Comparing responsiveness of the EQ-5D-5L, EQ-5D-3L and EQ VAS in stroke patients

Aims: To date, evidence to support the construct validity of the EQ-5D-5L has primarily focused on cross-sectional data. The aims of this study were to examine the responsiveness of EQ-5D-5L in patients with stroke and to compare it with responsiveness of EQ-5D-3L and visual analogue scale (EQ VAS). Methods: We performed an observational longitudinal cohort study of patients with stroke. At 1 week and 4 months post-stroke, patients were assessed with modified Rankin Scale (mRS) and Barthel Index (BI) and were administered the EQ-5D-5L and EQ-5D-3L, including the EQ VAS. The EQ-5D-5L index scores were derived using the crosswalk methodology developed by the EuroQol Group. We classified patients according to two external criteria, based on mRS or BI, into 3 categories: ‘improvement,’ ‘stable’ or ‘deterioration’. We assessed the responsiveness of each measure in each patient subgroup using: effect size (ES), standardized response mean (SRM), F-statistic, relative efficiency and area under the receiver operating characteristic curve. Results: A total of 112 patients (52 % females; mean age 70.6 years; 93 % ischemic stroke) completed all the instruments at both occasions. In subjects with clinical improvement, EQ-5D-5L was consistently responsive, showing moderate ES (0.51–0.71) and moderate to large SRM (0.69–0.86). In general, EQ-5D-3L index appeared to be more responsive (ES 0.63–0.82; SRM 0.77–1.06) and EQ VAS less responsive (ES 0.51–0.65; SRM 0.59–0.69) than EQ-5D-5L index. Conclusions: The EQ-5D-5L index, based on the crosswalk value set, seems to be appropriately responsive in patients with stroke, 4 months after disease onset. As far as EQ-5D-5L index is scored according to crosswalk approach, the EQ-5D-3L index appears to be more responsive in stroke population

(Belief in) life after death impacts the utility of life before it - a difference in preferences or an artefact?

In most of the religions the preservation of own, God-given, life is obligatory. The time-trade-off method (TTO) forces to voluntarily forego life years. We verify if this is a problem for the religious and how it impacts the TTO results. We used the data from the only EQ-5D valuation in Poland (2008, three-level, 321 respondents, 23 states each) a very religious (mostly catholic) country. We used the belief in afterlife question to measure the religiosity on two levels: strong (definitely yes) and some (also rather yes), both about a third of the sample. The religious on average (yet, not statistically significant) spend more time doing TTO and consider it more difficult. The religious more often are non-traders: odds ratio (OR)=1.97 (strongly), OR=1.55 (rather); and less often consider a state worse-than-death: OR=0.67 (strongly), OR=0.81 (rather). These associations are statistically significant (p< 0.001) and hold when controlling for possible confounders. Strong religiosity abates the utility loss: in the additive approach by 0.136, in the multiplicative approach by the factor of 2.08 (both p< 0.001). Removing the effect of religiosity from the value set reduces the utility by 0.046 on average. The impact of religiosity seems to be a TTO-artefact rather than a true difference in preferences (testing this requires further analysis of, e.g., discrete-choice or visual analogue scale data). Non-Weltanschauung-biased estimates should rather be used in cost-utility analysis to drive resource allocation.2016-0071-18SGH KAE Working Papers Serie

Towards a Central‑Eastern European EQ‑5D‑3L population norm: comparing data from Hungarian, Polish and Slovenian population studies

Abstract Background EQ-5D-3L population data are available only from Hungary, Poland and Slovenia in Central and Eastern Europe (CEE). We aimed to compare the accessible studies and estimate a regional EQ-5D-3L population norm for CEE. Methods A combined dataset using patient-level data of 8850 respondents was created. Based on the European Census of 2011, regional population norm estimates were calibrated by gender, age and education for the joint citizenry of 11 CEE countries. Results EQ-5D-3L health states were available for 6926 and EQ VAS scores for 6569 respondents. Demographic characteristics of the samples refected the recruitment methods (Hungary: online; Slovenia: postal survey, Poland: personal interviews). Occurrence of problems difered signifcantly by educational level in all the fve dimensions (p<0.001). The inter-country diferences persisted after controlling for demographic variables. The estimated EQ-5D-3L index CEE norms with UK tarifs for age groups 18–24, 25–34, 35–44, 45–54, 55–64, 65–74 and 75+were 0.911, 0.912, 0.871, 0.817, 0.762, 0.743 and 0.636 for males and 0.908, 0.888, 0.867, 0.788, 0.752, 0.68 and 0.584 for females, respectively. Estimates were provided also using Polish, European and Slovenian value sets. Conclusions Besides gender and age, education should be considered during the design and interpretation of quality-of-life studies in CEE. The estimated regional EQ-5D-3L population norm may be used as a benchmark by CEE countries with lack of local dataset. However, the substantial inter-country diferences in health status and scarcity of data over age 65 call for harmonized country-specifc EQ-5D-3L population norm studies in the CEE region

