Population norms of health-related quality of life in Moscow, Russia: the EQ-5D-5L-based survey

Population norms for the EQ-5D-5L for Hungary: comparison of online surveys and computer assisted personal interviews

BACKGROUND AND OBJECTIVES

The aims of this study were to provide population norms for EQ-5D-5L in Hungary and investigate the differences in EQ-5D-5L normative data by survey mode, i.e. online surveys and computer assisted personal interviews (CAPI).

METHODS

A pooled database was built comprising six online (N = 7,034) and two CAPI (N = 3,020) population-based studies with the EQ-5D-5L. Descriptive statistics were performed. Multinominal logistic and linear regression analyses were applied to compare the online and CAPI samples. Traditional and machine learning regression tools were used to investigate the determinants of EQ-5D-5L index values.

RESULTS

'No problems' in any of the five EQ-5D-5L domains were reported by 33.9% (online) and 58.9% (CAPI) of the participants. Most problems were reported on the pain/discomfort domain in both study types (51.9% and 33.6%, respectively). Men and more educated respondents had significantly higher average EQ-5D-5L index values. EQ-5D-5L index values and EQ VAS scores were significantly higher in the CAPI sample, except in age groups 65-74 (no difference) and 75+ (online scores were significantly higher). Only 7-10% of variance in the EQ-5D-5L index values was explained by the variables survey mode, education, sex and age, with age having the largest and sex the smallest effect.

CONCLUSIONS

EQ-5D-5L population norms derived from online and CAPI studies may differ significantly from each other. It is recommended to consider the survey mode, sampling and sociodemographic characteristics of the participants when choosing population norms as reference set. Further comparative studies investigating EQ-5D-5L population norms by different study designs and administration modes are encouraged.

Quality of evidence in the oral health international data: Contributions for a global profile

INTRODUCTION

The Oral Health Country/Area Profile Project (CAPP) is the largest global database on oral health, compiling information from 205 countries, including 193 members of the World Health Organization (WHO). Although this database is a source of information and provides an overview of global oral health, the extent to which it accurately reflects oral health in specific countries is uncertain.

OBJECTIVE

To analyze the quality of evidence underlying the global oral health profile provided by CAPP.

METHODS

The Appraisal tool for Cross-Sectional Studies (AXIS) was adapted and used to assess data extracted from the methods section of included records. The results were then analyzed using the Item Response Theory (IRT) to establish the weightings of each dimension. The score was assessed in relation to variables of interest: age group, year of the record, and geographic region.

RESULTS

The quality of oral health data showed polarization, with The quality of data from included documents varied according to age group analyzed, year of assessment, and geographic region. The Americas and Western Pacific regions demonstrated the highest quality of oral health data.

CONCLUSION

The global oral health profile depicted by CAPP may not accurately reflect reality. The process for including data in the database needs to be reviewed to ensure its reliability.

Norms for the EQ-5D-5L among the general adult population in Alberta, Canada

PURPOSE

To present EQ-5D-5L population norms for the general adult population in Alberta, Canada.

METHODS

We analyzed data from 11 population-based surveys conducted in Alberta between 2012 and 2021. By applying appropriate sampling weights, we estimated normative data for the EQ-5D-5L dimensions, index scores, and visual analogue scale (VAS) scores. This analysis was conducted for the overall population as well as for subgroups categorized by age, sex, provincial health zones, and 17 chronic conditions.

RESULTS

The analysis included data from 60,447 respondents (ages 18-99; 51.4% female) across various survey waves, revealing minimal variations in sample characteristics and EQ-5D-5L scores over time. The most frequently reported problems were pain/discomfort (62.2%) and anxiety/depression (41.7%), while 22.5% of respondents reported no issues on any dimension. The mean (SD) EQ-5D-5L index score was 0.845 (0.137), and the mean EQ VAS score was 77.4 (16.7). There was a notable increase in the proportion of reported problems across all dimensions with age, except for anxiety/depression, which showed a decline with advancing age. Females reported slightly more problems across all dimensions compared to males. Individuals with chronic pain had the lowest EQ-5D-5L index scores, followed by those with anxiety and depression, while the lowest EQ VAS scores were observed in individuals with congestive heart failure, kidney disease, and chronic obstructive pulmonary disease.

CONCLUSION

This study provides EQ-5D-5L norms for the adult population in Alberta. These reference values can be used to benchmark patients' outcomes as well as to establish burden of illness in this population and facilitate the interpretation of EQ-5D-5L scores in various applications.

EQ-5D-5L Population Scores in Mainland China: Results From a Nationally Representative Survey 2021

OBJECTIVES

There is a lack of monitoring changes in the population scores of the most recent version, EQ-5D-5L, in mainland China. This study aimed to address this knowledge gap by assessing the EQ-5D-5L scores in mainland China using a nationally representative sample.

