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This article explores the possibility of creating a single European EQ tariff and compares the values of different countries using the EuroQol instrument. It examines the differences in values between countries and investigates whether background variables account for these discrepancies. The study also replicates the York Study to test the cultural determinants of the EuroQol values. The article concludes that while there is room for a European tariff, differences between investigators and countries should be considered.
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Could there be a single European EQ tariff? • Jan J.V. Busschbach, Ph.D. • Former address: • iMTA, Erasmus university • Present address: • Medical Psychology and Psychotherapy • Erasmus Medical Center, Rotterdam • PO Box 1738 • 3000 DR Rotterdam, The Netherlands • Psychotherapeutic center “De viersprong” • PO Box 7 • 4660 AA Halsteren, The Netherlands • Busschbach@bmg.eur.nl
The EuroQol • MOBILITY • I have no problems in walking about • I have some problems in walking about • I am confined to bed • SELF-CARE • I have no problems with self-care • I have some problems washing or dressing myself • I am unable to wash or dress myself • USUAL ACTIVITIES (e.g. work, study, housework family or leisure activities) • I have no problems with performing my usual activities • I have some problems with performing my usual activities • I am unable to perform my usual activities • PAIN/DISCOMFORT • I have no pain or discomfort • I have moderate pain or discomfort • I have extreme pain or discomfort • ANXIETY/DEPRESSION • I am not anxious or depressed • I am moderately anxious or depressed • I am extremely anxious or depressed • Links values from the general public to 243 health states • 5 dimensions, 3 levels • Starting point of group: QoL-values differ over Europe • Different national TTO and VAS values are now available • Possibility to compare values from different countries
Problem & Hypotheses • German TTO values higher than English and Spanish • Explanation by exclusion • Culture • National nature of the inhabitants • Methods / investigators • Investigators use the same protocol • Sample • Back ground variable do matter • Back ground variables are distributed differently • Effect should disappear if we control for back ground variables • co-variate analysis
Samples differ in background variables • The German sample is older and smarter • But background variables do not explain the differences
Conclusion (so fare) • VAS does not differ • Not cultural determined • TTO differs • Back ground variables do not appear to account for the difference found • TTO could be cultural determined • But… country and investigator are linked • Differences between countries can be differences between investigators • Prove of the pudding…replication within country
Replication of York Study VASMacran S Kind P. Valuing the EQ-5D health states using a modified MVH protocol. Proceedings Plenary Meeting of the EuroQol Group, Sitges, Spain, 6/11/1999.
Replication of York Study TTOMacran S Kind P. Valuing the EQ-5D health states using a modified MVH protocol. Proceedings Plenary Meeting of the EuroQol Group, Sitges, Spain, 6/11/1999.
Conclusion (end) • VAS are not cultural determined • TTO differs • Back ground variables do not account for all difference • TTO are perhaps cultural determined • But differences between countries are also differences between investigators • Different investigators give different values • Little proof that TTO-values differ in Europe • Yes,…. there is room for an European tariff
Negative values • Negative values in York protocol are disputed • Little theoretical consensus • Difficult to handle • Compare negative and positive values separately
