications and intracerebral hemorrhage.
Abstract: BACKGROUND
Data from trials investigating the effects and risks of endovascular thrombectomy for the treatment of stroke due to basilar-artery occlusion are limited.
METHODS
We conducted a multicenter, prospective, randomized, controlled trial of endovascular thrombectomy for basilar-artery occlusion at 36 centers in China. Patients were assigned, in a 2:1 ratio, within 12 hours after the estimated time of basilar-artery occlusion to receive endovascular thrombectomy or best medical care (control). The primary outcome was good functional status, defined as a score of 0 to 3 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]), at 90 days. Secondary outcomes included a modified Rankin scale score of 0 to 2, distribution across the modified Rankin scale score categories, and quality of life. Safety outcomes included symptomatic intracranial hemorrhage at 24 to 72 hours, 90-day mortality, and procedural complications.
RESULTS
Of the 507 patients who underwent screening, 340 were in the intention-to-treat population, with 226 assigned to the thrombectomy group and 114 to the control group. Intravenous thrombolysis was used in 31% of the patients in the thrombectomy group and in 34% of those in the control group. Good functional status at 90 days occurred in 104 patients (46%) in the thrombectomy group and in 26 (23%) in the control group (adjusted rate ratio, 2.06; 95% confidence interval [CI], 1.46 to 2.91, P<0.001). Symptomatic intracranial hemorrhage occurred in 12 patients (5%) in the thrombectomy group and in none in the control group. Results for the secondary clinical and imaging outcomes were generally in the same direction as those for the primary outcome. Mortality at 90 days was 37% in the thrombectomy group and 55% in the control group (adjusted risk ratio, 0.66; 95% CI, 0.52 to 0.82). Procedural complications occurred in 14% of the patients in the thrombectomy group, including one death due to arterial perforation.
CONCLUSIONS
In a trial involving Chinese patients with basilar-artery occlusion, approximately one third of whom received intravenous thrombolysis, endovascular thrombectomy within 12 hours after stroke onset led to better functional outcomes at 90 days than best medical care but was associated with procedural complications and intracerebral hemorrhage. (Funded by the Program for Innovative Research Team of the First Affiliated Hospital of USTC and others; ATTENTION ClinicalTrials.gov number, NCT04751708.).
100 citations
TL;DR: A Thai value set for EQ-5D using hybrid model is developed based on societal preferences of Thai population to facilitate health technology assessment studies to inform policy decision-making as well as to promote the use of EQ- 5D-5L in various health research in Thailand.
Abstract: Background: At present, health technology assessment (HTA) guidelines of many countries including Thailand have recommended EQ-5D as the preferred method for assessing utility. This study aims to g...
86 citations
Cites background from "Estimating an EQ-5D-5L Value Set fo..."
...Recently, the value sets for EQ-5D5L have been generated for many countries such as England [16], Canada [17], Korea [18], Japan [19], China [20], Uruguay [21], Indonesia [22], and the Netherlands [23]....
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...Canada [17], Korea [18], Japan [19], China [20], Uruguay [21], Indonesia [22], and the Netherlands [23]....
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...In Thailand, the second best health state for Thai EQ-5D-5L is 11121 (utility = 0.9436) while they were 11211 and 21111 for England (utility = 0.950), 11211 for China (utility = 0.955), and 11112 for Indonesia (utility = 0.921)....
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TL;DR: In this paper, the authors used the data collected in an EQ-5D-5L valuation study in China between December 2012 and January 2013 to generate Chinese population norms for the EQ5D5L dimensions.
Abstract: To generate Chinese population norms for the EQ-5D-5L dimensions, EQ-VAS (Visual Analogue Scale) scores and EQ-5D-5L index scores, stratified by gender and age. The EQ-5D is a widely used generic health-related quality of life instrument to describe population health and health outcomes in clinical trials and health economic evaluations. Currently, there are no EQ-5D-5L population norms for China. This norm study utilized the data collected in an EQ-5D-5L valuation study in China between December 2012 and January 2013. In the valuation study, respondents were asked to report their own health states using the EQ-5D-5L descriptive system and the EQ-VAS. Respondents’ demographic information was also collected. The EQ index score was calculated using the EQ-5D-5L value set based on the Chinese urban population. Norm scores were reported by important demographic variables. The mean EQ-VAS scores ranged between 88.3 for males of 70 years to 0.971 for females of 30–39 years. Respondents reported more problems in the dimensions ‘pain/discomfort’ and ‘anxiety/depression’ than in the dimensions ‘mobility’, ‘self-care’ and ‘usual activities’ in all age groups. The population norm scores for the EQ-5D can be used as reference values for comparative purposes in future Chinese studies. Further research into rural and/or a more representative population is warranted.
