HEDS is part of the School of Health and Related Research (ScHARR) at the University of Sheffield. We undertake research, teaching, training and consultancy on all aspects of health related decision science, with a particular emphasis on health economics, HTA and evidence synthesis.

Wednesday 14 December 2022

Last Post - Farewell

After 12 years, more than 1600 and over 522,000 page views form 167 different countries, the HEDS Blog is closing down.  We have decided to concentrate our efforts on other platforms such as Twitter, our webinars and our podcasts. Read further on to find out where you can follow us. 

ScHARR - Regent Court
Regent Court (the home of the HEDS Blog)  

So while it was fun while it lasted – except for the threat of legal action in relation to one post about one particularly ludicrous cost-effectiveness model that will remain nameless (unless you buy me a drink at ISPOR) – we shall bid you all farewell.  Except North Dakota, from where nobody has yet to log on.

The Blog will remain to signpost people to our other platforms, but it will not be updated.  It shall slowly crumble, And on the pedestal these words appear:

My name is Ozymandias, king of kings:
Look on my works, ye Mighty, and despair!

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Monday 28 November 2022

Job vacacy at ScHARR - Research Programme Coordinator

The Health Economics and Decision Science (HEDS) Section are currently advertising for a Research Programme Coordinator to the National Institute for Health and Care Excellence (NICE) funded Decision Support Unit (DSU) and The Policy Research Unit in Economic Evaluation of Health and Social Care Interventions (EEPRU).

ScHARR, Regent Court

Job Reference Number: UOS035392

Contract Type: Fixed-term for 28 months

Working Pattern: Part-time, working 24.5 hours per week, days of working to be agreed

Faculty: Faculty of Medicine

Department: Health Economics and Decision Science (HEDS)

School of Health and Related Research (ScHARR)

Salary: Grade 6: £28,762 - £33,314 per annum pro-rata. Potential to progress to

£36,386 per annum through sustained exceptional contribution

Closing Date: 5th December 2022


The vacancy and ATJ can be found can be found here.

Monday 14 November 2022

Job Vacancy at ScHARR - Research Associate / Research Fellow

We are currently advertising for a Research Associate or a Research Fellow with a strong background in statistics and/or econometrics, preferably in the area of causal inference, with an interest in evaluating the efficacy and comparative effectiveness of care technologies/services. 

Regent Court, the home of ScHARR

Reference Number: UOS035218

Salary: Grade 7 / Grade 8

Details: Full-time and fixed-term for 2 years

Closing Date: Wednesday 30 November 2022 

The vacancy and ATJ can be found here.

The School of Health and Related Research (ScHARR) is looking to recruit an early or mid-career researcher with strong background in statistics and/or econometrics, preferably in the area of causal inference, with an interest in evaluating the efficacy and comparative effectiveness of care technologies/services, to join the Health Economic and Decision Science (HEDS) section.

You will mainly work in conjunction with the ScHARR Knowledge Exchange (KE) team, providing support in the development of non-randomised study designs and associated analyses for the evaluation of care technologies or services. You will also provide statistical and/or econometric support to multi-disciplinary teams as part of other HEDS research and consultancy projects. Work will include the evaluation of new care technologies or services, usually within non-randomised study designs with a focus on the efficacy and/or comparative effectiveness of the care technology. These evaluations could be supported through the use of primary data collection or reliant on existing ‘realworld data’ (RWD) sources.

You should be familiar with methods for estimating comparative effectiveness using nonrandomised data, such as those methods detailed within NICE Technical Support Document 17: https://www.sheffield.ac.uk/sites/default/files/2022-02/TSD17-DSU-Observational-data-FINAL.pdf

You will be encouraged to develop your own methodological research interests that are complementary to those within HEDS and help contribute to Masters level teaching and supervision.

Friday 4 November 2022

The Autumn/Winter 2022 issue of the HEDS Newsletter is out!

The newsletter you've all been waiting for! 