METHODS

Data were extracted from the 2021 Survey of Health Index of Chinese Families, which covered 31 provinces/autonomous regions/municipalities in mainland China. The survey used a multistage quota sampling strategy encompassing 120 prefecture-level cities. Quotas were allocated to each prefecture-level city in accordance with the 2020 China Population Census. This approach resulted in a final sample of 11 030 eligible questionnaires. The utility index (UI) and EuroQol Visual Analog Scale (EQ VAS) scores were reported for the entire sample (age-gender-urban/rural weighted) and by the characteristics of the study participants.

RESULTS

The study participants had a weighted mean UI of 0.939 (SD 0.135) and EQ VAS score of 80.19 (SD 18.39). The most commonly reported problem was anxiety/depression (26.37%), whereas self-care was the least reported problem (6.18%). Those who were male, were younger, lived without chronic conditions and disabilities, had higher levels of education, earned higher monthly household income, and were covered by basic medical insurance for urban employees had higher scores in both the UI and EQ VAS.

CONCLUSION

This study revealed slightly lower UI scores despite a much higher drop in EQ VAS scores whereas China maintained minimum cases of COVID-19 in 2021 compared with the population norms recorded in 2019. Further studies are warranted to unveil the full impacts of COVID-19 outbreaks.

Health-related quality of life assessed by EQ-5D-5L and its determinants among Chinese adults

Background

Due to the rising standard of living and advances in public health and medical care in recent years in China, the health-related quality of life (HRQoL) has been increasingly acknowledged as an important part of health management of adults. This study aimed to analyze the HRQoL of Chinese adults and identify the influencing factors, proposing specific recommendations for improvement.

Methods

A cross-sectional study was conducted among 1,291 selected adults from four provinces spanning different regions in China aged ≥18 years from July 2021 and January 2022. The EuroQol-5D-5L (EQ-5D-5L) was used to conduct the HRQoL survey, and a general questionnaire was administered to collect demographic characteristics, general information, and health behaviors of participants. The health utility value was measured, and one-way analysis of variance was performed. The Tobit regression model was employed to analyze the factors influencing the HRQoL of Chinese adults.

Results

The mean health utility values and visual analog scale scores for adults were 0.9400 ± 0.1197 and 84.09 ± 14.392, respectively. Notably, 60.3% of respondents reported no difficulties in any of the five dimensions of EQ-5D. However, a substantial proportion faced challenges in anxiety/depression (27%) and pain/discomfort (26.2%). Tobit regression model revealed that age, marital status, educational level, diet, sleep, mental state, mood, and chronic diseases significantly impact the HRQoL of Chinese adults.

Conclusion

The HRQoL among Chinese adults is generally satisfactory, but pay particular attention on areas such as pain, psychological anxiety, chronic diseases, and negative emotions is needed. The factors such as stress associated with marriage and the demands of high-skilled occupations might influence the overall health of the population. According to our findings, public health strategies to improve HRQoL should be developed to promote relatively healthy environments and lifestyles for older adults. Moreover, proactive measures are crucial for mitigating the potential health impacts associated with marital stress and high-skilled employment.

EQ-5D-5L Population Norms for China Derived From a National Health Survey

OBJECTIVES

To develop the EQ-5D-5L (5L) population norms for China and to assess the relationship between various factors and 5L data.

METHODS

This study used data derived from the Psychology and Behavior Investigation of Chinese Residents, a national sample survey of 21 909 representative participants aged 12 years and above. Participants' health-related quality of life (HRQoL) was measured by the 5L. Their socioeconomic characteristics, behavioral factors, and health conditions were also obtained from the survey. Norm scores were generated and compared for different socioeconomic variables. Multiple linear and logistic regressions were used to assess the relationships of the 3 kinds of variables with the 5L utility, visual analog scale (VAS) scores and 5L health problems.

RESULTS

The mean (SD) age of participants was 39.4 (18.9) years, and 50.0% of them were female. The mean (SD) utility and VAS scores were 0.940 (0.138) and 73.4 (21.6), respectively. Participants reported considerably more problems in anxiety/depression (26.2%) and pain/discomfort (22.2%) dimensions. The gender difference in HRQoL is attenuated. The participants older than 75 years suffered from a sharp decline in HRQoL; the participants in Shanghai and Tibet provinces reported lower utility and VAS scores and more health problems. Those who were younger, with better socioeconomic status and healthier lifestyles, and without diseases tended to report higher utility and VAS scores and fewer health problems.

CONCLUSIONS

This study derived the 5L population norms for China based on a representative population sample.

EQ-5D-3L and EQ-5D-5L population norms for Thailand

BACKGROUND

The previous Thai norm-based scores for the EQ-5D-5L were established with Thai general population samples aged 20-70 years in 2019. Nevertheless, these values need to be updated after the COVID-19 pandemic because of its effects on both physical and mental health. This study therefore aimed to establish population norms of the Thai EQ-5D-3L, EQ-5D-5L and EQ-VAS scores as well as to estimate disutility values associated with self-reported main diseases.

