Generating consistent health state utilities and QALYs across the life-course from cradle to grave
Theme 2: Measuring and Valuing Outcomes
Economic evaluation of health and social care interventions can require QALYs for a lifetime (quality adjusted life years) that require the generation of utility values from very young ages to old ages. However none of the available preference-weighted measures that can be used to generate QALYs are recommended for use from infants through to the elderly. Different measures of health are typically required for infants (e.g. EQ-TIPS), children and adolescents (e.g. EQ-5D-Y, CHU9D) and adults (typically EQ-5D-5L in the UK context) which will become especially important for conditions including those starting in infancy/childhood, gene therapies and vaccines. This means that both the measures change across the age of the patient, with some changes in dimensions and severity levels, but also the health state utility values that are generated by different measures change. In the UK there are new EQ-5D-5L and EQ-5D-Y value sets in progress that are expected to be based on different valuation protocols generating value sets both from different methodologies (e.g. different populations, different elicitation tasks, different people imagined living in the health state).
Aims
The project aim is to develop a better understanding of the problem and potential solutions to generate consistent health state utility values and hence QALYs across the life course to inform the economic evaluation of health and social care interventions.
The project objectives are:
1) To better understand the importance, characteristics and implications of the issue that leads to utility and QALY changes when switching between measures across the life course (e.g. EQ-5D-Y to EQ-5D-5L, EQ-TIPS to EQ-5D-Y);
2) To examine a range of potential solutions and their associated pros and cons;
3) To undertake detailed scoping of at least two feasible and appropriate solutions to the issue, with the potential to develop research proposals to provide an acceptable solution.
Project Team
Donna Rowen, Anju Keetharuth, Tess Peasgood
Contact
Donna Rowen d.rowen@sheffield.ac.uk
Plain English Summary
Challenges in capturing the value of health benefits consistently across the lifecourse
Background:
When evaluating healthcare treatments and procedures, we often use a measure called "quality-adjusted life years" (QALYs) to determine the effectiveness of the treatment or procedure. QALYs combine the length of life with the quality of life, and they are calculated using utility values that reflect how people feel about different health states. Utility values are used to reflect the quality of life in a health state and can be used to make comparisons of the impact of ill-health and treatments across different conditions. A utility value is higher for health states that people feel are better, lower for health states that people feel are worse, and the size of the difference in values reflects how much better or worse. However, there are challenges in generating consistent utility values for people of all ages, especially children, including:
Different measures for different ages: We use different tools to measure health in infants, children and adolescents, and adults. This means that the values we get for the same health state can vary depending on the age of the person.
Changing preferences: Preferences for different health states can be affected by the age of the person in ill health. This can affect the utility values we calculate.
Valuation methods: The way we ask people to value health states can also influence the results. Different instruments use different methods, which may lead to different utility values.
These challenges can make it difficult to compare the cost-effectiveness of treatments and procedures that affect people of different ages. For example, a treatment that improves the health of a child might look less cost-effective than a treatment that improves the health of an adult, even if the benefits are similar.
Aims and objectives:
We are working to better understand these challenges and develop consistent methods for valuing health across the lifespan. This will help us make better decisions about how to allocate healthcare resources.
Methods:
We have 4 stages to the project:
Review existing research: We will examine studies that have looked at how utility values change when people move from one health measurement tool to another, even if their health remains the same.
Explore potential solutions: We will consider a variety of possible solutions.
Gather expert opinions: We will conduct workshops with experts in health state valuation, economic evaluation, and policy-makers and public and patient representatives to discuss the challenges and potential solutions.
Develop research proposals: Based on the findings from the previous steps, we will select the most promising solutions and develop research proposals to understand how to implement them.
Policy relevance and dissemination:
This project is crucial because there are many new treatments and vaccines being developed that will benefit children and adolescents. To evaluate these treatments effectively, we need reliable methods for assessing the benefits of these new treatments. New health measurement tools for different age groups are being developed and will soon be available. This project will help us understand how to use these tools effectively and consistently.
We will write a scientific paper summarising our findings and conclusions. This will be published in a peer-reviewed journal, ensuring that other experts can review and verify our work.
We will share our results with policy makers, including those at the Department of Health and Social Care (DHSC) and the National Institute for Health and Care Excellence (NICE). These organisations play a crucial role in making decisions about healthcare funding and priorities.