Better data for better decisions
Sophie Cooper, senior scientific adviser at NICE, explains the importance of the recently published EQ-5D-5L value set and how it has the potential to help us decide if new treatments offer good value for money for the NHS.
Sophie Cooper
Senior scientific adviser in NICE’s science policy team
What is the EQ-5D-5L?
When deciding which treatments the NHS should offer, we need to understand not just whether a medicine works, but how much it improves people's lives. That's where the EQ-5D-5L comes in.
The EQ-5D-5L is a questionnaire that captures how someone's health affects their daily life. It asks people to rate themselves across five key areas:
mobility – how well you can move around
self-care – your ability to wash and dress yourself
usual activities – your ability to do work, study, or housework
pain or discomfort
anxiety or depression.
For each area, respondents choose from 5 levels, ranging from ‘no problems’ to ‘extreme problems’. This creates an overview of their health-related quality of life.
To be able to use the information from the EQ-5D-5L in our evaluations, we need the questionnaire answers to be converted into a ‘utility value’ that represents how good or bad a particular health state is. To do this, we use a mathematical model called a value set.
A value set comes from asking members of the general public to judge different health states and what they think the impact of each is. It reflects what society considers important about their health-related quality of life.
Introducing the new EQ-5D-5L value set
NICE has to date been using an old value set, based on data that was collected in the early 1990s. It is linked to an older version of the questionnaire (called EQ-5D-3L), which only offered 3 response options instead of 5.
However, a lot has changed since then. Our population looks different, healthcare has advanced significantly, and public awareness of health issues has evolved. The old data simply does not reflect how people today think about health and quality of life.
This is why we have worked closely with the researchers, our partners at Department of Health and Social Care (DHSC), NHS England (NHSE), and with EuroQol, the not-for-profit foundation that developed the EQ-5D questionnaires, to ensure that the recently published value set is robust and reliable.
Why is this good news?
Adopting the new value set later this year means NICE will be able to make more accurate assessments of how treatments improve health-related quality of life. This is particularly important because:
It reflects modern values: what people today consider important about their health.
It’s more reliable: the methods used to develop value sets have improved significantly since the EQ-5D-3L value set was created.
The questionnaire that the value set is based on is more sensitive: 5 response levels capture a broader range of experiences than 3.
It leads to better decisions: more accurate measurements help ensure NHS resources go to treatments that truly make the biggest difference to people's lives.
What will not change?
The new value set will not replace the overall system NICE uses to assess treatments. It simply provides better data to feed into that system. NICE will still be asking for data collected using the EQ-5D questionnaire and will still be calculating cost effectiveness in the same way – this just makes those calculations more accurate and reflective of what matters to people today.
What’s next?
In April, we’ll open a consultation about how we plan to implement the EQ-5D-5L value set into our methods. We’ll do this through our modular update process and we welcome feedback from all users and stakeholders.