Centre for Health Economics Research and Evaluation, University of Technology Sydney, 1 - 59 Quay St, Haymarket, Sydney, NSW, 2000, Australia.
School of Public Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia.
Soc Sci Med. 2019 Jul;233:28-37. doi: 10.1016/j.socscimed.2019.05.032. Epub 2019 May 21.
A key outcome in the evaluation of health technologies is the quality adjusted life year (QALY) which is often estimated using health measures such as the EuroQol instruments (EQ-5D-3L and EQ-5D-5L). The impacts of many interventions extend beyond a narrow definition of health to include non-health impacts such as social care related dimensions of quality of life (QoL). This means that there are circumstances where the QALY does not capture the full value of an intervention. In response to this, instruments with a wider measurement framework, such as the Adult Social Care Outcomes Toolkit (ASCOT), which measures social care related QoL, have been developed. Given the range of instruments available, it is important that decision-makers have tools to assess value for money comprehensively and consistently. To date, preference elicitation of different aspects of QoL combined within the same valuation procedure has not been tested. We investigate the relationship between health and social care aspects of QoL when assessed jointly by combining EQ-5D-5L and ASCOT in an online discrete choice experiment (DCE). In July 2016, 975 respondents recruited from internet panels completed 15 choice sets from an underlying design of 300. Conditional logit regression was used to estimate coefficient decrements for each attribute and examine their relative magnitude. Latent class and mixed logit modelling were used to understand preference heterogeneity. The results suggest trading across health and social care aspects indicated by coefficient estimates of differing magnitude. Dimensions with the largest disutility include four from EQ-5D-5L and one from ASCOT. There is evidence of preference heterogeneity at more severe dimension levels. We have used an established method to test the joint valuation of concepts measuring different aspects of QoL. The results have implications for the aspects of QoL that are included in QALY estimation and used in resource allocation decision-making.
健康技术评估的一个关键结果是质量调整生命年（QALY），它通常使用健康指标来估计，如欧洲五维健康量表（EQ-5D-3L 和 EQ-5D-5L）。许多干预措施的影响超出了健康的狭义定义，包括对生活质量（QoL）的非健康影响，如社会护理相关维度。这意味着在某些情况下，QALY 并不能完全捕捉到干预措施的价值。为了应对这一情况，已经开发了具有更广泛测量框架的工具，如测量社会护理相关 QoL 的成人社会护理结果工具包（ASCOT）。鉴于现有的各种工具，决策者需要有工具来全面、一致地评估物有所值。迄今为止，尚未在同一估值程序中测试对 QoL 的不同方面进行偏好 elicitation。我们通过将 EQ-5D-5L 和 ASCOT 结合在一个在线离散选择实验（DCE）中联合评估 QoL 的健康和社会护理方面，研究了它们之间的关系。2016 年 7 月，从互联网小组中招募了 975 名受访者，他们从 300 个基础设计中完成了 15 个选择集。条件逻辑回归用于估计每个属性的系数减少量，并检查它们的相对大小。潜在类别和混合逻辑回归模型用于理解偏好异质性。结果表明，在健康和社会护理方面存在着不同程度的交易，这表明不同大小的系数估计值存在差异。具有最大不舒适的维度包括 EQ-5D-5L 的四个维度和 ASCOT 的一个维度。在更严重的维度水平上，有偏好异质性的证据。我们已经使用一种既定的方法来测试不同方面的 QoL 的联合估值。这些结果对 QALY 估计中包含的 QoL 方面以及在资源分配决策中使用的 QALY 方面具有重要意义。
