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Osteoporosis International

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01-07-2012 | Original Article

SF-6D and EQ-5D result in widely divergent incremental cost-effectiveness ratios in a clinical trial of older women: implications for health policy decisions

Authors: J. C. Davis, T. Liu-Ambrose, K. M. Khan, M. C. Robertson, C. A. Marra

Published in: Osteoporosis International | Issue 7/2012

Abstract

Summary

Using two instruments (SF-6D and EQ-5D) to estimate quality adjusted life years (QALYs), we conducted an economic evaluation of a 12-month randomized controlled trial with a 12-month follow-up study in older women to evaluate the value for money of two doses of resistance training compared with balance and tone classes. We found that the incremental QALYs estimated from the SF-6D were two- to threefold greater than those estimated from the EQ-5D.

Introduction

Decision makers must continually choose between existing and new interventions. Hence, economic evaluations are increasingly prevalent. The impact of quality-adjusted life year (QALY) estimates using different instruments on the incremental cost-effectiveness ratios (ICERs) is not well understood in older adults. Thus, we compared ICERs, in older women, estimated by the EuroQol-5D (EQ-5D) and the Short Form-6D (SF-6D) to discuss implications on decision making.

Methods

Using both the EQ-5D and the SF-6D, we compared the incremental cost per QALY gained in a randomized controlled trial of resistance training in 155 community-dwelling women aged 65 to 75 years. The 12-month randomized controlled trial included a subsequent 12-month follow-up. Our focus, the follow-up study, included 123 of the 155 participants from the Brain Power study; 98 took part in the economic evaluation (twice-weekly balance and tone exercises, n = 28; once-weekly resistance training, n = 35; twice-weekly resistance training, n = 35). Our primary outcome measure was the incremental cost per QALY gained of once- or twice-weekly resistance training compared with balance and tone exercises.

Results

At cessation of the follow-up study, the incremental QALY was −0.051 (EQ-5D) and −0.144 (SF-6D) for the once-weekly resistance training group and −0.081 (EQ-5D) and −0.127 (SF-6D) for the twice-weekly resistance training group compared with balance and tone classes.

Conclusion

The incremental QALYs estimated from the SF-6D were two- to threefold greater than those estimated from the EQ-5D. Given the large magnitude of difference, the choice of preference-based utility instrument may substantially impact health care decisions.

Claxton K, Sculpher M, Drummond M (2002) A rational framework for decision making by the National Institute For Clinical Excellence (NICE). Lancet 360:711–715PubMedCrossRef

Fenwick E, Marshall DA, Blackhouse G, Vidaillet H, Slee A, Shemanski L, Levy AR (2008) Assessing the impact of censoring of costs and effects on health-care decision-making: an example using the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Value Health 11:365–375PubMedCrossRef

Neumann PJ, Greenberg D, Olchanski NV, Stone PW, Rosen AB (2005) Growth and quality of the cost-utility literature, 1976–2001. Value Health 8:3–9PubMedCrossRef

Siegel JE, Weinstein MC, Russell LB, Gold MR (1996) Recommendations for reporting cost-effectiveness analyses. Panel on Cost-Effectiveness in Health and Medicine. JAMA 276:1339–1341PubMedCrossRef

Brazier J, Roberts J, Tsuchiya A, Busschbach J (2004) A comparison of the EQ-5D and SF-6D across seven patient groups. Health Econ 13:873–884PubMedCrossRef

Tsuchiya A, Brazier J, Roberts J (2006) Comparison of valuation methods used to generate the EQ-5D and the SF-6D value sets. J Health Econ 25:334–346PubMedCrossRef

Neumann PJ, Goldie SJ, Weinstein MC (2000) Preference-based measures in economic evaluation in health care. Annu Rev Public Health 21:587–611PubMedCrossRef

McDonough CM, Tosteson AN (2007) Measuring preferences for cost-utility analysis: how choice of method may influence decision-making. Pharmacoeconomics 25:93–106PubMedCrossRef

Sach TH, Barton GR, Jenkinson C, Doherty M, Avery AJ, Muir KR (2009) Comparing cost-utility estimates: does the choice of EQ-5D or SF-6D matter? Med Care 47:889–894PubMedCrossRef

10.

Brooks R (1996) EuroQol: the current state of play. Health Policy 37:53–72PubMedCrossRef

11.

Dolan P, Roberts J (2002) Modelling valuations for Eq-5d health states: an alternative model using differences in valuations. Med Care 40:442–446PubMedCrossRef

12.

Brazier J, Roberts J, Deverill M (2002) The estimation of a preference-based measure of health from the SF-36. J Health Econ 21:271–292PubMedCrossRef

13.

Brazier J, Usherwood T, Harper R, Thomas K (1998) Deriving a preference-based single index from the UK SF-36 Health Survey. J Clin Epidemiol 51:1115–1128PubMedCrossRef

14.

Joore M, Brunenberg D, Nelemans P, Wouters E, Kuijpers P, Honig A, Willems D, de Leeuw P, Severens J, Boonen A (2011) The impact of differences in EQ-5D and SF-6D utility scores on the acceptability of cost-utility ratios: results across five trial-based cost-utility studies. Value Health 13:222–229CrossRef

15.

Marra CA, Woolcott JC, Kopec JA, Shojania K, Offer R, Brazier JE, Esdaile JM, Anis AH (2005) A comparison of generic, indirect utility measures (the HUI2, HUI3, SF-6D, and the EQ-5D) and disease-specific instruments (the RAQoL and the HAQ) in rheumatoid arthritis. Soc Sci Med 60:1571–1582PubMedCrossRef

16.

