Clinical Economics Resource Links: Outcomes Measurement

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Clinical Economics Resource Links

Outcomes Measurement

U.S. Valuation of the EuroQol EQ-5D Health States
Office of Management and Budget (OMB) 2003 Report to Congress
Medical Expenditure Panel Survey (MEPS)

U.S. Valuation of the EuroQol EQ-5D Health States

Principal Investigator: Stephen J. Coons

In response to a 1996 recommendation by the U.S. Panel on Cost-Effectiveness in Health and Medicine, AHRQ funded a study to establish population-based preference values for the EuroQol Group EQ-5D's health states for use in the United States.

Prior to this research, no preference weighting system for a prominent generic health status description and valuation system existed that reflected the values and preferences of a broad U.S. sample. This study directly measured preferences for the EQ-5D health states from a nationally representative sample of the U.S. general population through 4,048 in-home interviews.

The study placed a special emphasis on assessing the preferences of two of the largest minority population groups, oversampling Hispanics and non-Hispanic African Americans. The study's aims were to:

Determine preference values for 45 health states using time trade-off (TTO) exercises.
Compare the health state values for the two minority groups with those of the general U.S. population.
Impute values for the full set of 243 health states represented in the EQ-5D for the general U.S. population based on the data collected for the 45 health states.
Compare the U.S. population-based EQ-5D health state values with previously derived values for the United Kingdom.
Establish U.S. population norms for self-reported health status as measured by the EQ-5D.

For more information on EQ-5D Health States, and to download the data collection instruments and study data, go to: U.S. Valuation of the EuroQol EQ-5D Health States.

For more information on EQ-5D Index scoring, and to download the scoring algorithm, go to: Calculating the U.S. Population-based EQ-5D Index Score.

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Office of Management and Budget (OMB) 2003 Report to Congress

In 2003, OMB published its report to Congress on regulatory policy, which contains finalized new guidance for agencies on regulatory analysis.

This guidance introduces a requirement for cost-effectiveness analysis as well as benefit-cost analysis. It states:

"Both benefit-cost analysis (BCA) and cost-effectiveness analysis (CEA) provide a systematic framework for identifying and evaluating the likely outcomes of alternative regulatory choices. A major rulemaking should be supported by both types of analysis wherever possible. Specifically, you should prepare a CEA for all major rulemakings for which the primary benefits are improved public health and safety to the extent that a valid effectiveness measure can be developed to represent expected health and safety outcomes.

You should also perform a BCA for major health and safety rulemakings to the extent that valid monetary values can be assigned to the primary expected health and safety outcomes. In undertaking these analyses, it is important to keep in mind the larger objective of analytical consistency in estimating benefits and costs across regulations and agencies, subject to statutory limitations. Failure to maintain such consistency may prevent achievement of the most risk reduction for a given level of resource expenditure.

For all other major rulemakings, you should carry out a BCA. If some of the primary benefit categories cannot be expressed in monetary units, you should also conduct a CEA. In unusual cases where no quantified information on benefits, costs and effectiveness can be produced, the regulatory analysis should present a qualitative discussion of the issues and evidence."

Appendix D of the report describes the proposed use of CEA to evaluate regulatory measures affecting health and safety, and discusses questions relating to the selection of the effectiveness metric. OMB does not require agencies to use a specific measure of effectiveness; rather, it encourages agencies to report results using multiple measures. Go to Appendix D in the report, Regulatory Decisions: 2003 Report to Congress on the Costs and Benefits of Federal Regulations and Unfunded Mandates on State, Local and Tribal Entities at: http://www.whitehouse.gov/omb/inforeg/2003_cost-ben_ final_rpt.pdf (PDF Help).

In 2004, the OMB commissioned an Institute of Medicine (IOM) study to provide the agencies and OMB useful insight into how to improve the measurement of effectiveness of public health and safety regulations. The results of the deliberations of the IOM Committee on Evaluating Measures of Health Benefits for Environmental, Health, and Safety Regulation will be available in 2006. Go to: http://www.iom.edu/?id=19739.

Prior to the IOM report, OMB enlisted Resources for the Future (RFF) to host a workshop, sponsored by Federal agencies including AHRQ, exploring the implications of using cost-effectiveness versus cost-benefit analysis in regulatory impact analyses. The RFF report Valuing Health Outcomes: Policy Choices and Technical Issues is based on the discussions at this conference: http://www.rff.org/rff/Documents/RFF-RPT-ValuingHealthOutcomes- ExecSumm.pdf (PDF Help).

