1 / 25

EuroQol EQ-5D

EuroQol EQ-5D . Jan J. V. Busschbach, Ph.D Psychotherapeutic Centrum ‘De Viersprong’, Halsteren Jan.Busschbach@deviersprong.net Department of Medical Psychology and Psychotherapy, Erasmus MC Busschbach@mpp.fgg.eur.nl. EQ-5D. MOBILITY I have no problems in walking about

loyal
Download Presentation

EuroQol EQ-5D

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. EuroQol EQ-5D • Jan J. V. Busschbach, Ph.D • Psychotherapeutic Centrum ‘De Viersprong’, Halsteren • Jan.Busschbach@deviersprong.net • Department of Medical Psychology and Psychotherapy, Erasmus MC • Busschbach@mpp.fgg.eur.nl

  2. EQ-5D • MOBILITY • I have no problems in walking about • I have some problems in walking about • I am confined to bed • SELF-CARE • 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) • 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 • PAIN/DISCOMFORT • 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

  3. The clinical perspective • It is not the doctor who reports • Quality of life is subjective….. • “Given its inherently subjective nature, consensus was quickly reached that quality of life ratings should, whenever possible, be elicited directly from patients themselves. “ (Aaronson, in B Spilker (Ed): Quality of life and Pharmacoeconomics in Clinical Trails, 1996, page 180) • As a CONSUMER of care, the patient is the best judged about the quality of care • The patient values count in clinical quality of life research

  4. The economic perspective • In a normal market: the consumer values count • The patient seems to be the consumer • Thus the values of the patients…. • If indeed health care is a normal market… • But is it….?

  5. Health care is not a normal market • Supply induced demands • Subsidies (egalitarian structure) • Government control • Health care is an insurance market • A compulsory insurance market • The patient does not pay • Patient  Consumer • Potential patients are paying • Consumer = General public

  6. Who determines the payments of unemployment insurance? • Civil servant • Knowledge: professional • But strategy • more money, less problems • identify with unemployed persons • The unemployed persons themselves • Knowledge: specific • But strategy • General public (politicians) • Knowledge: experience • Payers

  7. Who’s values (of quality of life) should count in the health insurance? • Doctors • Knowledge: professional • But strategy • But see only selection of patient (the complainers) • Patients • Knowledge: disease specific • But strategy • But coping • General public • Knowledge: experience • Payers

  8. Patient values seem high • Stensman • Scan J Rehab Med 1985;17:87-99. • Scores on a visual analogue scale • 36 subjects in a wheelchair • 36 normal matched controls • Mean score • Wheelchair: 8.0 • Controls: 8.3

  9. Is there a problem? • There is no problem... • if effect is linear • In the past, the general perspective was seen as a proxy for patient perspective • There is a problem... • If there is no linear transformation • Patient and general public perspective reveal different results • Loss of power in patient perspective

  10. Patient Perspective

  11. The Societal Perspective • MOBILITY • I have no problems in walking about • I have some problems in walking about • I am confined to bed • SELF-CARE • 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) • 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 • PAIN/DISCOMFORT • 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

  12. Describe health states Have values from the general public Rosser QWB 15D HUI Mark 2 HUI Mark 3 EuroQol EQ-5D Validated Questionnaires

  13. EQ-5D • MOBILITY • I have no problems in walking about • I have some problems in walking about • I am confined to bed • SELF-CARE • 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) • 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 • PAIN/DISCOMFORT • 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

  14. EuroQol • EuroQol Group • Latest version: EQ-5D • 5 dimensions • Mobility, self-care, usual activities, pain / discomfort, anxiety / depression • 3 levels per dimension • 243 health states • Validation • Finland, Netherlands, Norway, Sweden, UK, Spain, Germany, Greece, US, Japan, New Zealand, Zimbabwe, Denmark • N = 200 - 3000

