EQ-5D-5L User Guide
Contents
1. EQ 5D 5L User Guide Basic information on how to use the EQ 5D 5L instrument Version 1 0 April 2011 Prepared by Rosalind Rabin Mandy Oemar Mark Oppe Bas Janssen Michael Herdman EuroQol Group Executive Office On behalf of the EuroQol Group EuroQol Group 2011 Table of contents T INTRODUCTION occitano 4 dd THE EBEUROQOL GROUP zer ea 4 12 ED 4 LEI QQ 4 1 22 A e einen 5 1 3 WHAT IS A HEALTH STATE soi rd ate prb 9 2 SCORING THE EQ 5D 5L DESCRIPTIVE SYSTEM 10 3 SCORING THE EQ VAS isnidixiixinna ni 11 4 CONVERTING EQ 5D 5L STATES TO AN INDEX VALUE 12 5 ORGANISING EQ 5D 5L DATA anne 14 6 PRESENTING EQ 5D 5L RESULTS eene 15 EL HEALTH PROFILES sua a 15 62 Ed VAS 17 6 3 EQ 5D 5L INDEX VALUE se 17 T BOSD PRODUCTS iiite a 19 71 EQ 5D 5L TRANSLATIONS AND OTHER FORMATS 19 2 2 OTHER EQ 5D PRODUCTS sis 19 7 2 1 EQ 5D 3L TRANSLATIONS AND FORMATS 19 7 2 2 EQ 5D Y TRANSLATIONS u a 19 7 3 TRANSLATION PROCESS sms ee 20 TA HOW TO OBTAIN EQ 5D ann ae 20 8 PAT as 21 9 ADDITIONAL INFORMATION ee 24 91 KEY EUROQOL GROUP REFERENCES ppp 24 9 2 REFERRING TO THE EQ 5D INSTRUMENT IN PUBLICATIONS 24 Ho EURBDBOUNS paa 24 1 Introduction This guide has been developed in order to give users basic information on how to use the EQ2. the box against the most appropriate statement in each of the 5 dimensions The EQ VAS records the respondent s self rated health on a vertical visual analogue scale where the endpoints are labelled Best imaginable health state and Worst imaginable health state This information can be used as a quantitative measure of health outcome as judged by the individual respondents The EQ 5D 3L has now been translated into more than 150 languages and is used worldwide However ceiling effects have been reported particularly when used in general population surveys but also in some patient population settings In order to address these criticisms and encouraged by demand from clinicians and other users the EuroQol Group decided to explore ways of improving the EQ 5D s measurement properties 1 2 2 EQ 5D 5L In 2005 a Task Force was established within the EuroQol Group to investigate methods to improve the instrument s sensitivity and to reduce ceiling effects After much discussion the Task Force decided that there should be no change in the number of dimensions for a new version of EQ 5D However previously published studies by EuroQol Group members showed that experimental 5 level versions of EQ 5D could significantly increase reliability and sensitivity discriminatory power while maintaining feasibility and potentially reducing ceiling effects The Group therefore decided that the new version of the EQ 5D should include five levels of s
3. Badia X Mayo NE 1999 Sample size calculations in studies using the EuroQol 5D Qual Life Res 8 6 539 49 5 Greiner W Weijnen T Nieuwenhuizen M et al 2003 A single European currency for EQ 5D health states Results from a six country study Eur J Health Econ 4 3 222 231 6 Shaw JW Johnson JA Coons SJ 2005 US valuation of the EQ 5D health states development and testing of the D1 valuation model Med Care 43 3 203 220 7 M Gudex C Lloyd A Janssen MF Kind P Parkin D Bonsel Badia X Development and preliminary testing of the new five level version of EQ 5D EQ 5D 5L Quality of Life Research accepted for publication 9 2 Referring to the EQ 5D instrument in publications When publishing results obtained with the EQ 5D the following references can be used 1 The EuroQol Group 1990 EuroQol a new facility for the measurement of health related quality of life Health Policy 16 3 199 208 2 Brooks R 1996 EuroQol the current state of play Health Policy 37 1 53 72 If you used a value set in your study you can also include a reference to the publication regarding that value set The appropriate references for the value sets can be found in the EQ 5D Value Sets Monograph and in the value set summary documents that can be ordered from the EuroQol Executive Office 9 3 EQ 5D Books The Measurement and valuation of health status using EQ 5D A European perspective Eds Brooks R Rabin R
