Preference-Based EQ-5D Index Scores for Chronic Conditions in the United States

University of Colorado Department of Economics, Boulder, USA.
Medical Decision Making (Impact Factor: 3.24). 07/2006; 26(4):410-20. DOI: 10.1177/0272989X06290495
Source: PubMed


The Panel on Cost-Effectiveness in Health and Medicine has called for an "off-the-shelf" catalogue of nationally representative, community-based preference scores for health states, illnesses, and conditions. A previous review of cost-effectiveness analyses found that 77% did not incorporate community-based preferences, and 33% used arbitrary expert or author judgment. These results highlight the necessity of making a wide array of appropriate, community-based estimates more accessible to cost-effectiveness researchers.
To provide nationally representative EQ-5D index scores for chronic ICD-9 codes.
The nationally representative Medical Expenditure Panel Survey (MEPS) was pooled (2000-2002) to create a data set of 38,678 adults. Ordinary least squares (OLS), Tobit, and censored least absolute deviations (CLAD) regression methods were used to estimate the marginal disutility of each condition, controlling for age, comorbidity, gender, race, ethnicity, income, and education.
Most chronic conditions, age, comorbidity, income, and education were highly statistically significant predictors of EQ-5D index scores. Homoskedasticity and normality assumptions were rejected, suggesting only CLAD estimates are theoretically unbiased. The magnitude and statistical significance of coefficients varied by analytic method. OLS and Tobit coefficients were on average 60% and 143% greater than CLAD, respectively. The marginal disutility of 95 chronic ICD-9 codes as well as unadjusted mean, median, and 25th and 75th percentiles are reported.
This research provides nationally representative, community-based EQ-5D index scores associated with a wide variety of chronic ICD-9 codes that can be used to estimate quality-adjusted life-years in cost-effectiveness analyses.

