The issue of how NICE measures and values health-related quality of life has been under discussion for some time following the development of a new version of an existing questionnaire. This questionnaire is completed by people in studies or trials to provide information about different aspects of their health.
At present we use the EQ‑5D questionnaire. For many years there has only been one version - EQ‑5D‑3L. The final part – the 3L in this case – is the number of multiple-choice response options each question has.
For example: question on pain/discomfort
□ I have no pain or discomfort
□ I have moderate pain or discomfort
□ I have extreme pain or discomfort
Extract from EQ-5D-3L, © EuroQol Research Foundation. EQ-5D™ is a trade mark of the EuroQol Research Foundation. Reproduced by permission of EuroQol Research Foundation.
A newer questionnaire created by the EuroQol Group has five multiple-choice options – EQ‑5D‑5L. So for the question on pain and discomfort people can choose from 5 response options: no, slight, moderate, severe or extreme pain or discomfort. The new questionnaire is designed to give more nuanced information about people’s health.
As well as the new questionnaire, researchers have created a new valuation set for England. The valuation set converts questionnaire responses into a single number that can be used in an economic analysis to represent the strength of the public’s preferences for different health states.
Concerns have been raised about the EQ-5D-5L valuation set for England by independent quality assurance commissioned by the Department of Health and Social Care. The concerns relate to the quality of the data and the modelling techniques used.
The authors of the valuation set disagree with many of the criticisms and published a response defending their methods.
Why does all this technical jargon matter? Because the measure of health-related quality of life and the valuation set used to analyse responses underpin the cost-effectiveness calculations that inform many of NICE’s decisions. If we start using an EQ-5D-5L valuation set that does not properly represent the preferences of the public in England, we risk making inappropriate recommendations about which interventions our health and care services should offer.
Working in partnership with the Department of Health and Social Care, NICE has commissioned four international experts to advise on our next steps with EQ-5D-5L. The aim is to see if there are ways of resolving the concerns that have been raised. The experts have access to the data and model for the valuation set for England, and they can ask questions of the valuation set authors and quality assurance team. The work is funded by an unrestricted grant to NICE from the EuroQol Research Foundation.
The experts’ reports should be finished by early autumn. Although the advice is non-binding, it will be used to inform future policy decisions at NICE and the Department of Health and Social Care. The experts’ reports will be made available on the NICE website when NICE releases an updated position statement on the EQ-5D-5L valuation set for England. In the meantime, the existing position statement still applies.