HEDS Newsletter Autumn/Winter 2022

The Autumn/Winter 2022 issue of the HEDS Newsletter is now available and includes:

  • International development of a new measure of Health and Wellbeing,
  • HEDS hosts the 100th Health Economists' Study Group (HESG) meeting,
  • A new framework to identify quality of mental healthcare,
  • And the latest publications by HEDS staff 

Read it online here

Latest HEDS Publications - August to October 2022

Here is our regular monthly trawl for new publications from HEDS in collaboration with colleagues in ScHARR and further afield. Many of these are currently in press, you can find much of our work in its open access form via our institutional repository. Find them here

Hnynn Si, P.E., Gair, R., Barnes, T., Dunn, L., Lee, S., Ariss, S., Walters, S.J., Wilkie, M. and Fotheringham, J., 2022. Symptom burden according to dialysis day of the week in three times a week haemodialysis patients. PloS one17(9), https://doi.org/10.1371/journal.pone.0274599

Mayland, C. R., Sunderland, K. A., Cooper, M., Taylor, P., Powell, P. A., Zeigler, L. & Fraser, L. K. (2022). Measuring quality of dying, death and end-of-life care for children and young people: A scoping review of available tools. Palliative medicine36(8), 1186-1206. https://doi-org.sheffield.idm.oclc.org/10.1177/02692163221105599

Gray, Laura A., Penny R. Breeze, and Elizabeth A. Williams. "BMI trajectories, morbidity, and mortality in England: a two‐step approach to estimating consequences of changes in BMI." Obesity 30.9 (2022): 1898-1907. https://doi-org.sheffield.idm.oclc.org/10.1002/oby.23510

Beyer, F.R., Kenny, R.P., Johnson, E., Caldwell, D.M., Garnett, C., Rice, S., Simpson, J., Angus, C., Craig, D., Hickman, M. and Michie, S., 2022. Practitioner and digitally delivered interventions for reducing hazardous and harmful alcohol consumption in people not seeking alcohol treatment: a systematic review and network meta‐analysis. Addiction. https://doi-org.sheffield.idm.oclc.org/10.1111/add.15999

McGrath, M., Gray, L. A., Rek, B., Davies, K. C., Savage, Z., McLean, J., ... & Zahedi, S. (2022). Can microprocessor knees reduce the disparity in trips and falls risks between above and below knee prosthesis users?. PloS one17(9), e0271315. https://doi.org/10.1371/journal.pone.0271315

See-Toh, R. S. E., Wong, X. Y., Mahboobani, K. S. K. H., Soon, S. S., Kearns, B., Cooper, K., ... & Ng, K. (2022). Cost-effectiveness of transcatheter aortic valve implantation in patients with severe symptomatic aortic stenosis of intermediate surgical risk in Singapore. BMC health services research22(1), 1-12. https://doi.org/10.1186/s12913-022-08369-5

Keetharuth, A.D., Hussain, H., Rowen, D. et al. Assessing the psychometric performance of EQ-5D-5L in dementia: a systematic review. Health Qual Life Outcomes 20, 139 (2022). https://doi.org/10.1186/s12955-022-02036-3

Daniels, S. L., Morgan, J., Lee, M. J., Wickramasekera, N., Moug, S., Wilson, T. R., ... & Wyld, L. (2022). Surgeon preference for treatment allocation in older people facing major gastrointestinal surgery: an application of the discrete choice experiment methodology. Colorectal Disease. https://doi-org.sheffield.idm.oclc.org/10.1111/codi.16296

Angus, Colin. "Evidence to inform effective alcohol pricing policies in the European Union." medRxiv (2022). https://doi.org/10.1101/2022.07.28.22277988

Maheswaran R, Tong T, Michaels J, Brindley P, Walters S, Nawaz S. Socioeconomic disparities in abdominal aortic aneurysm repair rates and survival. Br J Surg. 2022 Sep 9;109 (10):958-967. doi: 10.1093/bjs/znac222. https://doi.org/10.1093/bjs/znac222

Cardoso Pinto, A., Ranasinghe, L., Dodd, P. J., Budhathoki, S. S., Seddon, J. A., & Whittaker, E. (2022). Disruptions to routine childhood vaccinations in low-and middle-income countries during the COVID-19 pandemic: A systematic review. Frontiers in pediatrics, 1349. file:///C:/Users/cm4mjb/Downloads/fped-10-979769.pdf

