Abstract
ObjectivesThis study aimed to explore quality-adjusted life-year (QALY) and subsequent cost-effectiveness estimates based on the more physical health–focused EQ-5D 5-level version (EQ-5D-5L) value set for England or cross-walked EQ-5D 3-level version UK value set scores or more mental health recovery-focused Recovering Quality of Life Utility Index (ReQoL-UI), when using alternative within-trial statistical methods. We describe possible reasons for the different QALY estimates based on the interaction between item scores, health state profiles, preference-based scores, and mathematical and statistical methods chosen. MethodsQALYs are calculated over 8 weeks from a case study 2:1 (intervention:control) randomized controlled trial in patients with anxiety or depression. Complete case and with missing cases imputed using multiple-imputation analyses are conducted, using unadjusted and regression baseline-adjusted QALYs. Cost-effectiveness is judged using incremental cost-effectiveness ratios and acceptability curves. We use previously established psychometric results to reflect on estimated QALYs. ResultsA total of 361 people (241:120) were randomized. EQ-5D-5L crosswalk produced higher incremental QALYs than the value set for England or ReQoL-UI, which produced similar unadjusted QALYs, but contrasting baseline-adjusted QALYs. Probability of cost-effectiveness <£30 000 per QALY ranged from 6% (complete case ReQoL-UI baseline-adjusted QALYs) to 64.3% (multiple-imputation EQ-5D-5L crosswalk unadjusted QALYs). The control arm improved more on average than the intervention arm on the ReQoL-UI, a result not mirrored on the EQ-5D-5L nor condition-specific (Patient-Health Questionnaire-9, depression; Generalized Anxiety Disorder-7, anxiety) measures. ConclusionsReQoL-UI produced contradictory cost-effectiveness results relative to the EQ-5D-5L. The EQ-5D-5L’s better responsiveness and “anxiety/depression” and “usual activities” items drove the incremental QALY results. The ReQoL-UI’s single physical health item and “personal recovery” construct may have influenced its lower 8-week incremental QALY estimates in this patient sample.
Highlights
Economic evaluation evidence helps inform resource allocation between alternative care interventions within a finite care budget.[1]
We aim to explore the various quality-adjusted life-year (QALY) and subsequent costeffectiveness estimates based on the EQ-5D-5L (VSE or crosswalk) or Recovering Quality of Life (ReQoL)-UI, when using alternative within-trial statistical methods based on a case study trial
Cont. indicates, control; EQ-5D-5L, EQ-5D 5-level version; Int., intervention; Max, maximum; Min, minimum; N, number of responders; P., possible; ReQoL-UI, Recovering Quality of Life-utility index; unique health state profiles (UHSPs), unique health state profile; UPBS, unique preference-based score; VSE, value set for England. *Number of participants at baseline was as follows: both trial arms (“Both”), N = 361; Int. arms, N = 241; Cont. arms, N = 120. †UHSP: the descriptive system element of the EQ-5D-5L and ReQoL-UI questionnaires produces a 5-digit or 7-digit health state profile, respectively, that represents the level of reported problems on each of the 5 or 7 dimensions of health, for example, 11223 for the EQ-5D-5L or 1112234 for the ReQoL-UI
Summary
Economic evaluation evidence helps inform resource allocation between alternative care interventions within a finite care budget.[1].
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