一项探索 EQ-5D-5L 健康状态偏好的初步离散选择实验。
A pilot discrete choice experiment to explore preferences for EQ-5D-5L health states.
机构信息
Centre for Health Economics Research and Evaluation (CHERE), University of Technology, Sydney, Australia.
出版信息
Appl Health Econ Health Policy. 2013 Jun;11(3):287-98. doi: 10.1007/s40258-013-0035-z.
BACKGROUND
The EQ-5D-5L has recently been developed to improve the sensitivity of the widely used three-level version. Valuation studies are required before the use of this new instrument can be adopted. The use of discrete choice experiments (DCEs) in this area is a promising area of research.
PURPOSE
To test the plausibility and acceptability of estimating an Australian algorithm for the newly developed five-level version of the EQ-5D using a DCE.
METHODS
A choice experiment was designed, consisting of 200 choice sets blocked such that each respondent answered 10 choice sets. Each choice set presented two health state-duration combinations, and an immediate death option. The experiment was implemented in an online Australian-representative sample. A random-effects probit model was estimated. To explore the feasibility of the approach, an indicative algorithm was developed. The algorithm is transformed to a 0 to 1 scale suitable for use to estimate quality-adjusted life-year weights for use in economic evaluation.
RESULTS
A total of 973 respondents undertook the choice experiment. Respondents were slightly younger and better educated than the general Australian population. Of the 973 respondents, 932 (95.8 %) completed all ten choice sets, and a further 12 completed some of the choice sets. In choice sets in which one health state-duration combination dominated another, the dominant option was selected on 89.5 % of occasions. The mean and median completion times were 17.9 and 9.4 min, respectively, exhibiting a highly skewed distribution. The estimation results are broadly consistent with the monotonic nature of the EQ-5D-5L. Utility is increasing in life expectancy (i.e., respondents tend to prefer health profiles with longer life expectancy), and mainly decreases in higher levels in each dimension of the instrument. A high proportion of respondents found the task clear and relatively easy to complete.
CONCLUSIONS
DCEs are a feasible approach to the estimation of utility weights for more complex multi-attribute utility instruments such as the EQ-5D-5L.
背景
EQ-5D-5L 最近被开发出来，以提高广泛使用的三水平版本的灵敏度。在采用这种新仪器之前，需要进行评估研究。在这一领域使用离散选择实验（DCE）是一个很有前途的研究领域。
目的
测试使用 DCE 估计新开发的五水平版本 EQ-5D 的澳大利亚算法的合理性和可接受性。
方法
设计了一个选择实验，由 200 个选择集组成，每个被试回答 10 个选择集。每个选择集呈现两种健康状态-持续时间组合和立即死亡选项。该实验在澳大利亚代表性在线样本中实施。采用随机效应概率模型进行估计。为了探索该方法的可行性，开发了一个指示性算法。该算法转换为 0 到 1 的范围，适合用于估计质量调整生命年权重，用于经济评估。
结果
共有 973 名受访者参与了选择实验。受访者的年龄略小于、教育程度略高于澳大利亚总人口。在 973 名受访者中，932 名（95.8%）完成了所有十个选择集，另有 12 名完成了部分选择集。在一个健康状态-持续时间组合支配另一个组合的选择集中，主导选项的选择率为 89.5%。平均和中位数完成时间分别为 17.9 分钟和 9.4 分钟，呈高度偏态分布。估计结果与 EQ-5D-5L 的单调性质基本一致。效用随着预期寿命的增加而增加（即受访者倾向于偏好预期寿命较长的健康状况），并且主要在工具的每个维度的较高水平上降低。大多数受访者认为任务清晰，相对容易完成。
结论
DCE 是一种可行的方法，可以估计更复杂的多属性效用工具（如 EQ-5D-5L）的效用权重。
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