Palmer S, Borget I, Friede T, Husereau D, Karnon J, Kearns B, Medin E, Peterse EFP, Klijn SL, Verburg-Baltussen EJM, Fenwick E, Borrill J. A Guide to Selecting Flexible Survival Models to Inform Economic Evaluations of Cancer Immunotherapies. Value Health. 2022 Aug 13:S1098-3015(22)02105-2. https://doi-org.sheffield.idm.oclc.org/10.1016/j.jval.2022.07.009

Angus, C., Holmes, J., Purshouse, R., Meier, P. S., & Brennan, A. (2022). Does your measure matter? A comparison of alcohol availability measures in Great Britain. medRxiv. doi: https://doi.org/10.1101/2022.08.18.22278948

Jung S, Uttley L, Huang J. Housing With Care for Older People: A Scoping Review Using the CASP Assessment Tool to Inform Optimal Design. HERD: Health Environments Research & Design Journal. 2022; 15 (4):299-322. doi:10.1177/19375867221113359

Broadley M, Chatwin H, Søholm U, Amiel SA, Carlton J, De Galan BE, Hendrieckx C, McCrimmon RJ, Skovlund SE, Pouwer F, Speight J; Hypo-RESOLVE Consortium. The 12-Item Hypoglycemia Impact Profile (HIP12): psychometric validation of a brief measure of the impact of hypoglycemia on quality of life among adults with type 1 or type 2 diabetes. BMJ Open Diabetes Res Care. 2022 Aug; 10 (4):e002890. doi: 10.1136/bmjdrc-2022-002890

Howdon, D., Hinde, S., Lomas, J., & Franklin, M. (2022). Economic evaluation evidence for resource-allocation decision making: bridging the gap for local decision makers using English case studies. Applied Health Economics and Health Policy20(6), 783-792. https://doi-org.sheffield.idm.oclc.org/10.1007/s40258-022-00756-7

Powell, P.A., Carlton, J. A comprehensive qualitative framework for health-related quality of life in Duchenne muscular dystrophy. Qual Life Res (2022). https://doi.org/10.1007/s11136-022-03240-w

Metcalfe D, Parsons NR, Costa ML. Sterile versus non-sterile gloves for traumatic wounds in the ED. Emerg Med J. 2022 Sep; 39(9):648-649. doi: 10.1136/emermed-2022-212517

Oortwijn W, Husereau D, Abelson J, Barasa E, Bayani DD, Canuto Santos V, Culyer A, Facey K, Grainger D, Kieslich K, Ollendorf D, Pichon-Riviere A, Sandman L, Strammiello V, Teerawattananon Y. Designing and Implementing Deliberative Processes for Health Technology Assessment: A Good Practices Report of a Joint HTAi/ISPOR Task Force. Value Health. 2022 Jun;25(6):869-886. doi: 10.1016/j.jval.2022.03.018

Schurz, H., Naranbhai, V., Yates, T., Gilchrist, J., Parks, T., Dodd, P., …& Yang, Y. (2022). Multi-ancestry meta-analysis of host genetic susceptibility to tuberculosis identifies shared genetic architecture. medRxiv. doi: https://doi.org/10.1101/2022.08.26.22279009

Beecher C, Toomey E, Maeso B, Whiting C, Stewart DC, Worrall A, Elliott J, Smith M, Tierney T, Blackwood B, Maguire T, Kampman M, Ling B, Gill C, Healy P, Houghton C, Booth A, Garritty C, Thomas J, Tricco AC, Burke NN, Keenan C, Devane D. Priority III: top 10 rapid review methodology research priorities identified using a James Lind Alliance Priority Setting Partnership. J Clin Epidemiol. 2022 Aug 28;151:151-160. doi: 10.1016/j.jclinepi.2022.08.002

Pandor A, Daru J, Hunt BJ, Rooney G, Hamilton J, Clowes M, Goodacre S, Nelson-Piercy C, Davis S. Risk assessment models for venous thromboembolism in pregnancy and in the puerperium: a systematic review. BMJ Open. 2022 Oct 12;12(10):e065892. doi: 10.1136/bmjopen-2022-065892

Evans C, Evans K, Booth A, et alRealist inquiry into Maternity care @ a Distance (ARM@DA): realist review protocol BMJ Open 2022;12:e062106. doi: 10.1136/bmjopen-2022-062106

