New HEDS Discussion Paper - Applying EuroQol Portable Valuation Technology to the EQ Health and Wellbeing Short (EQHWB-S) : a pilot study. Report.

Mukuria, C, Peasgood, T. and Brazier, J. (2021) Applying EuroQol Portable Valuation Technology to the EQ Health and Wellbeing Short (EQHWB-S) : a pilot study. Report. ScHARR HEDS Discussion Papers . School of Health and Related Research, University of Sheffield

Read and download the Discussion paper here

HEDS Discussion Paper

Abstract

OBJECTIVES:The aim was to assess whether existing valuation methods were suitable for the nine item EQ Health and Wellbeing ShortTM (EQ‐HWB‐S).

METHODS: EuroQol Portable Valuation Technology (EQ‐PVT) which uses composite time trade‐off (cTTO) and discrete choice experiments (DCE) was modified for the EQ‐HWB‐STM. Volunteer non‐ academic University of Sheffield staff were recruited. A mixed methods approach involving qualitative interviews and assessment of quantitative data was used to assess the applicability and feasibility of EQ‐PVT to EQ‐HWB‐S. Participants valued six states using cTTO (three EQ‐HWB‐S and three EQ‐5D‐ 5LTM) and four EQ‐HWB‐S states using DCE.

RESULTS: Nineteen participants with mean (SD) age 48.2 (13.0) were interviewed. Mean TTO values were ordered as expected with higher mean values for the mild EQ‐HWB state compared to the moderate and severe states. Most participants found it fairly or very easy to understand cTTO questions for both EQ‐HWB‐S 94.7% (18/19) and EQ‐5D 89.5% (17/19). Pain, activities and depression were considered key drivers for respondents’ choices. Additional information in the EQ‐HWB‐S was useful in helping to imagine what life would be like but it could also be overwhelming and make the tasks difficult. ‘Coping’ was a problematic item as it was either used as an overall assessment of the state or ignored in favour of participants’ perceived ability to cope with the state. ‘Coping’ was replaced with ‘control’ which did not have the same problems. Participants generally preferred DCE to TTO. DCE presentations with overlap but with simple formatting were preferred.

CONCLUSIONS: A modified standardised valuation has been successfully applied to health and wellbeing states defined by the EQ‐HWB‐S. A full feasibility study is now required.

New HEDS Discussion Paper - Calibration and Validation of the Microsimulation Model in Cancer of the Bowel (MiMiC-Bowel), an Individual Patient Simulation Model for Investigation of the Cost-effectiveness of Personalised Screening and Surveillance Strategies

HEDS have published a new Discussion Paper 

Mandrik, O., Thomas, C., Strong, M. et al. (2021) Calibration and Validation of the Microsimulation Model in Cancer of the Bowel (MiMiC-Bowel), an Individual Patient Simulation Model for Investigation of the Cost-effectiveness of Personalised Screening and Surveillance Strategies. 

http://eprints.whiterose.ac.uk/171343/

Abstract

The Microsimulation Model in Cancer of the Bowel (MiMiC-Bowel) incorporates individual cancer risk to inform colorectal cancer (CRC) screening decisions in England. This work reports calibration and cross-validation of the MiMiC-Bowel.

Due to the complex and computationally intensive nature of the model a step-wise calibration approach was taken utilising manual and automated algorithmic fitting. Natural history disease model parameters were estimated via calibration to several data targets including English and adjusted German data relating to previously unscreened persons. The model was cross-validated to four international models. Incompatibility in calibration data was assessed by analysing CRC incidence, convergence feasibility, and predictions of screening test sensitivity. Data incompatibility was addressed by giving less weight in fitting the parameters to target data with lower reliability and applicability, and adjusting data sets to reflect differences between localities. The MiMiC-Bowel predicted 60% sensitivity of flexible sigmoidoscopy for CRC and 59% for high-risk adenoma. MiMiC-Bowel’s predictions of CRC cases that arise from potentially detectable adenomas and impact of perfect polypectomy on risk reduction were within ranges reported by the US models, but the predictions of the sojourn and dwell time were not (29.1 and 5.3 years vs 8-24 and 2-4 years respectively). CRC risk increased less rapidly by age in MiMiC-Bowel than German data suggests, which is supported by population data on pre-screening CRC incidence.

The HEDS Discussion Paper Series collection can be viewed here

http://eprints.whiterose.ac.uk/view/iau/Sheffield=2EHCM=2EWP.html

New HEDS Discussion Paper - Selection and validation of a classification system for a child-centred caries-specific utility measure

Helen Rodgers, Fiona Gilchrist, Zoe Marshman, Helen Rodd and Donna Rowen

                                                          Abstract

Dr Donna Rowen

Background: Caries Impacts and Experiences Questionnaire for Children (CARIES-QC) is a child-centred caries-specific quality of life measure. This study aimed to select, and validate with children, a classification system for a paediatric condition-specific preference-based measure, based on CARIES-QC.

