Nancy Devlin

Nancy Devlin
University of Melbourne | MSD · Melbourne School of Population Health

PhD

About

280
Publications
36,214
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11,780
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Introduction
Currently leading: (a) Quality of Life in Kids: Key Evidence for Decision Makers in Australia (QUOKKA). A 3-year programme funded by the Medical Research Future Fund. (b) A comparison of PROMIS and EQ-5D-5L measurement and utilities. Funded by the EuroQol Research Foundation. (c) Outcomes and cost effectiveness of robotic surgery and 3D printed prostheses for sarcoma - the 'just in time' project. Funded via IMCRC. Key expertise: HRQoL, MCDA, cost effectiveness thresholds, priority setting
Education
February 1985 - October 1989
University of Otago
Field of study
  • Health Economics

Publications

Publications (280)
Article
A new measure of 'voraciousness' in leisure activities is introduced as an indicator of the pace of leisure, facili-tating a theoretical linkage between the literature on time pressure, busyness and harriedness in late modernity, and the literature on cultural consumption. On the methodological side it is shown that time use diaries can pro-vide at...
Article
This paper proposes a theoretical framework, drawing on Hicks utility theory, for the Time Trade-off (TTO) method conventionally used to value health states. We briefly describe that theory and posit four distinctive TTO valuation approaches suggested by it: each of compensating variation and equivalent variation for both gains and losses in health...
Article
Time Trade-Off (TTO) valuations of health are widely used in economic evaluation of health care. Current approaches to eliciting TTO values, and their use in economic evaluation, rest on specific assumptions about the way utility relates to time and health. Both the assumptions themselves and evidence of violations of them are discussed in the lite...
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Purpose To examine the relationships between physical health problems, and borderline or clinical levels of mental health symptoms and children’s health-related quality of life (HRQoL). Methods Data were from the Longitudinal Study of Australian Children (2004–2018). Parents reported on their child’s HRQoL (PedsQL), physical health problems and me...
Article
Background: For nearly a decade, value sets for the EQ-5D-Y were not available, reflecting challenges in valuing child HRQoL. A methodological research programme led to publication of a valuation protocol in 2020, which was rapidly taken up by local study teams. By the end of 2022, between 11 and 17 EQ-5D-Y value sets will be available, more than...
Article
Objectives This study aimed to identify and summarize published guidance and recommendations for child self- and proxy assessment of existing child-specific instruments of health-related quality of life (HRQoL) that are accompanied by utilities. Methods A total of 9 databases plus websites of (1) health technology assessment and health economics o...
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There is growing interest in cost-effectiveness thresholds as a tool to inform resource allocation decisions in health care. Studies from several countries have sought to estimate health system opportunity costs, which supply-side cost-effectiveness thresholds are intended to represent. In this paper, we consider the role of empirical estimates of...
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Objectives Existing measures for estimating quality-adjusted life-years are mostly limited to health-related quality of life. This article presents an overview of the development the EQ Health and Wellbeing (EQ-HWB), which is a measure that encompasses health and wellbeing. Methods Stages: (1) Establishing domains through reviews of the qualitativ...
Chapter
One of the most common questions that the EuroQol Group is asked by users of the EQ-5D-5L is: ‘Which value set should I use?’. The aim of this chapter is to provide guidance on this issue for users. There are two principal ways that EQ-5D-5L value sets are applied and used. The first is for summarising health-related quality of life to estimate qua...
Chapter
This chapter introduces the EQ-5D-5L questionnaire and its development by the EuroQol Group. The availability of the EQ-5D-5L, and the growing evidence of its pivotal role as a measurement system, generated a demand for ‘values’ to accompany it that would enable the use of EQ-5D-5L data in the estimation of quality-adjusted life-years (QALYs) and o...
Chapter
This chapter provides structured summaries of all 25 currently published national EQ-5D-5L value sets. The summaries were developed by extracting information from the published manuscripts of each value set and conducting secondary data analyses of the original valuation data generated in each country/region. The summaries include the mathematical...
Chapter
The purpose of this chapter is to reflect on the future of EQ-5D-5L valuation studies, going beyond the value sets summarised in this book. This includes a number of linked themes. First, the EQ-5D-5L valuation research programme has allowed the continued evolution of methods, as methodological studies have demonstrated that aspects of the EQ-VT pr...
