Umeå University's logo

Purpose: The objective of this paper is to report on the origin of the EQ VAS and current understanding of the EQ VAS conceptual framework via a literature search based on the snowball approach.

Methods: A review was conducted in two steps: (1) a citation search and (2) a search of the EuroQol group’s grey literature.

Results: The findings indicate that the EQ VAS was originally designed as a warm-up task for valuing hypothetical health states. The characters of the EQ VAS reflect its valuation origin, such as drawing a line (the previous version), vertical orientation, and choice of end labels. None of these design elements of the EQ VAS were chosen for the purpose of measuring self-reported overall health. Despite this, the EQ VAS proves to be a valid self-reported health status measure with its psychometric properties demonstrated in various general and clinical populations. We found a dearth of literature addressing the conceptual framework of EQ VAS as a measure of self-rated overall health.

Conclusion: With its potential as a powerful measure of overall health, further research into EQ VAS design, conceptual framework and empirical function is warranted.

Background: Population reference data based on self-reported EQ-5D constitute a valuable resource in a broad range of settings. Within the UK, EQ-5D has been included in national population surveys for over 30 years, notably as part of the Health Survey for England, however, the extent to which such data varies over time remains largely unknown.

Methods: Between 1996 and 2014, the Health Survey for England included the original 3-level version of EQ-5D (EQ-5D-3L) and provides data from more than 100,000 respondents; these data form the basis of the present study. Age-stratified rates of reporting any problem in EQ-5D dimensions were computed for men and women; these were standardised using 1996 as the index year. Logit regression was used to examine the influence of year respondent socio-demographic characteristics, and current health status on rates of reporting any problems in EQ-5D-3L. The data of self-rated health status recorded on a 0-100 scale (EQ VAS) was also analyzed.

Results: More than 30% report a problem with Pain/Discomfort with around 20% reporting a problem with Anxiety/Depression, Mobility having a similar problem rate, about 18%. Some 5% of respondents report a problem with Self Care. After an initial fall from 1996, self-reported health remains relatively stable across 10 years, however between 2008 and 2012 rates of reporting any problem increased, particularly in the Anxiety/Depression dimension and amongst older women. Logit regression analysis demonstrates that most of the covariates had statistically significant coefficients, such as age, gender, education, economic activity, income, and long-standing illness/condition.

Conclusions: The study demonstrates the stability of EQ-5D responses over time in HSE data from 1996 to 2014. However, there is evidence of periodic deterioration in health status notably in the years immediately after 2007. Further investigation of this effect could have implications for the interpretation and use of population data based on EQ-5D. The study demonstrates the importance in national surveys of the general population of regular collection of health status data using a standardised measure of health-related quality of life.

Objective To estimate the willingness-to-pay (WTP) of patients with type 2 diabetes mellitus (T2DM) for oral antidiabetic drugs (OAD) using discrete choice experiments (DCE) and to investigate the heterogeneity of WTP in different subgroups.

Methods The attributes and levels were identified for this study through literature review, qualitative research, and expert consultation. From May to August 2023, a questionnaire survey, including demographic and clinical items, and DCE choice tasks, was conducted among T2DM patients in 16 provinces/municipalities in China using both online and offline sampling methods. A conditional logit model was constructed using Stata 17.0 software to estimate WTP. Subgroup analyses based on demographic and clinical characteristics was conducted to explore WTP heterogeneity among various respondent groups.

Results A total of 741 T2DM patients were included in the analysis, with 456 cases from online and 285 cases from offline surveys. The WTP results showed that for each 1 mmol/L reduction in blood glucose levels, respondents were willing to pay RMB ¥5.77 yuan per day. To reduce the frequency of medication from three times per day and once per day to once every two weeks, respondents were willing to pay RMB ¥23.20 yuan/day and RMB ¥12.06 yuan/day, respectively. Subgroup analyses showed that respondents with higher annual income, higher education level, living in first-tier or new first-tier cities, living in urban areas, and with a lower medication burden generally had higher WTP for most attributes and levels (all P<0.05).

