Wilson Ross, Hansen Paul, Langley John, Derrett Sarah
Department of Economics, University of Otago, Dunedin 9054, New Zealand.
Health Qual Life Outcomes. 2014 Feb 18;12:21. doi: 10.1186/1477-7525-12-21.
A near-universal finding internationally is that patient valuations of their own health, represented using the EQ-5D system, are mostly higher than general population valuations of the same EQ-5D states. This paper investigates whether this result also applies to New Zealand. Despite the EQ-5D's widespread use for cost-utility analysis in New Zealand, in particular by the Pharmaceutical Management Agency (PHARMAC) for health technology assessments, no previous studies comparing patient and general population valuations have included data for New Zealand.
Valuations of 13 EQ-5D health states from a 1999 survey of the New Zealand general population (n = 396) are compared with injured New Zealanders' (n = 2099) valuations of their own health (also represented on the EQ-5D) collected between 2007 and 2009 in the Prospective Outcomes of Injury Study. Which EQ-5D dimensions are most strongly associated with the population valuations is also investigated.
Injured population valuations are higher (better-rated health) than general population valuations for all 13 health states considered except 11111 (no problems on any EQ-5D dimension). This difference, which tends to be larger the 'worse' the state, is statistically significant at the 10% level for most of the states. State 11111 is rated significantly lower by the injured population than the general population. Pain/discomfort is more important in determining valuations for the general population than for injured people, whereas problems with self-care are more important for the injured population; anxiety/depression is important in both general and injured population valuations.
Consistent with the international literature, injured people's valuations of their own health are mostly higher than the general population's hypothetical valuations of the same EQ-5D states for New Zealand. These differences are practically significant in the sense that they are larger than minimally important differences for the EQ-5D from the literature, and they appear capable of significantly affecting CUA results.
国际上一个几乎普遍的发现是，使用EQ-5D系统表示的患者对自身健康的估值大多高于一般人群对相同EQ-5D状态的估值。本文研究这一结果是否也适用于新西兰。尽管EQ-5D在新西兰广泛用于成本效用分析，尤其是药物管理局（PHARMAC）用于卫生技术评估，但此前没有比较患者和一般人群估值的研究纳入新西兰的数据。
将1999年对新西兰一般人群（n = 396）的13种EQ-5D健康状态估值，与2007年至2009年在“损伤前瞻性结果研究”中收集的受伤新西兰人（n = 2099）对自身健康的估值（也用EQ-5D表示）进行比较。还研究了哪些EQ-5D维度与人群估值关联最为紧密。
除了11111（在任何EQ-5D维度上均无问题）之外，在所考虑的所有13种健康状态下，受伤人群的估值都高于一般人群的估值（健康评级更好）。这种差异往往在状态“越差”时越大，对于大多数状态在10%的水平上具有统计学显著性。受伤人群对11111状态的评级显著低于一般人群。对于一般人群而言，疼痛/不适在确定估值方面比受伤人群更重要，而自理问题对受伤人群更重要；焦虑/抑郁在一般人群和受伤人群的估值中都很重要。
与国际文献一致，对于新西兰而言，受伤人群对自身健康的估值大多高于一般人群对相同EQ-5D状态的假设估值。这些差异在实际意义上是显著的，因为它们大于文献中EQ-5D的最小重要差异量级，并且似乎能够显著影响成本效用分析结果。