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Background and aims: Patient-reported outcome measures (PROMs) for children (aged ≤ 18 years) present methodological challenges. PROMs can be categorised by their diverse underlying conceptual bases, including functional, disability and health (FDH) status; quality of life (QoL); and health-related quality of life (HRQoL). Some PROMs are designed...
Article
Introduction Standard valuation methods, such as TTO and DCE are inefficient. They require data from hundreds if not thousands of participants to generate value sets. Here, we present the Online elicitation of Personal Utility Functions (OPUF) tool; a new type of online survey for valuing EQ-5D-5L health states using more efficient, compositional e...
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Objective To compare problems reported in the five EQ-5D-3L dimensions and EQ VAS scores at baseline and at 1-year follow-up among different patient groups and specific diagnoses in 11 National Quality Registers (NQRs) and to compare these with the general population. Design Longitudinal, descriptive study. Participants 2 66 241 patients from 11...
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PurposeEQ-5D and PROMIS-29 are both concise, generic measures of patient-reported outcomes accompanied by preference weights that allow the estimation of quality-adjusted life years (QALYs). Both instruments are candidates for use in economic evaluation. However, they have different features in terms of the domains selected to measure respondents’...
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Introduction Measures of health-related quality of life (HRQoL), accompanied by the values (or utilities) required to estimate quality-adjusted life-years, are crucial for determining health benefits within economic evaluation and health technology assessment. Several generic and condition-specific measures or instruments of HRQoL, accompanied by v...
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Measuring and valuing health-related quality of life (HRQOL) in children can be challenging but is an important component for providing decision makers with accurate information to fund new interventions, including medicines and vaccines for public subsidy. We review funding submissions of medicines made to the Pharmaceutical Benefits Advisory Comm...
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Objectives The EQ-5D-5L and its value sets are widely used internationally. However, in the US and elsewhere, there is growing use of PROMIS, which has a value set (PROPr) based on the stated preferences of the US population. This paper aims to compare the characteristics of EQ-5D-5L and PROPr value sets and to highlight potential implications for...
Chapter
This chapter is an introduction to economic appraisal. It explains underlying concepts, describes methods used, and discusses the application to public health. Economic appraisal comprises techniques that weigh up the costs of an action, such as providing a public health intervention to an at-risk population group, against the benefits that it prov...
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Economic evaluation combines costs and benefits to support decision-making when assessing new interventions using preference-based measures to measure and value benefits in health or health-related quality of life. These health-focused instruments have limited ability to capture wider impacts on informal carers or outcomes in other sectors such as...
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Background EQ-5D is one of the most commonly used questionnaires to measure health-related quality of life. It is included in many of the Swedish National Quality Registers (NQRs). EQ-5D health states are usually summarized using “values” obtained from members of the general public, a majority of whom are healthy. However, an alternative, which rem...
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Background: There is a lack of psychometric evidence about pediatric health-related quality of life (HRQoL) instruments. Evidence on cost effectiveness, involving the measurement of HRQoL, is used in many countries to make decisions about pharmaceuticals, technologies, and health services for children. Additionally, valid instruments are required...
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Objective To generate a value set for the Mexican adult general population to support and facilitate the inclusion of quality-adjusted life years (QALYs) into the health technology assessment process of the Mexican healthcare authorities.MethodsA representative sample of the Mexican adult population stratified by age, sex and socio-economic status...
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In the UK few if any regular processes explicitly address comparisons of value for money between spending in different government departments, despite the existence of mechanisms that could in principle achieve that. This leaves a very important gap in evidence and means that decisions about public spending allocations are likely to miss opportunit...
Article
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One of the challenges with generating an EQ-5D-Y value set is that traditional methods are cognitively demanding and may not be appropriate for younger individuals. However, asking adults to complete a valuation task from the perspective of a child/adolescent presents its own challenges. This Research Paper describes a study examining adolescent an...
Preprint
BACKGROUND EQ-5D is one of the most commonly used questionnaires to measure health-related quality of life. It is included in many of the Swedish National Quality Registers (NQRs). EQ-5D health states are usually summarized using “values” obtained from members of the general public, a majority of whom are healthy. However, an alternative, which rem...