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Available from: Patrick W Sullivan, Nov 17, 2014
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    • "They come, for example, from the USA [3-6], New Zealand [7], Japan [8], China [9], the UK [10-13], Sweden [14], Spain [15,16], Greece [17,18], Denmark [19,20] and the Netherlands [21]; some studies combine data from different Western European countries [22-24]. Of course they also differ in the way the sample was drawn, but despite these differences they consistently show that HRQL increases with increasing SES, in terms of problems reported [9,12,19-21,23,24] and in terms of overall HRQL assessment [3-6,10,13,14,16,17,22]. "
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    ABSTRACT: A number of studies have shown an association between health-related quality of life (HRQL) and socioeconomic status (SES). Indicators of SES usually serve as potential confounders; associations between SES and HRQL are rarely discussed in their own right. Also, few studies assess the association between HRQL and SES among those with a chronic disease. The study focuses on the question of whether people with the same state of health judge their HRQL differently according to their SES, and whether a bias could be introduced by ignoring these differences. The analyses were based on a representative sample of the adult population in Germany (n = 11,177). HRQL was assessed by the EQ-5D-3 L, i.e. the five domains (e.g. 'moderate or severe problems' concerning mobility) and the Visual Analog Scale (VAS). SES was primarily assessed by educational level; age, sex and family status were included as potential confounders. Six chronic diseases were selected, each having a prevalence of at least 1% (e.g. diabetes mellitus). Multivariate analyses were conducted by logistic and linear regression. Among adults with a chronic disease, most 'moderate or severe problems' are reported more often in the low (compared with the high) educational group. The same social differences are seen for VAS values, also in subgroups characterized by 'moderate or severe problems'. Gender-specific analyses show that for women the associations with VAS values can just be seen in the total sample. For men, however, they are also present in subgroups defined by 'moderate or severe problems' or by the presence of a chronic disease; some of these differences exceed 10 points on the VAS scale. Low SES groups seem to be faced with a double burden: first, increased levels of health impairments and, second, lower levels of valuated HRQL once health is impaired. These associations should be analysed and discussed in their own right, based on interdisciplinary co-operation. Social epidemiologists could include measures of HRQL in their studies more often, for example, and health economists could consider assessing whether recommendations based on HRQL scales might include a social bias.
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    • "For example, the utility of the subjects with diabetes having CVD at the initiation age of 60 years was 0.584, which was derived from the median utility of diabetes with CVD (0.674) and subtracting 0.006 [(60–40) × (−0.0003)] and 0.084 (the coefficient of three conditions). For the individuals aged 25 years, the calculation of utilities only considered the impact of age [40], because no differences in severity of disease have been found between young and the middle-aged subjects with diabetes [45]. "
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    ABSTRACT: The serious consequences of diabetes mellitus, and the subsequent economic burden, call for urgent preventative action in developing countries. This study explores the clinical and economic outcomes of strategies that could potentially prevent diabetes based on Chinese circumstances. It aims to provide indicators for the long-term allocation of healthcare resources for authorities in developing countries. A representative sample of Chinese adults was used to create a simulated population of 20,000 people aged 25 years and above. The hybrid decision tree Markov model was developed to compare the long-term clinical and economic outcomes of four simulated diabetes prevention strategies with a control group, where no prevention applied. These preventive strategies were the following: (i) one-off screening for undiagnosed diabetes and impaired glucose tolerance (IGT), with lifestyle interventions on diet, (ii) on exercise, (iii) on diet combined exercise (duo-intervention) respectively in those with IGT, and (iv) one-off screening alone. Independent age-specific models were simulated based on diverse incidences of diabetes, mortalities and health utilities. The reported outcomes were the following: the remaining survival years, the quality-adjusted life years (QALYs) per diabetes or IGT subjects, societal costs per simulated subject and the comparisons between preventions and control over 40 years. Sensitivity analyses were performed based on variations of all assumptions, in addition to the performance and the compliance of screening. Compared with the control group, all simulated screening programmes prolonged life expectancy at the initiation ages of 25 and 40 years, postponed the onset of diabetes and increased QALYs at every initiation age. Along with an assumption of six years intervention, prevention programmes were associated with cost-saving compared with the control group, especially in the population aged 25 years. The savings were at least US$2017 per subject, but no statistically significant difference was observed among the intervention strategies within each age groups. The cost savings were reduced when screening was affected by poor performance and noncompliance. Developing countries have few effective strategies to manage the prevention of diabetes. One-off screening for undiagnosed diabetes and IGT, with appropriate lifestyle interventions for those with IGT are cost saving in China, especially in young adults.
    Full-text · Article · Aug 2013 · BMC Public Health
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    • "It’s known that HRQoL among patients with SLE is worse than the general population, particularly those fall victim at an earlier age [4]. Prior studies of HRQoL in SLE have employed generic tools, such as the Short Form-36 (SF-36) [5], EuroQoL scale (EQ-5D) [6], or 20-Item Short Form Health Survey (SF-20) [7], however it was found that generic tools were not sensitive enough, and lacked of specific domains and items for SLE. Therefore, attention has been turned toward developing a more disease-specific questionnaire. "
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    ABSTRACT: To adapt and assess the validity and reliability of LupusQoL for use in Chinese patients with systemic lupus erythematosus (SLE). Debriefing interviews of subjects with SLE guided the language modifications of the tool. The process of adaptation proceeded according to the guideline and pre-testing results of LupusQoL-China. 220 SLE patients completed LupusQoL-China and a generic preference-based measurement of health EuroQoL scale (EQ-5D), and 20 patients repeated them after 2 weeks. Internal consistency (ICR) and test-retest (TRT) reliability, convergent and discriminant validity were examined. Factor analysis and Rasch analysis were performed. The mean (SD) age of the 208 subjects with SLE was 33.93 (±9.19) years. ICR and TRT of the eight domains ranged from 0.811 to 0.965 and 0.836 to 0.974, respectively. The LupusQoL-China domains demonstrated substantial evidence of construct validity when compared with equivalent domains on the EQ-5D (physical health and usual activities r = -0.63, pain and pain/discomfort r = -0.778, emotional health and anxiety/depression r = -0.761, planning and usual activities r = -0.560). Most LupusQoL-China domains could discriminate patients with varied disease activities and end-organ damage (according to SELENA-SLEDAI and SLICC-DI). The principal component analysis revealed six factors, and confirmatory factor analysis result of which is similar to eight factors model. These results provide evidence that the LupusQoL-China is valid as a disease-specific HRQoL assessment tool for Chinese patients with SLE.
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