Campbell, F., Blank, L., Cantrell, A. et al. Factors that influence mental health of university and college students in the UK: a systematic review. BMC Public Health 22, 1778 (2022). https://doi.org/10.1186/s12889-022-13943-x

Tuck CZ, Akparibo R, Gray LA, et alWhat influences cancer treatment service access in Ghana? A critical interpretive synthesis BMJ Open 2022;12:e065153. doi: 10.1136/bmjopen-2022-065153

Cooper, C., Booth, A., Husk, K., Lovell, R., Frost, J., Schauberger, U., Britten, N., & Garside, R. (2022). A Tailored Approach: A model for literature searching in complex systematic reviews. Journal of Information Science, 0(0). https://doi.org/10.1177/01655515221114452

Lu H, Zhang C, Wu W, et al. MCPIP1 restrains mucosal inflammation by orchestrating the intestinal monocyte to macrophage maturation via an ATF3-AP1S2 axisGut Published Online First: 08 September 2022. doi: 10.1136/gutjnl-2022-327183

Saßmannshausen, M., Behning, C., Isselmann, B. et al. Relative ellipsoid zone reflectivity and its association with disease severity in age-related macular degeneration: a MACUSTAR study report. Sci Rep 12, 14933 (2022). https://doi.org/10.1038/s41598-022-18875-5

Ahern AL, Breeze P, Fusco F, Sharp SJ, Islam N, Wheeler GM, Hill AJ, Hughes CA, Duschinsky R, Thomas C, Bates S, Woolston J, Stubbings M, Whittle F, Boothby C, Bostock J, Jebb S, Aveyard P, Boyland E, Halford JCG, Morris S, Brennan A, Griffin SJ. Effectiveness and cost-effectiveness of referral to a commercial open group behavioural weight management programme in adults with overweight and obesity: 5-year follow-up of the WRAP randomised controlled trial. Lancet Public Health. 2022 Oct;7(10):e866-e875. doi: 10.1016/S2468-2667(22)00226-2

Kik J, Heijnsdijk EAM, Mackey AR, et al. Availability of data for cost-effectiveness comparison of child vision and hearing screening programmes. Journal of Medical Screening. 2022;0(0). doi:10.1177/09691413221126677

Carmona, C., Baxter, S. & Carroll, C. The conduct and reporting of qualitative evidence syntheses in health and social care guidelines: a content analysis. BMC Med Res Methodol 22, 267 (2022). https://doi.org/10.1186/s12874-022-01743-1

Munn Z, Pollock D, Barker TH, et alThe Pandora’s Box of Evidence Synthesis and the case for a living Evidence Synthesis TaxonomyBMJ Evidence-Based Medicine Published Online First: 14 October 2022. doi: 10.1136/bmjebm-2022-112065

Dodd, Pete, et al. "Transmission modeling to infer tuberculosis incidence, prevalence, and mortality in settings with generalized HIV epidemics." medRxiv (2022). doi: https://doi.org/10.1101/2022.10.07.22280817

Tesfaye S, Sloan G, Petrie J, White D, Bradburn M, Young T, Rajbhandari S, Sharma S, Rayman G, Gouni R, Alam U, Julious SA, Cooper C, Loban A, Sutherland K, Glover R, Waterhouse S, Turton E, Horspool M, Gandhi R, Maguire D, Jude E, Ahmed SH, Vas P, Hariman C, McDougall C, Devers M, Tsatlidis V, Johnson M, Bouhassira D, Bennett DL, Selvarajah D. Optimal pharmacotherapy pathway in adults with diabetic peripheral neuropathic pain: the OPTION-DM RCT. Health Technol Assess. 2022 Oct;26(39):1-100. doi: 10.3310/RXUO6757

Dowd, J. B., Angus, C., Zajacova, A., & Tilstra, A. (2022). Mid-life'Deaths of Despair'Trends in the US, Canada, and UK, 2001-2019: Is the US an Anomaly?. medRxiv. doi: https://doi.org/10.1101/2022.10.10.22280916

Rickman, H.M., Kamchedzera, W., Schwalb, A., Phiri, M.D., Ruhwald, M., Shanaube, K., Dodd, P.J., Houben, R.M., Corbett, E.L. and MacPherson, P., 2022. Know your tuberculosis epidemic–Is it time to add Mycobacterium tuberculosis immunoreactivity back into global surveillance?. PLOS Global Public Health2(10), p.e0001208. https://doi.org/10.1371/journal.pgph.0001208

Tuesday 18 October 2022

Job vacancy - Research Assistant/Research Associate

We are currently advertising for a Research Assistant/Associate who will work on applied and methodological research projects relating to interventions for obesity and prevention of diabetes and cardiovascular disease. 