Conclusion Patients with T2DM are willing to pay a certain fee for OAD that offer better glycemic control, less frequent dosing, fewer gastrointestinal side effects, and no dose adjustment required for patients with hepatic or renal insufficiency, in order to achieve related health benefits and medication convenience. Patients with higher income, higher education, and lower medication burden tend to have a relatively higher WTP for these attributes.

Background: Relapsed or refractory classic Hodgkin lymphoma (RRcHL) associates with poor prognosis and heavy disease burden to patients. This study evaluated the cost-effectiveness of brentuximab vedotin (BV) in comparison to conventional chemotherapy in patients with RRcHL, from a Chinese healthcare perspective.

Methods: The lifetime cost and quality adjusted life years (QALYs) were estimated through a partitioned survival model with three health states (progression free, post progression, and death). Two cohorts for each BV arm and chemotherapy arm were built, representing patients with and without transplant after BV or chemotherapy, respectively. Clinical parameters were retrieved from BV trials and the literature. Resource utilization data were mainly collected from local expert surveys and cost parameters were reflecting local unit prices. Utility values were sourced from the literature. A discount rate of 5% was employed according to the Chinese guideline. A series of deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness and uncertainty associated with the model.

Results: Results of the base case analysis showed that the incremental cost-effectiveness ratio (ICER) for BV versus chemotherapy was $2,867 (¥19,774). The main model driver was the superior progression-free and overall survival benefits of BV. The ICERs were relatively robust in a series of sensitivity analyses, all under a conventional decision threshold (1 time of Chinese per capita GDP). With this conventional threshold, the probability of BV being cost-effective was 100%.

Conclusions: Brentuximab vedotin can be considered a cost-effective treatment versus conventional chemotherapy in treating relapsed or refractory classic Hodgkin lymphoma in China.

Purpose: To quantify the preferences for an oral antidiabetic drug (OAD) among patients with type 2 diabetes mellitus (T2DM) in China.

Methods: A discrete choice experiment (DCE) with hypothetical OAD profiles was performed among patients with T2DM recruited from both online and offline sources. Each patient completed 12 DCE choice tasks. The attributes, elicited through mixed methods, include blood glucose level decrease, blood glucose level stability, frequency of medication, gastrointestinal side effects, dose adjustment and out-of-pocket expense. The conditional logit regression model was used to analyze the data. Patients’ willingness-to-pay (WTP) was also calculated. Subgroup analyses based on patient characteristics were also conducted.

Results: A total of 741 respondents were included in the analysis sample, covering 456 respondents online and 285 offline. The result showed that all attributes and levels were statistically significant, except one level “dose adjustment required for patients with hepatic or renal insufficiency” in the attribute of dose adjustment. WTP results showed that patients were willing to pay 12.06 and 23.20 yuan, respectively to reduce the frequency of medication from “once per day” and “three times per day” to “once every 2 weeks”, respectively. Subgroup analyses showed that the frequency of medication (once versus two to three times per day) had the largest impact and influenced most coefficient estimates.

Conclusion: The results suggest that Chinese patients with T2DM prioritized better efficacy, less frequency of medication, lower gastrointestinal side effects, no dose adjustment required for patients with hepatic or renal insufficiency, and less out-of-pocket expense of OAD treatment.

Introduction: Cost-utility analysis (CUA) is the preferred form of economic evaluation in many countries. As one of the key data inputs in cost-utility models, health state utility (HSU) has a crucial impact on CUA results. In the past decades, health technology assessment has been expanding rapidly in Asia, yet research examining the methodology and process used to generate cost-effectiveness evidence is scarce. The aim of this study was to examine the reporting of the characteristics of HSU data used in CUAs in Asia and how the characteristics have changed over time.

Methods: A systematic literature search was performed to identify published CUA studies targeting Asian populations. Information was extracted for both the general characteristics of selected studies and the characteristics of reported HSU data. For each HSU value identified, we extracted data for four key characteristics, including 1) estimation method; 2) source of health-related quality of life (HRQoL) data; 3) source of preference data; and 4) sample size. The percentage of nonreporting was calculated and compared over two time periods (1990–2010 vs 2011–2020).