4. If you want to know whether an EQ 5D 3L language version exists for your country please consult the website www euroqol org Likewise although the EQ 5D 3L was also primarily designed as a pen and paper self complete instrument it is now available in alternative formats and modes of administration and in multiple translations e g e Tablet and web based versions e versions IVR e Proxy versions e Versions for telephone and face to face interviews 7 2 2 EQ 5D Y Translations 19 The EQ 5D Y is an EQ 5D 3L self complete youth version for children adolescents aged 7 12 years At present this version is available in 9 different languages If you want to know if there is an EQ 5D Y version appropriate for your country please consult the website www euroqol org 7 3 Translation process All translation adaptations of EQ 5D are produced using a standardized translation protocol that conforms to internationally recognized guidelines These guidelines aim to ensure equivalence to the English source version and involve a forward backward translation process and cognitive debriefing Only the EuroQol Executive Office can give permission for a translation to be performed and translations can only be stamped as official if they are performed in cooperation with EuroQol Group reviewers 7 4 How to obtain EQ 5D All self report versions and alternative modes of administration and differ
5. all age groups reported higher EQ VAS scores than women Figure 3 Mean population EQ VAS scores by age group and sex 100 90 80 mem Men lt 3 mem Women 70 Total 60 50 H t 18 29 30 39 40 49 50 59 60 69 70 79 80 Age yrs 6 3 EQ 5D 5L index value EQ 5D 5L index values can be presented in much the same way as EQ VAS data i e using both a measure of central tendency and a measure of dispersion These can be mean values and standard deviations or standard errors or 95 confidence intervals or again if the data are skewed median values and the 25th and 75th percentiles Tables 5 and 6 and figures 4 and 5 show 2 examples of how to present EQ 5D 5L index value results Table 5 and figure 4 present the results from a study in which the effect of a treatment on health status is investigated Table 6 and figure 5 show results for a patient population and 3 subgroups Page 17 Table 5 EQ 5D 5L index values before and after treatment m Before treatment After treatment Mean Std error Median 25th 75th N Table 6 EQ 5D 5L index values for the total patient population and the 3 subgroups N All patients Subgroup 1 Subgroup 2 Subgroup 3 Mean 0 45 0 55 Std error 0 013 0 015 Median 0 40 0 55 25th 0 30 0 50 75th 0 50 0 60 N 100 75 Figure 4 EQ 5D 5L index values before and after treatment mean values and 95 confidence intervals 0
6. de Charro F Kluwer Acacemic Publishers 2005 This book reports on the results of the European Union funded EQ net project which furthered the development of EQ 5D in the key areas of valuation application and translation The book can be obtained from Springer at www springeronline com at a cost of 107 95 EQ 5D concepts and methods a developmental history Eds Kind P Brooks R Rabin R Springer 2005 This book is a collection of papers representing the collective intellectual enterprise of the EuroQol Group and can be obtained from Springer at www springeronline com at a cost of 85 00 Page 24 EQ 5D value sets Inventory comparative review and user guide Eds Szende A Oppe M Devlin N EuroQol Group Monographs Volume 2 Springer 2006 This book provides an essential guide to the use of the EuroQol Group s value sets for anyone working with EQ 5D data and can be obtained from Springer at www springeronline com at a cost of 49 95 Page 25 A Ti TT T UN AS D SIN NING N NN
7. 5D 5L version Topics include administering the instrument setting up a database for data collected using EQ 5D 5L as well as information about how to present the results Also included are several frequently asked questions dealing with common issues regarding the use of EQ 5D 5L and a list of currently available EuroQol Group products 1 1 The EuroQol Group e The EuroQol Group is a network of international multidisciplinary researchers devoted to the measurement of health status Established in 1987 the EuroQol Group originally consisted of researchers from Europe but nowadays includes members from North America Asia Africa Australia and New Zealand The Group is responsible for the development of EQ 5D a preference based measure of health status that is now widely used in clinical trials observational studies and other health Surveys e EuroQol Group has been holding annual scientific meetings since its inception in 1987 e The EuroQol Group can be justifiably proud of its collective scientific achievements over the last 20 years Research areas include valuation EQ 5D use in clinical studies and in population surveys experimentation with the EQ 5D descriptive system computerized applications interpretation of EQ 5D ratings and the role of EQ 5D in measuring social inequalities in self reported health e EuroQol Group s website www eurogol org contains detailed information about EQ 5D guidance for users a list o
