Swedish experience-based value sets for EQ-5D health states

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Abstract

Purpose

To estimate Swedish experience-based value sets for EQ-5D health states using general population health survey data.

Methods

Approximately 45,000 individuals valued their current health status by means of time trade off (TTO) and visual analogue scale (VAS) methods and answered the EQ-5D questionnaire, making it possible to model the association between the experience-based TTO and VAS values and the EQ-5D dimensions and severity levels. The association between TTO and VAS values and the different severity levels of respondents’ answers on a self-rated health (SRH) question was assessed.

Results

Almost all dimensions (except usual activity) and severity levels had less impact on TTO valuations compared with the UK study based on hypothetical values. Anxiety/depression had the greatest impact on both TTO and VAS values. TTO and VAS values were consistently related to SRH. The inclusion of age, sex, education and socioeconomic group affected the main effect coefficients and the explanatory power modestly.

Conclusions

A value set for EQ-5D health states based on Swedish valuations has been lacking. Several authors have recently advocated the normative standpoint of using experience-based values. Guidelines of economic evaluation for reimbursement decisions in Sweden recommend the use of experience-based values for QALY calculations. Our results that anxiety/depression had the greatest impact on both TTO and VAS values underline the importance of mental health for individuals’ overall HRQoL. Using population surveys is in line with recent thinking on valuing health states and could reduce some of the focusing effects potentially appearing in hypothetical valuation studies.

Electronic supplementary material

The online version of this article (doi:10.1007/s11136-013-0496-4) contains supplementary material, which is available to authorized users.

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Most cited references 49

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Swedish population health-related quality of life results using the EQ-5D.

K Burström, M Johannesson, F Diderichsen (2001)

Health-related quality of life (HRQoL) measured on population level may be useful to guide policies for health. This study aims to describe the HRQoL; in EQ-5D dimensions, mean rating scale (RS) scores and mean EQ-5D index values, in the general population, by certain disease and socio-economic groups, in Stockholm County 1998. The EQ-5D self-classifier and a RS were included in the 1998 cross-sectional postal Stockholm County public health survey to a representative sample (n = 4950, 20-88 years), 63% response rate. Mean RS score ranged from 0.90 (20-29 years) to 0.69 (80-88 years), mean EQ-5D index value ranged from 0.89 (20-29 years) to 0.74 (80-88 years). For different diseases mean RS scores ranged from 0.80 (asthma) to 0.69 (angina pectoris), mean EQ-5D index values ranged from 0.79 (asthma) to 0.66 (low back pain). The mean health state scores (RS and EQ-5D index) were 0.06 lower in the unskilled manual group than in the higher non-manual group after controlling for age and sex (p < 0.0001). This difference was 0.03 after controlling also for different diseases (p < 0.0001). In conclusion, our results show that the HRQoL varies greatly between socio-economic and disease groups. Furthermore, after controlling for age, sex and disease, HRQoL is lower in manual than in non-manual groups.

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A single European currency for EQ-5D health states. Results from a six-country study.

David Parkin, Paul Kind, Siem Oppe … (2003)

The EQ-5D questionnaire is a widely used generic instrument for describing and valuing health that was developed by the EuroQol Group. A primary objective of the EuroQol Group is the investigation of values for health states in the general population in different countries. As part of the EuroQol enterprise 11 population surveys were carried out in six Western European countries (Finland, Germany, The Netherlands, Spain, Sweden and the UK) to value health states as defined by the EQ-5D using a standardised visual analogue scale (EQ-5D VAS). This contribution reports how a European set of general population preference weights was derived from the data collected in the 11 valuation studies. The scores from this set of preference weights can be applied to generate a VAS-based weighted health status index for all the potential 243 EQ-5D health states for use in multi-national studies. To estimate the preference weights a multi-level regression analysis was performed on 82,910 valuations of 44 EQ-5D health states elicited from 6,870 respondents. Stable and plausible solutions were found for the model parameters. The R(2) value was 75%. The analysis showed that the major source of variance, apart from 'random error', was variance between individuals (28.3% of the total residual variance). These results suggest that VAS values for EQ-5D health states in six Western European countries can be described by a common model.

