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  1. Comparing Multi-Attribute Utility Measures: EQ-5D, HUI, and SF-6D Workshop for 6th World Congress of International Health Economics Association, Lund, Sweden, July 6, 2007 • David Feeny, Kaiser Permanente Northwest Center for Health Research, Institute of Health Economics, University of Alberta, and Health Utilities Inc. • John Horsman, McMaster University, and Health Utilities Inc. • Assisted by: Keiko Asakawa, Institute of Health Economics and University of Alberta and Morag Horsman, McMaster University

  2. Comparing Multi-Attribute Utility Measures: EQ-5D, HUI, and SF-6D Outline • Introduction/Administration of Selected Multi-Attribute Utility Measures • Conceptual Foundations • Direct Approaches to Obtaining Utility Scores for Health States • Multi-Attribute or Indirect Approaches to Obtaining Utility Scores for Health States • Evidence on Measurement Properties of Utility Measures: Reliability, Construct Validity, Responsiveness, Floor/Ceiling Effects, Predictive Validity, Interpretability • Applications in Cost-Effectiveness/Cost-Utility Analyses • Comparisons Among Measures • Criteria for Selecting an Appropriate Measure for your Study • Results from Demonstration • Summary

  3. Hypothetical Health State for Valuation Health State “B” • Able to see, hear, and speak normally. • Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around independently. • Occasionally angry, irritable, anxious, or depressed. • Able to learn and remember normally. • Eats, bathes, dresses, or uses the toilet independently with difficulty. • Free of pain and discomfort.

  4. Visual Analogue Scale “Feeling Thermometer” © Health Utilities Inc. (HUInc.) 2006

  5. TIME TRADE-OFF BOARD Your age now Your age now Life “A” 10 10 20 20 30 30 40 40 YEARS OF LIFE Life “B” YEARS OF LIFE A standard, blank, Time Trade-off Board on which you select Life “A” or Life “B” or are they ‘equal’ © Health Utilities Inc. (HUInc.) 2006

  6. TTO Scoring template - use 1st “Stop sign” TIME TRADE-OFF PREFER “A” EQUAL PREFER “B” T1 T2 T3 T4 T5 © Health Utilities Inc. (HUInc.) 2006

  7. TIME TRADE-OFF BOARD Your age now Your age now Life “A” 10 10 20 20 30 30 40 40 PERFECT HEALTH Able to see, hear, and speak normally. Able to walk, bend, lift, jump, and run normally for age. Generally happy and free from worry. Able to learn and remember normally. Able to eat, bathe, dress, and use the toilet normally. Free of pain and discomfort. YEARS OF LIFE Life “B” YEARS OF LIFE T1 Health State “B” Able to see, hear and speak normally. Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around. Occasionally angry, irritable, anxious, or depressed. Able to learn and remember normally. Eats, bathes, dresses, or uses the toilet independently with difficulty. Free of pain and discomfort. “Life ‘A’ Perfect Health” or “Life ‘B’ Health State B” or “Equal?” © Health Utilities Inc. (HUInc.) 2006

  8. TIME TRADE-OFF BOARD Your age now Your age now Life “A” 10 10 20 20 30 30 40 40 PERFECT HEALTH Able to see, hear, and speak normally. Able to walk, bend, lift, jump, and run normally for age. Generally happy and free from worry. Able to learn and remember normally. Able to eat, bathe, dress, and use the toilet normally. Free of pain and discomfort. YEARS OF LIFE Life “B” YEARS OF LIFE T2 Health State “B” Able to see, hear and speak normally. Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around. Occasionally angry, irritable, anxious, or depressed. Able to learn and remember normally. Eats, bathes, dresses, or uses the toilet independently with difficulty. Free of pain and discomfort. “Life ‘A’ Perfect Health” or “Life ‘B’ Health State B” or “Equal?” © Health Utilities Inc. (HUInc.) 2006

