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The Impact of Moving from EQ-5D-3L to -5L in NICE Technology Appraisals

Author

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  • Becky Pennington

    (University of Sheffield)

  • Monica Hernandez-Alava

    (University of Sheffield)

  • Stephen Pudney

    (University of Sheffield)

  • Allan Wailoo

    (University of Sheffield)

Abstract

Background The EuroQol-5 Dimension (EQ-5D) instrument is the National Institute for Health and Care Excellence (NICE)’s preferred measure of health-related quality of life (QoL) in adults. The three-level (3L) value set is currently recommended for use, but the five-level (5L) set is increasingly being used in practice. Objective We aimed to explore the impact of moving from 3L to 5L in NICE appraisals. Methods We adapted our existing mapping for use with health state utility values derived from a population where the original distribution of utilities was unknown. We used this mapping to estimate 5L utilities for 21 comparisons of interventions from models used in NICE technology appraisal decision making, covering a range of disease areas. Results All utilities increased using 5L, and the differences between highest and lowest utilities decreased. In ten oncology comparisons, using 5L generally increased the incremental quality-adjusted life-years (QALYs) as the benefit from improving survival increased. In four non-oncology comparisons where the intervention improved QoL only, the incremental QALYs decreased as the benefit of improving QoL was reduced. In seven non-oncology comparisons where interventions improved survival and QoL, there was a trade-off between increasing the benefit from survival and decreasing the benefit from improving QoL. Conclusion 3L and 5L lead to substantially different estimates of incremental QALYs and cost effectiveness. The direction and magnitude of the change is not consistent across case studies. Using 5L instead of 3L may lead to different reimbursement decisions. NICE will face inconsistencies in decision making if it uses 3L and 5L concurrently.

Suggested Citation

  • Becky Pennington & Monica Hernandez-Alava & Stephen Pudney & Allan Wailoo, 2019. "The Impact of Moving from EQ-5D-3L to -5L in NICE Technology Appraisals," PharmacoEconomics, Springer, vol. 37(1), pages 75-84, January.
    • Handle: RePEc:spr:pharme:v:37:y:2019:i:1:d:10.1007_s40273-018-0701-y
    DOI: 10.1007/s40273-018-0701-y
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    References listed on IDEAS

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    1. Brendan Mulhern & Yan Feng & Koonal Shah & Mathieu F. Janssen & Michael Herdman & Ben Hout & Nancy Devlin, 2018. "Comparing the UK EQ-5D-3L and English EQ-5D-5L Value Sets," PharmacoEconomics, Springer, vol. 36(6), pages 699-713, June.
    2. Brendan Mulhern & Yan Feng & Koonal Shah & Mathieu F. Janssen & Michael Herdman & Ben Hout & Nancy Devlin, 2018. "Correction to: Comparing the UK EQ-5D-3L and English EQ-5D-5L Value Sets," PharmacoEconomics, Springer, vol. 36(6), pages 727-727, June.
    3. Ines Buchholz & Mathieu F. Janssen & Thomas Kohlmann & You-Shan Feng, 2018. "A Systematic Review of Studies Comparing the Measurement Properties of the Three-Level and Five-Level Versions of the EQ-5D," PharmacoEconomics, Springer, vol. 36(6), pages 645-661, June.
    4. Mathieu F. Janssen & Gouke J. Bonsel & Nan Luo, 2018. "Is EQ-5D-5L Better Than EQ-5D-3L? A Head-to-Head Comparison of Descriptive Systems and Value Sets from Seven Countries," PharmacoEconomics, Springer, vol. 36(6), pages 675-697, June.
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    Cited by:

    1. Ting Zhou & Zhiyuan Chen & Hongchao Li & Feng Xie, 2021. "Using Published Health Utilities in Cost-Utility Analyses: Discrepancies and Issues in Cardiovascular Disease," Medical Decision Making, , vol. 41(6), pages 685-692, August.
    2. Beth Woods & Aimée Fox & Mark Sculpher & Karl Claxton, 2021. "Estimating the shares of the value of branded pharmaceuticals accruing to manufacturers and to patients served by health systems," Health Economics, John Wiley & Sons, Ltd., vol. 30(11), pages 2649-2666, November.
    3. Joanne Gregory & Matthew Dyer & Christopher Hoyle & Helen Mann & Anthony J. Hatswell, 2020. "The validation of published utility mapping algorithms: an example of EORTC QLQ-C30 and EQ-5D in non-small cell lung cancer," Health Economics Review, Springer, vol. 10(1), pages 1-10, December.

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