82 citations
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TL;DR: The fourth edition of the Methods for the Economic Evaluation of Health Care Programmes as mentioned in this paper has been thoroughly revised and updated, making it essential reading for anyone commissioning, undertaking, or using economic evaluations in health care, including health service professionals, health economists, and health care decision makers.
Abstract: The purpose of economic evaluation is to inform decisions intended to improve healthcare. The new edition of Methods for the Economic Evaluation of Health Care Programmes equips the reader with the necessary tools and understanding required to undertake evaluations by providing an outline of key principles and a 'tool kit' based on the authors' own experiences of undertaking economic evaluations. Building on the strength of the previous edition, the accessible writing style ensures the text is key reading for the non-expert reader, as no prior knowledge of economics is required. The book employs a critical appraisal framework, which is useful both to researchers conducting studies and to decision-makers assessing them. Practical examples are provided throughout to aid learning and understanding. The book discusses the analytical and policy challenges that face health systems in seeking to allocate resources efficiently and fairly. New chapters include 'Principles of economic evaluation' and 'Making decisions in healthcare' which introduces the reader to core issues and questions about resource allocation, and provides an understanding of the fundamental principles which guide decision making. A key part of evidence-based decision making is the analysis of all the relevant evidence to make informed decisions and policy. The new chapter 'Identifying, synthesising and analysing evidence' highlights the importance of systematic review, and how and why these methods are used. As methods of analysis continue to develop, the chapter on 'Characterising, reporting and interpreting uncertainty' introduces the reader to recent methods of analysis and why characterizing uncertainty matters for health care decisions. The fourth edition of Methods for the Economic Evaluation of Health Care Programmes has been thoroughly revised and updated, making it essential reading for anyone commissioning, undertaking, or using economic evaluations in health care, including health service professionals, health economists, and health care decision makers.
8,314 citations
01 Jan 1998
TL;DR: The second edition of the first edition of this book was published in 1987 as discussed by the authors, and the second edition includes new chapters on collection and analysis of data and on the presentation and use of data.
Abstract: We are witnessing a paradigm shift in the way medicine is practiced, taught, and evaluated. It was relatively recently that medicine knew no limits. New diagnostic procedures led to more medical and surgical procedures and to greater expense. It was assumed that patients would be the recipient of these advances. However, the uncontrolled costs of medical care and the poor documentation of patient benefit ushered in a new era of cost conscientiousness. Now, there is a need to show that medicine produces value for money. As a result, new methodologies such as cost-effectiveness analysis, cost-benefit analysis, and cost-utility analysis have become commonplace in medical journals. This has created a need to revise medical education and postgraduate training in order to accommodate new methodologies and new controversies. Within the last few years, several influential publications have emerged. Perhaps the most important of these is the book Cost-Effectiveness in Health and Medicine edited by Martha Gold and colleagues.1 This book summarizes the consensus of an expert panel convened to review cost-effectiveness analysis in health care. The Gold book covers the theory but does not teach the methods. Methods for the Economic Evaluation of Health Care Programmes by Michael Drummond and colleagues offers specific, step-by-step methodologies for conducting economic evaluations. This is the second edition of a book originally published in 1987. During the ten years between editions, there were very substantial advances in theory and methods for economic evaluations of health care programs. The revised edition brings the text up to date. Methods for the Economic Evaluation of Health Care Programmes arises from the teaching of health economics at McMaster University. The McMaster Centre for Health Economics and Policy Analysis is internationally regarded as a focal point for economic evaluations of health care. Among other advances, researchers at the Centre have produced a widely used methodology, known as the Health Utilities Index, for estimating the cost/utility of health programs. The book was originally developed for a course at McMaster and for a workshop offered by the McMaster faculty. The second edition adds one new author (Bernie O’Brien) who has more recently joined the McMaster faculty. The second edition also introduces substantial changes in the chapters on cost-effectiveness, cost-utility, and cost-benefit analysis. These are important improvements because of the profound methodological developments in these areas. In addition, the second edition includes new chapters on collection and analysis of data and on the presentation and use of data. These new chapters add discussion on the pros and cons of economic evaluations and on some of the difficulties in the interpretation of economic data. In addition, the second edition includes many more boxes and illustrations to facilitate the interpretation of the text. Perhaps the greatest contribution of the book is the very detailed presentation of cost/utility analysis. It is now common to offer discussions of the cost to produce a year of life adjusted for life quality. This is known as a quality adjusted life year (QALY). There are a variety of different methods for estimating QALYs. Nevertheless, QALYs estimated using different methods are often found in the same comparison or “league” table. This book goes into considerable detail in how QALYs are estimated and describes some of the methodological issues and problems in estimating these outcomes. Unlike other texts, the book provides systematic stepby-step instruction in how both costs and health benefits can be estimated. In summary, the role of health economics is becoming firmly established in the evaluation of health care programs. In combination with Gold and colleagues’ book,1 which provides a detailed theoretical discussion of economic analysis, Methods for the Economic Evaluation of Health Care Programmes offers systematic training in the application of economic methodologies. This book can serve as a basic text for students hoping to understand the complex methodologies of economic evaluation. In addition, the book is a handy reference for advanced practitioners of economic analysis.
