Abstract
Background
EQ-5D-3L scoring algorithms vary amongst countries, not only in the values of regression coefficients but also in the independent variables included in the regression model (hereafter referred to as model specification). It is unclear how much of this variation is due to differences in health state selection, the relative frequencies with which health states were valued, and model diagnostics, rather than to genuine differences in population preferences.
Methods
Using aggregate data from a recent review, we noted all model specifications that were used. For each country the country’s own model was re-fitted, as were all other model specifications. This was done twice: once using all valued health states for each country, and again using a common set of 17 health states for all countries. Goodness of fit was assessed using the following model diagnostics: mean absolute error (MAE), mean squared error (MSE) and rho (the Pearson correlation coefficient between predicted and observed mean utilities), both with and without leave-one-out cross-validation.
Results
Thirteen countries contributed data. Even when using a common set of health states, the preferred model varied across countries. However, choice of health states did impact the preferred model specification: when using cross-validation, the preferred specification changed in five of ten countries when moving from 17 health states to all valued health states. The relative frequency with which health states were valued had little impact on the preferred model.
Conclusions
Variation in choices of health states to value is responsible for some, but not all, of the observed heterogeneity in model specification. Relative frequency of health state valuation and choice of model diagnostic has a limited impact on model preference, however, use of cross-validation has a substantial impact. The use of cross-validation, implemented through omitting health states rather than respondents, is recommended as one approach to assessing model fit.
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References
National Institute for Health and Care Excellence: Guide to the methods of technology appraisal. National Institute for Health and Care Excellence, London, UK. http://publications.nice.org.uk/pmg9 (2013)
Canadian Agency for Drugs and Technology in Health: Guidelines for economic evaluation of health technologies, 3rd edn. Canadian Agency for Drugs and Technology in Health, Ottawa, ON, Canada (2006)
EuroQol–a new facility for the measurement of health-related quality of life.: The EuroQol group. Health Policy. 16, 199–208 (1990)
Dolan, P.: Modeling valuations for EuroQol health states. Med. Care 35, 1095–1108 (1997)
Badia, X., Roset, M., Herdman, M., Kind, P.: A comparison of United Kingdom and Spanish general population time trade-off values for EQ-5D health states. Med. Decis. Making 21, 7–16 (2001)
Johnson, J.A., Luo, N., Shaw, J.W., Kind, P., Coons, S.J.: Valuations of EQ-5D health states: are the United States and United Kingdom different? Med. Care 43, 221–228 (2005)
Tsuchiya, A., Ikeda, S., Ikegami, N., et al.: Estimating an EQ-5D population value set: the case of Japan. Health Econ. 11, 341–353 (2002)
Shaw, J.W., Johnson, J.A., Chen, S., Levin, J.R., Coons, S.J.: Racial/ethnic differences in preferences for the EQ-5D health states: results from the USA valuation study. J. Clin. Epidemiol. 60, 479–490 (2007)
Shaw, J.W., Johnson, J.A., Coons, S.J.: USA valuation of the EQ-5D health states: development and testing of the D1 valuation model. Med. Care 43, 203–220 (2005)
Jo, M.W., Yun, S.C., Lee, S.I.: Estimating quality weights for EQ-5D health states with the time trade-off method in South Korea. Value Health 11, 1186–1189 (2008)
Zarate, V., Kind, P., Valenzuela, P., Vignau, A., Olivares-Tirado, P., Munoz, A.: Social valuation of EQ-5D health states: the Chilean case. Value Health 14, 1135–1141 (2011)
Macaran S, Kind P.: Valuing EQ-5D health states using a modified MVH protocol. Prelim. Results 16, 205–39 (1999)
Lamers, L.M., McDonnell, J., Stalmeier, P.F., Krabbe, P.F., Busschbach, J.J.: The Dutch tariff: results and arguments for an effective design for national EQ-5D valuation studies. Health Econ. 15, 1121–1132 (2006)
Chuang, L.H., Kind, P.: The effect of health state selection on the valuation of EQ-5D. Med. Decis. Making 31, 186–194 (2011)
Viney, R., Norman, R., King, M.T., et al.: Time trade-off derived EQ-5D weights for Australia. Value Health 14, 928–936 (2011)
Wittrup-Jensen, K.U., Lauridsen, J., Gudex, C., Pedersen, K.M.: Generation of a Danish TTO value set for EQ-5D health states. Scand. J. Public Health 37, 459–466 (2009)
Bansback, N., Tsuchiya, A., Brazier, J., Anis, A.: Canadian valuation of EQ-5D health states: preliminary value set and considerations for future valuation studies. PLoS One 7, e31115 (2012)
Golicki, D., Jakubczyk, M., Niewada, M., Wrona, W., Busschbach, J.J.: Valuation of EQ-5D health states in poland: first TTO-based social value set in central and eastern Europe. Value Health 13, 289–297 (2010)
Norman, R., Cronin, P., Viney, R., King, M., Street, D., Ratcliffe, J.: International comparisons in valuing EQ-5D health states: a review and analysis. Value Health 12, 1194–1200 (2009)
Xie F, Gaebel K, Perampaladas K, Doble B, Pullenayegum EM.: Comparing EQ-5D valuation studies: a systematic review and methodological reporting checklist. Med. Decis. Making 22 Mar 2013 (epub ahead of print)
Augustovski, F.A., Irazola, V.E., Velazquez, A.P., Gibbons, L., Craig, B.M.: Argentine valuation of the EQ-5D health states. Value Health 12, 587–596 (2009)
Chevalier J, de Pouvourville G.: Valuing EQ-5D using time trade-off in France. Eur. J. Health. Econ. (2011)
Greiner, W., Claes, C., Busschbach, J.J., von der Schulenburg, J.M.: Validating the EQ-5D with time trade-off for the German population. Eur. J. Health. Econ. 6, 124–130 (2005)
Jelsma, J., Hansen, K., De Weerdt, W., De Cock, P., Kind, P.: How do Zimbabweans value health states? Popul. Health Metr. 1, 11 (2003)
Kind, P.: Valuing health benefits using the EQ-5D: the West Lothian question. In: Stavem, K. (ed.) 22nd Plenary meeting of the EuroQol Group, Oslo, Norway, pp. 55–77 (2005)
Shaw, J.W., Pickard, A.S., Yu, S., et al.: A median model for predicting United States population-based EQ-5D health state preferences. Value Health 13, 278–288 (2010)
Zarate, V., Kind, P., Chuang, L.H.: Hispanic valuation of the EQ-5D health states: a social value set for Latin Americans. Value Health 11, 1170–1177 (2008)
Chang, T.J., Tarn, Y.H., Hsieh, C.L., Liou, W.S., Shaw, J.W., Chiou, X.G.: Taiwanese version of the EQ-5D: validation in a representative sample of the Taiwanese population. J. Formos. Med. Assoc. 106, 1023–1031 (2007)
Acknowledgments
Eleanor Pullenayegum and Feng Xie are funded by the Canadian Institutes of Health Research New Investigator Salary Awards. Feng Xie is also funded by the Ontario Health Quality Council, and Eleanor Pullenayegum is funded by the Natural Sciences and Engineering Research Council.
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Pullenayegum, E.M., Perampaladas, K., Gaebel, K. et al. Between-country heterogeneity in EQ-5D-3L scoring algorithms: how much is due to differences in health state selection?. Eur J Health Econ 16, 847–855 (2015). https://doi.org/10.1007/s10198-014-0633-1
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DOI: https://doi.org/10.1007/s10198-014-0633-1