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Measuring the “Q” in QALYs for cost-effectiveness analysis: the EuroQol Group’s approach

Measuring the “Q” in QALYs for cost-effectiveness analysis: the EuroQol Group’s approach. Valuing health outcomes for healthcare decision making using the EQ-5D: a symposium for policy makers and researchers in Asia Friday , 22 March 2013

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Measuring the “Q” in QALYs for cost-effectiveness analysis: the EuroQol Group’s approach

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  1. Measuring the “Q” in QALYs for cost-effectiveness analysis: the EuroQol Group’s approach Valuing health outcomes for healthcare decision making using the EQ-5D: a symposium for policy makers and researchers in Asia Friday, 22 March 2013 Falcon Room, Level 3, Grand Copthorne Waterfront Hotel, Singapore

  2. Prof. Dr. Jan J.V. Busschbach • Chair of the EuroQol Research Foundation • Erasmus MC • Psychiatry • Section Medical Psychology and Psychotherapy • J.vanbusschbach@erasmusmc.nl

  3. Slides: www.busschbach.com

  4. The EQ-5D-3L questionnaire‘Simplified’ Chinese version

  5. The EQ-5D-3L questionnaire

  6. EuroQol jargon: state 11232

  7. Moving from 3 levels to 5…

  8. New developments • Developing the 5 level ‘EQ-5D-5L’ • Improving the validation • New methodology • Standardizing the validation • Standardizing methodology • Allowing cultural values

  9. The EuroQol Group • Founded 25 years ago • A network of about 100… • International, • multi-disciplinary, • researchers • Devoted to… • measurement of health status, • health related Quality of Life

  10. Still ‘Euro’? • Norway • Poland • Singapore • Slovenia • South Africa • Spain • Sweden • Trinidad & Tobago • United Kingdom • United States • Australia • Canada • Denmark • Finland • France • Germany • Greece • Italy • Netherlands • New Zealand

  11. Non commercial • An non profit organization • A foundation • No stock holders • Members votes for a Executive Board • The EuroQol Office • Executive Director: Dr. Bernhard Slaap • www.euroqol.org • All money goes into research

  12. Income • Pharmaceutical industry • Subscriptions for 3 years • Non commercial users • Sometimes fees • Any research • Free

  13. EuroQol Membership • Reserved for those who actively support the work of the EuroQol Group and make a positive and sustained commitment to it • Attend and scientifically contribute to the EuroQol Plenary Meetings and participate in Working Groups • Access to research grants and annual meeting

  14. EuroQol Annual Plenary Meeting

  15. EuroQol Annual Meeting • Present papers and posters on: • Methodological / valuation aspects of EQ-5D • Development of new EQ-5D versions • Alternative modes of administration • Use of EQ-5D in health population surveys

  16. EuroQol Executive Office

  17. EuroQol Office • Handles EQ-5D license requests • Scientific support clients • Scientific and operational support EQ sponsored studies • EQ members support • Based in Rotterdam • The Netherlands • 5.0 FTE + contractors

  18. Translation Protocol • Two versions in target language • Translators should be native in target language and fluent in English • First consensus version • Report to EuroQol Group 1. Forward Translation • Two versions in English • Translators should be native in English • and fluent in target language • Comparison to the original English version • Second consensus version • Report to EuroQol Group 2. Backward Translation • Test second consensus by 8 lay respondents • - Native to the target language • - Patients and healthy persons • - Range of socio-demographic characteristics • Third consensus version • Report to EuroQol Group 3. Respondent Testing Final translation of EQ-5D

  19. Certified language versions • All produced following recommended guidelinesfor cultural adaptation + rating scale exercise • Translation certificatesprovided for all versions

  20. EQ-5D User Guides

  21. EQ-5D Paper version EQ-5D-3L descriptive system EQ-5D-3L VAS

  22. Other formats Tablet, PDA, Web

  23. Other formats Tablet, PDA, Web

  24. EQ-5D Web

  25. EuroQol instruments • EQ-5D-3L Translations • More than 160 languages in Self-complete paper format • Also available in; Telephone, Face-to-face, Proxy, IVR, Web and Tablet format • EQ-5D-5L Translations • More than 90+ languages in self-complete paper format • Also available in Web and Tablet format • EQ-5D-Y Translations • Available in more than 20 languages • Youth between 7-12 years

