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Can The EQ-5D Detect Meaningful Change? A Systematic Review

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Abstract

Background

The EQ-5D is one of the most frequently used, generic, preference-based instruments for measuring the health utilities of patients in economic evaluations. It is recommended for health technology assessment by the National Institute for Health and Clinical Excellence. Because the EQ-5D plays such an important role in economic evaluations, useful information on its responsiveness to detect meaningful change in health status is required.

Objective

This study systematically reviewed and synthesized evidence on the responsiveness of the EQ-5D to detect meaningful change in health status for clinical research and economic evaluations.

Methods

We searched the EuroQol website, PubMed, PsychINFO, and EconLit databases to identify studies published in English from the inception of the EQ-5D until August 15, 2014 using keywords that were related to responsiveness. Studies that used only the EQ-VAS were excluded from the final analysis. Narrative synthesis was conducted to summarize evidence on the responsiveness of the EQ-5D by conditions or physiological functions.

Results

Of 1401 studies, 145 were included in the narrative synthesis and categorized into 19 categories for 56 conditions. The EQ-5D was found to be responsive in 25 conditions (45 %) with the magnitude of responsiveness varying from small to large depending on the condition. There was mixed evidence of responsiveness in 27 conditions (48 %). Only four conditions (7 %) (i.e., alcohol dependency, schizophrenia, limb reconstruction, and hearing impairment) were identified where the EQ-5D was not responsive.

Conclusion

The EQ-5D is an appropriate measure for economic evaluation and health technology assessment in conditions where it has demonstrated evidence of responsiveness. In conditions with mixed evidence of responsiveness, researchers should consider using the EQ-5D with other condition-specific measures to ensure appropriate estimates of effectiveness. These conditions should be a main focus for future research using the new EQ-5D version with five response levels.

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Abbreviations

AUC:

Area under the curve

AUROC:

Area under the receiver-operating characteristic curve

COPD:

Chronic obstructive pulmonary disease

CSM:

Condition-specific measures

EQ-5D 5L:

EuroQol-5 dimension 5 level descriptive system

EQ-5D:

EuroQol-5 dimension 3 level descriptive system

EQ-VAS:

EuroQol-visual analogue scale

ES:

Effect size

EULAR:

European League against Rheumatism

HRQL:

Health-related quality of life

HUI:

Health Utilities Index

HUI3:

Health Utilities Index Mark 3

NICE:

National Institute for Health and Clinical Excellence

NYHA:

New York Heart Association class

QALY:

Quality-adjusted life year

SF-6D:

Short-Form-6 dimension

SRM:

Standardized response means

TTO:

Time trade-off

WOMAC:

Western Ontario and McMaster Universities Osteoarthritis Index

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Acknowledgements

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Authors’ contributions

NP: study rationale and design, literature selection, quality assessment of studies, data extraction, evidence synthesis, interpretation and reflection, writing and reviewing of the manuscript, guarantor of the study. MMA: literature search, literature selection, data extraction, quality assessment of studies, writing of the manuscript. JMT: study rationale and design, interpretation and reflection, writing and reviewing of the manuscript.

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  1. Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot #522, Little Rock, AR, 72205, USA

    Nalin Payakachat & J. Mick Tilford

  2. Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Mir M. Ali & J. Mick Tilford

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  1. Nalin Payakachat
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  2. Mir M. Ali
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Payakachat, N., Ali, M.M. & Tilford, J.M. Can The EQ-5D Detect Meaningful Change? A Systematic Review. PharmacoEconomics 33, 1137–1154 (2015). https://doi.org/10.1007/s40273-015-0295-6

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