METHODS

Individual face-to-face interviews were conducted with 2000 adult (age ≥ 18 years) members of the general Thai population to estimate norm-based scores. Each participant completed the EQ-5D-3L and EQ-5D-5L as well as questions related to their sociodemographic factors and self-reported main diseases. Responses to the two instruments were converted to health utility (HU) scores on the basis of available value sets. Descriptive statistics were used to report the norm-based scores stratified by age and sex categories. Response redistribution determining the response consistency between EQ-5D versions was investigated. The HU score agreement from those two instruments was investigated using intraclass correlation coefficient (ICC). Tobit regression models were employed to investigate the relationships between sociodemographic factors and HU and EQ-VAS scores. Moreover, it was used to estimate the disutility values associated with self-reported main diseases.

RESULTS

The means (percentage of ceiling effects) of EQ-5D-3L, EQ-5D-5L, and EQ-VAS scores were 0.845 (57.80%), 0.923 (49.05%), and 79.83 (3.20%), respectively. The average percentage of inconsistent response was 1.09%. A good agreement level was found between both EQ-5D versions with the ICCs of 0.789 (95% CI: 0.558-0.878). Female, older, and unemployed participants and those with BMI ≥ 30 reported lower EQ-5D-3L and EQ-5D-5L than their counterparts. Bone/Joint disorder and stroke contributed to the largest disutility value for those two instruments.

CONCLUSIONS

The Thai norm-based scores from those two instruments were diminished when advancing age and among female, unemployed, and obese (BMI ≥ 30) participants. It is expected to provide information to policy makers to better allocate health care resources to those with diminished norm-based scores.

Health-related quality of life assessed by EQ-5D-5L and its determinants among rural adults: result from the Henan rural cohort study

OBJECTIVES

Evidence on the health-related quality of life (HRQoL) among Chinese rural populations and its influence factors were limited. This study aimed to describe the distribution of HRQoL assessed by EQ-5D-5L and its determinants among a Chinese rural population.

METHODS

A total of 23,510 eligible participants (9542 men and 13,968 women) from the Henan rural cohort study were included. Tobit regression and generalized linear models were performed to investigate the associations between demographic characteristics, lifestyle factors, common chronic diseases, and HRQoL.

RESULTS

Of all respondents, the most frequently reported problem was pain/discomfort dimension (23.05%), followed by mobility (12.72%), anxiety/depression (7.77%), and usual activities (6.45%), while the least reported was the self-care dimension (3.84%). The more problems reported in all dimensions with age increased except anxiety/depression. The mean (standard deviation) utility index and VAS score were 0.954 (0.111) and 78.34 (14.80), respectively. The regression analysis indicated that increasing age, former drinkers, poor sleep quality, and suffering from common chronic diseases were significantly associated with low HRQoL, while high education level, average monthly income, and physical activity were significantly associated with high HRQoL.

CONCLUSION

This study described the distribution of HRQoL and its influence factors among the Chinese rural population, which was helpful for medical institutions and policymakers to allocate medical resources and better understand HRQoL among the Chinese rural population.

Canada population norms for the EQ-5D-5L

OBJECTIVE

In Canada, population norms are only available for 2 provinces, Alberta and Quebec. The objective of this study was to derive the population norms for the EQ-5D-5L based on a representative sample of the Canadian general population.

METHODS

Data from the Canadian EQ-5D-5L valuation study, a cross-sectional study, were used. A quota sampling method was used to recruit a representative sample of the Canadian general population in terms of age, sex, and education. EQ-5D-5L utilities and EQ VAS were summarized using descriptive statistics and the impact of demographic characteristics on the EQ-5D-5L utilities was evaluated using statistical hypothesis testing and Tobit regression.

RESULTS

1207 eligible participants were included in the analysis. Pain/discomfort (53.1%) was the most frequently reported domain with any problem, and self-care (7.6%) domain was the least. The mean (standard deviation [SD]) EQ-5D-5L utility was 0.864 (0.121) and the mean (SD) EQ VAS was 82.3 (14.23). The highest mean EQ-5D-5L utility was 0.881 in age group 25-34 while the lowest was 0.839 in age group 55-64. Participants who had full-time employment, were married, a higher annual household income and no chronic health conditions had significantly higher EQ-5D-5L utilities.

CONCLUSION

This article reports the first Canadian population norms for the EQ-5D-5L and can be used as population references for economic evaluations and clinical research.

EQ-5D-5L Portuguese population norms

OBJECTIVES

The EQ-5D-5L is a generic preference-based quality-of-life measure for which the corresponding Portuguese population value set was only recently developed. This study sought to establish EQ-5D-5L population norms for Portugal and to identify significant relationships with sociodemographic variables.