8. 9 0 8 0 7 0 6 0 5 Before After treatment treatment Utility 0 4 0 3 0 2 0 1 Figure 5 Mean EQ 5D 5L index values and 95 confidence intervals for the total patient population and 3 subgroups 1 0 9 1 0 8 0 7 0 6 0 5 0 4 4 j t 0 3 0 2 0 1 m All patients Subgroup 1 Subgroup2 Subgroup 3 Utility Page 18 7 EQ 5D Products 7 1 EQ 5D 5L Translations and other formats EQ 5D 5L The EQ 5D 5L self complete paper version is currently available in more than 50 different language versions If you want to know whether an EQ 5D 5L version exists for your country please consult the website www eurogqol org Likewise although the EQ 5D 5L was primarily designed as a pen and paper self complete instrument it will increasingly become available in alternative formats and modes of administration These include e Tablet and web based versions e PDA versions e IVR Proxy versions e Versions for telephone and face to face interviews If you are interested in using one of these alternative formats or modes of administration please contact the EuroQol Executive Office 7 2 Other EQ 5D Products 7 2 1 EQ 5D 3L EQ 5D 3L Translations and formats The EQ 5D 3L EQ 5D 3 level self complete paper version is currently translated in more than 150 language versions
9. about SELF CARE have no problems washing or dressing myself have slight problems washing or dressing myself have moderate problems washing or dressing myself have severe problems washing or dressing myself Ooooo am unable to wash or dress myself USUAL ACTIVITIES e g work study housework family or leisure activities have no problems doing my usual activities have slight problems doing my usual activities have moderate problems doing my usual activities have severe problems doing my usual activities Ooooo am unable to do my usual activities PAIN DISCOMFORT have no pain or discomfort have slight pain or discomfort have moderate pain or discomfort have severe pain or discomfort Oooodo have extreme pain or discomfort ANXIETY DEPRESSION l am not anxious or depressed am slightly anxious or depressed am moderately anxious or depressed am severely anxious or depressed DODOO O l am extremely anxious or depressed Page 7 We would like to know how good or bad your health is TODAY e This scale is numbered from 0 to 100 100 means the best health you can imagine 0 means the worst health you can imagine Mark an the scale to indicate how your health is TODAY Now please write the number you marked on the scale in the box below YOUR HEALTH TODAY Page 8 The best health you can imagine 100 The worst health yo
10. ent languages must be obtained exclusively from the EuroQol Executive Office IVR web tablet and PDA versions are exclusively provided via the EuroQol Group s preferred vendors Normally only the language s appropriate to the country where the research request originates will be supplied Licensing fees are determined by the EuroQol Executive Office on the basis of information provided by the user Whether a fee is appropriate depends upon the type of study size and or number of patients respondents and requested languages Page 20 8 FAQ s 1 For what period of time does EQ 5D 5L record health status Self reported health status captured by EQ 5D 5L relates to the respondent s situation at the time of completion No attempt is made to summarise recalled health status over the preceding days or weeks although EQ 5D 3L has been tested in recall mode An early decision taken by the EuroQol Group determined that health status measurement ought to apply to the respondent s immediate situation hence the focus on your health today 2 Can luse only the EQ 5D 5L descriptive system or only the EQ VAS We cannot advise this EQ 5D 5L is a 2 part instrument so if you only use one part you cannot claim to have used EQ 5D 5L in your publications 3 How long should the EQ VAS be Officially for paper versions the EQ VAS scale should be 20 cm All methodological and developmental work has been carried out using this length To ensu