Research
Full-text available
By convention, values for generic ‘preference-based’ measures, such as the EQ-5D, are anchored at 1 = full health and 0 = dead. This paper challenges the assumption that anchoring health state values at ‘dead = 0’ is a necessary condition for values to be used in quality-adjusted life year (QALY) estimation. The authors consider five propositions,...
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Objectives Discrete choice experiments (DCEs) can be used to obtain latent scale values for the EQ-5D-Y, but these require anchoring at 0 = dead to meet the conventions of quality-adjusted life year (QALY) estimation. The primary aim of this study is to compare four preference elicitation methods for obtaining anchors for latent scale EQ-5D-Y value...
Chapter
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It is important when analysing EQ VAS data to understand the nature of this element of the EQ-5D questionnaire and the measurement properties that it has. (For a more detailed discussion, see Feng et al. 2014.) The EQ VAS has a unique design that does not conform to conventional Visual Analogue Scale (VAS) formats, and the widely-observed propertie...
Chapter
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Our focus, throughout this book, is on the analysis of EQ-5D data. The book is designed to meet the needs of those who have, or are planning to, collect EQ-5D data. Our hope is that this book will encourage all analysts, both those new to the EQ-5D and those experienced in using EQ-5D questionnaires, to make full use of the data provided by respond...
Chapter
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In the analyses described in Chapters 3 and 4, the objects of interest are EQ-5D values or EQ VAS scores measured at one or more points in time for one person or a group of people.
Chapter
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Profile data form the cornerstone of analyses of EQ-5D data and, in many cases, are likely to be the primary focus of interest. In this chapter, we provide an overview of methods that can be used to describe the profile data from respondents at a given point in time, and to describe the changes in profiles between different points in time.
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Despite the potential richness of the EQ-5D descriptive system demonstrated in the previous chapters, the instrument was originally developed as a measure of health status that could serve as the basis for summarising and comparing health outcomes (Williams 2005).
Article
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Economic evaluation provides important evidence on value for money in health care and is routinely used in health technology assessment processes. The relevant costs and benefits of health care that are considered may arise now and/or in the future, and the relative importance placed on costs and benefits in the future is reflected in the discount...
Article
Escalating levels of healthcare spending and price variation in the healthcare market have driven government and insurer interest in price transparency tools that are intended to help consumers shop for services and reduce overall healthcare spending. However, it is unclear whether the objectives of price transparency are being achieved. We conduct...
Article
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The EQ-5D-Y-3L is a generic, health-related, quality-of-life instrument for use in younger populations. Some methodological studies have explored the valuation of children’s EQ-5D-Y-3L health states. There are currently no published value sets available for the EQ-5D-Y-3L that are appropriate for use in a cost-utility analysis. The aim of this arti...
Article
Background Differences in healthcare use could relate to differences in the values assigned health as well as to differences in access. We sought to establish whether there existed evidence of differences in values assigned health states between individuals with and without insurance in Ireland. Methods Using the EuroQol Valuation Technology (EQ-V...
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Background: The FACT-8D is a new cancer-specific, preference-based measure (PBM) of health, derived from the Functional Assessment of Cancer Therapy - General (FACT-G) questionnaire. The FACT-8D's measurement properties have not been tested to date. We assessed it's validity and responsiveness in relapsed/refractory mantle cell lymphoma (RR MCL) a...
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Objectives To respond to the ‘quality assurance’ of the EQ-5D-5L value set for England study. Methods We provide a point-by-point response to the issues raised by the authors of the quality assurance paper, drawing on theoretical arguments, empirical analyses and practical considerations. Results We provide evidence to show that many of the point...
Article
Patient-reported outcomes (PROs), such as symptoms, function, and other health-related quality-of-life aspects, are increasingly evaluated in cancer randomised controlled trials (RCTs) to provide information about treatment risks, benefits, and tolerability. However, expert opinion and critical review of the literature showed no consensus on optima...
Book
This open access book is the first published guide about how to analyse data produced by the EQ-5D, one of the most widely used Patient Reported Outcomes questionnaires world wide. The authors provide practical, clear and comprehensive guidance in five concise chapters. Following an overview of the EQ-5D and its analysis, we describe how the questi...
Article
Methods for measuring and valuing health benefits for economic evaluation and health technology assessment in adult populations are well developed. In contrast, methods for assessing interventions for child and adolescent populations lack detailed guidelines, particularly regarding the valuation of health and quality of life in these age groups. Th...