METHODS

The research was based on a representative sample of Portugal's general population (n = 1006) aged 18 or older. The sample was stratified by gender, age group, and geographical region. The respondents were interviewed by telephone and asked to value their own state of health using both the EQ-5D-5L description system and the EuroQol-Visual Analogue Scale (EQ VAS).

RESULTS

The estimated mean EQ-5D-5L index for Portugal's general population is 0.887 (standard error [SE] = 0.0051), and the EQ VAS score was estimated as 76.0 (SE = 0.640). One-third of the population reported being in the best health state (11111). Women, individuals 70 years old or more and people with low education or a chronic disease reported a lower EQ-5D-5L index score (p < 0.001). Residents in the Azores and the Algarve reported higher health utility scores.

CONCLUSIONS

The EQ-5D-5L Portuguese population norms obtained can be used as reference scores. These norms are consistent with other countries' population norms. The findings facilitate clinical, economic, and policy decision-making processes and provide a fuller understanding of the Portuguese population's health-related quality of life.

Decomposing income-related inequality in health-related quality of life in mainland China: a national cross-sectional study

INTRODUCTION

Health equity is an important indicator measuring social development and solidarity. However, there is a paucity in nationwide studies into the inequity in health-related quality of life (HRQoL) in mainland China, in particular using the most recent data measuring HRQoL using the EuroQol 5-Dimension-5 Level (EQ-5D-5L). This study aimed to address the gap in the literature by estimating and decomposing income-related inequality of the utility index (UI) of EQ-5D-5L in mainland China.

METHODS

Data were extracted from the Psychology and Behaviour Investigation of Chinese Residents (2022), including 19 738 respondents over the age of 18 years. HRQoL was assessed by the UI of the EQ-5D-5L. Concentration index (CI) was calculated to measure the degree of income-related inequality in the UI. The contributions of individual, behavioural and context characteristics to the CI were estimated using the Wagstaff decomposition method.

RESULTS

The CI of the EQ-5D-5L UI reached 0.0103, indicating pro-rich inequality in HRQoL. Individual characteristics made the greatest contribution to the CI (57.68%), followed by context characteristics (0.60%) and health behaviours (-3.28%). The contribution of individual characteristics was mainly attributable to disparities in the enabling (26.86%) and need factors (23.86%), with the chronic conditions (15.76%), health literacy (15.56%) and average household income (15.24%) as the top three contributors. Educational level (-5.24%) was the top negative contributor, followed by commercial (-1.43%) and basic medical insurance (-0.56%). Higher inequality was found in the least developed rural (CI=0.0140) and western regions (CI=0.0134).

CONCLUSION

Pro-rich inequality in HRQoL is evident in mainland China. Targeted interventions need to prioritise measures that aim at reducing disparities in chronic conditions, health literacy and income.

Population norms for the EQ-5D-3L and EQ-5D-5L in Romania

BACKGROUND

The majority of patient reported outcome measures (PROMs) don't have population norms in Romania. This is the case with the EQ-5D as well. Therefore, we aimed to estimate population norms for the Romanian versions of the EQ-5D-5L, EQ-5D-3L, their indexes, and the EQ-VAS.

METHODS

A cross-sectional survey was conducted in all regions of Romania from November 2018 to November 2019. A three-stage probability sampling procedure stratified by region and settlement size was used to select a representative sample. Interviews were computer-assisted and conducted in respondents' homes by trained interviewers. Health status was assessed with the EQ-5D-5L, the EQ-5D-3L and the EQ VAS. Descriptive statistics were used to estimate population norms by age groups and sex for the EQ-5D-5L, the EQ-5D-3L, their indexes and the EQ VAS. Population norms were weighted using survey weights. Indexes for the EQ-5D questionnaires were estimated using the recently developed Romanian value sets.

RESULTS

Data from 1,649 interviews was analysed in the present study. Survey weights were used so that sex and place of residence ratios for the weighted sample matched the Romanian general population distribution. Participants' mean age was 47.4 years (SE = 1.157) and 50.3% of them reported being in good health. The dimension for which people reported the highest number of problems for both questionnaires was the pain/discomfort dimension. Men aged 35 plus reported fewer problems with pain/discomfort than women for both the EQ-5D-5L and EQ-5D-3L. Health decreased with age as shown by the decrease from age group 18-24 to age group 75 plus in the indexes of both questionnaires: from 0.977 (SE = 0.005) to 0.765 (SE = 0.017) for EQ-5D-5L and from 0.981 (SE = 0.005) to 0.784 (SE = 0.019) for EQ-5D-3L. There was 29.9 points drop in the EQ VAS score between the youngest and oldest group.

