Comparing the EQ-5D-5L crosswalks and value sets for England, the Netherlands and Spain: Exploring their impact on cost-utility results

Impact of Mental Health Literacy on Improving Quality of Life Among Adolescents in Barcelona

Background/Objectives: We aim to assess the effect of the Espaijove.net mental health literacy program on adolescents' quality of life (QOL). Additionally, we aim to describe their QOL and mental well-being. Methods: A multicenter, randomized, controlled trial was conducted, with pre- and post-intervention assessments and 6- and 12-month follow-ups. A total of 1032 students aged 13-14 from 18 schools in Barcelona participated in one of the three following mental health literacy (MHL) programs or were placed in a control group (CG): (1) a 1 h awareness session (G1h); (2) a 6 h MHL program (G6h); (3) a 7 h MHL program with stigma reduction (G7h). Measures: (1) Mental well-being: Strengths and Difficulties Questionnaire (SDQ); (2) QOL: EuroQol 5D-5L with its two parts: the EuroQol 5D-5L Index (0-1) and EuroQol 5D-5L visual analog scale (EQ-VAS) (0-100). Analyses were conducted on an intention-to-treat basis, using data imputation methods for missing data. Intervention effects were assessed using multilevel models. Results: Baseline EQ-VAS and EQ-5D-5L index scores were 77.84 (CI = 76.77-78.91) and 0.91 (CI = 0.90-0.92), respectively. Boys reported higher QOL and SDQ scores (p < 0.001), whereas participants of foreign nationality showed lower scores in QOL (EQ-VAS; p = 0.039) and mental well-being (p < 0.001). Post-intervention, all groups (intervention and control), except G6h, showed QOL improvements. However, in the 6-month follow-up, the CG outperformed the other groups. At 12 months, G7h achieved the highest EQ-VAS scores compared to the other groups. Conclusions: MHL-based interventions improved short-term QOL but failed to sustain these improvements over time. Groups with lower QOL and SDQ scores included girls and adolescents of foreign nationality.

Cost effectiveness of empagliflozin in adult patients with chronic kidney disease in the Netherlands

AIM

The recent EMPA-KIDNEY trial showed evidence for preventing disease progression in adult patients with chronic kidney disease (CKD) treated with empagliflozin. It is however yet unknown if use of empagliflozin is cost effective in the Netherlands. We aimed to evaluate the cost effectiveness of empagliflozin in adult patients with CKD in the Netherlands.

METHODS

A cost-effectiveness analysis was conducted using a Markov state microsimulation model, simulating kidney progression of CKD patients with eGFR <90 ml/min per 1.73 m2 comparing empagliflozin plus standard of care (SoC) and SoC alone. KDIGO classification was used to describe the risk of CKD progression. The input data were taken from the EMPA-KIDNEY trial (baseline characteristics, treatment effect, and utilities), and published data and national sources were used for general population mortality, treatment and event costs. The analyses were performed from a societal perspective with applying a lifetime horizon. Discounting was done according to the Dutch pharmacoeconomic guidelines. The incremental cost-effectiveness ratio (ICER) was compared to a willingness-to-pay threshold of €50,000/QALY. Deterministic and probabilistic sensitivity analyses were performed to explore the impact of uncertainty around the input parameters.

RESULTS

The base-case results showed total discounted costs for empagliflozin plus SoC and SoC alone of €200,193 and €234,574 respectively, indicating total savings of €34,380. Empagliflozin plus SoC was associated with higher total discounted health benefits of 11.06 life years (LYs) and 9.01 quality-adjusted life years (QALYs), compared with 9.74 LYs and 7.79 QALYs for SoC alone, resulting in an additional 1.31 LYs and 1.22 QALYs for empagliflozin plus SoC. Empagliflozin plus SoC is a dominant alternative compared to SoC alone. Sensitivity analyses confirmed the robustness of the findings and conclusion.

CONCLUSION

Using empagliflozin in addition to SoC in adult patients with CKD is likely to be cost saving compared to the current SoC in the Netherlands, irrespective of diabetes status and albuminuria.

To what extent does the use of crosswalks instead of EQ-5D value sets impact reimbursement decisions?: a simulation study

PURPOSE

Inconsistent results have been found on the impact of using crosswalks versus EQ-5D value sets on reimbursement decisions. We sought to further investigate this issue in a simulation study.

METHODS

Trial-based economic evaluation data were simulated for different conditions (depression, low back pain, osteoarthritis, cancer), severity levels (mild, moderate, severe), and effect sizes (small, medium, large). For all 36 scenarios, utilities were calculated using 3L and 5L value sets and crosswalks (3L to 5L and 5L to 3L crosswalks) for the Netherlands, the United States, and Japan. Utilities, quality-adjusted life years (QALYs), incremental QALYs, incremental cost-effectiveness ratios (ICERs), and probabilities of cost-effectiveness (pCE) obtained from values sets and crosswalks were compared.

