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Utilities of the EQ-5D

Transferable or Not?

  • Original Research Article
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Abstract

Background

Within the framework of economic evaluations, the transferability of utility scores between jurisdictions remains unclear. The EQ-5D is a generic instrument for measuring health-related quality of life in economic evaluations, which can be used for comparing utility scores across countries. At present, the EQ-5D has several national value sets or tariffs. Nevertheless, utility estimates from foreign studies are often used directly for cost-effectiveness estimates, without adapting by applying the appropriate national value set. It is unclear if this practice is advisable, due to dissimilarities between the national value sets.

Objective

To examine the effects of differences in national EQ-5D value sets on absolute and marginal utilities of health states, and determine to what degree these differences can be explained by methodological factors.

Methods

First, the relative importance of the EQ-5D domains for the utility estimates was compared across the 15 value sets. Second, two hypothetical health states for a depressed patient and a pain patient (21232 and 33321) were selected for additional analysis, by comparing the utilities as scored by the value sets. The marginal influence of a one-level deterioration in a domain of these health states on the utility estimate was then determined. Third, the differences between the value sets were examined in more detail by using multilevel analysis to examine the role of methodological differences in the valuation studies.

Results

Differences can be perceived between the national value sets of the EQ-5D in the preferences for the domains. The utilities of the two hypothetical health states show that the value sets differ substantially. Furthermore, the differences between the marginal values of the deteriorations are large, which can be explained partly by the type of valuation method. Other methodological differences also influence the value sets.

Conclusion

All results indicate that the differences between the EQ-5D value sets are considerable and should not be ignored. The differences can largely be explained by methodological differences in the valuation studies. The remaining differences may reflect cultural dissimilarities between countries. Therefore, further research should focus on investigating the transferability of utilities across countries or agreeing on a standard to perform valuation studies. For the time being, transferring utilities from one country to another without any adjustment is not advisable.

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Authors and Affiliations

  1. Department of Health Organization, Policy and Economics (HOPE), School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200, MD Maastricht, the Netherlands

    Saskia Knies, Silvia M. A. A. Evers, Johan L. Severens & André J. H. A. Ament

  2. Department of Methodology and Statistics (M&S), Maastricht University, Maastricht, the Netherlands

    Math J. J. M. Candel

  3. Department of Clinical Epidemiology and MTA (KEMTA), University Hospital Maastricht, Maastricht, the Netherlands

    Johan L. Severens

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  1. Saskia Knies
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  2. Silvia M. A. A. Evers
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  3. Math J. J. M. Candel
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Correspondence to Saskia Knies.

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Knies, S., Evers, S.M.A.A., Candel, M.J.J.M. et al. Utilities of the EQ-5D. Pharmacoeconomics 27, 767–779 (2009). https://doi.org/10.2165/11314120-000000000-00000

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