  9. TIME TRADE-OFF BOARD Your age now Your age now Life “A” 10 10 20 20 30 30 40 40 PERFECT HEALTH Able to see, hear, and speak normally. Able to walk, bend, lift, jump, and run normally for age. Generally happy and free from worry. Able to learn and remember normally. Able to eat, bathe, dress, and use the toilet normally. Free of pain and discomfort. YEARS OF LIFE Life “B” YEARS OF LIFE T3 Health State “B” Able to see, hear and speak normally. Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around. Occasionally angry, irritable, anxious, or depressed. Able to learn and remember normally. Eats, bathes, dresses, or uses the toilet independently with difficulty. Free of pain and discomfort. “Life ‘A’ Perfect Health” or “Life ‘B’ Health State B” or “Equal?” © Health Utilities Inc. (HUInc.) 2006

  10. TIME TRADE-OFF BOARD Your age now Your age now Life “A” 10 10 20 20 30 30 40 40 PERFECT HEALTH Able to see, hear, and speak normally. Able to walk, bend, lift, jump, and run normally for age. Generally happy and free from worry. Able to learn and remember normally. Able to eat, bathe, dress, and use the toilet normally. Free of pain and discomfort. YEARS OF LIFE Life “B” YEARS OF LIFE T4 Health State “B” Able to see, hear and speak normally. Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around. Occasionally angry, irritable, anxious, or depressed. Able to learn and remember normally. Eats, bathes, dresses, or uses the toilet independently with difficulty. Free of pain and discomfort. “Life ‘A’ Perfect Health” or “Life ‘B’ Health State B” or “Equal?” © Health Utilities Inc. (HUInc.) 2006

  11. TIME TRADE-OFF BOARD Your age now Your age now Life “A” 10 10 20 20 30 30 40 40 PERFECT HEALTH Able to see, hear, and speak normally. Able to walk, bend, lift, jump, and run normally for age. Generally happy and free from worry. Able to learn and remember normally. Able to eat, bathe, dress, and use the toilet normally. Free of pain and discomfort. YEARS OF LIFE Life “B” YEARS OF LIFE T5 Health State “B” Able to see, hear and speak normally. Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around. Occasionally angry, irritable, anxious, or depressed. Able to learn and remember normally. Eats, bathes, dresses, or uses the toilet independently with difficulty. Free of pain and discomfort. “Life ‘A’ Perfect Health” or “Life ‘B’ Health State B” or “Equal?” © Health Utilities Inc. (HUInc.) 2006

  12. Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal?’ © Health Utilities Inc. (HUInc.) 2006

  13. CHANCE BOARD S1 Life “A” 100 0 % CHANCE % CHANCE PERFECT HEALTH Able to see, hear and speak normally. Able to walk, bend, lift, jump, and run normally for age. Generally happy and free from worry. Able to learn and remember normally. Able to eat, bathe, dress, and use the toilet normally. Free of pain and discomfort. IMMEDIATE DEATH Life “B” Health State “B” Able to see, hear and speak normally. Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around. Occasionally angry, irritable, anxious, or depressed. Able to learn and remember normally. Eats, bathes, dresses, or uses the toilet independently with difficulty. Free of pain and discomfort. 100 % CHANCE Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal’ © Health Utilities Inc. (HUInc.) 2006

  14. CHANCE BOARD S2 Life “A” 10 90 % CHANCE % CHANCE PERFECT HEALTH Able to see, hear and speak normally. Able to walk, bend, lift, jump, and run normally for age. Generally happy and free from worry. Able to learn and remember normally. Able to eat, bathe, dress, and use the toilet normally. Free of pain and discomfort. IMMEDIATE DEATH Life “B” Health State “B” Able to see, hear and speak normally. Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around. Occasionally angry, irritable, anxious, or depressed. Able to learn and remember normally. Eats, bathes, dresses, or uses the toilet independently with difficulty. Free of pain and discomfort. 100 % CHANCE Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal’ © Health Utilities Inc. (HUInc.) 2006

  15. CHANCE BOARD S3 Life “A” 90 10 % CHANCE % CHANCE PERFECT HEALTH Able to see, hear and speak normally. Able to walk, bend, lift, jump, and run normally for age. Generally happy and free from worry. Able to learn and remember normally. Able to eat, bathe, dress, and use the toilet normally. Free of pain and discomfort. IMMEDIATE DEATH Life “B” Health State “B” Able to see, hear and speak normally. Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around. Occasionally angry, irritable, anxious, or depressed. Able to learn and remember normally. Eats, bathes, dresses, or uses the toilet independently with difficulty. Free of pain and discomfort. 100 % CHANCE Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal’ © Health Utilities Inc. (HUInc.) 2006