  26. Overview of the EQ-5D Purpose and origins of the descriptive system

  27. Health Economics • Comparing different allocations • Should we spent our money on • Wheel chairs • Screening for cancer • Comparing costs • Comparing outcome • Outcomes must be comparable • Make a generic outcome measure

  28. Outcomes in health economics • Specific outcome are incompatible • Allow only for comparisons within the specific field • Clinical successes: successful operation, total cure • Clinical failures: “events” • “Hart failure” versus “second psychosis” • Generic outcome are compatible • Allow for comparisons between fields • Life years • Quality of life • Most generic outcome • Quality adjusted life year (QALY)

  29. Quality Adjusted Life Years (QALY) 1.00 X 0.00 0.5 x 80 = 40 QALYs 80 40 Life years • Example • Blindness • Time trade-off value is 0.5 • Life span = 80 years • 0.5 x 80 = 40 QALYs

  30. Area under the curve

  31. QALY league tables

  32. 9000 Citations in PubMed

  33. Most controversy about the ‘Q’ in QALY An uni-dimensional value Like temperature, of km/h Like the IQ-test measures intelligence Ratio or interval scale Difference 0.00 and 0.80… … must be 8 time higher than 0.10

  34. Unidimensional, ratio scales • Two popular methods have these pretensions • Time trade-off • Standard gamble • Two methods are less clear…. • Visual analog scale • Paired comparison • Conjoint analysis; DCE, etc

  35. The Rosser & Kind Index

  36. The Rosser & Kind index One of the oldest valuation 1978: Magnitude estimation Magnitude estimation PTO / VAS N = 70 Doctors, nurses, patients and general public 1982: Transformation to “utilities” On a 0.00 to 1.00 scale Could be used for QALYs

  37. 1985: High impact article

  38. 1985: High impact article

  39. 1985: High impact article • Survey at the celebration of 25 years of health economics in the UK (HESG): chosen most influential article on health economics

  40. Criticism on the Matrix Sensitivity only 30 health states The unclear meaning of “distress” The involvement of medical personnel No clear way how to classify the patients into the matrix Only British values The compression of states in the high values

  41. Value compression

  42. New initiatives • Higher sensitivity (more then 30 states) • More and better defined dimensions • Other valuation techniques • Standard Gamble, Time Trade-Off, Visual Analogue Scale • Values of the general public • A questionnaire… • to allow patients to ‘self classify’ themselves • An international standard • to allow international comparisons • That is at that time “Europe”

  43. EuroQoL Group • First meeting 1987 • Participants from • UK, Finland, Sweden, The Netherlands • A common core instrument • To standardize the instrument • But allow different national values • To allow international comparisons • To allow linking of international results • Instrument should be small • Suitable for sever ill patients • The emerging of high tech medicine, especially transplantation

  44. The first EuroQol • Higher sensitivity (more then 30 states) • 216 states • More and better defined dimensions • 6 dimensions (EQ-6D) • Mobility; • Daily activity and self care; • Work performance • Family and leisure performance • Pain/discomfort • Present mood • Visual Analogue Scale

  45. The first EuroQol • Values of the general public • Values from general public • But also values from patients (!) • A questionnaire • to allow patients to ‘self classify’ themselves • A international standard • to allow international comparisons • That is at that time “Europe”

  46. Values from the patients

  47. Valuesfrom the general public

  48. First values general public

  49. Why values of the general public? • Original: To avoid ‘strategic responses’ • Patients pressure groups • To avoid coping • Underestimating the value of health • To allow complex utility assessments • Time Trade Off • Standard Gamble • Willingness to pay • Person Trade off • Paired comparisons (DCE) • To allow for societal values of health states • Like costs: the societal perspective

  50. Why indirect utility measures? • Original: To avoid ‘strategic responses’ • Patients pressure groups • To avoid coping • Underestimating the value of health • To allow complex utility assessments • Time Trade Off • Standard Gamble • Willingness to pay • Person Trade off • Paired comparisons (DCE) • To allow for societal values of health states • Like costs: the societal perspective

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