Transcript Quality of life Assessment

Could there be a single
European EQ tariff?
• Jan J.V. Busschbach, Ph.D.
• Former address:
– iMTA, Erasmus university
• Present address:
– Medical Psychology and Psychotherapy
» Erasmus Medical Center, Rotterdam
» PO Box 1738
» 3000 DR Rotterdam, The Netherlands
– Psychotherapeutic center “De viersprong”
» PO Box 7
» 4660 AA Halsteren, The Netherlands
– [email protected]
1
The EuroQol
•
• Links values from the
general public to 243
health states
– 5 dimensions, 3 levels
• Starting point of group:
QoL-values differ over
Europe
– Different national TTO and VAS
values are now available
– Possibility to compare values from
different countries
MOBILITY
–
–
–
•
SELF-CARE
–
–
–
•
I have no problems in walking about
I have some problems in walking about
I am confined to bed
I have no problems with self-care
I have some problems washing or dressing myself
I am unable to wash or dress myself
USUAL ACTIVITIES (e.g. work, study,
housework family or leisure activities)
–
–
–
•
PAIN/DISCOMFORT
–
–
–
•
I have no problems with performing my usual
activities
I have some problems with performing my usual
activities
I am unable to perform my usual activities
I have no pain or discomfort
I have moderate pain or discomfort
I have extreme pain or discomfort
ANXIETY/DEPRESSION
–
–
–
I am not anxious or depressed
I am moderately anxious or depressed
I am extremely anxious or depressed
2
First comparisons in 1988 (EQ-6D)
100
EQ-VAS values
90
80
Sweden
70
Uk
60
Netherlands
50
40
30
20
10
0
2
h
at
de 1
h
at
de
32
22
33
32
22
32
32
22
23
32
22
22
32
22
21
32
22
11
22
22
11
22
22
11
31
21
11
21
21
11
22
11
11
12
11
11
21
11
11
11
11
11
EuroQol 6-D health states
3
Comparisons in 1999 with (EQ-5D)
4
Spain
0.2
0.0
TTO MVH values
TTO-values EQ-5D in 1999
1.0
0.8
0.6
Germany
UK
0.4
-0.2
-0.4
-0.6
-0.8
3
33
33
n
co
un
3
32
33
2
23
33
1
33
32
2
23
32
2
33
13
3
22
32
3
31
32
3
23
22
1
32
33
2
23
23
3
31
23
3
13
21
3
13
11
2
21
33
1
33
22
3
32
22
3
32
21
2
23
21
1
21
32
1
32
23
3
22
21
3
22
12
1
13
11
1
31
13
2
21
13
3
11
11
2
22
22
2
31
21
2
12
22
2
22
21
2
22
12
2
31
11
1
12
22
2
11
22
2
12
11
1
12
12
1
21
12
2
11
11
1
11
12
1
12
11
1
21
11
1
11
21
5
EQ-5D Health states
Problem & Hypotheses
• German TTO values higher than English and Spanish
• Explanation by exclusion
– Culture
» National nature of the inhabitants
– Methods / investigators
» Investigators use the same protocol
– Sample
» Back ground variable do matter
» Back ground variables are distributed differently
» Effect should disappear if we control for back ground variables
• co-variate analysis
6
Samples differ in background
variables
• The German sample is older and smarter
• But background variables do not explain the
differences
Model parameters
Country
Without
With
background
Germany
0.189
0.172
Spain
0.001
0.000
7
Conclusion (so fare)
• VAS does not differ
– Not cultural determined
• TTO differs
– Back ground variables do not appear to account for the difference found
– TTO could be cultural determined
• But… country and investigator are linked
– Differences between countries can be differences between investigators
• Prove of the pudding…replication within country
8
Replication of York Study VAS
Macran S Kind P. Valuing the EQ-5D health states using a modified MVH protocol. Proceedings
Plenary Meeting of the EuroQol Group, Sitges, Spain, 6/11/1999.