ScHARR, Regent Court

Job Reference Number: UOS034891

Job Title: Research Assistant/Research Associate

Contract Type: Fixed-term for 2 years

Faculty: Faculty of Medicine

Department: Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR)

Salary: Grade 6: £28,762 - £33,314 per annum pro-rata. Potential to progress to
£36,386 per annum through sustained exceptional contribution.
Grade 7: £35,333 - £43,414 per annum pro-rata. Potential to progress to
£47,423 per annum through sustained exceptional contribution.

Closing Date: 26th October 2022

The vacancy and ATJ can be found can be found here

We have an exciting opportunity in the Health Economics and Decision Science (HEDS) section in the School of Health and Related Research (ScHARR)) to join the team at the forefront of development of public health economic modelling and microsimulation.

As a Research Assistant/Associate in Health Economic Modelling, you will work on applied and methodological research projects relating to interventions for obesity and prevention of diabetes and cardiovascular disease.

In addition to working to develop quantitative analyses of obesity interventions, you will contribute to the writing of research and consultancy proposals, and to the dissemination of research findings in peer-reviewed publications, at conferences and to non-academic audiences, as well as to the development and delivery of Masters level teaching, supervision of postgraduate students and the provision of other types of training.

Ideally you should have a track record of publication in peer-reviewed journals and conference presentation. You should have a Masters Degree or equivalent in a numerate subject, for example, mathematics, operational research, statistics or economics.

We are committed to enabling our employees to work in a hybrid model with flexibility over when, where and how to achieve the required outputs, in discussion with your manager.

We are committed to exploring flexible working opportunities which benefit the individual and University. We’re one of the best not-for-profit organisations to work for in the UK. The University’s Total Reward Package includes a competitive salary, a generous Pension Scheme and annual leave entitlement, as well as access to a range of learning and development courses to support your personal and professional development.

We build teams of people from different heritages and lifestyles from across the world, whose talent and contributions complement each other to greatest effect. We believe diversity in all its forms delivers greater impact through research, teaching and student experience.

Thursday 8 September 2022

The ‘wheelchair example’ – why it should be dropped from EQ-5D valuation tasks

Nancy Devlin Nancy Devlin, Clara Mukuria, Philip Powell, Tessa Peasgood

The EQ Valuation Technology (EQ-VT) protocol has been widely used in the valuation of EuroQol instruments, including in over 25 national EQ-5D-5L value sets and, in an adapted form, the valuation of EQ-5D-Y-3L. Adapted versions of it are also currently being used for the valuation of EQ Health and Wellbeing (EQ-HWB). The depth of experience with using EQ-VT means that it represents a mature technology.

However, as with any scientific endeavour, there is scope to strengthen existing approaches. The EuroQol Group is open to ideas about improving methods and is committed to transparency about the pros and cons of its valuation approaches.

In this blog post, we set out the case for dropping one aspect of the EQ-VT: the ‘wheelchair example’. The catalyst to this post was a detailed discussion of EQ-VT with members of the UK National Institute for Health and Care Excellence (NICE) Public Involvement Programme in January 2022. Members were individually interviewed using the EQ-VT, followed by an individual debrief interview, group debrief, and finally a focus group discussion about valuation, as part of ongoing work on the EQ-HWB.

Photo: handicap sign by Steve Johnson (flickr)

What is the ‘wheelchair example’?

