Skip to main content
SpringerLink
Log in

How the EQ-5D utilities are derived matters in Chinese diabetes patients: a comparison based on different EQ-5D scoring functions for China

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Objectives

In China, multiple approaches to calculating EQ-5D utilities are available, including the two EQ-5D-3L (3L2014 and 3L2018) scoring functions, the EQ-5D-5L (5L) scoring function, and the crosswalk function linking the 3L utilities and 5L health states. The study compared utilities derived from them in terms of agreement and discriminative power; and assessed whether the use of different approaches may affect QALY estimation in Chinese type 2 diabetes (T2D) patients.

Methods

Cross-sectional data of 289 T2D patients who self-completed both the 5L and 3L questions were used. Agreement were examined using intraclass correlation coefficient (ICC) and Bland–Altman plots. The ability of the EQ-5D utilities in differentiating the patients with and without clinical conditions was evaluated using F-statistics. Their influence on QALY estimation was assessed adopting mean absolute difference (MAD) in utility values between the patients.

Results

The ICC values were 0.881 (3L2014-3L2018), 0.958 (5L-c5L2014), and 0.806 (5L-c5L2018). The two 3L utilities and the three 5L utilities had poor agreement at the lower end of utility scale according to Bland–Altman plots. The 3L2018 utilities had lower F-statistics compared to the 3L2014 utilities; the two c5L utilities had larger or similar F-statistics compared to the 5L utilities. The mean MADs were 0.138 (5L), 0.116 (3L2014), 0.115 (c5L2014), 0.055 (c5L2018), and 0.055 (3L2018).

Conclusion

The 3L2014 utilities is more discriminative than the 3L2018 utilities; and the two c5L utilities have no worse discriminative power compared with the 5L utilities. The choice of the approach to calculating the EQ-5D utilities is likely to affect QALY estimates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Brooks, R. (1996). EuroQol: the current state of play. Health Policy, 37(1), 53–72.

    Article  CAS  PubMed  Google Scholar 

  2. Devlin, N. J., & Brooks, R. (2017). EQ-5D and the EuroQol Group: Past, Present and Future. Appl Health Econ Health Policy, 15(2), 127–137.

    Article  PubMed  Google Scholar 

  3. NICE. (2013). Guide to the methods of technology appraisal 2013. National Institute for Health and Care Excellence. Available at: https://www.nice.org.uk/process/pmg9/chapter/the-reference-case#measuring-and-valuing-health-effects. Accessed December 20, 2019.

  4. Liu, G. (2015). 2015 China Guidelines for Pharmacoeconomic Evaluations and Manual. Beijing: Science Press.

    Google Scholar 

  5. Dolan, P. (1997). Modeling valuations for EuroQol health states. Medical Care, 35(11), 1095–1108.

    Article  CAS  PubMed  Google Scholar 

  6. EuroQol. (2019). EQ-5D-3L Valuation. EQ-5D. Available at: https://euroqol.org/eq-5d-instruments/eq-5d-3l-about/valuation/. Accessed May 6, 2020.

  7. Herdman, M., Gudex, C., Lloyd, A., Janssen, M., Kind, P., et al. (2011). Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Quality of Life Research, 20(10), 1727–1736.

    Article  CAS  PubMed  Google Scholar 

  8. van Hout, B., Janssen, M. F., Feng, Y. S., Kohlmann, T., Busschbach, J., Golicki, D., et al. (2012). Interim scoring for the EQ-5D-5L: mapping the EQ-5D-5L to EQ-5D-3L value sets. Value Health, 15(5), 708–715.

    Article  PubMed  Google Scholar 

  9. Golicki, D., Niewada, M., Hout, B. V., Janssen, M. F., & Pickard, A. S. (2014). Interim EQ-5D-5L Value Set for Poland: First Crosswalk Value Set in Central and Eastern Europe. Value Health Reg Issues, 4, 19–23.

    Article  PubMed  Google Scholar 

  10. Pan, C. W., Sun, H. P., Zhou, H. J., Ma, Q., Xu, Y., Luo, N., et al. (2016). Valuing Health-Related Quality of Life in Type 2 Diabetes Patients in China. Medical Decision Making, 36(2), 234–241.

