Canadian TTO Valuations of the EQ-5D-5L:

East versus West Differences

Jeffrey A. Johnson

(on behalf of the Canadian EQ-5D-5L

Valuation Study Team)

Acknowledgements

• Canadian EQ-5D-5L Valuation Study Team Principal Investigators:

Feng Xie (McMaster University) and Jeffrey Johnson (U of Alberta)

Co-Investigators:

Nick Bansback, Stirling Bryan (UBC),

Arto Ohinmaa (University of Alberta),

Lise Poissant (University of Montreal),

Eleanor Pullenayegum (McMaster/University of Toronto)

Research Coordinator: Gaebel K (McMaster University)

Research Assistants: Samantha Pollard & Lidia Engel (UBC); Serena Humphries & Fatima Al Sayah (U of Alberta), Touria Addou (University of Montreal).

• Funding support from CIHR and the EuroQol Research Foundation

EQ-5D

• Preference-based HRQL (“utility”) instrument

• 5-dimension classification system and VAS

• Can produce variety of health status/HRQL scores

(5D profile, EQ-VAS, EQ-index)

• Preference-based scoring system provides index

score suitable for QALYs

• Country-specific preference-based value sets

recommended for local resource allocation decisions

EQ-5D-3L

Mobility

Self-Care

Usual

Activities

Pain/ Discomfort

Anxiety

Depression

I have no problems washing or dressing myself I have some problems washing or dressing myself I am unable to wash or dress myself

I have no problems doing my usual activities I have some problems doing my usual activities I am unable to do my usual activities

I have no pain or discomfort I have moderate pain or discomfort I have extreme pain or discomfort

I am not anxious or depressed I am moderately anxious or depressed I am extremely anxious or depressed

I have no problems in walking about I have some problems in walking about I am confined to bed

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243 health states

EQ-5D-5L

I have no problems in walking about I have slight problems in walking about I have moderate problems in walking about I have severe problems in walking about I am unable to walk about

I have no problems washing or dressing myself I have slight problems washing or dressing myself I have moderate problems washing or dressing myself I have severe problems washing or dressing myself I am unable to wash or dress myself

I have no problems doing my usual activities I have slight problems doing my usual activities I have moderate problems doing my usual activities I have severe problems doing my usual activities I am unable to do my usual activities

I have no pain or discomfort I have slight pain or discomfort I have moderate pain or discomfort I have severe pain or discomfort I have extreme pain or discomfort

I am not anxious or depressed I am slightly anxious or depressed I am moderately anxious or depressed I am severely anxious or depressed I am extremely anxious or depressed

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3125 health states

EQ-5D Descriptive System

Canadian EQ-5D-5L

Valuation Study Objective was to derive a value set for Canada for the new

EQ-5D-5L, based on preferences from the general

population in Canada.

Med Care 2016; 54:98-105

EQ Valuation Technology

(EQ-VT)

• Standardized, computer-based interview protocol

• Composite time trade-off (cTTO)

– 86 health states into 10 blocks (10 states/block)

– one of 5 very mild states (21111, 12111, 11211, 11121, 11112) is included in each block

– 55555 is included in each block

• Discrete choice experiment (DCE)

– 28 blocks (7 pairs per block)

• Demographics and feedback

• Recommended sample size: ~1000/country

cTTO-better than dead

CAN EQ-5D-5L Valuation Study

Computer-assisted face-to-

face interviews

EQ-VT and supplemental

component

N= 300 in Vancouver

Edmonton, Hamilton, and

Montreal

Various recruitment strategies:

random digit-dialing,

community posters

Quota sampling in terms of

age, sex, education

“Inconsistent” TTO Valuations

Considered respondents with

inconsistent valuations

Based on Dominance:

e.g. 21111 vs 31111

Number of health states

dominated by the very mild

state varied from 5 to 8

The exclusion criteria:

a participant gave the same or lower score to the very mild health state than to 55555; and

if a participant gave the same or lower score to the very mild health state than to the majority of the health states that are dominated by the very mild health state within the same block

Data Analysis

• Dependent variable TTO values (n=10/respondent)

– tTTO and positive cTTO values

– WTD values transformed for 0 to -1 scale

TTOij = {MO + SC + UA + PD + AD} +

age + sex + SES* + marital status + comorbidities + urban/rural +

ethnicity + birth country + health literacy + EQ-VAS +

{Vancouver/Edmonton/Hamilton/Montreal (ref)}

+/- inconsistent valuations (Y/N)

* education, employment, household income

-0.25

-0.2

-0.15

-0.1

-0.05

0

0.05

0.1

Vancouver Edmonton Hamilton Montreal (ref)

Ave

rage

Dif

fere

nce

in T

TO V

alu

atio

n*

TTO Valuations

West versus East

* adjusted age, sex, SES*, marital status, comorbidities, urban/rural, ethnicity, birth country,

health literacy, EQ-VAS & inconsistent valuations

-0.156

-0.124

0.02

TTO Valuations

West versus East

EQ-5D-5L Health State

Vancouver (N=299)

Edmonton (N=310)

Hamilton (N=300)

Montreal (N=300)

p-value

11112 (N=241) 0.72 0.88 0.93 0.90 0.001

12344 (N=109) 0.19 0.25 0.45 0.48 0.042

53243 (N=123) 0.10 0.17 0.53 0.53 0.001

55555 (N=1209) -0.13 -0.07 0.06 0.17 <0.001

Sample Characteristics

West versus East

Characteristic Vancouver (N=299)

Edmonton (N=310)

Hamilton (N=300)

Montreal (N=300)

p-value

Age (yr) 49.7 (18.8) 48.3 (17.5) 46.3 (16.8) 46.2 (16.0) <0.001

Sex (Female) 49% 44% 51% 37% <0.001

Married/Common Law

42% 60% 58% 53% <0.001

Household Income (<$75K)

60% 44% 60% 75% <0.001

Education (HS+) 89% 96% 88% 88% <0.001

Ethnicity White Aboriginal

50% 9%

63% 7%

71% 9%

67% 5%

<0.001

Born in Canada 67% 80% 83% 70% <0.001

Urban Dwelling 89% 81% 81% 77% <0.001

EQ-VAS 80.5 (14.7) 81.6 (13.9) 81.8 (14.9) 85.2 (12.9) <0.001

Comorbidities (2+) 35% 36% 28% 24% <0.001

Inconsistent Valuations

11% 6.5% 13% 14% <0.001

Discussion

• Socio-demographic characteristics (age,

sex, urban dwelling) are important

determinants of TTO valuations;

• Respondents from western Canadian

cities provided substantially lower TTO

valuations than form eastern cities

• Should one Canadian preference/value

set be used for EQ-5D-5L ?

Discussion

• Same valuation methodology (EQ-VT)

• Differences in recruitment/samples by city…?

• Interviewer effect within study site…?

– N=1 for QC and ON; N=2 or 4 for BC or AB

• Differences in health care policy/delivery…?

• Differences in health preferences…?

If you have been…,

thanks for listening.