The ‘wheelchair example’ is a warm-up task, used at the start of EQ-VT interviews with respondents. Its role is to introduce the time trade-off (TTO) tasks to be used in the interviews to elicit the stated preferences of respondents about health states described by a given instrument. In order to focus on the explanation of how TTO works, the initial state provided as an illustrative example is ‘in a wheelchair’, which is introduced as “you have problems with mobility which mean that you require a wheelchair”, rather than a state described by the generic descriptive system. The rationale for the choice of ‘in a wheelchair’ in this warm-up task is that it can be readily imagined by everyone. To our knowledge, the wheelchair example and how it is perceived by respondents has never been systematically evaluated. The wheelchair example has been included as part of EQ-VT from early in the methodological work which underpins its development and its use in Version 1 of the protocol.

Stolk et al (2019) note that, in Version 1, interviewers were supposed to use the wheelchair example to demonstrate the TTO tasks for states both better and worse than dead, but that “this was easy to forget and difficult to do”. In Version 2 of the protocol, the wheelchair example is accompanied by an additional task. After completing the TTO task for the wheelchair example, if living in a wheelchair was considered ‘better than dead’, respondents are asked to imagine a state ‘much worse than being in a wheelchair’, in order to move to the part of the evaluation space < 0 (and vice versa, if the respondent values living in a wheelchair as ‘worse than dead’, they are asked to imagine a state better than being in a wheelchair).

The time spent by interviewers on the practice wheelchair example is an indicator of interviewer quality included in the quality control (QC) process.

What is the problem with using the wheelchair example?

There are at least three reasons why using the wheelchair example is problematic.

It does not describe a health state.

Wheelchair users often identify as disabled, which may or may not be caused by or accompanied by health problems. Being in a wheelchair is not a health state. Moreover, the focus on describing the state with respect to their use of a wheelchair throws the focus onto the role of the wheelchair as a means of supporting and adapting to their physical impairment. This is not helpful as an example, as it directly contradicts what we ask people to do in the valuation tasks following the warm-up i.e., to consider a health state, ignoring any interventions which might be used to modify that state.

It is ableist.

Ableism is defined as discrimination and social prejudice against disabled people or people who are perceived to be disabled. Ableism characterises people as defined by their disabilities and inferior to the non-disabled (Linton, 1998). In the discussions which our research team undertook with members of the NICE Public Involvement Programme, and in the EQ-VT interviews which were undertaken with them individually beforehand, concerns about the wheelchair example were expressed in strong terms.

In the group discussion on 25th January 2022, one participant stated:

“I’m one of the people that found the initial example not good. I feel whichever condition you choose, but certainly being in a wheelchair is right up there, it feels like you’re making the assumption that people in wheelchairs feel that’s a bad thing which they don’t necessarily, and I just think you have to be very careful with things like that because we shouldn’t make assumptions.”

Other participants agreed with this view, with a second participant commenting:

“I agree wholeheartedly [with participant] around using the wheelchair perspective because I’m also a wheelchair user and I don’t necessarily find that as a restrictive thing on the quality or nature of my life.”

These views were echoed in the focus group discussions on 27th January 2022, with the first participant recapitulating the point:

“You chose mobility yourselves for your example for that first trade-off… life in a wheelchair or life as a healthy person and I think that does reflect an idea about losing mobility or being in a wheelchair as some terrible thing. I think there is a society view like that which I think a large section of the disabled community would disagree with it.”

These comments came from multiple participants, in both the individual debriefing as well as the focus groups. For example, in the individual debriefing, a participant noted

“I think it’s quite ableist actually. I don’t think it gives a positive message about disability… Obviously, you’d have to be mentally ill to say I’d prefer to live 10 years in a wheelchair than 10 years of good health, but I don’t really want to start saying I’d trade in three years, because what I am saying about people who live in wheelchairs? I’m saying things that I don’t want to say.”

The use of the wheelchair example reflects researchers’ judgement about people in wheelchairs having a lower quality of life than those not in wheelchairs and implicitly propagates this message to respondents. Even if this is a widely held view in society, it is offensive to those with disabilities, who represent an important part of the societies whose preferences and views we seek to take into account in such studies. It is also viewed as ableist by those who are aware of or work in disability issues. Thus, its use as the warm-up example may reflect poorly on the researchers who use it and the otherwise respected organisations that recommend its use. Given the challenging nature of the TTO tasks, which include the request to imagine living in very poor health states and reflect upon death, it is important that all participants are treated with care and compassion.