    Article  PubMed  Google Scholar 

  11. Kim, S. H., Ahn, J., Ock, M., Shin, S., Park, J., Luo, N., et al. (2016). The EQ-5D-5L valuation study in Korea. Quality of Life Research, 25(7), 1845–1852.

    Article  PubMed  Google Scholar 

  12. Luo, N., Liu, G., Li, M., Guan, H., Jin, X., & Rand-Hendriksen, K. (2017). Estimating an EQ-5D-5L Value Set for China. Value Health, 20(4), 662–669.

    Article  PubMed  Google Scholar 

  13. Wong, E., Ramos-Goni, J. M., Cheung, A., Wong, A., & Rivero-Arias, O. (2018). Assessing the Use of a Feedback Module to Model EQ-5D-5L Health States Values in Hong Kong. Patient, 11(2), 235–247.

    Article  PubMed  Google Scholar 

  14. Ramos-Goni, J. M., Craig, B. M., Oppe, M., Ramallo-Farina, Y., Pinto-Prades, J. L., Luo, N., et al. (2018). Handling Data Quality Issues to Estimate the Spanish EQ-5D-5L Value Set Using a Hybrid Interval Regression Approach. Value Health, 21(5), 596–604.

    Article  PubMed  Google Scholar 

  15. Mulhern, B., Feng, Y., Shah, K., Janssen, M. F., Herdman, M., van Hout, B., et al. (2018). Comparing the UK EQ-5D-3L and English EQ-5D-5L Value Sets. Pharmacoeconomics, 36(6), 699–713.

    Article  PubMed  Google Scholar 

  16. Janssen, M. F., Bonsel, G. J., & Luo, N. (2018). Is EQ-5D-5L Better Than EQ-5D-3L? A Head-to-Head Comparison of Descriptive Systems and Value Sets from Seven Countries. Pharmacoeconomics, 36(6), 675–697.

    Article  PubMed  Google Scholar 

  17. Ferreira, L. N., Ferreira, P. L., Ribeiro, F. P., & Pereira, L. N. (2016). Comparing the performance of the EQ-5D-3L and the EQ-5D-5L in young Portuguese adults. Health Qual Life Outcomes, 14, 89.

    Article  PubMed  Google Scholar 

  18. Jin, X., Al, S. F., Ohinmaa, A., Marshall, D. A., Smith, C., & Johnson, J. A. (2019). The EQ-5D-5L Is Superior to the -3L Version in Measuring Health-related Quality of Life in Patients Awaiting THA or TKA. Clinical Orthopaedics and Related Research, 477(7), 1632–1644.

    Article  PubMed  Google Scholar 

  19. NICE. (2019). Position statement on use of the EQ-5D-5L value set for England (updated October 2019). National Institute for Health and Care Excellence. Available at: https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/technology-appraisal-guidance/eq-5d-5l. Accessed December 20, 2019.

  20. Yang, F., Devlin, N., & Luo, N. (2019). Cost-Utility Analysis Using EQ-5D-5L Data: Does How the Utilities Are Derived Matter? Value Health, 22(1), 45–49.

    Article  PubMed  Google Scholar 

  21. Hernandez, A. M., Wailoo, A., Grimm, S., Pudney, S., Gomes, M., Sadique, Z., et al. (2018). EQ-5D-5L versus EQ-5D-3L: The Impact on Cost Effectiveness in the United Kingdom. Value Health, 21(1), 49–56.

    Article  Google Scholar 

  22. Liu, G. G., Wu, H., Li, M., Gao, C., & Luo, N. (2014). Chinese time trade-off values for EQ-5D health states. Value Health, 17(5), 597–604.

    Article  PubMed  Google Scholar 

  23. Zhuo, L., Xu, L., Ye, J., Sun, S., Zhang, Y., Burstrom, K., et al. (2018). Time Trade-Off Value Set for EQ-5D-3L Based on a Nationally Representative Chinese Population Survey. Value Health, 21(11), 1330–1337.

    Article  PubMed  Google Scholar 

  24. IDF. (2019). IDF DIABETES ATLAS 9th edition 2019. International Diabetes Federation. Available at: https://diabetesatlas.org/data/en/.Accessed March 14 2020.

  25. Jing, Z., Chu, J., Imam, S. Z., Zhang, X., Xu, Q., Sun, L., et al. (2019). Catastrophic health expenditure among type 2 diabetes mellitus patients: A province-wide study in Shandong China. J Diabetes Investig, 10(2), 283–289.

