Many decisions in healthcare are made by considering the costs and health benefits of different options. An important issue for decision-making bodies, like the National Institute for Health and Care Excellence (NICE) and the Department of Health and Social Care, is to assess the health benefits of different devices, medicines, vaccines and procedures in a consistent way, even though they affect different types of patients and health conditions. Questionnaires asking about broad health aspects, such as EQ-5D, are commonly used as the basis of measures of health benefit. In the case of EQ-5D, the questionnaire asks patients about their health in five areas: mobility, ability to self-care, usual activities, pain and anxiety/depression.
EQ-5D works well in many situations. However, there is a concern that this type of measure, chosen for its simplicity and applicability to a wide range of disease areas, may miss some important health benefits that more detailed disease specific measures can capture. Decision-makers have limited tools available to assess whether these claims are true and, if they are, no way to judge how incorrect estimates of health benefit might be. This is obviously unsatisfactory because decisions are based on these assessments and overall patient care may suffer as a result. Therefore, there is a need for improved methods to identify when EQ-5D may not be fully appropriate and to consider alternative approaches that can be taken when shortcomings are identified.
We have already proposed some simple methods that can be used as a starting point to assess these claims. Based on these, the project will use three case studies to develop and refine more appropriate methods. The aim is to establish first if there are aspects of health, relevant to healthcare decisions, that are missing or not fully captured by EQ-5D. Our research will develop methods that provide this information and can be applied quickly and easily using existing data from clinical studies. The methods will identify which important aspects of health may be missing or only partially covered. Next, we will consider the consequences of ignoring the missing benefits and explore adjustments that can be made to incorporate them within the existing healthcare decision-making structure.