Special Issue of EJHE Examines Progress on Refinement of the EQ-5D

Just released online [open access] is a special issue of the European Journal of Health Economics on the development of new research methods for the valuation of EQ-5D-5L. It is co-edited by OHE’s Professor Nancy Devlin and Professor Paul Krabbe of the University of Groningen/University Medical Center Groningen. Both are active members of the EuroQol Group; Nancy chairs its Executive Committee.

Just released online [open access] is a special issue of the European Journal of Health Economics[1] on the development of new research methods for the valuation of EQ-5D-5L. It is co-edited by OHE’s Professor Nancy Devlin and Professor Paul Krabbe of the University of Groningen/University Medical Center Groningen. Both are active members of the EuroQol Group; Nancy chairs its Executive Committee. 

The EQ-5D is arguably the best known and most commonly used generic measure of health status worldwide. Experience has provided evidence of both merits and limitations. One central concern is whether the three-level EQ-5D is sensitive enough to capture important aspects of health in certain disease areas. The EuroQol Group has undertaken an ambitious research and development program to address this, including the development of a five-level version of the EQ-5D, the EQ-5D-5L. This initiative is an opportunity to both advance methods for health state valuation and to offer a common protocol that can be followed in all countries.

Part of the EuroQol programme includes research aimed at overcoming well known problems and limitations with the “time trade off” (TTO) approach that is used to value the EQ-5D-5L. In particular, “lead” and “lag” time TTO approaches were investigated as potential methods for overcoming issues in valuing health states considered to be worse than being dead. The research also includes testing and evaluating preferences data for the EQ-5D-5L, which is more complex than its three-level predecessor for lay participants asked to value health states.

The papers in this issue report on this ambitious program of research. They draw together the findings from a multicountry pilot study to test an initial version of the study protocol and related experimentation with aspects of the methods in that protocol. Specifically, they compare the use of lead and lag time TTO; explore the effect on valuation of changing the length of duration of health states; examine the use of discrete choice methods in EQ-5D-5L valuation and explore the effect of different modes of data collection.

The research in this supplemental issue already has had an impact in refining and improving the methods in the Euroqol  Group’s final international protocol for producing EQ-5D-5L data sets. Studies based on this protocol are soon to be completed in Canada, China, England, The Netherlands and Spain; value sets for each country to be reported later this year. Value set studies are also about to commence in a range of other countries, including Germany, Japan, Hong Kong, Singapore, South Korea, Taiwan, Thailand and Uruguay. Other countries also have expressed interest. This fully documented research protocol will help ensure that studies undertaken meet a high standard. Moreover, the consistency of design and methods it promotes will allow for valid international comparisons of the EQ-5D-5L valuation data.

Research involving OHE’s Nancy Devlin and Koonal Shah is featured in several papers in this issue. For example, the article by Shah et al shows that the quality of TTO data clearly is affected by the mode of data collection: computer-assisted, one-on-one, interviewer-led interviews are superior to self-completion in a group setting. Nancy Devlin was involved in three of the studies on TTO: lead versus lag time, comparisons of lead/lag time to classic TTO approaches, and the use of visual aids in gathering reliable TTO valuations.

Previous research by Nancy and Koonal, available on this website as an OHE Research Paper:  

Download Devlin, N, Buckingham, K., Shah, K., Tsuchiya, A., Tilling, C., Wilkinson, G. and Van Hoot, B. (2010) A comparison of alternative variants of the lead and lag time TTO. Research Paper 10/02. London: Office of Health Economics.  [This has been published as: Devlin, N., Buckingham, K., Shah, K.K., Tsuchiya, A., Tilling, C., Wilkinson, G. and van Hout, B. (2013) A comparison of alternative variants of the lead and lag time TTO. Health Economics. 22(5), 517-532.]

See also Nancy’s recent presentations about the EuroQol Group and efforts worldwide to develop and apply EQ-5D measures on OHE’s SlideShare site. Her recent visits to Singapore and Sweden have been reported in this blog.