Abstract
The EQ-5D instrument is now used in many health systems as a health outcomes measure. Recently an EQ-5D valuation study was conducted for Trinidad and Tobago, but thus far there have been no population norms published for Trinidad and Tobago or for any Caribbean country. The objective of this study is to provide a set of population norms, and to investigate inequalities in health in Trinidad and Tobago. The EQ-5D-5L questionnaire was included in the 2012/2013 Adult Population Survey of the Global Entrepreneurship Monitor for Trinidad and Tobago. This survey covered a representative sample of 2,036 adults aged 18 and over. Demographic data and self-reported health using EQ-5D-5L were collected. The Trinidad and Tobago value set was used to obtain EQ-5D index values. The Kakwani index and logistic regression models were used to evaluate inequalities in health. Mean EQ-5D index values and EQ-VAS values were calculated by age group, ethnicity, gender, income, educational attainment, employment status and place of residence. The 10 most commonly observed EQ-5D-5L states accounted for 90% of the respondents. The mean VAS value for the sample was 83.6 and the mean EQ-5D-5L index value was 0.95. Pain/discomfort was found to be the EQ-5D dimension with the highest prevalence of reported problems with 22% of the population reporting pain at any level. Self-care was the dimension with the lowest prevalence of problems reported at any level (3%). Health declines with increasing age, and men reported fewer problems and higher levels of self-reported health than women. Age, gender and education level were found to be important drivers of health status as measured by the EQ-5D instrument. Being in a very low income group was also observed to affect EQ-VAS values among younger respondents. The population norms provided in this study can be used by clinicians, academics and policy makers in several ways. They can be used in comparing different demographic groups or patient groups, or as a basis for tracking the progress of patients through a treatment regimen. They can also provide a baseline for cost utility analysis of health interventions for Trinidad and Tobago.
Highlights
The EQ-5D instrument (EuroQol Group) is a preference-based measure that is used in healthcare decision making in many countries
At group level, the differences in mean Visual Analogue Scale (VAS) values and EQ-5D index values were both found to be significantly different at the 5% level for gender, health insurance and employment status, income and education groups, and household size
Comparison of overall VAS and EQ-5D index values should be made with caution since not all population norm studies are based on representative samples, and the overall mean values would be driven in part by demographic differences such as age distribution
Summary
The EQ-5D instrument (EuroQol Group) is a preference-based measure that is used in healthcare decision making in many countries This instrument is required, encouraged or recommended for use in cost utility analysis by health technology assessment agencies in countries as diverse as Egypt [1], Chile [2], Thailand [3], the Baltic states [4], England & Wales [5], The Netherlands [6] and others. Having the EQ-5D states and self-reported health ratings for a population provides clinical practitioners and policy makers with useful tools. These values are referred to as population norms and they can be used by clinical professionals to determine whether an individual patient scores better or worse than the average for their demographic group. Population norm studies using EQ-5D have found differences in EQ-5D outcomes among different socioeconomic groups [9]
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