  16. CHANCE BOARD S4 Life “A” 20 80 % CHANCE % CHANCE PERFECT HEALTH Able to see, hear and speak normally. Able to walk, bend, lift, jump, and run normally for age. Generally happy and free from worry. Able to learn and remember normally. Able to eat, bathe, dress, and use the toilet normally. Free of pain and discomfort. IMMEDIATE DEATH Life “B” Health State “B” Able to see, hear and speak normally. Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around. Occasionally angry, irritable, anxious, or depressed. Able to learn and remember normally. Eats, bathes, dresses, or uses the toilet independently with difficulty. Free of pain and discomfort. 100 % CHANCE Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal’ © Health Utilities Inc. (HUInc.) 2006

  17. CHANCE BOARD S5 Life “A” 80 20 % CHANCE % CHANCE PERFECT HEALTH Able to see, hear and speak normally. Able to walk, bend, lift, jump, and run normally for age. Generally happy and free from worry. Able to learn and remember normally. Able to eat, bathe, dress, and use the toilet normally. Free of pain and discomfort. IMMEDIATE DEATH Life “B” Health State “B” Able to see, hear and speak normally. Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around. Occasionally angry, irritable, anxious, or depressed. Able to learn and remember normally. Eats, bathes, dresses, or uses the toilet independently with difficulty. Free of pain and discomfort. 100 % CHANCE Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal’ © Health Utilities Inc. (HUInc.) 2006

  18. CHANCE BOARD S6 Life “A” 30 70 % CHANCE % CHANCE PERFECT HEALTH Able to see, hear and speak normally. Able to walk, bend, lift, jump, and run normally for age. Generally happy and free from worry. Able to learn and remember normally. Able to eat, bathe, dress, and use the toilet normally. Free of pain and discomfort. IMMEDIATE DEATH Life “B” Health State “B” Able to see, hear and speak normally. Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around. Occasionally angry, irritable, anxious, or depressed. Able to learn and remember normally. Eats, bathes, dresses, or uses the toilet independently with difficulty. Free of pain and discomfort. 100 % CHANCE Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal’ © Health Utilities Inc. (HUInc.) 2006

  19. CHANCE BOARD S7 Life “A” 70 30 % CHANCE % CHANCE PERFECT HEALTH Able to see, hear and speak normally. Able to walk, bend, lift, jump, and run normally for age. Generally happy and free from worry. Able to learn and remember normally. Able to eat, bathe, dress, and use the toilet normally. Free of pain and discomfort. IMMEDIATE DEATH Life “B” Health State “B” Able to see, hear and speak normally. Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around. Occasionally angry, irritable, anxious, or depressed. Able to learn and remember normally. Eats, bathes, dresses, or uses the toilet independently with difficulty. Free of pain and discomfort. 100 % CHANCE Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal’ © Health Utilities Inc. (HUInc.) 2006

  20. CHANCE BOARD S8 Life “A” 40 60 % CHANCE % CHANCE PERFECT HEALTH Able to see, hear and speak normally. Able to walk, bend, lift, jump, and run normally for age. Generally happy and free from worry. Able to learn and remember normally. Able to eat, bathe, dress, and use the toilet normally. Free of pain and discomfort. IMMEDIATE DEATH Life “B” Health State “B” Able to see, hear and speak normally. Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around. Occasionally angry, irritable, anxious, or depressed. Able to learn and remember normally. Eats, bathes, dresses, or uses the toilet independently with difficulty. Free of pain and discomfort. 100 % CHANCE Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal’ © Health Utilities Inc. (HUInc.) 2006