Methods: First, a provisional classification system for a preference-based measure based on CARIES-QC was developed using Rasch analysis, psychometric testing, involvement of children and parents, and the developer of CARIES-QC. Second, qualitative, semi-structured ‘think aloud’ validation interviews were undertaken with a purposive sample of children with dental caries. The interviewer aimed to identify whether items were considered important and easily understood, whether any were overlapping and if any excluded items should be reintroduced. Interview recordings were transcribed verbatim and thematic analysis conducted.

Results: Rasch analysis identified poor item spread for the items ‘cross’ and ‘school’. Items relating to eating were correlated and the better performing items were considered for selection. Children expressed some confusion regarding the items ‘school’ and ‘food stuck’. Parent representatives thought that impacts surrounding toothbrushing (‘brushing’) were encompassed by the item ‘hurt’. Five items were selected from CARIES-QC for inclusion in the provisional classification system; ‘hurt’, ‘annoy’, ‘carefully’, ‘kept awake’ and ‘cried’. Validation interviews were conducted with 20 children aged 5-16 years old. Participants thought the questionnaire was straightforward and covered a range of impacts. Children thought an item about certain foods being ‘hard to eat’ was more relevant than one about having to eat more carefully because of their teeth and so the ‘carefully’ item was replaced with ‘hard to eat’.

Conclusion: Following child-centred modification, the preliminary five-item classification system is considered valid and suitable for use in a valuation survey. The innovative child-centred methods used to both identify and validate the classification system can be applied in the development of other preference-based measures.

Download the HEDS Discussion paper here.

New HEDS Discussion Paper - Mapping the Health of Nation Outcomes Scale (HoNOS) onto the Recovering Quality of Life Utility Index (ReQoL-UI)

Anju Keetharuth and Donna Rowen

                                          Abstract

Dr Anju Devianee Keetharuth

Aim: The aim of this project is to develop and assess a mapping function to predict ReQoL-UI (a patient-reported mental health-specific preference-based measure) scores from HoNOS scores (clinician-reported measure, Health of Nation Outcomes Score).

Methods: Participants were recruited from 14 secondary mental health services in England, UK, and their clinician completed HoNoS. Mapping models were estimated using Ordinary Least Squares (OLS) on individual level and mean level data and different model specifications were explored. Model performance was assessed using mean absolute error (MAE), root mean square error (RMSE), percentage of observations with absolute errors greater than 0.1, and plots of the observed and predicted ReQoL-UI utilities and errors.

Results: Matched ReQoL-UI and HoNOS scores were collected for 649 participants. The sample comprised 56% inpatients, with overall mean ReQoL-UI utility of 0.683 and range from 1 to -0.195. Correlations between ReQoL-UI (items and utility) and HoNOS scores were moderate (0.2<r<0.4) or small (<0.2). The best model was OLS estimated using mean level data, with lowest MAE (0.046) and RMSE (0.056).

Discussion: There is little conceptual overlap between ReQoL-UI and HoNOS. They measure different concepts and, arguably, service users and clinicians, who complete the measures respectively, have different perspectives. Under these circumstances, caution is recommended when applying these estimates.        

Download the Discussion Paper here.     

Dr Donna Rowen

             

New HEDS Discussion Paper - Estimating a preference-based index for mental health from the Recovering Quality of Life (ReQoL) measure : valuation of ReQoL-UI

Anju Devianee Keetharuth, Donna Rowen, Jakob Bue Björner and John Brazier

Dr Anju Devianee Keetharuth

Abstract

Objectives There are increasing concerns about the appropriateness of generic preference-based measures to capture health benefits in the area of mental health. This study estimates preference weights for a new measure, Recovering Quality of Life (ReQoL-10), to better capture the benefits of mental health care.

Methods Psychometric analyses of a larger sample of mental health service users (n = 4266) using confirmatory factor analyses and item response theory (IRT) were used to derive a health state classification system and inform the selection of health states for utility assessment. A valuation survey with members of the UK public representative in terms of age, gender and region was conducted using face-to-face interviewer administered time-trade-off (TTO) with props. A series of regression models were fitted to the data and the best performing model selected for the scoring algorithm.

Results The ReQoL-UI classification system comprises six mental health items and one physical health (PH) item. Sixty-four health states were valued by 305 participants. The preferred model was a random effects model, with significant and consistent coefficients and best model fit. Estimated utilities modelled for all health states ranged from -0.195 (state worse than dead) to 1 (best possible state).

Conclusions The development of the ReQoL-UI is based on a novel application of IRT methods for generating the classification system and selecting health states for valuation. Conventional TTO was used to elicit utility values that are modelled to enable the generation of QALYs for use in cost-utility analysis of mental health interventions.

Download the HEDS Discussion Paper here