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Observational Study
. 2023 Apr;32(4):1199-1208.
doi: 10.1007/s11136-022-03303-y. Epub 2022 Dec 10.

An experience- and preference-based EQ-5D-3L value set derived using 18 months of longitudinal data in patients who sustained a fracture: results from the ICUROS

Axel Svedbom  1   2 , Fredrik Borgstöm  3 , Emma Hernlund  4 , Vidmantas Alekna  5 , Maria Luisa Bianchi  6 , Patricia Clark  7 , Manuel Diaz-Curiel  8   9 , Hans Peter Dimai  10 , Mikk Jürisson  11 , Olga Lesnyak  12 , Eugene McCloskey  13 , Kerrie M Sanders  14 , Stuart Silverman  15 , Marija Tamulaitiene  5 , Thierry Thomas  16 , Anna N A Tosteson  17 , Bengt Jönsson  18 , John A Kanis  14   19
Affiliations
Observational Study

An experience- and preference-based EQ-5D-3L value set derived using 18 months of longitudinal data in patients who sustained a fracture: results from the ICUROS

Axel Svedbom et al. Qual Life Res. 2023 Apr.

Abstract

Introduction: EQ-5D-3L preference-based value sets are predominately based on hypothetical health states and derived in cross-sectional settings. Therefore, we derived an experience-based value set from a prospective observational study.

Methods: The International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) was a multinational study on fragility fractures, prospectively collecting EQ-5D-3L and Time trade-off (TTO) within two weeks after fracture (including pre-fracture recall), and at 4, 12, and 18 months thereafter. We derived an EQ-5D-3L value set by regressing the TTO values on the ten impairment levels in the EQ-5D-3L. We explored the potential for response shift and whether preferences for domains vary systematically with prior impairment in that domain. Finally, we compared the value set to 25 other EQ-5D-3L preference-based value sets.

Results: TTO data were available for 12,954 EQ-5D-3L health states in 4683 patients. All coefficients in the value set had the expected sign, were statistically significant, and increased monotonically with severity of impairment. We found evidence for response shift in mobility, self-care, and usual activities. The value set had good agreement with the only other experience- and preference-based value set, but poor agreement with all hypothetical value sets.

Conclusions: We present an experience- and preference-based value set with high face validity. The study indicates that response shift may be important to account for when deriving value sets. Furthermore, the study suggests that perspective (experienced versus hypothetical) is more important than country setting or demographics for valuation of EQ-5D-3L health states.

Keywords: Fracture; Health Utility; Health-Related Quality of Life; Osteoporosis.

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Conflict of interest statement

During development of the manuscript, a contract research organization. FB is employed by and own equity in Quantify Research, a contract research organization. JAK received consultancies/speaking fees from AgNovos healthcare, Amgen, D3A, Lilly, Medimaps, Unigene, Radius Health, Pfizer, Servier, and Takeda; and research support from Asahi, Amgen, GSK, Lilly, Medtronic, Novartis, Pfizer, Sanofi-Aventis, Servier, and Warner Chilcott. EM received consultancies, honoraria and speaking fees from Active Signal, Alliance for Better Bone Health, Amgen, Bayer, Boehringer Ingelheim, Consilient Healthcare, Eli Lilly, GE Lunar, GSK, Hologic, Internis, Medtronic, Merck, Novartis, Pfizer, Roche, Servier, Synexus, Tethys, and UCB; and research funding from the Alliance for Better Bone Health, Amgen, Arthritis Research UK, EPSRC, Internis, Medical Research Council, and NIHR. HPD reports consultancies, honoraria and speaking fees from Amgen, BRAINCON, Daiichi-Sankyo, Eli Lilly, Merck Sharp & Dohme, Novartis, Nycomed, Servier, Sinapharm, Alexion, Daiichi-Sankyo, Genericon, Kyphon, and Genericon. TT reports consultancies, honoraria and speaking fees, and grants from Abbvie, Amgen, BMS, Chugai/Roche, Eli Lilly, Expanscience, Gilead, Merck Sharp & Dohme, Medac, Thuasne, UCB, HAC-Pharma, LCA, Novartis, Pfizer, Servier, and TEVA. The remaining authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
Line plot of mean predicted time trade-off (TTO) values and mean observed TTO values for health states with at least ten observations in the validation set (sorted by predicted TTO value). The health states are ordered from highest to lowest predictive value
Fig. 2
Fig. 2
Panel A shows the interaction coefficients and 95% confidence intervals between each level of impairment for the five dimensions of the EQ-5D and Phase 1. Positive values indicate a potential negative response shift with time, i.e., that patients value impairments more with time, whereas negative values indicate a negative response shift, i.e., that patients value impairments less with time. Panel B shows the interaction coefficients and 95% confidence intervals between each level of impairment for the five dimensions of the EQ-5D and any impairment in the same dimension prior to fracture. The dotted lines indicate a clinically significant change
See this image and copyright information in PMC

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