EQ5D, HUI and SF36

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EQ-5D, HUI and SF-36

• Of the shelf instruments.

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Direct valuation
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or use validated questionnaires

• MOBILITY
• I have no problems in walking about
• I have some problems in walking about
• I am confined to bed
• SELF-CARE
• I have no problems with self-care
• I have some problems washing or dressing myself
• I am unable to wash or dress myself
• USUAL ACTIVITIES (e.g. work, study, housework
  family or leisure activities)
• I have no problems with performing my usual
  activities
• I have some problems with performing my usual
  activities
• I am unable to perform my usual activities
• PAIN/DISCOMFORT
• I have no pain or discomfort
• I have moderate pain or discomfort
• I have extreme pain or discomfort
• ANXIETY/DEPRESSION
• I am not anxious or depressed
• I am moderately anxious or depressed

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Validated questionnaires
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The Rosser Kind Index
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The Rosser Kind index

• One of the oldest valuation
• 1978 Magnitude estimation
• Magnitude estimation ? PTO
• N 70 Doctors, nurses, patients and general
  public
• 1982 Transformation to utilities
• 1985 High impact article
• Williams A. For Debate... Economics of Coronary
  Artery Bypass Grafting. British Medical Journal
  291 326-28, 1985.
• Survey at the celebration of 25 years of health
  economics chosen most influential article on
  health economics

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More health states

• Criticism on the Rosser Kind index
• Sensitivity (only 30 health states)
• The unclear meaning of distress
• The compression of states in the high values
• The involvement of medical personnel
• New initiatives
• Higher sensitivity (more then 30 states)
• More and better defined dimensions
• Other valuation techniques
• Standard Gamble, Time Trade-Off
• Values of the general public

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Validated questionnaires
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No longer value all states

• Impossible to value all health states
• If one uses more than 30 health states
• Estimated the value of the other health states
  with statistical techniques
• Statistically inferred strategies
• Regression techniques
• EuroQol, Quality of Well-Being Scale (QWB)
• Explicitly decomposed methods
• Multi Attribute Utility Theory (MAUT)
• Health Utility Index (HUI)

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Statistically inferred strategies

• Value a sample of states empirically
• Extrapolation
• Statistical methods, like linear regression
• 11111 1.00
• 11113 .70
• 11112 ?

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Statistically inferred strategies

• EuroQol
• EQ-5D 5 dimensions of health
• 245 health states
• Quality of Well-Being scale (QWB)
• 4 dimensions of health
• 2200 health states plus 22 additional symptoms
• SF-36
• SF-6D 6 dimensions of health
• 18.000 health states

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Explicitly Decomposed Methods

• Value dimensions separately
• Between the dimensions
• What is the relative value of
• Mobility... 20
• Mood.. 15
• Self care. 24.
• Value the levels
• Within the dimensions
• What is the relative value of
• Some problems with walking 80
• Much problems with walking... 50
• Unable to walk.10

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Explicitly Decomposed Methods

• Combine values of dimensions and levels with
  specific assumptions
• Multi Attribute Utility Theory (MAUT)
• Mutual utility independence
• Structural independence

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Explicitly Decomposed Methods

• Health Utilities Index (Mark 2 3)
• Torrance at McMaster
• 8 dimensions
• Mark 2 24.000 health states
• Mark 3 972.000 health states
• The 15-D
• Sintonen H.
• 15 dimensions
• 3,052,000,000 health states (3 billion)

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Exercise

• EuroQol EQ-5D

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More health states, higher sensitivity ? (1)

• EuroQol criticised for low sensitivity
• Low number of dimensions
• Development of EQ-5D plus cognitive dimension
• Low number of levels (3)
• Gab between best and in-between level

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More health states, higher sensitivity ? (2)

• Little published evidence
• Sensitivity EQ-5D lt SF-36
• Compared as profile, not as utility measure
• Sensitivity EQ-5D ? HUI
• Sensitivity ? the number of health states
• How well maps the classification system the
  illness?
• How valid is the modelling?
• How valid is the valuation?

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More health states, more assumptions

• General public values at the most 50 states
• The ratios empirical (50) versus extrapolated
• Rosser Kind 11
• EuroQol 15
• QWB 144
• SF-36 1180
• HUI (Mark III) 119,400
• 15D 1610,000,000
• What is the critical ratio for a valid validation?

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SF-36 as utility instrument

• Transformed into SF6D
• SG
• N 610
• Inconsistencies in model
• 18.000 health states
• regression technique stressed to the edge
• Floor effect in SF6D

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Conflicting evidence sensitivity SF-36
Liver transplantation, Longworth et al., 2001
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EQ-5D

• Strong punts
• Very sensitive in the low
• Measures subjective burden (inside the skin)
• Low administrative burden
• Many translations
• Cheap
• Most used QALY questionnaire
• Most international validations
• Weak points
• Only there levels per dimensions
• Insensitive in the high regions

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HUI

• Strong punts
• Sensitive
• Measures objective burden (outside the skin)
• Well developed proxy versions
• Well developed child versions
• Weak points
• Expensive

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SF-6D

• Strong punts
• Probably sensitive in the high regions
• Often already include in trials (SF-36)
• Cheap
• Many translations
• Weak points
• Insensitive in the low regions
• Only one validation study
• Changed Standard Gamble
• Upwards shift of values

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Conclusions

• More states ? better sensitivity
• The three leading questionnaires
• have different strong and weak points