As indicated in its recent statement, NICE supports a new valuation study to generate a value set for the EQ-5D-5L. We welcome this announcement.

As indicated in its recent statement, NICE supports a new valuation study to generate a value set for the EQ-5D-5L. We welcome this announcement.

Background

In 2012, OHE and the University of Sheffield commenced a study valuing the EQ-5D-5L: it was one of the first studies worldwide to use the EuroQol Group’s new valuation study protocol (EuroQol Valuation Technology, or ‘EQ-VT’) and was part of the first wave of studies including China, Canada, Spain, and the Netherlands. The study was funded by the National Institute for Health Research (NIHR) and was overseen by an advisory group appointed by the (then) Department of Health (DH), comprising senior UK academics and staff from NICE and the DH. All aspects of the data and modelling were reported to the advisory group. It was the recommendation of the advisory group, anxious to avoid ‘gaming’, that just one value set be reported from the extensive modelling work undertaken by the research team, and this was duly published in a pair of papers in Health Economics (Devlin et al., 2018 and Feng et al., 2018).

What happened next?

Given the importance of the value set to Department of Health and Social Care (DHSC) decisions informed by EQ-5D-5L data, the DHSC commissioned EEPRU (a collaboration between University of Sheffield and University of York) to undertake an ‘external validation’ of the value set. The EEPRU report and the research team’s response should be read side by side.

Papers summarising EEPRU’s review and our responses to it will be published in the peer-reviewed journal Value in Health in the coming months.

NICE subsequently commissioned four additional expert reviews of the EQ-5D-5L value set. These reviews are now publicly available. The outcome of this process makes it clear that sufficient doubt has been cast over the data and modelling as to make NICE’s use of the current EQ-5D-5L value set for England untenable. It’s time to move forward.

What now?

There are some things that all parties (mostly) agree on:

• The EQ-5D-5L is a superior descriptive system to the EQ-5D-3L, but a value set is needed to support its use in HTA.
• There are problems with the 1997 EQ-5D-3L value set currently being used in HTA and it is over 20 years old.
• Similarly, mapping from the EQ-5D-5L to the EQ-5D-3L is not an ideal solution because that also requires use of the 1997 EQ-5D-3L value set.
• An EQ-5D-5L value set is urgently required for use in supporting NICE’s HTA processes.

The value set for England, which we started in 2012, was ‘state of the art’ at the time. A lot has been learned from our experience and from the subsequent EQ-5D-5L value set studies undertaken or underway worldwide. Experience has led to improvements in the protocol. We can now benefit from that collective experience and help do a better study.

The research team is pleased to have been invited to be involved in the planning of a new EQ-5D-5L value set study. The new study will be coordinated by the EuroQol Research Foundation in close collaboration with NICE, NHS England, and the DHSC.

 

Written on behalf of the study team:

Professor Nancy J. Devlin, Centre for Health Policy, University of Melbourne & Senior Fellow, Office of Health Economics

Professor Ben van Hout, ScHARR, University of Sheffield

Brendan Mulhern, Senior Research Fellow, CHERE, University of Technology Sydney & Honorary Research Fellow, ScHARR, University of Sheffield

Dr Koonal K. Shah, PHMR, London & Honorary Research Fellow, ScHARR, University of Sheffield

Dr Yan Feng, Senior Lecturer in Health Economics, Queen Mary University of London