CONCLUSIONS

Population norms for the Romanian versions of the EQ-5D-5L, EQ-5D-3L, their indexes, and the EQ VAS are now available. These can now be used as reference values by healthcare professionals, researchers and decision-makers leading to a further development of health-related quality of life research in Romania.

Impact of COVID-19 Confinement on Quality of Life of Patients with Age-Related Macular Degeneration: A Two-Wave Panel Study

Age-related macular degeneration (AMD) is the leading cause of blindness in developed countries. Intravitreal injections of antiangiogenic agents (anti-VEGF) can stop vision loss in the neovascular form of the disease (nAMD). The aim of this study was to assess the general health-related quality of life (HRQoL) in a cohort of patients with nAMD treated with intravitreal anti-VEGF injections and to detesrmine to what extent their HRQoL was affected by COVID-19. This was an observational, analytical, and longitudinal study performed with a two-wave panel survey. Clinical outcomes, HRQoL, and tangible support were evaluated. In the final survey, changes in living conditions and medical visits due to the COVID-19 pandemic were also examined. Of the 102 patients initially interviewed in the before-COVID survey, 24 were lost after 30 months of follow-up. In the initial assessment, the mean health index was 0.73 ± 0.2. The EQ VAS score worsened at the final survey (p = 0.048). Patients needing treatment in both eyes (p = 0.007) and with lower levels of bilateral visual acuity (p = 0.018) reported an increase in social support at the final survey. In conclusion, patients perceived a worsening in HRQoL after confinement. However, patients enjoyed good social support that improved in the after-COVID survey.

EQ-5D-5L Population Norms for Italy

OBJECTIVES

This study aimed to provide normative data obtained in response to the EQ-5D-5L questionnaire in Italy and compare this with data from other countries.

METHODS

A sample of the Italian adult population (aged ≥ 18 years) was recruited and interviewed online using videoconferencing software (Zoom) between November 2020 and February 2021. The distribution of answers was estimated as per the descriptive system of the EQ-5D-5L, and descriptive statistics were calculated for the EQ VAS score and EQ-5D-5L index value in the whole sample and relevant subgroups. An ordinary least square (OLS) regression was performed to evaluate the impact of sociodemographic variables on EQ-5D-5L results. Lastly, a comparison was made with EQ-5D-5L population norms of other countries. Data analysis was performed using Microsoft Excel and Stata 13.

RESULTS

Overall, 1182 people representative of the Italian population (2020) in terms of sex and geographical area responded to the survey. Of the 3125 potential EQ-5D-5L health states, only 106 (3.4%) were selected, and the '11111' and '11112' states were chosen by half of the participants. In terms of EQ-5D-5L dimensions, the frequency of any problems (from slight to extreme) associated with anxiety and depression was high among the very young (18-24 years, 56.0%) and in women of all ages (49.7%). The mean index value (± standard deviation [SD]) was 0.93 (± 0.11) for the entire sample and gradually decreased with age, moving from 0.95 (± 0.06) in the youngest group (18-24 years) to 0.91 (± 0.13) in the oldest age group (≥ 75 years). Similarly, the mean EQ VAS score (± SD) was 81.8 (± 13.5), and decreased from 87.0 (± 8.9) in the 18-24 years age group to 75.1 (± 16.4) among participants > 75 years of age. The existence of self-reported chronic conditions (e.g., cardiovascular disease), female sex, and social assistance recipiency were negatively associated with the EQ-5D index value, while the EQ VAS score was significantly lower in people with chronic conditions and aged > 55 years. Conversely, higher income levels had a positive impact on both the EQ-5D index value and the EQ VAS score. Lastly, both the EQ-5D index value and EQ VAS score in Italy were, on average, higher than in most European countries.

CONCLUSIONS

EQ-5D-5L population norms provide useful insights into the health status of the Italian population and can be used as a reference for other surveys using the same instrument.

Health-related quality of life among Indian population: The EQ-5D population norms for India

Background

The EuroQol 5 dimensions (EQ-5D) is the most used generic health-related quality of life (HRQoL) instrument for measuring population health and health outcomes. Since there are no EuroQol 5 dimensions 5 levels (EQ-5D-5L) population norms available for India, this study developed the Indian population norms for the EQ-5D-5L. The potential influencing factors of HRQoL of the Indian population have been identified.

Methods

The data was collected alongside the Indian EQ-5D-5L valuation study (Development of an EQ-5D Value Set for India Using an Extended Design: DEVINE Study). A cross-sectional survey of 3548 adult respondents was conducted across five states of India, in which respondents were asked to report their own health states using the EQ-5D-5L descriptive system and the EuroQol Visual Analog Scale (EQ VAS). The utility score was calculated using the EQ-5D-5L value set based on the preferences of the Indian population. Norm scores were generated for age, sex, and other important socio-demographic variables. The proportion of patients reporting problems in different dimensions of EQ-5D-5L was assessed. The impact of socio-economic determinants on health-related quality of life was evaluated using multiple linear regression.