6,537 citations
TL;DR: A 5-level version of the EQ-5D has been developed by the EuroQol Group and further testing is required to determine whether the new version improves sensitivity and reduces ceiling effects.
Abstract: This article introduces the new 5-level EQ-5D (EQ-5D-5L) health status measure. EQ-5D currently measures health using three levels of severity in five dimensions. A EuroQol Group task force was established to find ways of improving the instrument's sensitivity and reducing ceiling effects by increasing the number of severity levels. The study was performed in the United Kingdom and Spain. Severity labels for 5 levels in each dimension were identified using response scaling. Focus groups were used to investigate the face and content validity of the new versions, including hypothetical health states generated from those versions. Selecting labels at approximately the 25th, 50th, and 75th centiles produced two alternative 5-level versions. Focus group work showed a slight preference for the wording 'slight-moderate-severe' problems, with anchors of 'no problems' and 'unable to do' in the EQ-5D functional dimensions. Similar wording was used in the Pain/Discomfort and Anxiety/Depression dimensions. Hypothetical health states were well understood though participants stressed the need for the internal coherence of health states. A 5-level version of the EQ-5D has been developed by the EuroQol Group. Further testing is required to determine whether the new version improves sensitivity and reduces ceiling effects.
5,345 citations
"Estimating an EQ-5D-5L Value Set fo..." refers background or methods in this paper
...[4] Herdman M, Gudex C, Lloyd A, et al....
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...The new version is referred to as the EQ-5D-5L [4]....
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TL;DR: The model presented in this article appears to predict the values of the states for which there are direct observations and, thus, can be used to interpolate values for theStates for which no direct observations exist.
Abstract: OBJECTIVES. It has become increasingly common for preference-based measures of health-related quality of life to be used in the evaluation of different health-care interventions. For one such measure, The EuroQol, designed to be used for these purposes, it was necessary to derive a single index value for each of the 243 health states it generates. The problem was that it was virtually impossible to generate direct valuations for all of these states, and thus it was necessary to find a procedure that allows the valuations of all EuroQol states to be interpolated from direct valuations on a subset of these. METHODS. In a recent study, direct valuations were elicited for 42 EuroQol health states (using the time trade-off method) from a representative sample of the UK population. This article reports on the methodology that was adopted to build up a "tariff" of EuroQol values from this data. RESULTS. A parsimonious model that fits the data well was defined as one in which valuations were explained in terms of the level of severity associated with each dimension, an intercept associated with any move away from full health, and a term that picked up whether any dimension in the state was at its most severe level. CONCLUSIONS. The model presented in this article appears to predict the values of the states for which there are direct observations and, thus, can be used to interpolate values for the states for which no direct observations exist.
4,324 citations
"Estimating an EQ-5D-5L Value Set fo..." refers methods in this paper
...The N5 model, an extension of the EQ-5D-3L N3 model [17]: With N5, the core models were expanded with four additional dummy variables labeled N2, N3, N4, and N5, representing the presence of any problems at levels 2 through 5, respectively....
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...ADD20r corresponds to the method described as random effects or generalized least squares in several EQ-5D valuation studies [17]....
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