EQ-5D in Central and Eastern Europe : 2000-2015

Objective: Cost per quality-adjusted life year data are required for reimbursement decisions in many Central and Eastern European (CEE) countries. EQ-5D is by far the most commonly used instrument to generate utility values in CEE. This study aims to systematically review the literature on EQ-5D from eight CEE countries. Methods: An electronic database search was performed up to July 1, 2015 to identify original EQ-5D studies from the countries of interest. We analysed the use of EQ-5D with respect to clinical areas, methodological rigor, population norms and value sets. Results: We identified 143 studies providing 152 country-specific results with a total sample size of 81,619: Austria (n=11), Bulgaria (n=6), Czech Republic (n=18), Hungary (n=47), Poland (n=51), Romania (n=2), Slovakia (n=3) and Slovenia (n=14). Cardiovascular (20%), neurologic (16%), musculoskeletal (15%) and endocrine/nutritional/metabolic diseases (14%) were the most frequently studied clinical areas. Overall 112 (78%) of the studies reported EQ VAS results and 86 (60%) EQ-5D index scores, of which 27 (31%) did not specify the applied tariff. Hungary, Poland and Slovenia have population norms. Poland and Slovenia also have a national value set. Conclusions: Increasing use of EQ-5D is observed throughout CEE. The spread of health technology assessment activities in countries seems to be reflected in the number of EQ-5D studies. However, improvement in informed use and methodological quality of reporting is needed. In jurisdictions where no national value set is available, in order to ensure comparability we recommend to apply the most frequently used UK tariff. Regional collaboration between CEE countries should be strengthened

The burden of informal caregiving in Hungary, Poland and Slovenia: results from national representative surveys

Background We aimed to investigate the burden of informal care in Hungary (HU), Poland (PL) and Slovenia (SI). Methods A cross-sectional online survey was performed involving representative samples of 1000 respondents per country. Caregiving situations were explored; health status of informal caregivers/care recipients and care-related quality of life were assessed using the EQ-5D-5L and CarerQol-7D. Results The proportion of caregivers was (HU/PL/SI) 14.9, 15.0 and 9.6%, respectively. Their mean age was 56.1, 45.6 and 48.0, and the average time spent on informal care was 27.6, 35.5 and 28.8 h/week. Chronic care was dominant (> 1 year: 78.5%, 72.0%, 74.0%) and care recipients were mainly (own/in-law) parents. Average EQ-5D-5L scores of care recipients were 0.53, 0.49 and 0.52. For Poland and Slovenia, EQ-5D-5L scores of informal care providers were signifcantly lower than of other respondents. Average CarerQol-7D scores were (HU/PL/SI) 76.0, 69.6 and 70.9, and CarerQol-VAS was 6.8, 6.4 and 6.6, respectively. Overall, 89, 87, and 84% of caregivers felt some or a lot fulflment related to caring. Problems with combining tasks with daily activities were most important in Hungary and Slovenia. Women had a higher probability of being a caregiver in Hungary. CarerQol-7D scores were signifcantly associated with caregivers’ EQ-5D-5L scores. In Hungary and Poland, living in a larger household was positively, while caring for patients with mental health problems was negatively associated with CarerQol-7D scores. Conclusions These frst results from the Central and Eastern European region using preference-based measures for the evaluation of informal care can serve as a valuable input for health economic analyses

Parallel Valuation of the EQ-5D-3L and EQ-5D-5L by Time Trade-Offin Hungary

Objectives The wording of the Hungarian EQ-5D-3L and EQ-5D-5L descriptive systems differ a great deal. This study aimed to (1) develop EQ-5D-3L and EQ-5D-5L value sets for Hungary from a common sample, and (2) compare how level wording affected valuations. Methods In 2018 to 2019, 1000 respondents, representative of the Hungarian general population, completed composite time trade-off tasks. Pooled heteroscedastic Tobit models were used to estimate value sets. Value set characteristics, single-level transition utilities from adjacent corner health states, and mean transition utilities for all possible health states were compared between the EQ-5D-3L and EQ-5D-5L. Results Health utilities ranged from -0.865 to 1 for the EQ-5D-3L and -0.848 to 1 for the EQ-5D-5L. The relative importance of the 5 EQ-5D-5L dimensions was as follows: mobility, pain/discomfort, self-care, anxiety/depression, and usual activities. A similar preference ranking was observed for the EQ-5D-3L with self-care being more important than pain/discomfort. The EQ-5D-5L demonstrated lower ceiling effects (range of utilities for the mildest states: 0.900-0.958 [3L] vs 0.955-0.965 [5L]) and better consistency of mean transition utilities across the range of scale. Changing “confined to bed” (3L) to “unable to walk” (5L) had a large positive impact on utilities. Smaller changes with more negative wording in the other dimensions (eg, “very much anxious/feeling down a lot” [3L] vs “extremely anxious/depressed” [5L]) had a modest negative impact on utilities. Conclusion This study developed value sets of the EQ-5D-3L and EQ-5D-5L for Hungary. Our findings contribute to the understanding of how the wording of descriptive systems affects the estimates of utilities

