Institute for Health Economics and Health Care Management, Helmholtz Zentrum Mnchen, Neuherberg, Germany.
Pharmacoeconomics. 2011 Jun;29(6):521-34. doi: 10.2165/11538380-000000000-00000.
Decision makers responsible for allocation of healthcare resources may require that health states are valued by the population for whom they are making decisions. To achieve this, health-state descriptions can be combined with a value set that reflects the valuations of the target population. In the decision-utility approach, such a value set is at least partly based on wants and expectations regarding given health states. This may reflect aspects different from the health state experienced and valued by a respondent.
To derive a value set that is completely based on experienced health states, emphasising the patient's perspective, and test its predictive performance in comparison with established approaches.
Problem descriptions and rating scale valuations of the EQ-5D were drawn from two representative German population surveys in 2006 and 2007. Two models based on given health states but differing in valuation method (1a, b) were analysed, along with three models based on experienced health states: (2) ordinary least squares regression; (3) scale-transformed regression; and (4) a generalized linear model with binomial error distribution and constraint parameter estimation. The models were compared with respect to issues in specification, and accuracy in predicting the actual valuations of experienced health states in a new data set, using correlation, mean error and ranking measures for the latter. In addition, the impact of standardizing experience-based index models for age and sex of the subjects was investigated.
Models 1 (a, b), 2 and 3 partly led to plausible and comparable parameter estimates, but also led to problems of insignificance and inconsistencies in some of the estimates. Model 4 achieved consistency and featured partly equivalent and partly better predictive accuracy. Using this model, mean valuations of health states were much better predicted by the experience-based approach than by the decision-utility approach, especially for health states that frequently (>10) occurred in the population sample. Standardizing the experience-based index models for age and sex further improved predictive accuracy and strengthened the position of model 4.
A value set for the EQ-5D can be plausibly estimated from experience-based valuations. The approach offers an alternative to decision makers who prefer experience-based valuation over decision utilities in the measurement of health outcome. Although usefulness in population samples was shown, use in a clinical context will first require indication-specific tests. Current limitations include use in a general population only, and a restricted range of health states covered.
负责分配医疗资源的决策者可能需要让为其做决策的人群对健康状况进行赋值。为实现这一点，可以将健康状况描述与反映目标人群赋值的效用量值集相结合。在决策效用方法中，这样的效用量值集至少部分基于对特定健康状况的期望和预期。这可能反映了与受访者所经历和看重的健康状况不同的方面。
推导出一个完全基于所经历的健康状况的效用量值集，强调患者的观点，并将其预测性能与已建立的方法进行比较测试。
从 2006 年和 2007 年两次具有代表性的德国人群调查中抽取 EQ-5D 的问题描述和等级评定量表赋值。分析了两种基于给定健康状况但估值方法不同的模型（1a，b），以及三种基于所经历的健康状况的模型：（2）普通最小二乘法回归；（3）等级变换回归；（4）二项错误分布和约束参数估计的广义线性模型。通过相关性、新数据集的实际赋值的平均误差和排序度量，比较了这些模型在规范和准确预测所经历的健康状况的赋值方面的问题。此外，还研究了为年龄和性别标准化基于经验的指数模型的影响。
模型 1（a，b）、2 和 3 部分产生了合理且可比较的参数估计，但也导致了一些估计的不显著和不一致的问题。模型 4 达到了一致性，并具有部分等效和部分更好的预测准确性。使用该模型，基于经验的方法对健康状况的平均赋值的预测明显优于决策效用方法，特别是对于在人群样本中经常（>10）出现的健康状况。为年龄和性别标准化基于经验的指数模型进一步提高了预测准确性，并加强了模型 4 的地位。
可以从基于经验的赋值中合理估计 EQ-5D 的效用量值集。该方法为决策者提供了一种替代决策效用的方法，在健康结果的测量中，决策者更倾向于基于经验的赋值而非决策效用。虽然在人群样本中显示了有用性，但在临床环境中的使用将首先需要特定于指示的测试。当前的局限性包括仅在一般人群中使用，以及所涵盖的健康状况范围有限。
