Leidl Reiner, Reitmeir Peter
Institute for Health Economics and Health Care Management, HelmholtzZentrum München, Neuherberg, Germany; Munich Center of Health Sciences, Ludwig-Maximilians University, Munich, Germany.
Institute for Health Economics and Health Care Management, HelmholtzZentrum München, Neuherberg, Germany.
Value Health. 2017 Sep;20(8):1150-1156. doi: 10.1016/j.jval.2017.04.019. Epub 2017 Jun 1.
Valuation of health states provides a summary measure useful to health care decision makers. Results may depend on whether the currently experienced health state or a hypothetical health state is being evaluated. This study derives a value set for the EuroQoL Five-Dimensional Five-Level Questionnaire (EQ-5D-5L) by focusing on the individual's current experience.
Data include four pooled population surveys of the general German population in 2012-2015 (N = 8114). For valuation, a visual analogue scale (VAS) was used. Six specifications of a generalized linear model with binomial error distribution and constraint parameter estimation were analyzed. In each 1000 simulation runs, models were cross-validated after splitting the sample into an estimation part and a validation part. Predictive accuracy was measured by mean absolute error and sum of squared errors.
The models rendered a consistent set of parameters. With regard to predictive accuracy, the model considering all problem levels within the five dimensions and the highest problem level reached performed best overall.
Estimation proved to be feasible. Predictive accuracy exceeded that of a similar, experience-based value set for the EQ-5D-3L. Compared with a Dutch value set for the EQ-5D-5L derived for hypothetical health states, experienced values tended to be slightly lower for mild health states and substantially higher for severe health states. Clinical relevance and usefulness of the value set remain to be determined in future studies.
For decision makers who prioritize patient-relevant benefit, the experience-based value set provides a novel option to summarize health states, reflecting how health states experienced are valued in a population.
健康状态评估为医疗保健决策者提供了一种有用的综合衡量指标。评估结果可能取决于所评估的是当前经历的健康状态还是假设的健康状态。本研究通过关注个体当前的经历，得出了欧洲五维健康量表（EQ-5D-5L）的价值集。
数据包括2012 - 2015年对德国普通人群进行的四项汇总人口调查（N = 8114）。评估采用视觉模拟量表（VAS）。分析了六种具有二项式误差分布和约束参数估计的广义线性模型规范。在每次1000次模拟运行中，将样本分为估计部分和验证部分后对模型进行交叉验证。预测准确性通过平均绝对误差和平方误差之和来衡量。
这些模型得出了一组一致的参数。在预测准确性方面，考虑五个维度内所有问题水平以及最高问题水平的模型总体表现最佳。
估计被证明是可行的。预测准确性超过了基于经验的EQ-5D-3L类似价值集。与为假设健康状态得出的荷兰EQ-5D-5L价值集相比，对于轻度健康状态，基于经历的值往往略低，而对于重度健康状态则显著更高。该价值集的临床相关性和实用性仍有待未来研究确定。
对于优先考虑与患者相关益处的决策者而言，基于经历的价值集为总结健康状态提供了一种新的选择，反映了人群对所经历的健康状态的重视程度。
