Kim Hansoo, Cook Greg, Goodall Stephen, Liew Danny
School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
Bristol-Myers Squibb, Mulgrave, VIC, Australia.
Pharmacoecon Open. 2021 Sep;5(3):459-467. doi: 10.1007/s41669-021-00265-8. Epub 2021 Apr 23.
The National Institute for Health and Care Excellence (NICE) prefers the use of the generic EQ-5D instrument to estimate quality-adjusted life years (QALYs), and recommends that condition-specific instruments only be used when EQ-5D data are not available or not appropriate.
This study aimed to compare the utility gain and cost-effectiveness results of using the generic EQ-5D-3L instrument to the condition-specific Quality-of-Life Utility Measure-Core 10 dimensions (QLU-C10D) by applying both sets of values in a published cost-utility analysis (CUA) of immunotherapy for metastatic melanoma.
Quality-of-life data were drawn from a clinical study in which both QLQ-C30 and EQ-5D-3L tools were used. The potential influence of the two instruments on cost-effectiveness was assessed using a three-state Markov model. Descriptive statistics and standard health economic outputs were compared between analyses that applied the two different utility measures.
Mean baseline utility values as measured by the QLU-C10D (mean = 0.744, SD = 0.219) were not statistically different (p > 0.05) compared to values derived from EQ-5D-3L (mean = 0.735, SD = 0.239). The two instruments were correlated (Pearson's correlation = 0.74); however, concordance was low (Lin's concordance correlation coefficient < 0.90) at baseline. The model predicted slightly higher QALYs gained when using EQ-5D-3L over QLU-C10D-derived utilities (1.87 vs 1.74, respectively). This resulted in an incremental cost-effectiveness ratio of US$30.5K when using EQ-5D-3L utilities, compared to US$32.7K when using QLU-C10D utilities. Cost-effectiveness acceptability curves based on the two sets of utilities were almost indistinguishable.
This study supports the use of the generic EQ-5D instrument in immunotherapy treated metastatic melanoma, and found no additional benefit for using the disease-specific QLU-C10D when using Australian weights.
英国国家卫生与临床优化研究所（NICE）倾向于使用通用的EQ-5D工具来估计质量调整生命年（QALYs），并建议仅在无法获得或不适合使用EQ-5D数据时才使用特定疾病的工具。
本研究旨在通过在已发表的转移性黑色素瘤免疫治疗成本效用分析（CUA）中应用两组值，比较使用通用的EQ-5D-3L工具与特定疾病的生活质量效用测量核心10维度（QLU-C10D）的效用增益和成本效益结果。
生活质量数据来自一项临床研究，该研究同时使用了QLQ-C30和EQ-5D-3L工具。使用三状态马尔可夫模型评估这两种工具对成本效益的潜在影响。比较了应用两种不同效用测量方法的分析之间的描述性统计和标准卫生经济产出。
与从EQ-5D-3L得出的值（平均值 = 0.735，标准差 = 0.239）相比，QLU-C10D测量的平均基线效用值（平均值 = 0.744，标准差 = 0.219）无统计学差异（p > 0.05）。这两种工具具有相关性（Pearson相关性 = 0.74）；然而，在基线时一致性较低（Lin一致性相关系数 < 0.90）。该模型预测，与使用QLU-C10D得出的效用相比，使用EQ-5D-3L时获得的QALYs略高（分别为1.87和1.74）。这导致使用EQ-5D-3L效用时的增量成本效益比为30,500美元，而使用QLU-C10D效用时为32,700美元。基于两组效用的成本效益可接受性曲线几乎无法区分。
本研究支持在免疫治疗的转移性黑色素瘤中使用通用的EQ-5D工具，并且发现在使用澳大利亚权重时，使用疾病特异性的QLU-C10D没有额外益处。
