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Health and Quality of Life Outcomes
Published in: Health and Quality of Life Outcomes 1/2017

Open Access 01-12-2017 | Research

International comparison of experience-based health state values at the population level

Authors: Richard Heijink, Peter Reitmeir, Reiner Leidl

Published in: Health and Quality of Life Outcomes | Issue 1/2017

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Abstract

Background

Decision makers need to know whether health state values, an important component of summary measures of health, are valid for their target population. A key outcome is the individuals’ valuation of their current health. This experience-based perspective is increasingly used to derive health state values. This study is the first to compare such experience-based valuations at the population level across countries.

Methods

We examined the relationship between respondents’ self-rated health as measured by the EQ-VAS, and the different dimensions and levels of the EQ-5D-3 L. The dataset included almost 32,000 survey respondents from 15 countries. We estimated generalized linear models with logit link function, including country-specific models and pooled-data models with country effects.

Results

The results showed significant and meaningful differences in the valuation of health states and individual health dimensions between countries, even though similarities were present too. Between countries, coefficients correlated positively for the values of mobility, self-care and usual activities, but not for the values of pain and anxiety, thus underlining structural differences.

Conclusions

The findings indicate that, ideally, population-specific experience-based value sets are developed and used for the calculation of health outcomes. Otherwise, sensitivity analyses are needed. Furthermore, transferring the results of foreign studies into the national context should be performed with caution. We recommend future studies to investigate the causes of differences in experience-based health state values through a single international study possibly complemented with qualitative research on the determinants of valuation.
Appendix
Available only for authorised users
Footnotes
1
For example, the EQ-5D-3 L descriptive profile includes the following dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension has three levels: severe problems, some problems, and no problems.
 
2
Most often, the Time Trade Off or the Standard Gamble technique is used. See e.g. Brazier et al. [9].
 
3
Dolan and Kahneman preferred ‘moment-to-moment measurements’ such as the day reconstruction method in which people are asked to rate on a single scale how they felt the day before [11]. However, the latter instruments have been applied to a limited extent and require further development, particularly in the area of health.
 
4
The education variable comprised three levels (low, medium, and high) based on two questions: “left school at minimum age?” & “having a degree or professional qualification?”. Yes&No = low education, No&No = medium eductation, No/Yes&Yes = high education. In a few countries, additional questions were used to identify the level of education.
 
5
As explained in Leidl et al.: “The binomial distribution can be seen to reflect a (large) series of experiments in which a person with the true health state of p is being confronted with a number randomly drawn from the (0,1) range. This number is said to reflect a well-defined health state. The respondent is then asked whether or not his/her health state is at least as good as this health state. The share of experiments in which this person is expected to agree is p” [33]
 
6
Previous HHS-based valuation studies used the following two variables for each dimension: a three-level ordinal variable (no, some, severe problems) and a dummy variable for severe problems versus no or some problems.
 
7
Transformation is based on the formula \( \frac{ \exp (sum)}{1+ \exp (sum)} \), where sum equals the sum of the coefficients related to a particular health state.
 
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Metadata
Title
International comparison of experience-based health state values at the population level
Authors
Richard Heijink
Peter Reitmeir
Reiner Leidl
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2017
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-017-0694-9

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