  21. CHANCE BOARD S9 Life “A” 60 40 % CHANCE % CHANCE PERFECT HEALTH Able to see, hear and speak normally. Able to walk, bend, lift, jump, and run normally for age. Generally happy and free from worry. Able to learn and remember normally. Able to eat, bathe, dress, and use the toilet normally. Free of pain and discomfort. IMMEDIATE DEATH Life “B” Health State “B” Able to see, hear and speak normally. Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around. Occasionally angry, irritable, anxious, or depressed. Able to learn and remember normally. Eats, bathes, dresses, or uses the toilet independently with difficulty. Free of pain and discomfort. 100 % CHANCE Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal’ © Health Utilities Inc. (HUInc.) 2006

  22. CHANCE BOARD S10 Life “A” 50 50 % CHANCE % CHANCE PERFECT HEALTH Able to see, hear and speak normally. Able to walk, bend, lift, jump, and run normally for age. Generally happy and free from worry. Able to learn and remember normally. Able to eat, bathe, dress, and use the toilet normally. Free of pain and discomfort. IMMEDIATE DEATH Life “B” Health State “B” Able to see, hear and speak normally. Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around. Occasionally angry, irritable, anxious, or depressed. Able to learn and remember normally. Eats, bathes, dresses, or uses the toilet independently with difficulty. Free of pain and discomfort. 100 % CHANCE Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal’ © Health Utilities Inc. (HUInc.) 2006

  23. Comparing Multi-Attribute Utility Measures: EQ-5D, HUI, and SF-6D Outline Introduction/Administration of Selected Multi-Attribute Utility Measures Conceptual Foundations Direct Approaches to Obtaining Utility Scores for Health States Multi-Attribute or Indirect Approaches to Obtaining Utility Scores for Health States Evidence on Measurement Properties of Utility Measures: Reliability, Construct Validity, Responsiveness, Floor/Ceiling Effects, Predictive Validity, Interpretability Applications in Cost-Effectiveness/Cost-Utility Analyses Comparisons Among Measures Criteria for Selecting an Appropriate Measure for your Study Results from Demonstration Summary

  24. Desirable Propertiesfor Measures of HRQL Acceptability Burden Reliability Validity Responsiveness Interpretability Usefulness

  25. Major Uses of Utility Measures of HRQL As an Outcome Measure Input into Economic Evaluations (Cost-Effectiveness, Cost Utility, Cost-Benefit Analyses) Input into Health Technology Assessments

  26. Useful Properties of Utility Measures of HRQL Comprehensive Conventional Scale: Dead = 0.00; Perfect Health = 1.00 Interval-Scale Properties Permit Broad Comparisons Integrate Treatment Process and Outcome Integrate over Time Integrate Mortality and Morbidity Link Clinical and Population Health Applications

  27. Taxonomy of Measures of Health-Related Quality of Life I. Specific Instruments II. Generic Instruments Health-Profile Measures Utility (Preference-Based) Measures Source: Guyatt, Feeny, and Patrick (1993).

  28. Definitions and Concepts Three Major Paradigms in HRQL Measurement Psychometric Clinimetric Utility/Preference-Based Purposes of Measurement Description - Assess Burden of Morbidity Assess Place of Individual/Group in the Distribution of Health Status Discrimination Prediction Evaluation: Assess Within-Person Change over Time - Individual Patients, Groups, Clinical Trials Valuation of Health Status - Conventional Scale (Dead = 0.00; Perfect Health = 1.00) Assist in Informing Resource Allocation Decisions Approaches to the Assessment of Health-Related Quality of Life (HRQL)

  29. A Definition of HRQL “Health-related quality of life is the value assigned to duration of life as modified by the impairments, functional states, perceptions, and social opportunities that are influenced by disease, injury, treatment, or policy.” Source: Donald L. Patrick and Pennifer Erickson, Health Status and Health Policy: Quality of Life in Health Care Evaluation and Resource Allocation. New York: Oxford University Press, 1993, p 22.