Results: A total of 789 studies were included and 4,052 HSUs were identified. Of these HSUs, 3,351 (82.7%) were from published literature and 656 (16.2%) were from unpublished empirical data. Overall, the characteristics of HSU data were not reported in more than 80% of the studies. Of HSUs whose characteristics were reported, most of them were estimated using the EQ-5D (55.7%), Asian HRQoL data (91.9%), and Asian health preferences (87.7%); 45.7% of the HSUs was estimated with a sample of 100 or more individuals. All four characteristics showed improvements after 2010.

Conclusion: Over the past two decades, there has been a significant increase in CUA studies targeting Asian populations. However, HSU’s characteristics were not reported in most of the CUA studies, making it difficult to evaluate the quality and appropriateness of the HSUs used in those cost-effectiveness studies.

Objectives: Systemic anaplastic large-cell lymphoma (sALCL) is a rare hematological malignancy with poor prognosis, which is associated with a significant economic burden. This study aimed to evaluate the cost-effectiveness of brentuximab vedotin (BV) in comparison to conventional chemotherapy in patients with relapsed/refractory sALCL, from a Chinese healthcare perspective.

Methods: A partitioned survival model with three health states (progression-free survival, post-progression survival, and death) was adapted to compare BV against chemotherapy. Comparator represented a basket of commonly used chemotherapies in China. Two cohorts in each arm were estimated, representing patients receiving no transplant and autologous stem cell transplant (ASCT) after BV or chemotherapy. Clinical data was obtained from the pivotal phase-II trial (NCT00866047) for BV and also from the literature for a comparator. Resource use items covered drug acquisition and administration; concomitant medications; ASCT; treatment of adverse events; and long-term follow-up. Cost parameters were based on Chinese sources. Outcomes were measured in quality-adjusted life-years (QALYs). Both costs and effects were discounted at 5% according to Chinese guidelines. The impact of uncertainty was evaluated using deterministic and probabilistic sensitivity analyses.

Results: The incremental cost-effectiveness ratio (ICER) for BV vs. chemotherapy was $9,610 (¥62,084) per QALY in the base case. The main model driver was superior progression-free and overall survival benefits of BV. The ICERs were relatively robust in the majority of sensitivity analyses, ranging around ±10% of the base case. Under the conventional decision thresholds (1–3 times of Chinese per capita GDP), the probability of BV being cost-effective ranged from 56 to 100%. Limitations of the study included the lack of comparative data from the trial and the small and heterogeneous sample due to its disease nature.

Conclusions: BV may be a cost-effective treatment vs. chemotherapy in treating relapsed or refractory systemic anaplastic large-cell lymphoma in China.

Background: The study aims to elicit a value set based on the EQ-VT for the EQ-5D-5L that can be used to support decision-making in Sweden.

Methods: Participants were recruited from the general population based on age, sex and urban/rural area quota sampling from five regions across Sweden. In total, 785 interviews were conducted from February 2020 to April 2021 using the EQVT 2.1 protocol, and both composite time trade-off (c-TTO) and discrete choice experiments (DCE) were used to elicit health preferences. A variety of models have been tested for the c-TTO data (generalized least square, Tobit, heteroskedastic models) and DCE data (conditional logit model), as well as the combined c-TTO and DCE data (hybrid modelling). Model selection was based on theoretical considerations, logical consistency of the parameter estimates, and significance of the parameters (p = 0.05). Model goodness-of-fit was assessed by AIC and BIC, and prediction accuracy was assessed in terms of mean absolute error. The predictions for the EQ-5D-5L health states between models were compared using scatterplots.

Results: The preferred model for generating the value set was the heteroskedastic model based on the c-TTO data, with the health utilities ranging from -0.31 for the worst (55,555) to 1 for the best (11111) EQ-5D-5L states.

Conclusion: This is the first c-TTO-based social value set for the EQ-5D-5L in Sweden. It can be used to support the health utility estimation in economic evaluations for reimbursement decision making in Sweden.