Liu-Ambrose T, Nagamatsu LS, Graf P, Beattie BL, Ashe MC, Handy TC (2010) Resistance training and executive functions: a 12-month randomized controlled trial. Arch Intern Med 170:170–178PubMedCrossRef

17.

Davis JC, Marra CA, Robertson MC, Khan KM, Najafzadeh M, Ashe MC, Liu-Ambrose T (2010) Economic evaluation of dose-response resistance training in older women: a cost-effectiveness and cost-utility analysis. Osteoporos Int 22:1355–1366PubMedCrossRef

18.

Davis JC, Marra CA, Beattie BL, Robertson MC, Najafzadeh M, Graf P, Nagamatsu LS, Liu-Ambrose T (2010) Sustained cognitive and economic benefits of resistance training among community-dwelling senior women: a 1-year follow-up study of the Brain Power study. Arch Intern Med 170:2036–2038PubMedCrossRef

19.

Maetzel A, Li LC, Pencharz J, Tomlinson G, Bombardier C (2004) The economic burden associated with osteoarthritis, rheumatoid arthritis, and hypertension: a comparative study. Ann Rheum Dis 63:395–401PubMedCrossRef

20.

Liu-Ambrose T, Ashe MC, Marra C, Conditions Research Team PA (2008) Among older adults with multiple chronic conditions, physical activity is independently and inversely associated with health care utilization. Br J Sports Med 44(14):1024–1028PubMedCrossRef

21.

(2008) http://www.health.gov.bc.ca/msp/infoprac/physbilling/payschedule/index.html

22.

Dolan P (1997) Modeling valuations for EuroQol health states. Med Care 35:1095–1108PubMedCrossRef

23.

Manca A, Hawkins N, Sculpher MJ (2005) Estimating mean QALYs in trial-based cost-effectiveness analysis: the importance of controlling for baseline utility. Health Econ 14:487–496PubMedCrossRef

24.

Manca A, Palmer S (2005) Handling missing data in patient-level cost-effectiveness analysis alongside randomised clinical trials. Appl Health Econ Health Policy 4:65–75PubMedCrossRef

25.

Matthews JN, Altman DG, Campbell MJ, Royston P (1990) Analysis of serial measurements in medical research. BMJ 300:230–235PubMedCrossRef

26.

Briggs AH, Gray AM (1999) Handling uncertainty when performing economic evaluation of healthcare interventions. Health Technol Assess 3:1–134PubMed

27.

Fenwick E, Claxton K, Sculpher M (2001) Representing uncertainty: the role of cost-effectiveness acceptability curves. Health Econ 10:779–787PubMedCrossRef

28.

Davis JC, Marra CA, Robertson MC, Khan KM, Najafzadeh M, Ashe MC, Liu-Ambrose T (2011) Economic evaluation of dose-response resistance training in older women: a cost-effectiveness and cost-utility analysis. Osteoporos Int 22:1355–1366PubMedCrossRef

29.

Barton GR, Sach TH, Avery AJ, Jenkinson C, Doherty M, Whynes DK, Muir KR (2008) A comparison of the performance of the EQ-5D and SF-6D for individuals aged > or =45 years. Health Econ 17:815–832PubMedCrossRef

30.

Bharmal M, Thomas J 3rd (2006) Comparing the EQ-5D and the SF-6D descriptive systems to assess their ceiling effects in the US general population. Value Health 9:262–271PubMedCrossRef

31.

Drummond MF, Sculpher MJ, Torrance GW, O'Brien B, Stoddart GL (2005) Methods for the economic evaluation for health care programmes, Thirdth edn. Oxford University Press, New York

32.

Conner-Spady B, Suarez-Almazor ME (2003) Variation in the estimation of quality-adjusted life-years by different preference-based instruments. Med Care 41:791–801PubMedCrossRef

33.

Marra CA, Esdaile JM, Guh D, Kopec JA, Brazier JE, Koehler BE, Chalmers A, Anis AH (2004) A comparison of four indirect methods of assessing utility values in rheumatoid arthritis. Med Care 42:1125–1131PubMedCrossRef

34.

Pickard AS, Johnson JA, Feeny DH (2005) Responsiveness of generic health-related quality of life measures in stroke. Qual Life Res 14:207–219PubMedCrossRef

35.

Marra CA, Marion SA, Guh DP, Najafzadeh M, Wolfe F, Esdaile JM, Clarke AE, Gignac MA, Anis AH (2007) Not all “quality-adjusted life years” are equal. J Clin Epidemiol 60:616–624PubMedCrossRef

36.

Pignone M, Earnshaw S, Pletcher MJ, Tice JA (2007) Aspirin for the primary prevention of cardiovascular disease in women: a cost-utility analysis. Arch Intern Med 167:290–295PubMedCrossRef

Title: SF-6D and EQ-5D result in widely divergent incremental cost-effectiveness ratios in a clinical trial of older women: implications for health policy decisions
Authors: J. C. Davis
T. Liu-Ambrose
K. M. Khan
M. C. Robertson
C. A. Marra
Publication date: 01-07-2012
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue 7/2012
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-011-1770-3

At a glance: The STEP trials

Springer Medicine

SF-6D and EQ-5D result in widely divergent incremental cost-effectiveness ratios in a clinical trial of older women: implications for health policy decisions

Abstract

Summary

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

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