OHE Awarded £457K Grant on Measuring Public Preferences for Health States

OHE’s Prof Nancy Devlin and Prof Ben van Hout of the University of Sheffield have been awarded a £457,000 grant from the Policy Research Programme (PRP) of the UK’s National Institute for Health Research (NIHR) for research to produce an EQ-5D-5L Value Set for England.

Prof Nancy Devlin

 

OHE’s Prof Nancy Devlin and Prof Ben van Hout of the University of Sheffield have been awarded a £457,000 grant from the Policy Research Programme (PRP) of the UK’s National Institute for Health Research (NIHR) for research to produce an EQ-5D-5L Value Set for England.[1]  Initial findings are expected early next year. Potential applications of the results of the research include the NHS PROMs program; population health surveys; and clinical trials and observational studies that feed into the NICE HTA process and, ultimately, value based pricing.

Already England’s most commonly-used measure of health status, the EQ-5D instrument is accompanied  by value sets — numerical summaries of the preferences of the general public about living in certain states of health, along a continuum from “good” to “bad”.  One of the applications of these value sets is to enable EQ-5D data to be used to estimate quality-adjusted life years (QALYs). The EQ-5D-5L, an expanded version of the EQ-5D instrument, captures subtler differences in health state preferences and already is in use in some settings in England.  The research under this grant will produce an English Value Set for the EQ-5D-5L that will facilitate the use of EQ-5D-5L data in a wide range of decisions.  The research project also will address some important methodological issues about how best to model preference data.

The research addresses five key issues:

1. What the best method is for generating an EQ-5D-5L value set to capture the preferences of the English general public about health states
2. Whether “average” preferences should be based on means or medians and the implications of designating one of these as “best”
3. How conceptually different types of preference data can be combined in modelling health states – specifically time trade off (TTO) and discrete choice (DC) data
4. How to best handle extreme negative opinions about health states – e.g. when a person is willing to trade off an exceptional number of years of life to avoid a particularly “bad” heath state
5. Whether patterns exist in how people differ in their stated preferences for quality of life and for life and death, e.g. whether individual characteristics affect preference and whether individuals with extreme negative opinions form a typical group

Data will be collected from 1,000 members of the adult general public in England, selected to be representative of the general population with respect to key socioeconomic characteristics. Each participant will value ten health states using TTO and seven pairs of health states using DC.  Data will be collected using computer-assisted personal interviews. These methods are informed by previous research by the investigators with samples of the general public. The research protocol and computer aid to be used for this work — the EQ-VT — was developed and extensively tested by the EuroQol Group in eight pilot studies conducted around the world during 2011.

These data then will form the basis for extensive exploration of alternative ways of modelling, including alternative ways of representing “average” preferences (mean vs. median), and alternatives for modelling “extreme” preferences. The researchers also will formally explore preference heterogeneity, using a range of econometric approaches, to identify the extent to which distinct preference types exist and to explore how these findings might be incorporated into the value sets.

In addition to Profs Devlin and van Hout, the research team includes Dr. Yan Feng and Koonal Shah from the OHE, and Brendan Mulhern from the University of Sheffield.  This team has extensive experience in the design, management and analysis of stated preference studies in England and internationally, and will work closely with other experts in the EuroQol Group. An advisory board to be appointed by England’s Department of Health will provide further guidance and input from NICE and other key stakeholders in the Department.

Extending the project across the UK?

Discussions now are underway with authorities in Scotland, Wales and Northern Ireland to explore the possibilities of building on the research getting underway in England.  This would involve additional data collection and analysis to produce an EQ-5D-5L Value Set for all of the UK, which may be important in some decision making contexts.

For further information, please contact Prof Nancy Devlin at OHE.