A vision ‘bolt-on’ increases the responsiveness of EQ-5D: preliminary evidence from a study of cataract surgery
(1) To evaluate the effect of adding a vision dimension (‘bolt-on’) to the 5-level EQ-5D (EQ-5D-5L) and 3-level EQ-5D (EQ-5D-3L) on their responsiveness, and (2) to compare the responsiveness of a vision ‘bolt-on’ EQ-5D-3L (EQ-5D-3L + V) with SF-6D and Health Utilities Index Mark 3 (HUI3) to the benefit of cataract surgery.
Sixty-three patients were assessed before and after their cataract surgery using the EQ-5D-3L, EQ-5D-5L, SF-6D, HUI3, as well as a 3-level and a 5-level vision dimension. Preference-based indices were calculated using available value sets for EQ-5D-3L, EQ-5D-3L + V, EQ-5D-5L, SF-6D, and HUI3, and non-preference-based indices were calculated using the sum-score method for EQ-5D-5L and EQ-5D-5L + V (vision bolt-on EQ-5D-5L). Responsiveness was assessed using the standardized response mean (SRM) and F-statistic.
Among preference-based indices, mean changes from pre to post-surgery in EQ-5D-3L + V and EQ-5D-3L indices were 0.031 and 0.018, respectively. The mean changes for EQ-5D-5L, SF-6D and HUI3 indices were 0.020, 0.012 and 0.105, respectively. The SRM (F-statistic) for EQ-5D-3L + V and EQ-5D-3L indices were 0.458 (13.2) and 0.098 (0.6), respectively. The responsiveness of EQ-5D-3L + V was better than EQ-5D-5L, SF-6D; the responsiveness of HUI3 was better than all other measures. Using non-preference-based indices, mean change for EQ-5D-5L + V and EQ-5D-5L were 0.067 and 0.017, respectively. The corresponding SRM (F-statistic) were 0.709 (31.7) and 0.295 (5.4).
Preliminary evidence from our study suggests that a vision ‘bolt-on’ may increase the responsiveness of EQ-5D-3L and EQ-5D-5L to change in health outcomes experienced by patients undergoing cataract surgery. In absence of the preference-based vision bolt-on EQ-5D-5L index, HUI3 was the most responsive measure.
KeywordsEQ-5D Responsiveness Vision Bolt-on Cataract
We thank the EuroQol Research Foundation for funding this study and all patients of this study for their participation.
MA, MFJ, and NL jointly conceived the study. KT, CWW, and YCHW contributed in the study design and patient recruitment. RLYT contributed in the data collection form design, patient recruitment and data management. MG analyzed the data and drafted the first version of the manuscript. All authors reviewed and approved the manuscript.
Compliance with ethical standards
Conflict of interest
The study had financial support from the EuroQol Research Foundation (EQ Project 2016310), The Netherlands; MFJ is a member of the scientific team of the EuroQol Business Office and both MFJ and NL are members of the EuroQol Group. The EuroQol Research Foundation has had no other involvement in the running of the study or the writing of the manuscript. The views expressed by the authors in this paper do not necessarily reflect the views of the EuroQol Group. No other relationship or activities that could appear to have influenced the submitted work. Other authors declare that they have no conflict of interest.
Research involving human participants and/or animals
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
The study was approved by the SingHealth Centralized Institutional Review Board (CIRB Ref: 2016/2649). Informed consent was obtained from all individual participants included in the study.
- 1.Longworth, L., Yang, Y., Young, T., Mulhern, B., Alava, M.H., Mukuria, C., Rowen, D., Tosh, J., Tsuchiya, A., Evans, P.: Use of generic and condition-specific measures of health-related quality of life in NICE decision-making: a systematic review, statistical modelling and survey. Health Technol. Assess. 18(9), 1–224 (2014). https://doi.org/10.3310/hta18090 CrossRefPubMedPubMedCentralGoogle Scholar
- 5.NICE: Guide to the methods of technology appraisal 2013. https://www.nice.org.uk/process/pmg9/chapter/1-foreword (2013). Accessed 28 Feb 2018
- 7.Longworth, L., Yang, Y., Young, T., Mulhern, B., Hernández Alava, M., Mukuria, C., Rowen, D., Tosh, J., Tsuchiya, A., Evans, P., Devianee Keetharuth, A., Brazier, J.: Use of generic and condition-specific measures of health-related quality of life in NICE decision-making: a systematic review, statistical modelling and survey. Health Technol Assess. 18(9), 1–224 (2014). https://doi.org/10.3310/hta18090 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Geraerds, A.J.L.M., Bonsel, G.J., Janssen, M.F., de Jongh, M.A., Spronk, I., Polinder, S., Haagsma, J.A.: The added value of the EQ-5D with a cognition dimension in injury patients with and without traumatic brain injury. Qual. Life Res. (2019). https://doi.org/10.1007/s11136-019-02144-6 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Swinburn, P., Lloyd, A., Boye, K.S., Edson-Heredia, E., Bowman, L., Janssen, B.: Development of a disease-specific version of the EQ-5D-5L for use in patients suffering from psoriasis: lessons learned from a feasibility study in the UK. Value Health 16(8), 1156–1162 (2013). https://doi.org/10.1016/j.jval.2013.10.003 CrossRefPubMedGoogle Scholar
- 18.NICE: Position statement on use of the EQ-5D-5L valuation set for England (updated November 2018). https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/technology-appraisal-guidance/eq-5d-5l (2018). 3 Jun 2019
- 24.Furlong, W., Feeny, D., Torrance, G., Goldsmith, C., DePauw, S., Zhu, Z., Denton, M., Boyle, M.: Multiplicative multi-attribute utility function for the Health Utilities Index Mark 3 (HUI3) system: a technical report. In: Centre for Health Economics and Policy Analysis (CHEPA). McMaster University, Hamilton (1998)Google Scholar
- 29.Cohen, J.: Statistical power analysis for the behavioral sciences, 2nd edn. In. Erlbaum Associates, Hillsdale (1988)Google Scholar
- 32.Bilbao, A., Quintana, J.M., Escobar, A., García, S., Andradas, E., Baré, M., Elizalde, B., Group, I.-C.: Responsiveness and clinically important differences for the VF-14 index, SF-36, and visual acuity in patients undergoing cataract surgery. Ophthalmology 116(3), 418–424.e411 (2009)CrossRefGoogle Scholar