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Medical Expenditure Panel Survey (MEPS)

The Medical Expenditure Panel Survey (MEPS) is a nationally representative survey of health care utilization and expenditures in the U.S. non-institutionalized population. AHRQ has administered this survey since 1996. MEPS represents a valuable tool for those seeking nationally representative health status and health utility information.

Utilities. In 2000, the MEPS began collecting health status data from adult participants using the SF-12 Health Survey and the EuroQoL EQ-5D survey. EQ-5D data were collected for 3 years (2000-2003); SF-12 data continue to be collected annually. In the 2000 MEPS survey, both EQ-5D and SF-12 data were available on 14,580 respondents.

Web Site. MEPS data are available as public-use files, along with documentation and survey instruments, on the MEPS Web site. Go to: http://www.meps.ahrq.gov

Data. MEPS collects demographic, health, and health utilization data from more than 10,000 respondents annually. MEPS is a 2-year overlapping panel survey; in any year, approximately one-half of the respondents were enrolled that year, and one-half were enrolled the year prior. The survey uses a household sampling design using the National Health Interview Survey (NHIS) sampling frame. The SF-12 and EQ-5D surveys were administered in the Self-Administered Questionnaire (SAQ), a paper and pencil survey given to all adults in the households in rounds 2 and 4 of the MEPS. The surveys are available in English and Spanish versions.

SF-12. This health status survey is commonly used, brief (12 questions), and provides a description of the respondent's health. This survey is based upon the SF-36 Health Survey, another commonly used survey, and has at least one question from each of the SF-36's original eight domains:

Physical function.
Role limitations due to physical functioning.
General health perceptions.
Bodily pain.
Social functioning.
Energy/vitality.
Role limitations due to emotional functioning.
Mental health.

The SF-12 is scored on two summary scales, the Physical Component Summary (PCS) scale and the Mental Component Summary (MCS) scale, representing the physical and mental factors measured in the survey (Ware J, et al., 1996).

Both scales are scored such that the adult population mean is 50, with a standard deviation of 10, and higher scores represent better function. Item level SF-12 responses, PCS scores, and MCS scores are available for adult respondents in the MEPS data files. In 2001-2, the SF-12 v. 1 was administered; starting in 2003, the SF-12 v. 2 was administered.

EQ-5D. The EuroQoL EQ-5D is a commonly used multi-attribute health state classification system, or "utility index." This survey has 5 questions, one for each domain:

Mobility.
Self-care.
Usual activities.
Pain/discomfort.
Anxiety/depression.

Answers to the EQ-5D can be scored to represent an average community or societal utility, representing respondents in the United Kingdom (Dolan, 1997) or a nationally representative sample of U.S. respondents (Coons, 2005).

These scores represent preference weights suitable for use in quality-adjusted life year (QALY) calculations, e.g. for use in decision- or cost-utility analyses, or for use as summary measures of population health for burden of illness analyses.

In addition to the 5 question index, respondents complete a rating scale for their current health, bounded by 0 and 100, representing worst and best states of health imaginable, respectively. Item-level responses to the 5-question index and the rating scale are available in the MEPS data files.

References:

Coons S. Med Care 2005; forthcoming.

Dolan P. Modeling valuations for EuroQoL health states. Med Care 1997;35:1095-106. Select for Abstract on PubMed®.

Ware J, et al. How to Score the SF-12 Physical and Mental Health Summary Scales, 2nd Ed. Lincoln RI: Quality Metric, Inc., and the Health Assessment Lab; 1996

Publications:

The following articles feature outcomes measures research using MEPS data:

Lawrence WF, Fleishman JA. Predicting EuroQoL EQ-5D preference scores from the SF-12 Health Survey in a nationally representative sample. Med Decis Making 2004; 24(2):160-9. Select for Abstract on PubMed®.
Franks P, Lubetkin EI, Gold MR, Tancredi DJ, Jia H. Mapping the SF-12 to the EuroQoL EQ-5D Index in a national U.S. sample. Med Decis Making 2004;24:247-54. Select for abstract on PubMed®.
Fleishman JA, Lawrence WF. Demographic variation in SF-12: True differences or differential item functioning? Med Care 2003;41 Supp:III-75-86. Select for abstract on PubMed®.
Yabroff KR, Lawrence WF, Clauser S, Davis WW, Brown ML. Burden of illness in cancer survivors: findings from a population-based national sample. J Natl Cancer Inst 2004;96:1322-30. Select for abstract on PubMed®.

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Internet Citation:

Clinical Economics Resource Links: Outcomes Measurement. February 2005. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/rice/ceoutc.htm