Background We investigate whether and how general population health state values were influenced ... more Background We investigate whether and how general population health state values were influenced by the initial stages of the COVID-19 pandemic. Changes could have important implications, as general population values are used in health resource allocation. Data In Spring 2020, participants in a UK general population survey rated 2 EQ-5D-5L states, 11111 and 55555, as well as dead, using a visual analogue scale (VAS) from 100 = best imaginable health to 0 = worst imaginable health. Participants answered questions about their pandemic experiences, including COVID-19’s effect on their health and quality of life, and their subjective risk/worry about infection. Analysis VAS ratings for 55555 were transformed to the full health = 1, dead = 0 scale. Tobit models were used to analyse VAS responses, as well as multinomial propensity score matching (MNPS) to create samples balanced according to participant characteristics. Results Of 3021 respondents, 2599 were used for analysis. There were ...
General population health state values are used in healthcare resource allocation, including heal... more General population health state values are used in healthcare resource allocation, including health technology assessment. We examine whether UK general population health valuations changed during the COVID‐19 pandemic. Ratings of EQ‐5D‐5L health states 11111 (no problems), 55555 (extreme problems), and dead were collected in a UK general population survey during the pandemic (April–May 2020) using the 0 = worst imaginable health, 100 = best imaginable health visual analog scale (EQ‐VAS). Ratings for 55555 were transformed to a full health = 1, dead = 0 scale. Responses were compared to similar data collected pre‐pandemic (2018). After propensity score matching to minimize sample differences, EQ‐VAS responses were analyzed using Tobit regressions. On the 0–100 scale, 11111 was rated on average 8.67 points lower, 55555 rated 9.56 points higher, and dead rated 7.45 points lower post‐pandemic onset compared to pre‐pandemic. On the full health = 1, dead = 0 scale, 55555 values were 0.09...
Where a licence is displayed above, please note the terms and conditions of the licence govern yo... more Where a licence is displayed above, please note the terms and conditions of the licence govern your use of this document. When citing, please reference the published version. While the University of Birmingham exercises care and attention in making items available there are rare occasions when an item has been uploaded in error or has been deemed to be commercially or otherwise sensitive.
indicated as primary (n = 5) or secondary (n = 22; of which 4 are secondary and/or exploratory) o... more indicated as primary (n = 5) or secondary (n = 22; of which 4 are secondary and/or exploratory) or both (n = 12).The majority of PRO statements are characterized as sign and symptom measures followed by HRQOL measures. Within FDA, 5 required PRO and 8 suggest use of PRO. The majority of PRO statements are characterized as sign and symptom measures, followed by measures of function/ feeling. CONCLUSIONS: PRO data in many disease areas are viewed by regulatory agencies as supportive evidence of the primary endpoint. PRO data are essential in the support of product submissions to regulatory stakeholders, especially within EMEA.
patients with T2DM in the UK had significantly lower (p 0.0001) physical summary scores than othe... more patients with T2DM in the UK had significantly lower (p 0.0001) physical summary scores than other EU countries. Patients experiencing depression symptoms were more likely to visit the ER [OR 1.74; 95% CI:(1.35, 2.23); p 0.0001], be hospitalized [OR 1.43; 95% CI:(1.11, 1.84); p 0.005] and had more physician visits in the last six months ( 5.37, p 0.0001). Patients in Spain had significantly more provider visits (p 0.05) and ER visits (p 0.0001) than UK patients, while patients in France were hospitalized more often than UK patients (p 0.05). CONCLUSIONS: Comorbid depression in patients with T2DM greatly decreases physical and mental summary scores of the SF-12, and increases resource use. Further research is needed to clarify associations between the two conditions, including geographical and cultural influences on health outcomes in this cohort.
