Econometric modelling of multiple self-reports of health states: the switch from EQ-5D-3L to EQ-5D-5L in evaluating drug therapies for rheumatoid arthritis
Open accessAbstract
EQ-5D is used in cost-effectiveness studies underlying many important health policy decisions. It comprises a survey instrument describing health states across five domains, and a system of utility values for each state. The original 3-level version of EQ-5D is being replaced with a more sensitive 5-level version but the consequences of this change are uncertain. We develop a multi-equation ordinal response model incorporating a copula specification with normal mixture marginals to analyse joint responses to EQ-5D-3L and EQ-5D-5L in a survey of people with rheumatic disease, and use it to generate mappings between the alternative descriptive systems. We revisit a major cost-effectiveness study of drug therapies for rheumatoid arthritis, mapping the original EQ-5D-3L measure onto a 5L valuation basis. Working within a comprehensive, flexible econometric framework, we find that use of simpler restricted specifications can make very large changes to cost-effectiveness estimates with serious implications for decision-making.
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The UK's National Institute for Health and Care Excellence currently recommends the use of the algorithm developed by Hernandez-Alava for scoring the EQ-5D-5L.
“The EQ-5D-5L will be scored using the rec ommended scoring algorithm at the time of analysis: currently, the UK's National Institute for Health and Care Excellence recommends the use of the algorithm developed by Hernandez-Alava [33].”
From The clinical and cost effectiveness of internet-delivered self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS): Study protocol for a randomised controlled trial with ethnically diverse family carers (2024) · cites this paper as [33]
The Conclusions (page unavailable) say the authors developed a method for mapping between EQ-5D-3L and EQ-5D-5L, and the Introduction says NICE recommends EQ-5D. But the paper does not say NICE recommends their method for scoring EQ-5D-5L; its Utility scores section instead identifies the Devlin et al. (2016) 5L value set as a standard choice in England. (LLM, conf=0.82)
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- Authors
- Hernández-Alava, M., & Pudney, S.
- Affiliations
- University of Sheffield (GB)
- Corresponding author
- Pudney, Stephen
- Venue
- Journal of Health Economics
- Publisher
- Elsevier BV
- Published
- 2017-09
- Volume
- 55
- Pages
- 139-152
- ISSN
- 0167-6296 (ISSN-L)
- PMC
- PMC5597047
- OpenAlex
- W2731622813
- Cited by
- 64
- References
- 34
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 5 · 2023: 6 · 2022: 13 · 2021: 9 · 2020: 7 · 2019: 6 · 2018: 4 · 2017: 1
- FWCI
- 9.35
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Health Economics (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- University of Nebraska Medical Center
- Medical Research Council (MR/L022575/1)
- Economic and Social Research Council (ES/K005146/1, ES/L009153/1, ES/H00811X/1)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Environmental Valuation
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
- Keywords
- EQ-5D-3L, EQ-5D-5L, health state valuation, utility mapping, copulas, rheumatoid arthritis, health-related quality of life
- MeSH terms
- Arthritis, Rheumatoid, Cost-Benefit Analysis, Female, Health Status, Humans, Male, Quality of Life, Treatment Outcome, Models, Econometric, Antirheumatic Agents, Self Report
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