New and ongoing areas of research

In the EuroQol Group

New research• International 5L valuation

– Discussed already• EQ-5D-Y

– Youth version• Disease specific adaptations

– ‘Bolt on’ additional dimensions

EQ-5D-Y: Youth

EQ-5D-Y: Youth• Translations

– Available in more than 20 languages

– Youth between 7-12 years• Proxy versions

– In development

Administration seems OK

But not yet a value set• How should value the health states

– Children?– Parents?– The general public?

• How do you include:– Development backlog?– The remarkable coping skills children?

Are values different• Do we value health states different?

– For ourselves– For someone other like ourselves– For a 10-year child

• New paper of the 2012 Meeting

Values for children 10% lower

Feedback from the 2012 meeting

• Small number of health states• Still VAS

– Does this also apply for TTO?– Complication:

• How to apply TTO for health states of children?

• Descriptive system EQ-5d-Y is different!

Bolt-on• Do we miss dimensions?• In the past: EQ-6D

– Mobility; – Daily activity and self care;– Work performance– Family and leisure performance– Pain/discomfort– Present mood

• First attempts– EQ-5D+cog: addition of cognition?

EQ-5D+cog• Used in DALY WHO project

– Cognition was recognized as important• Lot of discussion

– Is it necessary?– Who is making the value set?– An unofficial set exist

• Based on mapping DALY project

• Is used…– But gives confusion

• No official status

Why not other dimensions?

• Developed already– Psoriasis– Vision

VF-14 by Visual acuity in macular degeneration

2423374311N =

Better-seeing Eye VA (distant, LogMAR)

lo thru 0.30

0.31 thru 0.60

0.61 thru 1.30

1.31 thru 2.00

2.01 thru hi

VF

-14

Inde

x

120

100

80

60

40

20

0

-20

114

EQ-5D by Visual acuity in macular degeneration

2423374311N =

Better-seeing Eye VA (distant, LogMAR)

lo thru 0.30

0.31 thru 0.60

0.61 thru 1.30

1.31 thru 2.00

2.01 thru hi

EQ-5

D1.2

1.0

.8

.6

.4

.2

0.0

-.2

71

102

147

91120

202

107101124

132

Evidence on EQ-5D: some examples

Hearing

SchizophreniaBipolar disorderVision

Depression and anxietySome cancersSkinPersonality disorder

Psoriasis

Estimation of utilities

• Used standard EQ-5D-3L TTO protocol• General public interviews in UK only

– N = 300• Sub-set of 49 states were included

using orthogonal design

Results

• OLS and random effects models estimated– Interaction terms; collapsing levels

• Both dimensions have a significant impact

• Some inconsistencies in the data• The largest gap is between level 3 and 4

(moderate and severe)

Modeling TTO values Psoriasis

Discussion 2012 meeting• No real problem when seen as pilot

– Convenience sample– TTO not standardised

• Methodological complications– Things get complicated for responders fast

• 223451 versus 122345• Cognition overload

– 57 = 78.125 health states• Similar values for 4th and 5th levels• Modeling stressed to the limit?