  30. Axioms of Cardinal Expected Utility Theory • Rational behavior under risk (uncertainty) consists of: • Preferences for outcomes exist and are transitive, • e.g. if A > B and B > C, then A > C • Preferences for a risky prospect are independent of whether it has one stage or two, • e.g. if P1 = (0.5A, 0.5P2) where P2 = (0.5A, 0.5B), and P3 = (0.75A, 0.25B), then P1 ~ P3 • Preferences are continuous (Standard Gamble), e.g. if A > B > C, then there is some probability p such that the person is indifferent between B for sure and a risky prospect (pA, (1-p)C) [Continuity Axiom]

  31. Basic Underlying Heuristic Framework from Economics Utility = U(C, HS) where U is the utility function; C = composite final consumption good; HS = health status. Further assume that U/  C > 0;  U/  HS > 0. Final “goods” (C, HS) are produced within the household using time and inputs purchased from the market

  32. Implications for the Valuation of Health Status 1. Intrinsic Value of Health Status   Health status is an argument in the utility function; it contributes directly to utility, well being, or life satisfaction. 2. “Indirect” Value of Health Status   Being healthy reduces time lost due to illness and enhances productivity in market work and household production and thus has “indirect” value. 3.Scope. Scope of utility measure needs to be specified. Is the measure intended to cover the intrinsic value only or both the intrinsic value and the indirect value?

  33. Direct Approaches to Obtaining Utility Scores for Health States Rank Ordering of Health States Category Scaling/Visual Analogue Scale (VAS) - Feeling Thermometer (FT) Choice-Based Techniques   Time Tradeoff (TTO)   Standard Gamble (SG) Note: CS/VAS/FT and TTO scores technically are value scores; SG scores are utility scores.

  34. FeelingThermometer -- 100 -- -- 95 -- -- 90 -- -- 85 -- -- 80 -- -- 75 -- -- 70 -- -- 65 -- -- 60 -- -- 55 -- -- 50 -- -- 45 -- -- 40 -- -- 35 -- -- 30 -- -- 25 -- -- 20 -- -- 15 -- -- 10 -- -- 5 -- -- 0 -- Most Desirable Perfect Health Health State #2 Health State #3 Health State #1 Dead Least Desirable

  35. Time Trade-Off for a Chronic Health State Preferred to Dead Value Alternative 2 HEALTHY 1.0 Alternative 1 STATE i hi 0.0 DEAD Time t x TTO Value Score for State i = x*/t (where x* is the indifference time) Source: Drummond, O’Brien, Stoddart, and Torrance (1997), p. 155.

  36. Standard Gamble for a Chronic Health State Preferred to Dead HEALTHY Probability p Alternative 1 DEAD Probability 1-p Alternative 2 STATE i Utility of State i = p* (indifference probability)

  37. Multi-Attribute or Indirect Approaches for Obtaining Utility Scores for Health States • Assess Health Status using Existing Multi-Attribute Health Status Classification System • Value Health Status using Existing Multi-Attribute Preference Function, typically based on Community Preferences • Selected Prominent Systems: Quality of Well Being Scale (QWB) EuroQol, EQ-5D Health Utilities Index (HUI) Short-Form 6D (SF-6D)

  38. Number of Attributes Mobility Physical Activity Social Activity Symptom/Problem Complex Number of Health States 4 3 Levels 3 Levels 5 Levels 27 Levels 1,215 QUALITY OF WELL-BEING - SA(Kaplan and Anderson 1996) Scoring Function: Based on VAS Scores; Linear Additive; Scores: 0.00 to1.00

  39. Number of Attributes Mobility Self-Care Usual Activities Pain/Discomfort Anxiety/Depression Number of Health States 5 3 Levels 3 Levels 3 Levels 3 Levels 3 Levels 243 EuroQol, EQ-5D(Essink-Bot et at., 1993; Dolan 1997; Shaw et al. 2005) Scoring Function: Based on TTO; Ad Hoc ModifiedLinear Additive; UK Scores: -0.59 to1.00; US Scores: -0.11 to 1.00

  40. Number of Attributes Physical Function Role Limitation Social Functioning Pain Mental Health Vitality Number of Health States 6 6 Levels 4 Levels 5 Levels 6 Levels 5 Levels 5 Levels 18,000 The Short Form 6D(Based on SF-36 and SF-12) (Brazier, Roberts, and Deverill 2002; Brazier and Roberts 2004) Scoring Function: Based on SG; Ad Hoc Modified Linear Additive; Scores: 0.00 = Dead; 0.30 = all-worst 6D state; 1.00 = perfect health. The version based on SF-12 describes 7,500 health states; see Brazier and Roberts 2004.