RESULTS

Differences between value sets and crosswalks ranged from -0.33 to 0.13 for utilities, from -0.18 to 0.13 for QALYs, and from -0.01 to 0.08 for incremental QALYs, resulting in different ICERs. For small effect sizes, at a willingness-to-pay of €20,000/QALY, the largest pCE difference was found for moderate cancer between the Japanese 5L value set and 5L to 3L crosswalk (difference = 0.63). For medium effect sizes, the largest difference was found for mild cancer between the Japanese 3L value set and 3L to 5L crosswalk (difference = 0.06). For large effect sizes, the largest difference was found for mild osteoarthritis between the Japanese 3L value set and 3L to 5L crosswalk (difference = 0.08).

CONCLUSION

The use of crosswalks instead of EQ-5D value sets can impact cost-utility outcomes to such an extent that this may influence reimbursement decisions.

Assessing the psychometric performance of EQ-5D-5L in dementia: a systematic review

BACKGROUND

EQ-5D is widely used for valuing changes in quality of life for economic evaluation of interventions for people with dementia. There are concerns about EQ-5D-3L in terms of content validity, poor inter-rater agreement and reliability in the presence of cognitive impairment, but there is also evidence to support its use with this population. An evidence gap remains regarding the psychometric properties of EQ-5D-5L.

OBJECTIVES

To report psychometric evidence around EQ-5D-5L in people with dementia.

METHODS

A systematic review identified primary studies reporting psychometric properties of EQ-5D-5L in people with dementia. Searches were completed up to November 2020. Study selection, data extraction and quality assessment were undertaken independently by at least 2 researchers.

RESULTS

Evidence was extracted from 20 articles from 14 unique studies covering a range of dementia severity. Evidence of known group validity from 5 of 7 studies indicated that EQ-5D-5L distinguishes severity of disease measured by cognitive impairment, depression, level of dependence and pain. Convergent validity (9 studies) showed statistically significant correlations of weak and moderate strengths, between EQ-5D-5L scores and scores on other key measures. Statistically significant change was observed in only one of 6 papers that allowed this property to be examined. All seven studies showed a lack of inter-rater reliability between self and proxy reports with the former reporting higher EQ-5D-5L scores than those provided by proxies. Five of ten studies found EQ-5D-5L to be acceptable, assessed by whether the measure could be completed by the PwD and/or by the amount of missing data. As dementia severity increased, the feasibility of self-completing EQ-5D-5L decreased. Three papers reported on ceiling effects, two found some evidence in support of ceiling effects, and one did not.

CONCLUSIONS

EQ-5D-5L seems to capture the health of people with dementia on the basis of known-group validity and convergent validity, but evidence is inconclusive regarding the responsiveness of EQ-5D-5L. As disease progresses, the ability to self-complete EQ-5D-5L is diminished.

Can EQ-5D-3L utility values of low back pain patients be validly predicted by the Oswestry Disability Index for use in cost-effectiveness analyses?

PURPOSE

To assess whether regression modeling can be used to predict EQ-5D-3L utility values from the Oswestry Disability Index (ODI) in low back pain (LBP) patients for use in cost-effectiveness analysis.

METHODS

EQ-5D-3L utility values of LBP patients were estimated using their ODI scores as independent variables using regression analyses, while adjusting for case-mix variables. Six different models were estimated: (1) Ordinary Least Squares (OLS) regression, with total ODI score, (2) OLS, with ODI item scores as continuous variables, (3) OLS, with ODI item scores as ordinal variables, (4) Tobit model, with total ODI score, (5) Tobit model, with ODI item scores as continuous variables, and (6) Tobit model, with ODI item scores as ordinal variables. The models' performance was assessed using explained variance (R2) and root mean squared error (RMSE). The potential impact of using predicted instead of observed EQ-5D-3L utility values on cost-effectiveness outcomes was evaluated in two empirical cost-effectiveness analysis.

RESULTS

Complete individual patient data of 18,692 low back pain patients were analyzed. All models had a more or less similar R2 (range 45-52%) and RMSE (range 0.21-0.22). The two best performing models produced similar probabilities of cost-effectiveness for a range of willingness-to-pay (WTP) values compared to those based on the observed EQ-5D-3L values. For example, the difference in probabilities ranged from 2 to 5% at a WTP of 50,000 €/QALY gained.

CONCLUSION

Results suggest that the ODI can be validly used to predict low back pain patients' EQ-5D-3L utility values and QALYs for use in cost-effectiveness analyses.