Medical decision making : an international journal of the Society for Medical Decision Making, Feb 22, 2015
Most EQ-5D-3L valuation studies include the same sample of health states that was used in the pro... more Most EQ-5D-3L valuation studies include the same sample of health states that was used in the protocol of the original UK Measurement and Valuation of Health (MVH) study. Thus far, no studies using a time tradeoff utility elicitation method have been carried out using all 243 EQ-5D health states. Because the values and preferences regarding health outcomes differ among countries, it is essential to have country-specific data to enable local high-level decisions regarding resource allocation. This study developed a country-specific set of values for EQ-5D-3L health states. A multicentric study was conducted in 4 Brazilian areas. A probabilistic sample of the general population, aged 18 to 64 y, stratified by age and gender, was surveyed. The interview followed a revised version of the MVH protocol, in which all 243 health states were valued. Each respondent ranked and valued 7 health states using the TTO in a home interview. Data were collected from 9148 subjects. The best-fitting re...
Objectives: Cost-effectiveness analysis has been recom- mended by national health agencies worldw... more Objectives: Cost-effectiveness analysis has been recom- mended by national health agencies worldwide. In the United Kingdom, the National Institute of Health and Clinical Excellence supports the use of generic health-related quality of life instruments such as EuroQol EQ-5D when quality- adjusted life-years are used to measure health benefits. Despite the urgent need for appropriate methodologies to improve the use of
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, Jan 19, 2015
To test whether or not adults assign the same values to hypothetical health states that describe ... more To test whether or not adults assign the same values to hypothetical health states that describe health in adults as when those same descriptions refer to the health of a child. A two-part self-completion questionnaire was designed in which respondents were asked firstly to rate a fixed set of EQ-5D-Y health states on a 0-100 visual analogue scale as if they themselves were in these states. Two versions of the questionnaire were produced each with a different second part. One version instructed respondents to value the same states but to imagine them describing another adult. The second version required respondents to value these states as if they applied to a 10-year-old child. Questionnaires were distributed to adults recruited in three countries (Germany, Spain and England) using convenience sampling methods. A total of 1085 questionnaires were completed. Despite some significant differences in the characteristics of the achieved samples in the three countries involved, the rank ...
patients with T2DM in the UK had significantly lower (p 0.0001) physical summary scores than othe... more patients with T2DM in the UK had significantly lower (p 0.0001) physical summary scores than other EU countries. Patients experiencing depression symptoms were more likely to visit the ER [OR 1.74; 95% CI:(1.35, 2.23); p 0.0001], be hospitalized [OR 1.43; 95% CI:(1.11, 1.84); p 0.005] and had more physician visits in the last six months ( 5.37, p 0.0001). Patients in Spain had significantly more provider visits (p 0.05) and ER visits (p 0.0001) than UK patients, while patients in France were hospitalized more often than UK patients (p 0.05). CONCLUSIONS: Comorbid depression in patients with T2DM greatly decreases physical and mental summary scores of the SF-12, and increases resource use. Further research is needed to clarify associations between the two conditions, including geographical and cultural influences on health outcomes in this cohort.
Background: EQ-5D-3L valuation studies continue to employ the MVH protocol or variants of MVH. On... more Background: EQ-5D-3L valuation studies continue to employ the MVH protocol or variants of MVH. One issue that has received attention is the selection of the states for direct valuation by respondents. Changes in the valuation subset have been found to change the coefficients of the utility function. The purpose of this study was to test the performance of valuation subsets based on orthogonal experiment designs. The design of the study also allowed a comparison of models based on raw or untransformed VAS values with values transformed at the level of the respondent and at the aggregate level. Methods: Two different valuation subsets were developed based on orthogonal arrays. A VAS elicitation was undertaken with two groups of similar respondents and the resulting utility functions based on the valuations of the two different valuation subsets were compared using mean absolute errors between model and observed values, and by correlation with values in and out of sample. The impact of using untransformed versus VAS values transformed at the level of the individual and at aggregate level and the inclusion of a constant term in the utility functions were also investigated. Results: The utility functions obtained from the two valuation subsets were very similar. The models that included a constant and based on raw VAS values from the two valuation studies returned rank correlation coefficients of 0.994 and 0.995 when compared with respective observed values. MAEs of model values with observed values were 2.4% or lower for all models that included a constant term. Several models were developed and evaluated for the combined data (from both valuation subsets). The model that included the N3 term performed best. The finding that two very different valuation subsets can produce strikingly similar utility functions suggests that orthogonal designs should be given some attention in further studies. The impact of rescaling VAS values at the level of the individual versus at aggregate level had minimal impact on the performance of the models when compared to models based on the raw VAS values.