9
Replication of York Study TTO
Macran S Kind P. Valuing the EQ-5D health states using a modified MVH protocol. Proceedings
Plenary Meeting of the EuroQol Group, Sitges, Spain, 6/11/1999.
1.0
Germany
0.8
UK
Spain
0.6
UK 1998
TTO MVH values
0.4
0.2
0.0
-0.2
-0.4
-0.6
-0.8
3
33
33
n
co
un
3
32
33
2
23
33
1
33
32
2
23
32
2
33
13
3
22
32
3
31
32
3
23
22
1
32
33
2
23
23
3
31
23
3
13
21
3
13
11
2
21
33
1
33
22
3
32
22
3
32
21
2
23
21
1
21
32
1
32
23
3
22
21
3
22
12
1
13
11
1
31
13
2
21
13
3
11
11
2
22
22
2
31
21
2
12
22
2
22
21
2
22
12
2
31
11
1
12
22
2
11
22
2
12
11
1
12
12
1
21
12
2
11
11
1
11
12
1
12
11
1
21
11
1
11
21
EQ-5D Health states
10
Conclusion (end)
• VAS are not cultural determined
• TTO differs
– Back ground variables do not account for all difference
• TTO are perhaps cultural determined
– But differences between countries are also differences between investigators
– Different investigators give different values
• Little proof that TTO-values differ in Europe
• Yes,…. there is room for an European tariff
11
Euro Tariff
Random effects regression model specifications, based on UK, German
and Spanish values. State 11111 = 1.00. EuroQol book, Chapter 9,
forthcoming
B
SE
0.996
0.051
N3 *
-0.280
0.006
Mobility = 2
-0.085
0.004
Mobility = 3
-0.343
0.005
Self Care = 2
-0.112
0.004
Self Care = 3
-0.239
0.005
Usual activities = 2
-0.050
0.005
Usual activities = 3
-0.120
0.006
Pain/discomfort = 2
-0.113
0.004
Pain/discomfort = 3
-0.352
0.005
Anxiety/depression = 2
-0.066
0.004
Anxiety/depression = 3
-0.212
0.005
Constant
* Seen for an explanation of the N3 parameter Dolan, 1997.
12
Negative values
•
•
•
•
Negative values in York protocol are disputed
Little theoretical consensus
Difficult to handle
Compare negative and positive values separately
13
0.60
0.50
0.40
Mean positive TTO values
Positive values
1.00
0.90
Germany
UK
0.80
Spain
0.70
0.30
0.20
0.10
0.00
3
33
33
3
32
33
2
23
33
1
33
32
2
33
13
3
22
32
3
31
32
3
23
22
3
31
23
1
32
33
2
23
23
2
23
32
3
13
21
2
21
33
3
13
11
3
32
22
1
33
22
2
23
21
1
21
32
3
32
21
3
22
21
3
22
12
1
32
23
1
13
11
1
31
13
2
21
13
3
11
11
2
22
22
2
31
21
2
12
22
2
22
12
2
22
21
2
31
11
2
11
22
1
12
22
1
12
12
2
12
11
1
21
12
2
11
11
1
12
11
1
11
12
1
21
11
1
11
21
14
EQ-5D health states
-0.40
-0.45
-0.50
Mean negative TTO values
Negative values
-0.25
-0.30
Germany
UK
-0.35
Spain
-0.55
-0.60
-0.65
-0.70
3
33
33
1
33
32
2
23
33
3
32
33 2
23
23
2
33
13
2
23
32
3
13
11 3
23
22
3
31
23
2
12
11
3
13
21 1
32
23
3
31
32
3
22
32
2
21
33 2
23
21
1
21
32
3
22
21
1
33
22 1
12
22
3
32
22
1
32
33
2
22
21 1
13
11
1
31
13
2
12
22
1
11
12 2
31
21
3
11
11
1
21
12
2
22
22 2
21
13
2
31
11
2
11
11
2
11
22 3
22
12
1
11
21
1
12
12
2
22
12
15
EQ-5D Health states with more than 20 obseverations