EQ-5D-5L: Smaller steps but a major step change?

Abstract

), potentially has important implications for technology coverage decision making in many jurisdictions around the world.The 5-level version of EQ-5D (EQ-5D-5L) was developed in response to criticism centring on questions of sensitivity of the original 3-level version; many patients would indicate no problems on all five dimensions (i.e., State 11111), despite many of these respondents reporting they do have problems on similar dimensions of other measures (Brazier, Ratcliffe, Tsuchiya, & Solomon, 2017). At the same time, for some dimensions, particularly mobility and self-care, very few patients reported Level 3. It was increasingly recognised that the move from "none" to "some" to "unable"/"severe" does not have the sensitivity to reflect many of the important differences or changes found in patient populations. Despite this sensitivity limitation, the EQ-5D has nevertheless compared reasonably favourably with other generic measures, in terms of validity, for many conditions (Longworth et al., 2014). Perhaps less well recognised and understood have been the concerns with the preference elicitation method used in the UK valuation survey conducted in the early 1990s. This was a variant of the time trade-off (TTO) technique and adopted an unusual approach to valuing and transforming states worse than dead. In addition, simplistic modelling methods were used and, of course, general population preferences may well have changed over subsequent 25 years.Reassuringly, the increase to the five levels of "none," "slightly," "moderate," "severe," and "extreme"/"unable" has resulted in a measure that is better descriptively, with reduced "ceiling effects" (Herdman et al., 2011), more even distribution of responses across the levels (Mulhern et al., 2017), and this should result in greater sensitivity to differences between groups of patients and to changes over time. The replacement of the label "confined to bed" (in the EQ-5D-3L) by "unable to walk about" on the mobility dimension has been another descriptive improvement, although the continued reliance on the term "walking" has been challenged (Hannan et al., 2017). Further, concerns from a linguistic perspective have been expressed in relation to the level descriptors; unsurprisingly some respondents have been unclear on the differences between "slight" and "moderate" or "severe" and "extreme."As developers, the Euroqol Group have used the new descriptive system as an opportunity to improve, test new approaches and standardise the valuation methods, in part reflecting the development of research methods over the past 20 years since the publication of the EQ-5D-3L value sets. They chose to keep with TTO but made a number of important modifications to the original protocol. States worse than dead are now valued using a lead time TTO task, for example, where respondents are given an extra 10 years of good health before the tenth, they are asked to assume they will live in the health state being valued (Devlin, Tsuchiya, Buckingham, & Tilling, 2011). This task, although mo...

Developing Accessible, Pictorial Versions of Health-Related Quality-of-Life Instruments Suitable for Economic Evaluation: A Report of Preliminary Studies Conducted in Canada and the United Kingdom

“…For example, early considerations that require the systematic review of available evidence and/or developmental pilot work include evaluating the relative merits of using (1) line drawings compared with photographs, (2) images for every response option compared with images at the ends of the scale only, and (3) the same images in different clinical contexts. Once a new pictorial descriptive classification system has been developed, examination of measurement properties will be required, such as the assessment of practicality, reliability, responsiveness and validity [ 34 , 35 ]. The importance of comparability across studies and conditions was the primary reason for modifying EuroQol instruments rather than developing a new instrument.…”

“…Given the significant complexities of developing pictorial instruments compared with more conventional text-based instruments, a further important issue is whether there is a need for three-level and five-level pictorial variants. Such decisions will be influenced, to some extent, by the current research and debate surrounding the role of the EQ-5D-5L in health technology assessment [ 34 , 35 ].…”

Once Bitten Twice Shy: Thinking Carefully Before Adopting the EQ-5D-5L

“…The first UK valuation study of the 5L descriptive system was formally available in 2017 [4]. As Brazier, Bryan and Briggs recently summarize [5], the 5L version of the instrument has been found to reduce ceiling effects and exhibits a more even distribution of responses. Hernandez et al [6] have shown that as a consequence of the changes to the tool and the new valuation system, utility scores derived using the 5L version are compressed towards the full health end of the measurement scale, suggesting that while the 5L version describes more distinct health states, the values placed on them are potentially less sensitive for detecting clinically meaningful changes in health utility.…”

“…Would it solve a problem not solved by a competing tool? In a competitive marketplace, would adoption of the 5L tool be justified, given its already contested descriptive system and valuation study [5]? Or would a different instrument be preferred?…”

Prm202 - Comparing the Eq-5d-5l Crosswalks and Value Sets for England, the Netherlands and Spain: Do Conclusions Change?

“…Moreover, the impact of using one utility estimation method over the other on the statistical uncertainty surrounding cost–utility estimates is still unclear. The latter is particularly important as it provides insight into the validity of reimbursement decisions based on economic evaluations that relied on interim crosswalk QALY estimates (Brazier, Briggs, & Bryan, ).…”