It may not be fit for purpose in other ways

For the wheelchair example to work as a warm-up task, requiring the use of a wheelchair has to be universally considered to involve impaired quality of life. If people with lived experience of wheelchair use do not share that view, the wheelchair example is not fit for purpose with an important segment of the general public whose views are being sought.

There may be further issues related to the wheelchair example which impact its practical usefulness as a warm-up task. For example, Shabasy et al (2022), reporting on the use of EQ-VT in Egypt, noted that

“In Egypt and many other developing countries, independent living in a wheelchair is challenging due to unequipped public transportation and lack of wheelchair-friendly infrastructure like ramps and elevators in most buildings, which may have prompted most participants to decide that living in a wheelchair was a fate worse than death… Thus, the use of the ‘wheelchair example’ as the initial cTTO example was not acceptable for most of the participants.”

For these reasons, the researchers replaced the wheelchair example with ‘migraine’.

Is there an alternative?

As Shabasy et al (2022) have shown, there are other states or short one-sentence vignettes which could be used to replace the wheelchair example. These avoid the issues noted above, while providing examples of states which respondents can just as readily imagine. For example, it would be possible to simply ask respondents to imagine that they have some degree of pain (which is something all people have experienced and is universally regarded as being associated with a decrease in health-related quality of life). Not mentioning a specific condition or disability removes the possibility of the example being seen by respondents as marginalising or promoting a particular negative value judgment relating to that condition, which may not resonate with all respondents. It reduces the possibility that preconceptions about the named example influence subsequent valuations.

There are likely to be issues with any example that is used, but these are mainly issues of how specific the description is and how that affects how different people imagine and conceptualise the state. This is of less importance, given the purpose of the warm-up task is simply to introduce people to TTO and the tasks for states better than dead and worse than dead. One potential issue that may require exploration is whether the choice of state in the warm-up task exerts a framing effect on subsequent tasks (e.g., whether a focus on mobility or pain affects the valuation of states containing those problems). This could readily be addressed as a methodological add-on in future studies, and, if true, may already be a problem that exists with the wheelchair example (i.e., by focusing respondents on mobility issues).


The wheelchair example is a long-standing feature of EQ-VT valuation studies, and researchers using it (including us) have such familiarity with its use that we are guilty of having stopped questioning its inclusion. However, the feedback we have received from the NICE Public Involvement Programme Panel members raises issues, which we believe should prompt serious reflection. There is an opportunity to explore alternatives to the ‘wheelchair example’, which provide just as good a basis for these warm-up tasks. The data from the wheelchair example do not form part of the valuation results reported from studies. This means that the loss of comparability from shifting from ‘in a wheelchair’ to a different example state in future valuation research should be of minimal consequence, though this requires testing. We have recommended that the EuroQol Group consider this issue, and identify the steps needed to explore it, as soon as possible.

Kindly reposted with permission by the AHE Blog

Tuesday 6 September 2022

Why the NHS recommends Recovering Quality of Life (ReQoL-10) for use in Community Mental Health services

Patient Reported Outcome Measures (PROMs) are tools (usually in a questionnaire format) that help to assess an individual’s mental health and wellbeing needs and measure change. Measuring outcomes can help clinicians and services better understand the impact of 1:1 interventions; ensure services are meeting the needs of different service users; and monitor and improve effectiveness, efficiency and quality of the service offered to its service users.  It is important as it helps to understand the benefit and impact people receive from their mental health services.

In October 2021, NHS England and NHS Improvement established a task and finish group to look at a consistent approach to outcome measurement and recommend which PROMs should be used across CMH services for adults, including older adults, with severe mental illness. The group looked at a large number of PROMs and assessed against agreed selection criteria which included acceptability; validity; reliability; interoperability; and burden.

The group recommended the use of three PROMs, including Recovering Quality of Life (ReQoL-10).  ReQoL-10 was chosen because:

  • It is recovery focused and can be used to assess the key recovery domains of connectedness, hope, identity, meaning and empowerment (CHIME) for people with different mental health conditions.  

  • It was co-produced and tested with over 6,000 service users.  

  • It provides an understanding of the factors contributing to service user’s own personal recovery 

  • Nationally, it can be used to benchmark and build evidence and demonstrate good quality.  

