The Incorporation of Health Benefits in Cost Utility Analysis Using the Eq-5d Report by the Decision Support Unit

Acknowledgements: We thank Aki Tsuchiya, John Brazier and Ben van Hout for helpful comments and advice and Jenny Dunn for formatting the report. The content of this report is the responsibility of the authors alone. 2 SUMMARY Economic evaluation is an important component for decision making, underpinning much of the guidance issued by NICE. Typically these economic evaluations have taken the form of cost-utility analyses where health benefits are expressed in terms of Quality Adjusted Life Years (QALYs). One of the most widely used preference based instruments for the assessment of Health Related Quality of Life (HRQoL) that can be used to generate QALYs is the EQ-5D. This is stated to be the preferred instrument for NICE. The EQ-5D has been the subject of criticisms levelled at NICE. This report considers these criticisms of EQ-5D. It aims to identify the types of claims that have been made about EQ-5D and identify the empirical evidence to support such claims. This is used to inform a series of case studies in different disease areas, where evidence of the performance of EQ-5D is systematically identified and reviewed. The report identifies many claims that have been made as part of individual technology appraisals and in evidence submitted to the Kennedy review into the value of innovation. Many of these claims relate to the QALY as a measure of outcome per se or the decision rule of QALY maximisation. There were few examples of claims that EQ-5D is inappropriate as a measurement tool within these general frameworks. Where such claims were identified they were rarely supported by empirical evidence. These claims can be broadly categorised as relating to situations where a specific relevant dimension of health is not directly included in the EQ-5D instrument, such as fatigue or sensory impairment, or where the disease course is characterised by flares of unpredictable symptom severity. Several claims were made regarding inappropriateness in broad disease areas such as cancer and mental health. We conducted case study reviews in the areas of rheumatoid arthritis, asthma and incontinence and refer to a separately funded report on visual disorders. In general terms we found that there were several studies that suggest EQ-5D is less responsive or sensitive than disease specific outcome measures. This was the case for both preference and non preference based outcomes. Other generic preference based measures do not seem to systematically perform differently to EQ-5D. Where an alternative …