Small differences in EQ-5D-5L health utility scores were interpreted differently between and within respondents

Nathan S McClure; Feng Xie; Mike Paulden; Arto Ohinmaa; Jeffrey A Johnson

doi:10.1016/j.jclinepi.2021.10.019

Small differences in EQ-5D-5L health utility scores were interpreted differently between and within respondents

J Clin Epidemiol. 2022 Feb:142:133-143. doi: 10.1016/j.jclinepi.2021.10.019. Epub 2021 Nov 2.

Authors

Nathan S McClure¹, Feng Xie², Mike Paulden³, Arto Ohinmaa¹, Jeffrey A Johnson⁴

Affiliations

¹ School of Public Health, University of Alberta, 11405 87 Avenue, Edmonton, T6G 1C9, Alberta, Canada; Alberta PROMs and EQ-5D Research and Support Unit (APERSU), University of Alberta, 8602 112 Street, Edmonton, T6G 2E1, Alberta, Canada.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, L8S 4K1, Ontario, Canada; Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, Hamilton, L8S 4K1, Ontario, Canada.
³ School of Public Health, University of Alberta, 11405 87 Avenue, Edmonton, T6G 1C9, Alberta, Canada.
⁴ School of Public Health, University of Alberta, 11405 87 Avenue, Edmonton, T6G 1C9, Alberta, Canada; Alberta PROMs and EQ-5D Research and Support Unit (APERSU), University of Alberta, 8602 112 Street, Edmonton, T6G 2E1, Alberta, Canada. Electronic address: jeff.johnson@ualberta.ca.

PMID: 34737062
DOI: 10.1016/j.jclinepi.2021.10.019

Abstract

Objectives: This study aims to determine how population-based health-utility score (HUS) differences reflect individuals' health preferences using responses from the Canadian EQ-5D-5L Valuation Study, including time trade-off (TTO) and discrete-choice experiment (DCE) tasks (n = 1073).

Study design and setting: Cardinal TTO responses were transformed into pairwise comparisons to yield ordinal TTO responses. We investigated how EQ-5D-5L HUS differences differ from participants' stated cardinal preferences, and determined the smallest HUS difference that may be expected to represent participants' ordinal preferences.

Results: HUS differences near zero have 30.6% (95% confidence interval: 29.1-31.9%) probability of representing a tie in individuals' TTO values. Differences in EQ-5D-5L HUS of -0.054 (-0.071 to -0.029) and 0.047 (0.026-0.076) maximized the sensitivity and specificity of discriminating transitions to worse/better health states. For small HUS differences of ±0.03 to ±0.07, the magnitude of respondents' average TTO difference on the cardinal scale was 0.17 and 0.35 whether ties were included or excluded, respectively. Absolute HUS differences between 0.042 and 0.062 had a 50% probability of representing respondents' ordinal preferences.

Conclusion: A HUS needs to be large enough to reflect individuals' stated health preferences, which may lend support to the application of a minimally important difference for decision-making.

Keywords: Decision-making; Health utility scores; Interpretability; Minimally important difference; Patient-reported outcome measures; Preference heterogeneity.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Canada
Health Status*
Humans
Probability
Quality of Life*
Surveys and Questionnaires