    Article  PubMed  Google Scholar 

  26. Zhuang, Y., Ma, Q. H., Pan, C. W., & Lu, J. (2020). Health-related quality of life in older Chinese patients with diabetes. PLoS ONE, 15(2), e229652.

    Article  Google Scholar 

  27. Pan, C. W., Wang, S., Wang, P., Xu, C. L., & Song, E. (2018). Diabetic retinopathy and health-related quality of life among Chinese with known type 2 diabetes mellitus. Quality of Life Research, 27(8), 2087–2093.

    Article  PubMed  Google Scholar 

  28. Zhang, Y., Wu, J., Chen, Y., & Shi, L. (2020). EQ-5D-3L Decrements by Diabetes Complications and Comorbidities in China. Diabetes Ther, 11(4), 939–950.

    Article  PubMed  Google Scholar 

  29. Pan, C. W., Sun, H. P., Wang, X., Ma, Q., Xu, Y., Luo, N., et al. (2015). The EQ-5D-5L index score is more discriminative than the EQ-5D-3L index score in diabetes patients. Quality of Life Research, 24(7), 1767–1774.

    Article  PubMed  Google Scholar 

  30. Kind, P. (2009). A Revised Protocol for the Valuation of Health States Defined by the EQ-5D-3L Classification System: Learning the Lessons from the MVH Study. York: Centre for Health Economics, University of York.

    Google Scholar 

  31. Oppe, M., Devlin, N. J., van Hout, B., Krabbe, P. F., & de Charro, F. (2014). A program of methodological research to arrive at the new international EQ-5D-5L valuation protocol. Value Health, 17(4), 445–453.

    Article  PubMed  Google Scholar 

  32. Machin, D., & Fayers, P. M. (2016). Quality of life: the assessment, analysis, and reporting of patient-reported outcomes (3rd ed.). Chichester: John Wiley & Sons Inc.

    Google Scholar 

  33. Bland, J. M., & Altman, D. G. (1986). Statistical methods for assessing agreement between two methods of clinical measurement. Lancet, 1(8476), 307–310.

    Article  CAS  PubMed  Google Scholar 

  34. Jin, X., Liu, G. G., Gerstein, H. C., Levine, M., Guan, H., Li, H., et al. (2018). Minimally important difference and predictors of change in quality of life in type 2 diabetes: A community-based survey in China. Diabetes Metab Res Rev, 34(8), e3053.

    Article  PubMed  Google Scholar 

  35. McClure, N. S., Sayah, F. A., Ohinmaa, A., & Johnson, J. A. (2018). Minimally Important Difference of the EQ-5D-5L Index Score in Adults with Type 2 Diabetes. Value Health, 21(9), 1090–1097.

    Article  PubMed  Google Scholar 

  36. Luo, N., Cheung, Y. B., Ng, R., & Lee, C. F. (2015). Mapping and direct valuation: do they give equivalent EQ-5D-5L index scores? Health Qual Life Outcomes, 13, 166.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was funded by Shanghai Pujiang Program under grant no. 18PJC016. The authors declare that they have no competing interests in this work.

Author information

Author notes

  1. Chen-Wei Pan and Ruo-Yu Zhang have contributed equally to this work

Authors and Affiliations

  1. School of Public Health, Medical College of Soochow University, Suzhou, China

    Chen-Wei Pan

  2. School of Public Health, Fudan University, Shanghai, China

    Ruo-Yu Zhang, Jun-Yi He, Rui-Jie Liu, Xiao-Hua Ying & Pei Wang

  3. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

    Nan Luo

  4. Key Lab of Health Technology Assessment, National Health Commission of the People’s Republic of China (Fudan University), Shanghai, China

    Pei Wang

Authors
  1. Chen-Wei Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ruo-Yu Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nan Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jun-Yi He
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rui-Jie Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiao-Hua Ying
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pei Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pei Wang.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 43 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pan, CW., Zhang, RY., Luo, N. et al. How the EQ-5D utilities are derived matters in Chinese diabetes patients: a comparison based on different EQ-5D scoring functions for China. Qual Life Res 29, 3087–3094 (2020). https://doi.org/10.1007/s11136-020-02551-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-020-02551-0

Keywords

Search

Navigation