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Generation of a Danish TTO value set for EQ-5D health states.

Kim U Wittrup-Jensen, Claire Gudex, M. Pedersen … (2009)

Health policy decisions should be based on national social preferences. In the absence of a set of Danish health preferences, patient outcome studies using the EQ-5D instrument have typically used UK health state valuations. This article describes the development of a Danish EQ-5D value set. Regression modelling was based on Time Trade-Off (TTO) data derived from computer-assisted interviews conducted with 1,332 respondents from the Danish general population. Using a split-sample technique, 46 health states were directly valued by the respondents. Five different model types were tested and compared on statistical and theoretical grounds. Eleven different specifications were then tested for the chosen model type to identify the most appropriate model that had high explanatory power and parameters that were both consistent (positively signed) and statistically significant. An additive random effects model was found to be superior to ordinary least squares, fixed effects, random coefficient and censored Tobit modelling approaches. From the 11 model specifications tested, the TTO3 model (main effects model, without an N3 factor) performed best and was used to generate a Danish set of health state preferences. An additive random effects model appears to adequately generate a Danish set of EQ-5D health state preferences. The model has high explanatory power and produces consistent and significant parameters for EQ-5D dimensions and levels. It is recommended that this value set be used in Danish cost-utility studies using EQ-5D.

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Author and article information

Contributors

Kristina Burström: +46-8-12337271 , +46-8-300592 , kristina.burstrom@ki.se

Journal

Journal ID (nlm-ta): Qual Life Res

Journal ID (iso-abbrev): Qual Life Res

Title: Quality of Life Research

Publisher: Springer International Publishing (Cham )

ISSN (Print): 0962-9343

ISSN (Electronic): 1573-2649

Publication date (Electronic): 22 August 2013

Publication date PMC-release: 22 August 2013

Publication date (Print): 2014

Volume: 23

Pages: 431-442

Affiliations

[ ]Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden

[ ]Department of Public Health Sciences, Equity and Health Policy Research Group, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden

[ ]Stockholm County Council, Health Care Services, Tomtebodavägen 18A, 171 77 Stockholm, Sweden

[ ]Department of Economics, Lund University, P.O. Box 7082, 220 07 Lund, Sweden

[ ]Health Economics and Management, Institute of Economic Research, Lund University, P.O. Box 7082, 220 07 Lund, Sweden

[ ]Centre for Primary Health Care Research, Lund University, P.O. Box 7082, 220 07 Lund, Sweden

[ ]Department of Health Economics, AstraZeneca Nordic, 151 85 Södertälje, Sweden

[ ]Department of Economics, Stockholm School of Economics, P.O. Box 6501, 113 83 Stockholm, Sweden

[ ]Department of Medical and Health Sciences, Center for Medical Technology Assessment, Linköping University, 581 83 Linköping, Sweden

[ ]The Dental and Pharmaceutical Benefits Agency, P.O. Box 225 20, 104 22 Stockholm, Sweden

Article

Publisher ID: 496

DOI: 10.1007/s11136-013-0496-4

PMC ID: 3967073

PubMed ID: 23975375

SO-VID: 6fb1a1ce-569c-40fe-8e05-f008f9be3aed

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

History

Date accepted : 30 July 2013

Custom metadata

ScienceOpen disciplines: Public health

Keywords: eq-5d,experience-based value set,general population,self-rated health,time trade off,visual analogue scale

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ScienceOpen disciplines: Public health

Keywords: eq-5d, experience-based value set, general population, self-rated health, time trade off, visual analogue scale

Swedish experience-based value sets for EQ-5D health states

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Abstract

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Electronic supplementary material

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Global Health Next Generation Network

Most cited references 49

Swedish population health-related quality of life results using the EQ-5D.

A single European currency for EQ-5D health states. Results from a six-country study.

Generation of a Danish TTO value set for EQ-5D health states.

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