11. er all health states data is probably more appropriate The decision about which value set to use will also depend on whether the relevant decision making body in each country specifies any requirements or preferences in regard to the methodology used in different contexts e g TTO standard gamble SG VAS or discrete choice modelling DCM These guidelines are the topic of an on going international debate but the Page 23 EuroQol Group website is planning to provide a summary of health care decision making bodies internationally together with their stated requirements regarding the valuation of health states Detailed information on valuation protocols together with guidelines on which value set to use and tables of all available value sets has recently been published by Springer in EuroQol Group Monograph series Volume 2 EQ 5D value sets inventory comparative review and user guide see section 8 for more information Chapter 4 by Nancy Devlin and David Parkin will be of special interest to researchers pondering the issue of which value set to use 9 Additional information 9 1 Key EuroQol Group references 1 The EuroQol Group 1990 EuroQol a new facility for the measurement of health related quality of life Health Policy 16 3 199 208 2 Brooks R 1996 EuroQol the current state of play Health Policy 37 1 53 72 3 Dolan P 1997 Modeling valuations for EuroQol health states Med Care 35 11 1095 108 4 Roset M
12. everity in each of the existing five EQ 5D dimensions and that it would be called the EQ 5D 5L Figure 1 The existing EQ 5D will be renamed the EQ 5D 3L The EQ 5D 5L still consists of 2 pages the EQ 5D 5L descriptive system page 2 and the EQ visual Analogue scale EQ VAS page 3 The descriptive system comprises the same 5 dimensions as the EQ 5D 5D 3L mobility self care usual activities pain discomfort anxiety depression However each dimension now has 5 levels no problems slight problems moderate problems severe problems and extreme problems The respondent is asked to indicate his her health state by ticking or placing a cross in the box against the most appropriate statement in each of the 5 dimensions This decision results in a 1 digit number expressing the level selected for that dimension The digits for 5 dimensions can be combined in a 5 digit number describing the respondent s health state It should be noted that the numerals 1 5 have no arithmetic properties and should not be used as a cardinal score During the development of the EQ 5D 5L the opportunity was also taken to improve some of the wording in the dimensions to enhance consistency and facilitate understanding For example the old wording of confined to bed to indicate the upper extreme in the EQ 5D 3L has been replaced with I am unable to walk about which is more consistent with the wording within the Mobility dimension and with the extreme levels o
13. f available language versions EQ 5D references and contact details 1 2 EQ 5D EQ 5D is a standardised measure of health status developed by the EuroQol Group in order to provide a simple generic measure of health for clinical and economic appraisal Applicable to a wide range of health conditions and treatments it provides a simple descriptive profile and a single index value for health status that can be used in the clinical and economic evaluation of health care as well as in population health surveys EQ 5D is designed for self completion by respondents and is ideally suited for use in postal surveys in clinics and in face to face interviews It is cognitively undemanding taking only a few minutes to complete Instructions to respondents are included in the questionnaire 1 2 4 EQ 5D 3L The EQ 5D 3 level version EQ 5D 3L was introduced in 1990 The EQ 5D 3L essentially consists of 2 pages the EQ 5D descriptive system page 2 and the EQ visual analogue scale EQ VAS page 3 The EQ 5D 3L descriptive system comprises the following 5 dimensions mobility self care usual activities pain discomfort and anxiety depression Each dimension has 3 levels no problems some problems extreme problems The respondent is asked to indicate his her health state by ticking or placing a cross in 1 EuroQol Group EuroQol a new facility for the measurement of health related quality of life Health Policy 1990 16 199 208 Page 4