BACKGROUND: Quality of life weights based on valuations of health states are often used in cost u... more BACKGROUND: Quality of life weights based on valuations of health states are often used in cost utility analysis and population health measures. This paper reports on an attempt to develop quality of life weights within the Zimbabwe context. METHODS: 2,384 residents in randomly selected small residential plots of land in a high-density suburb of Harare valued descriptors of 38 health states based on different combinations of the five domains of the EQ-5D (mobility, self-care, usual activities, pain or discomfort and anxiety or depression). The English version of the EQ-5D was used. The time trade-off method was used to determine the values, and 19,020 individual preferences for health states were analysed. A residual maximum likelihood linear mixed model was used to estimate a function for predicting the values of all possible combinations of levels on the five domains. The model was fit to a random subset of two-thirds of the observations, with the remaining observations reserved f...
report well. However, the utilities subsequently derived followed an unconventional, bunched shap... more report well. However, the utilities subsequently derived followed an unconventional, bunched shape compared to the original study. By optimizing the parameters in order to minimize the sum of squared errors between approaches, a more suitable approach ("Beta rank fit") was identified. Utilities could in principle therefore be derived using this method alone, without recourse to TTO models. ConClusions: This paper outlines an approach that may be suitable for converting ordinal preference data into cardinal utilities, and offering a number of advantages over previously described approaches. Ranking exercises for participants are considerably easier to carry out than full TTO studies, so the approach may be suitable for resource limited settings or for underrepresented subpopulations.
This study analyzes how different health dimensions defined by the EQ-5D-3L instrument affect ave... more This study analyzes how different health dimensions defined by the EQ-5D-3L instrument affect average individual preferences for health states. This analysis is an important benchmark for the incorporation of health technologies as it takes into consideration Brazilian population preferences in health resource allocation decisions. The EQ-5D instrument defines health in terms of five dimensions (mobility, daily activities, self-care activities, pain/discomfort, and anxiety/depression) each divided into three levels of severity. Data came from a valuation study with 3,362 literate individuals aged between 18 and 64 living in urban areas of Minas Gerais State, Brazil. The main results reveal that health utility decreases as the level of severity increases. With regard to health issues, mobility stands out as the most important EQ-5D dimension. Independently of severity levels of the other EQ-5D-3L dimensions, the highest decrements in utilities are associated with severe mobility prob...
To elicit preference weights for a subset of EuroQol fivedimensional (EQ-5D) questionnaire health... more To elicit preference weights for a subset of EuroQol fivedimensional (EQ-5D) questionnaire health states from a representative sample for the state of Minas Gerais, Brazil, using a time tradeoff (TTO) method and to analyze these data so as to estimate social preference weights for the complete set of 243 states. Methods: Data came from a valuation study with 3362 literate individuals aged between 18 and 64 years living in urban areas. The present study was based on quota sampling by age and sex. Face-to-face interviews were conducted in participants' own homes. A total of 99 EQ-5D questionnaire health states were selected, presorted into 26 blocks of six unique health states. Each participant valued one block together with the full health, worst health, and dead states. Each health state was evaluated by more than 100 individuals. TTO data were modeled at both individual and aggregate levels by using ordinary least squares and random effects methods. Results: Values estimated by different models yielded very similar results with satisfactory goodness-of-fit statistics: the mean absolute error was around 0.03 and fewer than 25% of the states had a mean absolute error greater than 0.05. Dummies coefficients for each level within the EQ-5D questionnaire dimensions of health displayed an internally consistent ordering, with the mobility dimension demonstrating the largest value decrement. The values of mean observed transformed TTO values range from 0.869 to À0.235. Conclusions: The study demonstrates the feasibility of conducting face-to-face interviews using TTO in a Brazilian population setting. The estimated values for EQ-5D questionnaire health states based on this Minas Gerais survey represent an important first step in establishing national Brazilian social preference weights for the EQ-5D questionnaire.