  15. How to get these societal values? • Patient fills in questionnaire • Choose the value function from the literature • Calculate societal value COMPUTE MVH_A1 = 1. VARIABLE LABELS MVH_A1 'York A1 tariff'. DO IF (NVALID(mo, sc, ua, pd, ad) < 5 ). RECODE MVH_A1 (1 = SYSMIS). END IF. IF (MAX(mo, sc, ua, pd, ad) > 1) MVH_A1 = MVH_A1 -.081. IF (mo = 2) MVH_A1 = MVH_A1 - .069. IF (mo = 3) MVH_A1 = MVH_A1 - .314. IF (sc = 2) MVH_A1 = MVH_A1 - .104. IF (sc = 3) MVH_A1 = MVH_A1 - .214. IF (ua = 2) MVH_A1 = MVH_A1 - .036. IF (ua = 3) MVH_A1 = MVH_A1 - .094. IF (pd = 2) MVH_A1 = MVH_A1 - .123. IF (pd = 3) MVH_A1 = MVH_A1 - .386. IF (ad = 2) MVH_A1 = MVH_A1 - .071. IF (ad = 3) MVH_A1 = MVH_A1 - .236. IF (MAX(mo, sc, ua, pd, ad) > 2) MVH_A1 = MVH_A1 - .269.

  16. An example of a value function * SPSS syntax Dolan 1997, Medical Care, 1997;35:1095-108. * mo = mobility, sc= self care, ua = usual activities, pd = pain & discomfort , ad = anxiety and depression. COMPUTE MVH_A1 = 1. VARIABLE LABELS MVH_A1 'York A1 tariff'. DO IF (NVALID(mo, sc, ua, pd, ad) < 5 ). RECODE MVH_A1 (1 = SYSMIS). END IF. IF (MAX(mo, sc, ua, pd, ad) > 1) MVH_A1 = MVH_A1 -.081. IF (mo = 2) MVH_A1 = MVH_A1 - .069. IF (mo = 3) MVH_A1 = MVH_A1 - .314. IF (sc = 2) MVH_A1 = MVH_A1 - .104. IF (sc = 3) MVH_A1 = MVH_A1 - .214. IF (ua = 2) MVH_A1 = MVH_A1 - .036. IF (ua = 3) MVH_A1 = MVH_A1 - .094. IF (pd = 2) MVH_A1 = MVH_A1 - .123. IF (pd = 3) MVH_A1 = MVH_A1 - .386. IF (ad = 2) MVH_A1 = MVH_A1 - .071. IF (ad = 3) MVH_A1 = MVH_A1 - .236. IF (MAX(mo, sc, ua, pd, ad) > 2) MVH_A1 = MVH_A1 - .269.

  17. Some values • Broken arm • 12211 • no problems in walking about • some problems washing or dressing • some problems with performing usual activities • no pain or discomfort • not anxious or depressed • Societal value = 0.779

  18. Some values • Broken hip • 22222 • some problems in walking about • some problems washing or dressing • some problems with performing usual activities • moderate pain or discomfort • moderately anxious or depressed • Societal value = 0.516

  19. Impact on quality of life

  20. Effect psychotherapy

  21. Reimbursement arguments • Dunning’s Funnel • 1990 • Government declaration 2002 • Necessary care • Need • Equity elements • Efficacy • Cost effectiveness • Own account and responsibility

  22. Reimbursement arguments Impact on QoL Effect on QoL Cost effectiveness ? QALYs

  23. Quality Adjusted Life Years (QALY) • Multiply life years with quality index • Quality of life index • 1.0 = normal health • 0.0 = extremely bad health (death) • Example • Losing sense of sight • Quality of life index is 0.5 • Life = 80 years • 0.5 x 80 = 40 QALYs • Accepted measure of health • Used by the WHO (DALY)

  24. QALY league table

  25. EQ-5D and cost effectiveness • EQ-5D specially designed • Social perspective • Generic • 0 to 1 scale • Use EQ-5D for QALY analysis

More Related