Health Services Research (HSR) Brussels: Belgian Health Care Knowledge Centre (KCE). 2021. KCE Repor, 01-07-2021

An EQ-5D-5L value set for Belgium – How to value health-related quality of life?

Bouckaert N, Gerkens S, Devriese S, Cleemput I


The objective of this study is to produce an EQ-5D-5L value set for Belgium, based on the preferences of the general public. The new EQ-5D-5L value set updates the currently used EQ-5D-3L value set from 2003 with 243 potential health states to a more extensive value set with 3 125 potential health states in addition to the state of unconsciousness. • The EQ-5D-5L value set developed in this study is based on a strong and valid method. o The study design followed the most recent valuation protocol developed by EuroQol. o Respondents were randomly selected using a multistage, stratified, cluster sampling with unequal probability design. The final sample of 892 respondents was representative for the Belgian population in terms of age, sex, region, health status, health-related quality of life, education and employment status. o In face‐to‐face, computer-assisted interviews, respondents completed 10 composite time trade‐off (cTTO) exercises and a discrete choice experiment (DCE) with 7 paired choice tasks. About 20% of the respondents also valued the state of unconsciousness by cTTO. o Data were collected over the period May 2018 to September 2020. One limitation of the study is that the desired target of 1 000 respondents was not reached. The COVID-19 crisis was one reason, but in general it proved very difficult to recruit respondents for face-to-face interviews at home. o Face validity of the data has been demonstrated, with more severe health states generally given lower values. Interviewer specific effects may impact the valuation of health states considered worse than dead. o A wide range of potential models were estimated and evaluated on logical consistency, goodness of fit, predictive accuracy and theoretical considerations. A parsimonious 8-parameter multiplicative hybrid model with random effects and correction for heteroscedasticity was selected to produce the value set for the 3 125 EQ-5D-5L health states. The utility of the unconscious state was not modelled but taken directly from survey results. • Problems in the dimensions pain/discomfort and anxiety/depression have the highest negative impact on health-related quality of life. • Compared to the existing EQ-5D-3L value set, the 5L value set has a higher fraction of health states valued worse than dead (15.0% in 5L and 6.6% in 3L) and covers a wider range of utility values (-0.532 to 0.939 in 5L and -0.158 to 0.817 in 3L, excluding state 11111). A wider range of utility values allows for a better discrimination between patients, both for mild and (very) severe health conditions. • The new EQ-5D-5L value set will support the use of the EQ-5D-5L instrument in research – e.g. clinical trials, population norms –, outcome measurement – e.g. PROMs –, and decision-making – e.g. cost-effectiveness analysis for pricing decisions in the public health insurance, quality management. Analyses performed with the current 3L and the new 5L value set are expected to produce different results. For example, QALY gains for a specific intervention in cost-effectiveness analysis can be larger or smaller.

Quality of Life, Quality-Adjusted Life Years, Survey, Cost-Benefit Analysis, Models, Statistical, Valuation, TTO, DCE EQ-5D-5L