The other PROMs recommended by the group were Goal Based Outcomes (GBO) and DIALOG. Each fulfils a different purpose and it is not expected that all three will be used at the same time and by the same care professional. The goal is for services to start embedding at least one of three PROMs in their systems in 22/23 with the aim of embedding all three in CMH services by the end of 23/24. Nationally, there will be an analysis of the data through the Mental Health Services Data Set (MHSDS) along with the development of supporting resources. 

The ReQoL-10 questionnaire has been developed into a visualisation tool which can now be accessed online https://reqol-visualisation-tool.group.shef.ac.uk/ Further resources can be accessed here: https://www.reqol.org.uk/p/overview.html 

One of the aims of the YH ARC Health Economics, Evaluation and Equality Theme has been to support NHS Trusts to meaningfully implement the data in the NHS to improve health outcomes for patients with mental health conditions through the implementation and use of the ReQoL. 

This blog was written by Dr Lizzie Taylor Buck and Amanda Lane, Health Economics, Evaluation and Equality theme, Yorkshire and Humber ARC.

Tuesday 16 August 2022

Data collection for the UK EQ-5D-5L valuation study to start in October 2022

Data collection for the UK EQ-5D-5L valuation study to start in October 2022

Data collection for this key study to generate a UK value set for the EQ-5D-5L is due to start in October and will involve 1,200 interviews conducted in a representative sample of people living in England, Scotland, Northern Ireland and Wales.

EuroQol EQ-5D logo

The launch of the new EQ-5D-5L valuation study for the United Kingdom was delayed due to the global COVID-19 pandemic. However, during this period extensive methodological work has been undertaken in preparation for the study. The study team has worked closely with the Steering Group, the EuroQol EQ-VT support team, and the Quality Control (QC) team (see the study governance document for an explanation of the various teams) on how to reliably and safely collect interview data in light of COVID-19. The study team have also conducted an equivalence study, in which two modes of administration of the EQ-VT TTO interviews were compared: interview by videoconference vs the regular face-to-face interview. The results from this study demonstrate that video interviews are feasible and acceptable with both interviewing modes generating good-quality data. To make the study inclusive and maximise sample representativeness, both modes will be used in the UK valuation study, with respondents able to choose the one they prefer.

The study team is led by Professor Donna Rowen from ScHARR at the University of Sheffield and comprises six institutions. For a listing of the full study team and more details about the study and its governance please go to the UK EQ-5D-5L valuation study Blog on the EuroQol website. The study proposal and statistical analysis plan have been approved for funding by EuroQol’s Executive Committee and signed off by the study’s Steering Group. The protocol and statistical analysis plan were informed by a systematic review of published papers generating international EQ-5D-5L value sets.

Professor Donna Rowen
Professor Donna Rowen
Professor Donna Rowen said “After facing delays due to COVID-19 and undertaking a large amount of preparatory and methodological work to inform the study, the study team are very excited to be starting this important study.”

NICE’s current position on EQ-5D-5L valuation in England: Prior to the completion and publication of the new valuation study, the interim position in England regarding the use of the EQ-5D-5L for companies, academic groups, and others preparing evidence submissions for NICE remains in place and can be viewed in Section 4.3.16 of the new NICE health technology evaluations manual on their website.

Steering Group: The Steering Group comprises representatives from the National Institute for Health and Care Excellence (NICE), Department of Health and Social Care, NHS England, the EuroQol Research Foundation, and academic experts. The list of members can be found on the EuroQol Blog.

About valuation studies: The new valuation study will provide a UK value set for the EQ-5D-5L. The value set will provide values (weights) for EQ-5D-5L health state descriptions according to the preferences of the UK general population. These are used in the calculation of quality adjusted life years (QALYs) that inform economic evaluations of healthcare interventions. An overview of the EQ-5D-5L value sets internationally is available on the EuroQol website here.

About EuroQol: The EuroQol Research Foundation is funding the study, and is a not-for-profit organization. Their mission is to to improve decisions about health and health care throughout the world by supporting, initiating and performing scientific research and development of instruments, such as EQ-5D-5L, with the widest possible applicability for the measurement and valuation of health. For further information please visit their website.