  41. HUI® Attributes • HUI2 1. Sensation (4 levels) 5. Self-Care (4 levels) 2. Mobility (5 levels) 6. Pain (5 levels) 3. Emotion (5 levels) 7. Fertility (3 levels) - optional 4. Cognition (4 levels) • Partial structural independence; 24,000 health states • -0.03 for all-worst HUI2 state; 0.00 for Dead; 1.00 for Perfect Health • Multiplicative multi-attribute utility function based on VAS and SG • HUI3 1. Vision (6 levels) 5. Dexterity (6 levels) 2. Hearing (6 levels) 6. Emotion (5 levels) 3. Speech (5 levels) 7. Cognition (6 levels) 4. Ambulation (6 levels) 8. Pain (5 levels) • Full structural independence; 972,000 health states • -0.36 for all-worst HUI3 state; 0.00 for Dead; 1.00 for Perfect Health • Multiplicative multi-attribute utility function based on VAS and SG Sources: Horsman et al. 2003; Furlong et al. 2001.

  42. Health Utilities Index Mark 3 System (HUI3) Attribute Level Level Description EMOTION 1 Happy and interested in life 2 Somewhat happy 3 Somewhat unhappy 4 Very unhappy 5 So unhappy that life is not worthwhile. Source: Feeny, Torrance, and Furlong (1996).

  43. Major Functional Forms for Multi-Attribute Utility Functions Let uj (xj) = the single attribute utility function for attribute j. Additive: u(x) = kj uj (xj) where  kj = 1 Multiplicative: u (x) = (1/k) [ (1 + k kj uj (xj)) -1] where (1 + k) =  (1 + k kj) Multilinear: u (x) = k1 u1 (x1) + k2 u2 (x2) + ... + k12 u1 (x1) u2 (x2) + k13 u1 (x1) u3 (x3) + ... K123 u1 (x1) u2 (x2) u3 (x3) + ... + ... where  All k’s = 1

  44. Major Approaches to the Estimation of Multi-Attribute Utility Functions • Statistical Inference/Regression Models EQ-5D, SF-6D • Decomposed Approach HUI1, HUI2, HUI3

  45. EQ-5D “Perfect Health” • I have no problems walking about • I have no problems with self care • I have no problems with performing my usual activities • I have no pain or discomfort • I am not anxious or depressed

  46. EQ-5D “All-Worst State” • I am confined to bed • I am unable to wash or dress myself • I am unable to perform my usual activities • I have extreme pain or discomfort • I am extremely anxious or depressed

  47. Thought Experiment Part A. Imagine that you go from perfect health in the EQ-5D system (1,1,1,1,1) to “I have some problems in walking about”, otherwise healthy (2,1,1,1,1) Please Think About the Decrement in Your Health-Related Quality of Life Part B. Imagine that you have the health state (1,2,2,2,2): no problems with mobility, but some problems with self-care, usual activities, pain, and anxiety/depression. What score do you attach to this health state? Now imagine that you go from (1,2,2,2,2) to the health state (2,2,2,2,2), some problems in all 5 dimensions. Please Think About the Decrement in Your Health-Related Quality of Life Part C. Please compare the decrement in Part A to the decrement in Part B

  48. EQ-5D Scoring Formula, UK TTO Version Source: Drummond, et al. (1997), p 164.

  49. EQ-5D Scoring Formula, US TTO Version Dimension Coefficient Mobility, level 2 -0.146 Mobility, level 3 -0.558 Self-care, level 2 -0.175 Self-care, level 3 -0.471 Usual Activity, level 2 -0.140 Usual Activity, level 3 -0.374 Pain/discomfort, level 2 -0.173 Pain/discomfort, level 3 -0.537 Anxiety/depression, level 2 -0.156 Anxiety/depression, level 3 -0.450 D1, # dimensions at level 2 or 3, beyond 1st 0.140 I2-squared -0.011 I3 0.122 I3-squared 0.015 Note: I2-squared = square of # of dimensions at level 2 beyond 1st; I3 = # of dimensions at level 3 beyond 1st. Source: Shaw et al. 2005, Appendix 2, p 220.