Abstract
BackgroundThe validity, reliability and cross-country comparability of summary measures of population health (SMPH) have been persistently debated. In this debate, the measurement and valuation of nonfatal health outcomes have been defined as key issues. Our goal was to quantify and decompose international differences in health expectancy based on health-related quality of life (HRQoL). We focused on the impact of value set choice on cross-country variation.MethodsWe calculated Quality Adjusted Life Expectancy (QALE) at age 20 for 15 countries in which EQ-5D population surveys had been conducted. We applied the Sullivan approach to combine the EQ-5D based HRQoL data with life tables from the Human Mortality Database. Mean HRQoL by country-gender-age was estimated using a parametric model. We used nonparametric bootstrap techniques to compute confidence intervals. QALE was then compared across the six country-specific time trade-off value sets that were available. Finally, three counterfactual estimates were generated in order to assess the contribution of mortality, health states and health-state values to cross-country differences in QALE.ResultsQALE at age 20 ranged from 33 years in Armenia to almost 61 years in Japan, using the UK value set. The value sets of the other five countries generated different estimates, up to seven years higher. The relative impact of choosing a different value set differed across country-gender strata between 2% and 20%. In 50% of the country-gender strata the ranking changed by two or more positions across value sets. The decomposition demonstrated a varying impact of health states, health-state values, and mortality on QALE differences across countries.ConclusionsThe choice of the value set in SMPH may seriously affect cross-country comparisons of health expectancy, even across populations of similar levels of wealth and education. In our opinion, it is essential to get more insight into the drivers of differences in health-state values across populations. This will enhance the usefulness of health-expectancy measures.
Highlights
The validity, reliability and cross-country comparability of summary measures of population health (SMPH) have been persistently debated
In SMPH, the number of years lived in a particular population is combined with information on the prevalence of health states or diseases and the value of these nonfatal health outcomes
The gender-age interaction term shows that the age effect differed between men and women: the reduction in health-related quality of life (HRQoL) over age was somewhat smaller for males
Summary
The validity, reliability and cross-country comparability of summary measures of population health (SMPH) have been persistently debated In this debate, the measurement and valuation of nonfatal health outcomes have been defined as key issues. In SMPH, the number of years lived in a particular population (taken from life tables) is combined with information on the (proportional) prevalence of health states or diseases and the value of these nonfatal health outcomes. In this way, the number of life years lived in a population is transformed into the number of healthy life years lived.. The number of life years lived in a population is transformed into the number of healthy life years lived. The value sets provide the link between the information on nonfatal health outcomes and the information on mortality
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