Preparatory study for the re-evaluation of the EQ-5D tariff
Lead Research Organisation:
University of Sheffield
Department Name: Health and Related Research
Abstract
Resources are limited and need to be allocated efficiently. The National Institute for Health and Clinical Excellence (NICE) was set up to help make better health care resource allocation decisions. NICE bases its recommendations on cost effectiveness, and the EQ-5D is the preferred instrument to use when quantifying the health related quality of life impact of medical interventions. EQ-5D is a tool that classifies 243 different health states with 5 different dimensions of health, each with an identified level of severity.
NICE uses an EQ-5D ?tariff?. This is a set of numbers that indicate the level of health related quality of life of each EQ-5D health state, on a scale with 1 for full health and 0 for dead. By comparing the different EQ-5D states patients are in before and after treatment, analysts can calculate how effective the treatment is.
The current EQ-5D tariff is based on a survey in 1994. The study asked members of the general public to ?value? a selection of hypothetical EQ-5D states using a specially designed questionnaire. However, in the past 15 years, there have been various developments that have lead to the need for a ?re-evaluation? of the EQ-5D. In order for NICE to make the most appropriate decisions, the EQ-5D population value set needs to be one that is up to date, based on the latest understanding of how to value health states.
The proposed preparatory study is a methodological piece of work that will contribute to the re-evaluation of the EQ-5D tariff. The aim is to produce a protocol for an actual re-evaluation study to use. The project will look into different ways of surveying members of the public, for instance, by on-line surveys or by face to face interviews. The project will also look at different ways of designing and wording the questionnaire to value hypothetical EQ-5D states, or which EQ-5D states to use. It will start with a large scale on-line survey to gauge the relevant concerns, where a long list of issues can be explored by surveying a large number of people, but not in much detail. The study will then move on to a smaller scale interview study, where researchers can ask participants more detailed questions. The final stage of the project will be to test out a recommended study protocol for the actual re-evaluation study to use, and make any further fine tuning adjustments.
NICE uses an EQ-5D ?tariff?. This is a set of numbers that indicate the level of health related quality of life of each EQ-5D health state, on a scale with 1 for full health and 0 for dead. By comparing the different EQ-5D states patients are in before and after treatment, analysts can calculate how effective the treatment is.
The current EQ-5D tariff is based on a survey in 1994. The study asked members of the general public to ?value? a selection of hypothetical EQ-5D states using a specially designed questionnaire. However, in the past 15 years, there have been various developments that have lead to the need for a ?re-evaluation? of the EQ-5D. In order for NICE to make the most appropriate decisions, the EQ-5D population value set needs to be one that is up to date, based on the latest understanding of how to value health states.
The proposed preparatory study is a methodological piece of work that will contribute to the re-evaluation of the EQ-5D tariff. The aim is to produce a protocol for an actual re-evaluation study to use. The project will look into different ways of surveying members of the public, for instance, by on-line surveys or by face to face interviews. The project will also look at different ways of designing and wording the questionnaire to value hypothetical EQ-5D states, or which EQ-5D states to use. It will start with a large scale on-line survey to gauge the relevant concerns, where a long list of issues can be explored by surveying a large number of people, but not in much detail. The study will then move on to a smaller scale interview study, where researchers can ask participants more detailed questions. The final stage of the project will be to test out a recommended study protocol for the actual re-evaluation study to use, and make any further fine tuning adjustments.
Technical Summary
Resources are limited and need to be allocated efficiently. The National Institute for Health and Clinical Excellence (NICE) was set up to help make better health care resource allocation decisions. NICE bases its recommendations on cost effectiveness, and the EQ-5D is the preferred instrument to use when quantifying the health related quality of life impact of medical interventions.
The current EQ-5D ?tariff? is based on a survey in 1994. The study asked members of the general public to value a selection of hypothetical EQ-5D states using the time trade off (TTO) method. However, in the past 15 years, there have been various developments that have lead to the need for a re-evaluation of the EQ-5D. In order for NICE to make the most appropriate decisions, the EQ-5D population value set needs to be one that is up to date, based on the latest understanding of health state preferences.
The proposed preparatory study is a methodological piece of work that will contribute to the re-evaluation of the EQ-5D population value set, by exploring a number of methodological issues, as identified in the MRC Scoping Study. The aim is to produce a protocol for an actual re-evaluation study to use. This is done in 4 Stages.
The objective of Stage 1 is to examine a number of assumptions and design issues, with a view to inform the selection of issues to be examined in more detail in Stage 3. Stage 1 will consist of a large scale on-line questionnaire.
The objective of Stage 2 is to explore the strengths and weaknesses of the different modes of administration and to provide recommendations for the re-evaluation of the EQ-5D tariff. Stage 2 will consist of interview surveys that replicate one of the on-line survey versions in Stage 1.
The objective of Stage 3 is to inform Stage 4. Stage 3 will consist of face to face interviews to examine in more detail and depth the issues examined in Stage 1 for further analyses. The interviews will consist of TTO and Discrete Choice Experiment tasks, each combined with probing questions inviting the respondent to explain their choices, and inform the development of a valuation protocol.
The objective of Stage 4 is to produce and test out the final re-evaluation protocol, based on face to face interviews of a convenience sample. This will involve an iterative process of trial and error.
The current EQ-5D ?tariff? is based on a survey in 1994. The study asked members of the general public to value a selection of hypothetical EQ-5D states using the time trade off (TTO) method. However, in the past 15 years, there have been various developments that have lead to the need for a re-evaluation of the EQ-5D. In order for NICE to make the most appropriate decisions, the EQ-5D population value set needs to be one that is up to date, based on the latest understanding of health state preferences.
The proposed preparatory study is a methodological piece of work that will contribute to the re-evaluation of the EQ-5D population value set, by exploring a number of methodological issues, as identified in the MRC Scoping Study. The aim is to produce a protocol for an actual re-evaluation study to use. This is done in 4 Stages.
The objective of Stage 1 is to examine a number of assumptions and design issues, with a view to inform the selection of issues to be examined in more detail in Stage 3. Stage 1 will consist of a large scale on-line questionnaire.
The objective of Stage 2 is to explore the strengths and weaknesses of the different modes of administration and to provide recommendations for the re-evaluation of the EQ-5D tariff. Stage 2 will consist of interview surveys that replicate one of the on-line survey versions in Stage 1.
The objective of Stage 3 is to inform Stage 4. Stage 3 will consist of face to face interviews to examine in more detail and depth the issues examined in Stage 1 for further analyses. The interviews will consist of TTO and Discrete Choice Experiment tasks, each combined with probing questions inviting the respondent to explain their choices, and inform the development of a valuation protocol.
The objective of Stage 4 is to produce and test out the final re-evaluation protocol, based on face to face interviews of a convenience sample. This will involve an iterative process of trial and error.