Development of Population Tariffs for the CarerQol Instrument for Hungary, Poland and Slovenia

__Background:__ The CarerQol instrument can be used in economic evaluations to measure the care-related quality of life of informal caregivers. Tariff sets are available for Australia, Germany, Sweden, the Netherlands, the UK, and the USA. __Objective:__ Our objective was to develop tariff sets for the CarerQol instrument for Hungary, Poland and Slovenia and to compare these with the existing value sets. __Methods:__ Discrete-choice experiments were carried out in Hungary, Poland and Slovenia. Data were collected through an online survey between November 2018 and January 2019, using representative samples of 1000 respondents per country. Tariffs were calculated from coefficient estimates from panel mixed multinomial logit models with random parameters. __Results:__ All seven CarerQol domains contributed significantly to the utility associated with different caregiving situations. Attributes valued highest were ‘physical health

A comparison of European, Polish, Slovenian and British EQ-5D-3L value sets using a Hungarian sample of 18 chronic diseases

Background In the Central and Eastern European region, the British EQ-5D-3L value set is used commonly in quality of life (QoL) studies. Only Poland and Slovenia have country-specifc weights. Our study aimed to investigate the impact of value set choice on the evaluation of 18 chronic conditions in Hungary. Methods Patients’ EQ-5D-3L index scores were calculated using the VAS-based Slovenian and European and the time-tradeof-based Polish and British value sets. We performed pairwise comparisons of mean index values by dimensions, diagnoses and age groups. We evaluated disease burden by comparing index values matched by age and gender in each condition with those of the general population of the CEE region in all four value sets. Results Altogether, 2421 patients (55% female) were included in our sample with the average age of 55.87 years (SD=17.75). The average Slovenian, European, Polish and British EQ-5D-3L scores were 0.598 (SD=0.279), 0.661 (SD=0.257), 0.770 (SD=0.261) and 0.644 (SD=0.279), respectively. We found highly signifcant diferences in most diagnoses, with the greatest diference between the Polish and Slovenian index values in Parkinson’s disease (0.265). Systematic pairwise comparison across all conditions and value sets revealed greatest diferences between the time-trade-of (TTO) and VAS-based value sets as well as varying sensitivity of the disease burden evaluations of chronic disease conditions to the choice of value sets. Conclusions Our results suggest that the choice of value set largely infuences the health state utility results in chronic diseases, and might have a signifcant impact on health policy decisions

Validation of the Hungarian version of the CarerQol instrument in informal caregivers: results from a cross‑sectional survey among the general population in Hungary

Purpose The CarerQol instrument has been designed and validated as an instrument able to measure both the positive and the negative impacts of caregiving on the quality of life of informal caregivers (CarerQol-7D), as well as their general happiness (CarerQol-VAS). The aim of this study was to assess the construct validity of the CarerQol in the Hungarian context. Methods The CarerQol was translated into Hungarian. Subsequently, in a cross-sectional online survey, representative for the general Hungarian population (N=1000), informal caregivers were identifed (N=149, female 51.2%, mean age 53.2). Clinical, convergent and discriminant validity of the CarerQol were evaluated in relation to the caregivers’ and care recipients’ EQ-5D-5L health status, and caregiving situation characteristics. Results Average CarerQol-7D and CarerQol-VAS scores were 76.0 (SD 16.2) and 6.8 (SD 2.3), respectively. CarerQol-7D and CarerQol-VAS scores were signifcantly correlated with caregiving time (r=−0.257; −0.212), caregivers’ EQ-5D-5L scores (r=0.453; 0.326) and the CarerQol-7D also with care recipients’ EQ-5D-5L scores (r=0.247). CarerQol-7D scores difered signifcantly with relevant caregiving characteristics (e.g. nature and severity of care recipients’ health status, sharing household) and both the CarerQol-7D and CarerQol-VAS with the overall care experience. Conclusion Our fndings confrmed the validity of the Hungarian language version of the CarerQol and support the crosscultural validity of the instrument. CarerQol-7D scores performed better in distinguishing caregiving situation characteristics than the general happiness measure CarerQol-VAS. Care recipients’ health status was only weakly associated with informal caregivers’ care-related quality of life and happiness. Caregivers’ own health and caregiving circumstances were more strongly associated with these scores