14. ge 10 3 Scoring the EQ VAS The EQ VAS should be scored for example as follows The best health you can imagine 100 We would like to know how good or bad your health is 95 TODAY 90 This scale is numbered from 0 to 100 85 100 means the best health you can imagine 0 means the worst health you can imagine 80 Mark an X on the scale to indicate how your health is TODAY 75 Now please write the number you marked on the scale in the 70 box below For example this 60 response should be coded as 77 YOUR HEALTH TODAY 50 45 40 35 30 25 The worst health you can imagine NB Missing values should be coded 999 NB If there is a discrepancy between where the respondent has placed the X and the number he she has written in the box administrators should use the number in the box Page 11 4 Converting EQ 5D 5L states to an index value EQ 5D 5L health states defined by the EQ 5D 5L descriptive system may be converted into a single index value The index values presented in country specific value sets are a major feature of the EQ 5D instrument facilitating the calculation of quality adjusted life years QALYs that are used to inform economic evaluations of health care interventions Pilot studies that directly elicit preferences from general populations in order to derive index based values for the EQ 5D 5L are currently underway in a numbe
15. ive system as a health profile 2 Presenting results of the EQ VAS as a measure of overall self rated health status 3 Presenting results from the EQ 5D 5L index value The way results can be presented is determined both by the data and by what message you as a researcher wish to convey to your audience 6 1 Health profiles One way of presenting data as a health profile is by making a table with the frequency or the proportion of reported problems for each level for each dimension These tables can be broken down to include the proportions per subgroup such as age before vs after treatment treatment vs comparator etc Sometimes it is more convenient to dichotomise the EQ 5D 5L levels into no problems i e level 1 and problems i e levels 2 to 5 therefore changing the profile into frequencies of reported problems This can be the case for example in a general population survey where the numbers of reported problems are low Tables 2 and 3 are examples of how to present EQ 5D 5L data in tabulated form Table 2 Percentage of a general population sample reporting levels 1 to 5 by dimension and by age group AGE GROUPS EQ 5D DIMENSION 18 29 30 39 40 49 50 59 60 69 TOTAL Level 1 95 2 90 7 87 296 67 8 78 999 47 1 86 0 Level 2 4496 8 196 10 196 18 6 14 196 41 2 10 2 MOBILITY Level 3 0 4 0 6 2 1 10 2 4 2 5 9 2 7 Level 4 0 0 0 6 0 5 3 4 2 8 5 9 1 1 Level 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Le
16. lking about Q m Level 1 is I am unable to walk about Q a coded as SELF CARE I have no problems washing or dressing myself Q a I have slight problems washing or dressing myself Y a Level 2 is I have moderate problems washing or dressing myself Q coded as I have severe problems washing or dressing myself a m 2 I am unable to wash or dress myself a a USUAL ACTIVITIES e g work study housework family or leisure activities I have no problems doing my usual activities a Level 3 is I have slight problems doing my usual activities a 4 coded as I have moderate problems doing my usual activities Y a a 3 I have severe problems doing my usual activities a Y I am unable to do my usual activities Q PAIN DISCOMFORT I have no pain or discomfort Q I have slight pain or discomfort a Level 4 is I have moderate pain or discomfort Q a coded as I have severe pain or discomfort Y aid I have extreme pain or discomfort a ANXIETY DEPRESSION d I am not anxious or depressed a I am slightly anxious or depressed Q I am moderately anxious or depressed a I am severely anxious or depressed a Level 5 is Iam extremely anxious or depressed Y coded as Q a 5 a Y This example identifies the health state 12345 NB There should be only ONE response for each dimension NB Missing values can be coded as 9 NB Ambiguous values e g 2 boxes are ticked for a single dimension should be treated as missing values Pa