Health-Related Quality of Life Population Norms for Belize Using EQ-5D-5L

OBJECTIVES

There has been a growing interest in the use of EQ-5D health outcomes measures in Latin America and the Caribbean. Population norms data provide a benchmark against which clinicians, researchers, and policy makers can compare the health status of patient, treatment, or demographic groups. This study aimed to provide EQ-5D-5L population norms for Belize.

METHODS

The EQ-5D-5L questionnaire was included in a national survey in Belize in 2014. The survey also captured key demographic variables. EQ-5D-5L health states, EQ-5D visual analog scale (EQ VAS) scores, and EQ-5D-5L index values (based on the Trinidad and Tobago value set) were obtained for key demographic groups in Belize.

RESULTS

A representative sample of 2078 respondents completed the survey. The mean index value, EQ VAS score, and ceiling level for Belize were 0.947, 82.6, and 67.8%, respectively. Similar to other Caribbean countries, Belizeans self-reported relatively high EQ VAS scores and ceiling levels compared with non-Caribbean regions. Men reported generally higher health status than women, health status declined as age rises, and the dimensions with the highest burden were pain/discomfort and mobility.

CONCLUSIONS

This study provides researchers and practitioners in Belize with tools to use EQ-5D-5L. Users can apply the EQ VAS scores and EQ-5D-5L states presented herein as reference values. Until an EQ-5D-5L value set is created for Belize, the Trinidad and Tobago index values can be applied to Belizean-reported EQ-5D-5L states, which can then be compared with the index values presented in this study.

Properties of the EQ-5D-5L when prospective longitudinal data from 28,902 total hip arthroplasty procedures are applied to different European EQ-5D-5L value sets

Background

The purpose of this study was to evaluate the impact of using different country-specific value sets in EQ-5D-5L based outcome analyses.

Methods

We obtained data on patients surgically treated with total hip arthroplasty (THA) between 2017 and 2019 from the national Swedish Hip Arthroplasty Register. Preoperative and one-year postoperative data on a total of 28,902 procedures were available for analysis. The EQ-5D-5L health states were coded to the EQ-5D-5L preference indices using 13 European value sets. The EQ-5D-5L index distributions were then estimated with kernel density estimation. The change in EQ-5D-5L index before and one year after treatment was evaluated with the standardized response mean (SRM). The lifetime gain in quality-adjusted life years (QALYs) was estimated with a 3.5% annual QALY discount rate.

Findings

There was a marked variability in means and shapes of the resulting EQ-5D-5L index distributions. There were also considerable differences in the EQ-5D-5L index distribution shape before and after the treatment using the same value set. The effect sizes of one-year change (SRM) were similar for all value sets. However, the differences in estimated QALY gains were substantial.

Interpretation

The EQ-5D-5L index distributions varied considerably when a single large data set was applied to different European EQ-5D-5L value sets. The most pronounced differences were between the value sets based on experience-based valuation and the value sets based on hypothetical valuation. This illustrates that experience-based and hypothetical value sets are inherently different and also that QALY gains derived with different value sets are not comparable. Our findings are of importance in study planning since the results and conclusions of a study depend on the choice of value set.

Funding

None.

The impact of multimorbidity patterns on health-related quality of life in the general population: results of the Belgian Health Interview Survey

BACKGROUND

Chronic diseases and multimorbidity are a major cause of disease burden-for patients, caregivers, and society. Little is known however about potential interaction effects between specific disease combinations. Besides an additive effect, the presence of multiple conditions could also act synergistically or antagonistically regarding the impact on patients' health-related quality of life (HRQoL). The aim was to estimate the impact of coexisting chronic diseases on HRQoL of the adult general Belgian population.

METHODS

The Belgian Health Interview Survey 2018 provided data on self-reported chronic conditions and HRQoL (EQ-5D-5L) for a nationally representative sample. Linear mixed models were used to analyze two-way and three-way interactions of disease combinations on HRQoL.

RESULTS

Multimorbidity had a prevalence of 46.7% (≥ 2 conditions) and 29.7% (≥ 3 conditions). HRQoL decreased considerably with the presence of multiple chronic diseases. 14 out of 41 dyad combinations and 5 out of 13 triad combinations showed significant interactions, with a dominant presence of negative/synergistic effects. Positive/antagonistic effects were found in more subjective chronic diseases such as depression and chronic fatigue. Conditions appearing the most frequently in significant disease pair interactions were dorsopathies, respiratory diseases, and arthropathies.

CONCLUSIONS

Diverse multimorbidity patterns, both dyads and triads, were synergistically or antagonistically associated with lower HRQoL. Tackling the burden of multimorbidity is needed, especially because most disease combinations affect each other synergistically, resulting in a greater reduction in HRQoL. Further knowledge about those multimorbidity patterns with a greater impact on HRQoL is needed to better understand disease burden beyond mortality and morbidity data.