Results

The mean EQ VAS score of the Indian population is 75.18 (95% confidence interval (CI) = 74.50-75.90), whereas mean utility score is 0.848 (95% CI = 0.840-0.857). The EQ VAS scores, and utility scores decreased with age. Males reported higher EQ VAS values than females. The highest mean utility score was observed for males of <20 years (0.936), whereas the lowest mean score was observed for females of >70 years (0.488). The mean VAS score ranged between 85.24 for females of <20 years and 50.67 for females of >70 years. Highest problems were reported in the dimension of "pain / discomfort", closely followed by "anxiety / depression". Age, educational qualification, marital status, substance abuse, presence of ailments, state / region of residence, number of dependent members in the household, and time spent on mobile are the significant determinants of HRQoL of Indian population.

Conclusions

These population norms will be used as reference values for comparative purposes in future Indian studies. Economic evaluations can use these average age-specific HRQoL population norms to value the health-state of not having the specific disease under investigation.

Patient acceptable symptom state (PASS): thresholds for the EQ-5D-5L and Oxford hip and knee scores for patients with total hip and knee replacement

PURPOSE

To define patient acceptable symptom state (PASS) cut-off values for the EQ-5D-5L and Oxford hip (OHS) and knee (OKS) scores 6 and 12 months after total hip (THR) or knee (TKR) replacement. To compare PASS cut-off values for the EQ-5D-5L scored using: (1) the Canadian value set, (2) the crosswalk value set, and (3) the equal weighted Level Sum Score (LSS).

METHODS

We mailed questionnaires to consecutive patients following surgeon referral for primary THR or TKR and at 6 and 12 months post-surgery. Patient reported outcome measures (PROMs) were the EQ-5D-5L, the OHS, and OKS. We assessed PASS cut-off values for PROMs using percentile and ROC methods, with the Youden Index.

RESULTS

Five hundred forty-two surgical patients (mean age, 64 years, 57% female, 49% THR) completed baseline and 12-month questionnaires. 89% of THR and 81% of TKR patients rated PASS as acceptable at 12 months. PASS cut-off values for THR for the EQ-5D-5L (Canadian) were 0.85 (percentile) and 0.84 (Youden) at 12 months. Cut-off values were similar for the LSS (0.85 and 0.85) and lower for the crosswalk value set (0.74 and 0.73), respectively. EQ-5D-5L cut-off values for TKR were Canadian, 0.77 (Percentile) and 0.78 (Youden), LSS, 0.75 and 0.80, and crosswalk, 0.67 and 0.74, respectively. Cut-off values 6 and 12 months post-surgery ranged from 38 to 39 for the OHS, and 28 to 36 for the OKS (range 0 worst to 48 best).

CONCLUSION

PASS cut-off values for the EQ-5D-5L and Oxford scores varied, not only between methods and timing of assessment, but also by different EQ-5D-5L value sets, which vary between countries. Because of this variation, PASS cut-off values are not necessarily generalizable to other populations of TJR patients. We advise caution in interpreting PROMs when using EQ-5D-5L PASS cut-off values developed in different countries. A standardization of methods is needed before published cut-off values can be used with confidence in other populations.

Health-related Quality of Life using the EQ-5D-5L: normative utility scores in a Dutch female population

PURPOSE

Normative utility scores represent the health related quality of life of the general population, are of utmost importance in cost-effectiveness studies and should reflect relevant sexes and age groups. The aim of this study was to estimate EQ-5D-5L normative utility scores in a population of Dutch females, stratified by age, and to compare these scores to those of female populations of three other countries.

METHODS

Dutch women completed the EQ-5D-5L online between January and July 2020. Mean normative utilities were computed using the Dutch EQ-5D-5L value set, stratified by age, tested for differences using the Kruskall-Wallis test, and compared to normative utility scores of female populations elsewhere. Additionally, to support the use of the Dutch EQ-5D-5L data in other settings, normative utility scores were also calculated by applying the value sets of Germany, United Kingdom and USA.

RESULTS

Data of 9037 women were analyzed and the weighted mean utility score was 0.911 (SD 0.155, 95% CI 0.908-0.914). The mean normative utility scores differed between age groups, showing lower scores in older females. Compared to other normative utility scores of female populations, Dutch mean utilities were consistently higher except for age groups 18-24 and 25-34. With the three country-specific value sets, new age-specific mean normative utility scores were provided.

CONCLUSION

This study provides mean normative utility scores of a large cohort of Dutch females per age group, which were found to be lower in older age groups. Utility scores calculated with three other value sets were made available.

Population Norms for SF-6Dv2 and EQ-5D-5L in China

OBJECTIVES

To derive the population norms for EQ-5D-5L and SF-6Dv2 among the Chinese general population.