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The EuroQol Group's health descriptive systems, the EQ-5D-3L and its successor introduced in 2009, the EQ-5D-5L, are widely used worldwide for valuing health-related quality of life for cost-utility analysis and patient-reported health outcome measures. A new online tool for creating personal and social EQ-5D-5L value sets was recently developed an...
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Introduction. Health utilities are widely used in health care. The distributions of utilities differ between countries; some countries more often report worse than dead health states, while mild states are valued more or less the same. We hypothesize that cultural values explain these country-related utility differences. Research Question. What is...
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Background: Standard methods for eliciting the preference data upon which 'value sets' are based generally have in common an aim to 'uncover' people's preferences by asking them to evaluate a subset of health states, then using their responses to infer their preferences over all dimensions and levels. An alternative approach is to ask people direc...
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Objectives: This study aimed to evaluate the performance of EQ-5D data mapped from SF-12 in terms of estimating cost effectiveness in cost-utility analysis (CUA). The comparability of SF-6D (derived from SF-12) was also assessed. Methods: Incremental quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calcu...
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Purpose To extend existing analyses of whether and how the age of respondents is related to their time trade-off (TTO) valuations of hypothetical EQ-5D-3L health states, and to contribute to the existing debate about the rationale and implications for using age-specific utilities in health technology assessment (HTA). Methods We use data from the...
Article
Background The distribution of EQ-5D-3L values (health state profiles, weighted by value sets) often shows two distinct groups, arising from both the distribution of profiles and the characteristics of value sets. To date, there is little evidence about the distribution of EQ-5D-5L values. Objectives To explore the distribution of EQ-5D-5L profile...
Conference Paper
Background: By convention, values for the EQ-5D are anchored at 1 = full health and 0 = dead for use in estimating QALYs for cost effectiveness analysis. Consequently, the stated preference methods used to value health states often involve consideration of the state 'dead' or 'immediate death'. Using dead as an anchor also implies that states worse...
Article
Although patient-reported outcomes (PROs), such as health-related quality of life, are important endpoints in randomised controlled trials (RCTs), there is little consensus about the analysis, interpretation, and reporting of these data. We did a systematic review to assess the variability, quality, and standards of PRO data analyses in advanced br...
Article
Background: There is currently a lack of consensus on how health-related quality of life and other patient-reported outcome measures in cancer randomized clinical trials are analyzed and interpreted. This makes it difficult to compare results across randomized controlled trials (RCTs) synthesize scientific research, and use that evidence to inform...
Article
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Background: Valuations of health states were affected by the wording of the two instruments (EQ-5D-3L and EQ-5D-Y) and by the perspective taken (child or adult). Objectives: There is a growing demand for value sets for the EQ-5D-Y (EQ-5D instrument for younger populations). Given the similarities between EQ-5D-Y and EQ-5D-3L, we investigated whethe...
Article
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Background: The Quality Adjusted Life Year influences the allocation of significant amounts of healthcare resources. Despite this surprisingly little research effort has been devoted to analysing how beliefs and attitudes to hastening death influence preferences for health states anchored at "dead" and "perfect health". In this paper we examine ho...
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Objective: Our objective was to develop a value set based on Irish utility values for the EuroQol 5-Dimension, 5-Level instrument (EQ-5D-5L). Methods: The research design and data collection followed a protocol developed by the EuroQol Group. The EuroQol Valuation Technology (EQ-VT) software was administered using computer-assisted personal inte...
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Objectives To explore how the use of EQ-5D-5L value set and crosswalk from EQ-5D-5L to EQ-5D-3L (and use of 3L value set) would affect cost-effectiveness analysis results for England and six other countries (Canada, the Netherlands, China, Japan, South Korea, and Singapore). Methods Individual-level utilities derived from primary 5L data using bot...
Article
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Background: In health state valuation studies, health states are typically presented as a series of sentences, each describing a health dimension and severity 'level'. Differences in the severity levels can be subtle, and confusion about which is 'worse' can lead to logically inconsistent valuation data. A solution could be to mimic the way patien...
Article
The article 3L, 5L, What the L? A NICE Conundrum Written by Nancy Devlin, John Brazier, A. Simon Pickard, Elly Stolk was originally published electronically on the publisher’s internet portal (currently Springer Link) on (26th February, 2018) without open access.