US Valuation of the EQ-5D Health States: Development and Testing of the D1 Valuation Model

Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA.
Medical Care (Impact Factor: 2.94). 04/2005; 43(3):203-20. DOI: 10.1097/00005650-200503000-00003
Source: PubMed

ABSTRACT The EQ-5D is a brief, multiattribute, preference-based health status measure. This article describes the development of a statistical model for generating US population-based EQ-5D preference weights.
A multistage probability sample was selected from the US adult civilian noninstitutional population. Respondents valued 13 of 243 EQ-5D health states using the time trade-off (TTO) method. Data for 12 states were used in econometric modeling. The TTO valuations were linearly transformed to lie on the interval [-1, 1]. Methods were investigated to account for interaction effects caused by having problems in multiple EQ-5D dimensions. Several alternative model specifications (eg, pooled least squares, random effects) also were considered. A modified split-sample approach was used to evaluate the predictive accuracy of the models. All statistical analyses took into account the clustering and disproportionate selection probabilities inherent in our sampling design.
Our D1 model for the EQ-5D included ordinal terms to capture the effect of departures from perfect health as well as interaction effects. A random effects specification of the D1 model yielded a good fit for the observed TTO data, with an overall R of 0.38, a mean absolute error of 0.025, and 7 prediction errors exceeding 0.05 in absolute magnitude.
The D1 model best predicts the values for observed health states. The resulting preference weight estimates represent a significant enhancement of the EQ-5D's utility for health status assessment and economic analysis in the US.

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    • "Several utility tariffs have been developed on the basis of stated health preferences of respondents from different countries including the United Kingdom [26], Japan [27], Korea [25], New Zealand [28], the United States [29], and Malaysia [30]. When local tariffs are not available, studies have applied utility tariffs from other countries, such as the UK population tariff or others [26]. "
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    • "Additionally, data from a visual analogue scale, which ranges from 0 (worst imaginable health) to 100 (best imaginable health), are also included as part of the EQ-5D measure. The current study used the norms and time tradeoff valuations developed for the U.S. population (Shaw et al., 2005). "
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    • "Models with these interaction terms, however, suffered from multicollinearity. Moreover, the inclusion of a large number of first-order interaction effects may introduce the risk that some become significant purely by chance [14] [21]. Such interaction terms were usually excluded from modeling analysis in previous studies. "
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    ABSTRACT: Objective To generate a Chinese general population–based three-level EuroQol five-dimensios (EQ-5D-3L) social value set using the time trade-off method. Methods The study sample was drawn from five cities in China: Beijing, Guangzhou, Shenyang, Chengdu, and Nanjing, using a quota sampling method. Utility values for a subset of 97 health states defined by the EQ-5D-3L descriptive system were directly elicited from the study sample using a modified Measurement and Valuation of Health protocol, with each respondent valuing 13 of the health states. The utility values for all 243 EQ-5D-3L health states were estimated on the basis of econometric models at both individual and aggregate levels. Various linear regression models using different model specifications were examined to determine the best model using predefined model selection criteria. Results The N3 model based on ordinary least square regression at the aggregate level yielded the best model fit, with a mean absolute error of 0.020, 7 and 0 states for which prediction errors were greater than 0.05 and 0.10, respectively, in absolute magnitude. This model passed tests for model misspecification (F = 2.7; P = 0.0509, Ramsey Regression Equation Specification Error Test), heteroskedasticity (χ2 = 0.97; P = 0.3254, Breusch-Pagan/Cook-Weisberg test), and normality of the residuals (χ2 = 1.285; P = 0.5259, Jarque-Bera test). The range of the predicted values (−0.149 to 0.887) was similar to those estimated in other countries. Conclusions The study successfully developed Chinese utility values for EQ-5D-3L health states using the time trade-off method. It is the first attempt ever to develop a standardized instrument for quantifying quality-adjusted life-years in China.
    Value in Health 07/2014; 17(5). DOI:10.1016/j.jval.2014.05.007 · 2.89 Impact Factor
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