METHODS

Data collected alongside the Chinese SF-6Dv2 valuation study conducted between June and September 2019 were used. SF-6Dv2 and EQ-5D-5L, as well as social-demographic characteristics and self-reported chronic conditions, were collected through face-to-face interviews among a representative sample of the general population stratified by age, gender, education, and area of residence (urban/rural) in China. SF-6Dv2 and EQ-5D-5L responses were converted to utility values using the corresponding Chinese value sets. Utility values for both measures and EQ VAS scores were summarized by age and gender, and then described by different social-demographic characteristics and chronic conditions.

RESULTS

A total of 3397 respondents (51.2% male, age range 18-90 years) were included. 420 (12.4%) and 1726 (50.8%) respondents reported no problems on all SF-6Dv2 and EQ-5D-5L dimensions, respectively. The mean [standard deviation (SD)] utility values were 0.827 (0.143) for SF-6Dv2 and 0.946 (0.096) for EQ-5D-5L. The mean (SD) EQ VAS score was 87.1 (11.5). Respondents who resided in rural areas, were married, and were employed had higher utility values. Respondents with memory-related diseases or stroke had lower utility values than those with other chronic conditions. Utility values decreased with the increase in the number of chronic conditions.

CONCLUSION

This study reports the first Chinese population norms for the EQ-5D-5L and SF-6Dv2 derived using a representative sample of the Chinese general population. The norms can be used as references for economic evaluations and healthcare decision-making in China.

Development of an EQ-5D Value Set for India Using an Extended Design (DEVINE) Study: The Indian 5-Level Version EQ-5D Value Set

OBJECTIVES

This study aimed to develop the Indian 5-level version EQ-5D (EQ-5D-5L) value set, which is a key input in health technology assessment for resource allocation in healthcare.

METHODS

A cross-sectional survey using the EuroQol Group's Valuation Technology was undertaken in a representative sample of 3548 adult respondents, selected from 5 different states of India using a multistage stratified random sampling technique. The participants were interviewed using a computer-assisted personal interviewing technique. This study adopted a novel extended EuroQol Group's Valuation Technology design that included 18 blocks of 10 composite time trade-off (c-TTO) tasks, comprising 150 unique health states, and 36 blocks of 7 discrete choice experiment (DCE) tasks, comprising 252 DCE pairs. Different models were explored for their predictive performance. Hybrid modeling approach using both c-TTO and DCE data was used to estimate the value set.

RESULTS

A total of 2409 interviews were included in the analysis. The hybrid heteroscedastic model with censoring at -1 combining c-TTO and DCE data yielded the most consistent results and was used for the generation of the value set. The predicted values for all 3125 health states ranged from -0.923 to 1. The preference values were most affected by the pain/discomfort dimension.

CONCLUSIONS

This is the largest EQ-5D-5L valuation study conducted so far in the world. The Indian EQ-5D-5L value set will promote the effective conduct of health technology assessment studies in India, thereby generating credible evidence for efficient resource use in healthcare.

First population norms for the EQ-5D-3L in the Russian Federation

Purpose

The EQ–5D survey instrument is routinely applied to general and patient specific populations in many countries, as a means of measuring Health Related Quality of Life (HRQOL) and/or informing Health Technology Assessment. The instrument is the subject of growing interest in the Russian Federation, as too is Health Technology Assessment. This research is the first to systematically present the EQ–5D–3L nationally representative population norms and to examine the socioeconomic and socio-demographic characteristics of the instrument among a representative sample of the Russian population.

Methods

Based on a nationally representative health and well-being survey of the Russian population, conducted in November 2017, we establish the descriptive results, including the EQ-VAS and the EQ-5D Index, by age and gender, examine the correspondence between the EQ–5D health classifications and the separate EQ-VAS scores, and draw on a set of augmented logistic regressions to evaluate the association between the presence of problems in each dimension and various socio-economic and health-related characteristics.

Results

We find strong evidence that the EQ-5D instrument is sensitive to underlying observed and latent health experiences, that it mirrors many of the characteristics familiar from other settings but that there are Russian specificities which merit further research, particularly with respect to the anxiety/depression dimension of the instrument.

Conclusion

This research represents an important landmark for HRQOL studies in Russia as well as for the prospects of continuing to develop the scholarly and practical infrastructure necessary for Russian Health Technology Assessment to advance.

Inequality and heterogeneity in health-related quality of life: findings based on a large sample of cross-sectional EQ-5D-5L data from the Swedish general population

PURPOSE

This study aimed to investigate inequality and heterogeneity in health-related quality of life (HRQoL) and to provide EQ-5D-5L population reference data for Sweden.