17. n other dimensions The EQ VAS records the respondent s self rated health on a 20 cm vertical visual analogue scale with endpoints labelled the best health you can imagine and the worst health you can imagine This information can be used as a quantitative measure of health as judged by the individual respondents The instructions for the EQ VAS task have been changed and simplified in the EQ 5D 5L The EuroQol Group had received feedback over the years that respondents sometimes found it difficult to draw a line from the box to the Herdman M Gudex C Lloyd A Janssen MF Kind P Parkin D Bonsel G Badia X Development and preliminary testing of the new five level version of EQ 5D EQ 5D 5L Quality of Life Research accepted for publication Page 5 scale lt was also cumbersome for administrators to record their scores The EQ 5D 5L now asks respondents to simply mark an X on the scale to indicate how your health is TODAY and then to write the number you marked on the scale in the box below This should make the task easier for both respondents and users Page 6 Figure 1 EQ 5D 5L UK English sample version Under each heading please tick the ONE box that best describes your health TODAY MOBILITY have no problems in walking about have slight problems in walking about have moderate problems in walking about have severe problems in walking about am unable to walk
18. ocietal perspective For anyone working with EQ 5D 3L data an essential guide to the Group s available value sets can be found in EuroQol Group Monograph series Volume 2 EQ 5D value sets inventory comparative review and user guide recently published by Springer see section 8 for more information EQ 5D 5L value sets are available for each country that performed a valuation study for the EQ 5D 3L table 1 By using the crosswalk link function and the individual responses to the EQ 5D 5L descriptive system index values for the EQ 5D 5L can be calculated Many different terms are in use for these index values such as preference weights preference based values utilities QALY weights etc Here we use the term index value Page 12 Table 1 List of available value sets references available on the website Country N Valuation method Belgium 722 EQ 5D VAS Denmark 1686 EQ 5D VAS Denmark 1332 TTO Europe 8709 EQ 5D VAS Finland 1634 EQ 5D VAS France 443 VAS TTO Germany 339 EQ 5D VAS Germany 339 TTO Japan 621 TTO Netherlands 309 TTO New Zealand 1360 EQ 5D VAS Slovenia 733 EQ 5D VAS Spain 300 EQ 5D VAS Spain 1000 TTO Thailand 1324 TTO UK 3395 EQ 5D VAS UK 3395 TTO US 4048 TTO Zimbabwe 2440 TTO In development Canada Chile Italy and Singapore Documents containing information on the crosswalk project tables of values for all 3125 health states and syntax files for calculating the crosswalk index val
19. r of countries Argentina Canada China England the Netherlands Singapore Spain US However it will take 2 3 years to complete and publish definitive valuation studies and for results to be available to EQ 5D 5L users Until then a crosswalk between the EQ 5D 3L index values and the new EQ 5D 5L descriptive system has been undertaken resulting in crosswalk value sets for the new EQ 5D 5L descriptive system The EQ 5D 5L Crosswalk Project coordinated by the EuroQol Group was conducted on 3691 patients across six countries The crosswalk establishes a link or bridge between the EQ 5D 3L and EQ 5D 5L descriptive systems This link is based on responses of patients who completed both the EQ 5D 3L and EQ 5D 5L instruments Several methods were consequently tested to optimize the link function between the two descriptive systems The crosswalk link function resulting from this exercise can be used to calculate index values for EQ 5D 5L based on the existing value sets for the EQ 5D 3L Value sets have been derived for EQ 5D 3L in several countries using the EQ 5D visual analogue scale EQ 5D VAS valuation technique or the time trade off TTO valuation technique The list of currently available value sets with the number of respondents and valuation technique applied is presented in table 1 Most of the EQ 5D 3L value sets have been obtained using a representative sample of the general population thereby ensuring that they represent the s
20. re that you print the correct length make sure your paper size is set at A4 and the box in your printing instructions labelled scale to paper size is set at no scaling 4 Can publish our study using EQ 5D Yes you are free to publish your results If you are reproducing the EQ 5D 5L in an appendix we request that you use the sample version of EQ 5D 5L and that the following text plus the date the version was translated is included in the footer O 1990 Group EQ 5D is a trade mark of the EuroQol Group 5 Whatis the difference between the EQ 5D 5L descriptive system and the EQ VAS Page 21 The descriptive system can be represented as a health state e g health state 21143 represents a patient who indicates slight problems on the mobility dimension