OHE_ seminar_5L_value_set_Oct2014
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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.
![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]](https://image.slidesharecdn.com/oheseminar5lvaluesetoct2014revisedjun15-150713081627-lva1-app6891/85/OHE_-seminar_5L_value_set_Oct2014-42-320.jpg)
OHE_ seminar_5L_value_set_Oct2014
- 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 Please do not quote from or circulate these slides without permission of the presenting authors.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