METHODS

Based on a large Swedish population-based survey, 25,867 respondents aged 30‒104 years, HRQoL is described by sex, age, education, income, economic activity, health-related behaviours, self-reported diseases and conditions. Results are presented by EQ-5D-5L dimensions, respondents rating of their overall health on the EQ visual analogue scale (EQ VAS), VAS index value and TTO (time trade-off) index value allowing for calculation of quality-adjusted life years (QALYs). Ordinary Least Squares and multivariable logistic regression analyses were used to study inequalities in observed EQ VAS score between socioeconomic groups and the likelihood to report problems on the dimensions, respectively, adjusted for confounders.

RESULTS

In total, 896 different health states were reported; 24.1% did not report any problems. Most problems were reported with pain/discomfort. Women reported worse HRQoL than men, and health deteriorated with age. The strongest association between diseases and conditions and EQ VAS score was seen for depression and mental health problems. There was a socioeconomic gradient in HRQoL; adjusting for health-related behaviours, diseases and conditions slightly reduced the differences between educational groups and income groups, but socioeconomic inequalities largely remained.

CONCLUSION

EQ-5D-5L population reference (norms) data are now available for Sweden, including socioeconomic differentials. Results may be used for comparisons with disease-specific populations and in health economic evaluations. The observed socioeconomic inequality in HRQoL should be of great importance for policy makers concerned with equity aspects.

Health-Related Quality of Life Measurement in Public Health

Patient-reported outcomes are recognized as essential for the evaluation of medical and public health interventions. Over the last 50 years, health-related quality of life (HRQoL) research has grown exponentially from 0 to more than 17,000 papers published annually. We provide an overview of generic HRQoL measures used widely in epidemiological studies, health services research, population studies, and randomized clinical trials [e.g., Medical Outcomes Study SF-36 and the Patient-Reported Outcomes Measurement Information System (PROMIS^®)-29]. In addition, we review methods used for economic analysis and calculation of the quality-adjusted life year (QALY). These include the EQ-5D, the Health Utilities Index (HUI), the self-administered Quality of Well-being Scale (QWB-SA), and the Health and Activities Limitation Index (HALex). Furthermore, we consider hybrid measures such as the SF-6D and the PROMIS-Preference (PROPr). The plethora of HRQoL measures has impeded cumulative science because incomparable measures have been used in different studies. Linking among different measures and consensus on standard HRQoL measurement should now be prioritized. In addition, enabling widespread access to common measures is necessary to accelerate future progress. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

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.

Health-Related Quality of Life Norm Data of the Peruvian Adolescents: Results Using the EQ-5D-Y

(1) Introduction: There is a growing interest in health-related quality of life (HRQOL) in adolescent population. The EQ-5D-Y is a generic HRQOL instrument that allows adolescents to understand the health status of different levels of physical, mental, and social health. This study was carried out with an adolescent population in Peru. The main objective of this article is to report the normative values of the EQ-5D-Y questionnaire in Peruvian adolescents. (2) Methods: The EQ-5D-Y questionnaire was administered to Peruvian adolescent students. A total of 1229 young people participated in the survey. The EQ-5D-Y score was reflected as a function of sex and age. (3) Results: The mean utility index of the EQ-5D-Y for the total sample was 0.890; this rating was significantly better for males at (0.899) and females at (0.881). The ceiling effect was higher for adolescent males with (47.3) females (40.7). (4) Conclusions: The results of the present study provide evidence that schooled adolescents show a positive perception of HRQOL.

Valuation of the EQ-5D-3L in Russia

Purpose

The most widely used generic questionnaire to estimate the quality of life for yielding quality-adjusted life years in economic evaluations is EQ-5D. Country-specific population value sets are required to use EQ-5D in economic evaluations. The aim of this study was to establish an EQ-5D-3L value set for Russia.

Methods

A representative sample aged 18+ years was recruited from the Russia`s general population. Computer-assisted face–to–face interviews were conducted based on the standardized valuation protocol using EQ-Portable Valuation Technology. Population preferences were elicited utilizing both composite time trade-off (cTTO) and discrete choice experiment (DCE) techniques. To estimate the value set, a hybrid regression model combining cTTO and DCE data was used.

Results

A total of 300 respondents who successfully completed the interview were included in the primary analysis. 120 (40.0%) respondents reported no health problems of any dimension, and 56 (18.7%) reported moderate health problems in one dimension of the EQ‐5D‐3L. Median self-rated health using EQ‐VAS was 80 with IQR 70–90. Comparing cTTO and DCE-predicted values for 243 health states resulted in a similar pattern. This supports the use of hybrid models. The predicted value based on the preferred model for the worst health state “33333” was −0.503. Mobility dimension had the most significant impact on the utility decrement, and anxiety/depression had the lowest decrement.

Conclusion

Determining a Russian national value set may be considered the first step towards promoting cost-utility analysis use to increase comparability among studies and improve the transferability of healthcare decision-making in Russia.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-021-02804-6.