no problems on the self care and usual activities dimensions severe pain or discomfort and moderate problems on the anxiety depression dimension These health states can be converted to a single index value using the crosswalk link function based on the existing value sets for the EQ 5D 3L described in Section 4 above These EQ 5D 3L value sets are based on VAS or TTO valuation techniques and reflect the opinion of the general population The EQ VAS scores are patient based and are therefore not representative of the general population The EQ VAS self rating records the respondent s own assessment of their health status The EQ VAS scores however are anchored on 100
21. re underestimate their need for healthcare EQ 5D 5L value sets are therefore based on general population values 8 Multinational clinical trials Page 22 Information relating to EQ 5D 5L health states gathered in the context of multinational trials may be converted into a single index value using the crosswalk link function based on the available EQ 5D 3L value sets as described in Section 4 above There are different options available to do this using appropriate value sets however the choice depends on the context in which the information will be used by researchers or decision makers In cases where data from an international trial are to be used to inform decision makers in a specific country it seems reasonable to expect decision makers to be interested primarily in value sets that reflect the values for health states in that country So for example if applications for reimbursement of a drug are rolled out from country to country country specific value sets should be applied and reported in each pharmaco economic report This is no different from the requirement to use country specific costs In the absence of a country specific value set the researcher should select another set of values for a population that most closely approximates that country Sometimes however information about index values utilities is required to inform researchers or decision makers in an international context In these instances one value set applied ov
22. sentations Two or three dimensional bar charts can be used to summarise the results in a single graph see Figure 2 Figure 2 shows the sum of the proportion of reported levels 2 to 5 for each of the 5 EQ 5D 5L dimensions for 3 different age groups Older people reported more problems on all dimensions but the effect of age was strongest for mobility and weakest for anxiety depression Figure 2 Profile of the population reporting problem 70 Y eo 50 7 40 T 18 39 yrs 840 59 yrs m 60 yrs 30 4 Proportion reporting problem Mobility Self care Usual act Pain Disc Anx Depr Page 16 6 2 EQ VAS In order to present all aspects of the EQ VAS data you should present both a measure of the central tendency and a measure of dispersion This could be the mean values and the standard deviations or if the data are skewed the median values and the 25th and 75th percentiles An example is presented in table 4 Table 4 EQ VAS values by age mean standard deviation and median percentiles AGE GROUPS EQ VAS 18 29 30 39 40 49 50 59 60 69 70 TOTAL Mean Std Dev Median 25th 75th You can present a graphical representation of the data by using bar charts line charts or both see figure 3 Figure 3 shows the mean EQ VAS scores reported by men women and both for 7 different age groups Mean EQ VAS scores are seen to decrease with increasing age Also men in
23. the best health you can imagine and O the worst health you can imagine whereas the value sets are anchored on 11111 1 and dead 0 and can therefore be used in QALY calculations 6 What is the difference between the VAS and TTO techniques The difference between the TTO and VAS based value sets is that the techniques used to elicit the values on which the models are based differ In the TTO task respondents are asked to imagine that they will live in a certain health state e g 33333 for 10 years and have to specify the amount of time they would be willing to give up to live in full health instead i e 11111 For example someone might find 8 years in 11111 equivalent to 10 years in 33333 The VAS technique on the other hand asks people to indicate where on a vertical thermometer like scale ranging from best imaginable health to worst imaginable health they think a health state should be positioned 7 General population value sets vs patient population value sets If you want to undertake a utility analysis you will need to use a value set Generally speaking utility analysis requires a general population based value set as opposed to a patient based set The rationale behind this is that the values should reflect the preferences of local taxpayers and potential receivers of healthcare Additionally patients tend to rate their health states higher than the general population because of coping or other factors and may therefo