(mCRC) was not recommended in the UK (until June 2009), but accepted under a price volume agreeme... more (mCRC) was not recommended in the UK (until June 2009), but accepted under a price volume agreement scheme with prior authorization in Italy, and without restriction in France and Germany. These products are funded on top of DRG costs in France, but not in other countries. We reviewed how such differences might affect usage of TRZ and CTX in France, Germany, Italy and UK. METHODS: Data on drug utilization from June 2006 to July 2009 were extracted from the Synovate Oncology Monitor, an ongoing database tracking prescribing of anti-cancer therapies. Sample sizes varied between countries and indications, from 1700 to 6200 patients. RESULTS: Proportions of patients receiving TRZ from July 08 to June 09 ranged from 9% (UK) to 16% (Italy) in early BC, 12% (Italy) to 19% (France) in first-line advanced BC and 10% (France) to 34% (Italy) in second-line (irrespective of HER2 screening). For CTX, utilization rates ranged from 0% (UK) to 13% (France) in firstline and 2% (UK) to 19% (Italy) in second-line. Utilization of TRZ increased over time in early stage BC. Utilization of CTX was stable in France, increased in Germany and decreased in Italy. Dosages and patient profiles were comparable across countries. CONCLUSIONS: Funding on top of DRG does not appear to increase drug uptake. Health technology assessment conclusions influence utilization strongly. When access is granted, administrative constraints may reduce first-line utilization to the benefit of second-line. This should be considered when decisions are made about access to innovative medicine.
The Disease Elimination Life Table Analysis (DELTA) approach allows deterministic modelling of in... more The Disease Elimination Life Table Analysis (DELTA) approach allows deterministic modelling of interventions which affect the incidence of several diseases, such as smoking cessation, hormone therapy and diabetes prevention, without causing the number of health states to explode. To analyse the differences of applying the DELTA approach to an individual patient simulation model for modelling diabetes. METHODS: Five diseases are modelled; macrovascular disease (including MI's and strokes), heart failure, retinopathy, renal disease and peripheral vascular disease. The price for modelling these diseases deterministically is three assumptions concerning independence: the probability to get a disease (to die) in submodel A is independent of the probability to get a disease (to die) in sub-model B. The same UK Prospective Diabetes Study (UKPDS) risk equations are used in the patient simulation model as in the DELTA model. Using both models estimates are obtained and compared concerning life expectancies and the time in different diseases. Probabilistic sensitivity analyses are carried out to obtain confidence intervals surrounding the estimates. The expected life time QALY's for females of ages 47, 52, 57, and 62 in the UKPDS and DELTA models are 20.2, 17.9, 15.7 and 13.5, and 20.1, 17.6, 15.1, and 13.2 respectively. Similarly for males the expected life time QALY's in both models are 19.0, 16.2, 13.6, and 11.1 and 18.9, 16.0, 13.3, and 10.34 respectively. The time needed for a probabilistic sensitivity analysis with 100 draws from the uncertainty distribution is approximately 10 seconds. CONCLUSION: The DELTA approach offers a flexible way to model multiple diseases at the same time. The underlying independency assumptions-which may restrict its need-do not seem to affect the outcomes in the case of modelling diabetes. The loss in terms of subtlety seem to be outweighed by the gains in clarity and computational speed.
Objectives: This study establishes the South Korean population-based preference weights for EQ-5D... more Objectives: This study establishes the South Korean population-based preference weights for EQ-5D based on values elicited from a representative national sample using the time trade-off (TTO) method. Methods: The data for this paper came from a South Korean EQ-5D valuation study where 1307 representative respondents were invited to participate and a total of 101 health states defined by the EQ-5D descriptive system were directly valued. Both aggregate and individual level modeling were conducted to generate values for all 243 health states defined by EQ-5D. Various regression techniques and model specifications were also examined in order to produce the best fit model. Final model selection was based on minimizing the difference between the observed and estimated value for each health state. The N3 model yielded the best fit for the observed TTO value at the aggregate level. It had a mean absolute error of 0.029 and only 15 predictions out of 101 had errors exceeding 0.05 in absolute magnitude. The study successfully establishes South Korean populationbased preference weights for the EQ-5D. The value set derived here is based on a representative population sample, limiting the interpolation space and possessing better model performance. Thus, this EQ-5D value set should be given preference for use with the South Korean population.
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