Abstract
OBJECTIVES: To develop and validate approaches for mapping Oswestry Disability Index (ODI) responses to EQ-5D-3L utility values and to evaluate the impact of using mapped utility values on cost-utility results compared to published regression models.
METHODS: Three response mapping approaches were developed in a random sample of 70% of 18,692 patients with low back pain: non-parametric approach (Non-p), non-parametric approach excluding logical inconsistencies (Non-peLI), and ordinal logistic regression (OLR). Performance was assessed in the remaining 30% using R-square (R2), Root Mean Square Error (RMSE), and Mean Absolute Error (MAE). To evaluate whether MAEs and their 95% limits of agreement (95%LA) were clinically relevant, a minimally clinically important difference (MCID) of 0.074 was used. Probabilities of cost-effectiveness estimated using observed and mapped utility values were compared in two economic evaluations.
RESULTS: The Non-p performed best (R2=0.43; RMSE=0.22; MAE=0.03; 95%LA=-0.40;0.47) compared to the Non-peLI (R2=0.07; RMSE=0.29; MAE=-0.15; 95%LA=-0.63;0.34), and ORL (R2=0.22; RMSE=0.26; MAE=0.02; 95%LA=-0.49;0.53). MAEs were lower than the MCID for the Non-p and OLR, but not for the Non-peLI. Differences in probabilities of cost-effectiveness ranged from 1-4% (Non-p), 0.1-9% (Non-peLI), and 0.1-20% (OLR).
CONCLUSIONS: Results suggest that the developed response mapping approaches are not valid for estimating individual patients' EQ-5D-3L utility values, and - depending on the approach - may considerably impact cost-utility results. The developed approaches did not perform better than previously published regression-based models and are therefore not recommended for use in economic evaluations.
Original language | English |
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Pages (from-to) | 873-882 |
Journal | Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research |
Volume | 26 |
Issue number | 6 |
Early online date | 9 Feb 2023 |
DOIs | |
Publication status | Published - Jun 2023 |
Bibliographical note
Funding Information:Conflict of Interest Disclosures: Dr Ostelo reported receiving grants from ZonMw and WCF outside the submitted work. Dr Huygen reported receiving personal fees from Abbott and Grunenthal outside the submitted work. Dr Huygen has a patent P121304EP00 pending and a patent P121304NL00 pending. Dr Oosterhuis reported receiving grants from ZonMW, Ministry of Social Affairs and employment outside the submitted work. No other disclosures were reported.
Funding Information:
Conflict of Interest Disclosures: Dr Ostelo reported receiving grants from ZonMw and WCF outside the submitted work. Dr Huygen reported receiving personal fees from Abbott and Grunenthal outside the submitted work. Dr Huygen has a patent P121304EP00 pending and a patent P121304NL00 pending. Dr Oosterhuis reported receiving grants from ZonMW, Ministry of Social Affairs and employment outside the submitted work. No other disclosures were reported.Funding/Support: This study was internally funded by the Vrije Universiteit Amsterdam through the van Meenen middelen.
Publisher Copyright:
© 2023 International Society for Pharmacoeconomics and Outcomes Research, Inc.
Funding
Conflict of Interest Disclosures: Dr Ostelo reported receiving grants from ZonMw and WCF outside the submitted work. Dr Huygen reported receiving personal fees from Abbott and Grunenthal outside the submitted work. Dr Huygen has a patent P121304EP00 pending and a patent P121304NL00 pending. Dr Oosterhuis reported receiving grants from ZonMW, Ministry of Social Affairs and employment outside the submitted work. No other disclosures were reported. Conflict of Interest Disclosures: Dr Ostelo reported receiving grants from ZonMw and WCF outside the submitted work. Dr Huygen reported receiving personal fees from Abbott and Grunenthal outside the submitted work. Dr Huygen has a patent P121304EP00 pending and a patent P121304NL00 pending. Dr Oosterhuis reported receiving grants from ZonMW, Ministry of Social Affairs and employment outside the submitted work. No other disclosures were reported.Funding/Support: This study was internally funded by the Vrije Universiteit Amsterdam through the van Meenen middelen.
Funders | Funder number |
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Ministry of Social Affairs | |
ZonMw | P121304NL00, P121304EP00 |
Keywords
- EQ-5D
- low back pain
- Oswestry Disability Index
- response mapping