24. u can imagine 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 1 3 What is a health state Each of the 5 dimensions comprising the EQ 5D descriptive system is divided into 5 levels of perceived problems Level 1 indicating no problem Level 2 indicating slight problems Level 3 indicating moderate problems Level 4 indicating severe problems Level 5 indicating extreme problems A unique health state is defined by combining 1 level from each of the 5 dimensions Anxiety Depression Pain Discomfort Usual Activities A total of 3125 possible health states is defined in this way Each state is referred to in terms of a 5 digit code For example state 11111 indicates no problems on any of the 5 dimensions while state 12345 indicates no problems with mobility slight problems with washing or dressing moderate problems with doing usual activities severe pain or discomfort and extreme anxiety or depression 9 2 Scoring the EQ 5D 5L descriptive system The EQ 5D 5L descriptive system should be scored for example as follows Levels of perceived problems are coded as Under each heading please tick the ONE box that best describes your health TODAY follows MOBILITY Y I have no problems in walking about Y I have slight problems in walking about Q a I have moderate problems in walking about a I have severe problems in wa
25. ues can be ordered from the EuroQol Executive Office Page 13 5 Organising EQ 5D 5L data Data collected using EQ 5D 5L can be entered in a database according to the following schema Variable name ID Variable patient description ID MOBILITY 1 No problems 2 Slight problems COUNTRY Country where data 1 Male 2 Female Year in which data 1 Low 2 Medium 999 Missing value number value 1001 9 Missing 3 High 9 Missing value was collected was collected 3 Moderate problems 4 Severe problems 5 Unable to 9 Missing value Data row 1 Data row 2 Variable name Variable description 1002 SELFCARE 1 No problems 2 Slight problems 3 Moderate problems 4 Severe problems 5 Unable to 9 Missing value ACTIVITY 1 No problems 2 Slight problems 3 Moderate problems 4 Severe problems 5 Unable to 9 Missing value 1 No pain 2 Slight pain 3 Moderate pain 4 Severe pain 5 Extreme pain 9 Missing value ANXIETY 1 Not anxious 2 Slightly anxious 3 Moderately anxious 4 Severely anxious 5 Extremely anxious 9 Missing value 5 digit code for EQ 5D 5L 999 Missing value Data row 1 Data row 2 Page 14 6 Presenting EQ 5D 5L results Data collected using EQ 5D 5L can be presented in various ways A basic subdivision can be made according to the structure of the EQ 5D 5L 1 Presenting results from the EQ 5D 5L descript
26. vel 1 98 0 96 9 97 3 91 5 91 5 88 2 95 9 Level 2 0 4 1 9 2 7 6 8 8 5 5 9 3 0 SELF CARE Level 3 0 8 1 2 0 0 0 8 0 0 5 9 0 7 Level 4 0 4 0 0 0 0 0 0 0 0 0 0 0 1 Level 5 0 4 0 0 0 0 0 8 0 0 0 0 0 2 Level 1 66 5 64 6 54 3 37 3 50 7 41 2 57 1 A Level 2 30 7 29 896 36 796 415 394 41 2 34 5 ACTIVITY Level 3 1 6 5 0 8 5 14 4 7 0 17 6 6 6 Level 4 0 8 0 6 0 5 6 8 2 8 0 0 1 7 Level 5 0 4 0 0 0 0 0 0 0 0 0 0 0 1 Page 15 AGE GROUPS EQ 5D DIMENSION 40 49 50 59 60 69 TOTAL Level 1 79 3 75 2 75 0 78 0 78 9 Level 2 16 3 19 3 19 7 17 8 15 5 PAIN DISCOMFORT Level 3 2 8 4 3 4 3 2 5 5 6 Level 4 1 2 1 2 1 196 1 796 0 096 Level 5 0 496 0 096 0 096 0 096 0 096 Level 1 92 496 85 196 83 596 65 396 84 596 Level 2 6 896 9 396 11 796 19 596 9 996 ANXIETY DEPRESSION Level 3 0 096 4 396 3 296 1 1 996 4 296 Level 4 0 496 1 296 1 6 3 4 1 4 Level 5 0 4 0 0 0 0 0 0 0 0 Table 3 Frequency of reported problems for a general population sample by dimension and age group AGE GROUPS EQ 5D DIMENSION 18 29 30 39 40 49 50 59 60 69 70 79 TOTAL MOBILITY No problems Problems SELF CARE No problems Problems No problems USUAL ACTIVITY Problems No problems PAIN DISCOMFORT Problems ANXIETY No problems DEPRESSION Problems In addition to presenting the results in tabulated form you can also use graphical pre
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