TY - JOUR
T1 - Mapping Oswestry Disability Index Responses to EQ-5D-3L Utility Values
T2 - Are Cost-Utility Results Valid?
AU - Ben, Ângela Jornada
AU - Pellekooren, Sylvia
AU - Bosmans, Judith E.
AU - Ostelo, Raymond W. J. G.
AU - Maas, Esther T.
AU - el Alili, Mohamed
AU - van Tulder, Maurits W.
AU - Huygen, Frank J. P. M.
AU - Oosterhuis, Teddy
AU - Apeldoorn, Adri T.
AU - van Hooff, Miranda L.
AU - van Dongen, Johanna M.
N1 - Funding Information:
Conflict of Interest Disclosures: Dr Ostelo reported receiving grants from ZonMw and WCF outside the submitted work. Dr Huygen reported receiving personal fees from Abbott and Grunenthal outside the submitted work. Dr Huygen has a patent P121304EP00 pending and a patent P121304NL00 pending. Dr Oosterhuis reported receiving grants from ZonMW, Ministry of Social Affairs and employment outside the submitted work. No other disclosures were reported.
Funding Information:
Conflict of Interest Disclosures: Dr Ostelo reported receiving grants from ZonMw and WCF outside the submitted work. Dr Huygen reported receiving personal fees from Abbott and Grunenthal outside the submitted work. Dr Huygen has a patent P121304EP00 pending and a patent P121304NL00 pending. Dr Oosterhuis reported receiving grants from ZonMW, Ministry of Social Affairs and employment outside the submitted work. No other disclosures were reported.Funding/Support: This study was internally funded by the Vrije Universiteit Amsterdam through the van Meenen middelen.
Publisher Copyright:
© 2023
PY - 2023/6
Y1 - 2023/6
N2 - Objectives: To develop and validate approaches for mapping Oswestry Disability Index responses to 3-level version of EQ-5D utility values and to evaluate the impact of using mapped utility values on cost-utility results compared with published regression models. Methods: Three response mapping approaches were developed in a random sample of 70% of 18 692 patients with low back pain: nonparametric approach (Non-p), nonparametric approach excluding logical inconsistencies (Non-peLI), and ordinal logistic regression (OLR). Performance was assessed in the remaining 30% using R-square (R2), root mean square error (RMSE), and mean absolute error (MAE). To evaluate whether MAEs and their 95% limits of agreement (LA) were clinically relevant, a minimally clinically important difference of 0.074 was used. Probabilities of cost-effectiveness estimated using observed and mapped utility values were compared in 2 economic evaluations. Results: The Non-p performed the best (R2 = 0.43; RMSE = 0.22; MAE = 0.03; 95% LA = −0.40 to 0.47) compared with the Non-peLI (R2 = 0.07; RMSE = 0.29; MAE = −0.15; 95% LA = −0.63 to 0.34) and OLR (R2 = 0.22; RMSE = 0.26; MAE = 0.02; 95% LA = −0.49 to 0.53). MAEs were lower than the minimally clinically important difference for the Non-p and OLR but not for the Non-peLI. Differences in probabilities of cost-effectiveness ranged from 1% to 4% (Non-p), 0.1% to 9% (Non-peLI), and 0.1% to 20% (OLR). Conclusions: Results suggest that the developed response mapping approaches are not valid for estimating individual patients’ 3-level version of EQ-5D utility values, and—depending on the approach—may considerably affect cost-utility results. The developed approaches did not perform better than previously published regression-based models and are therefore not recommended for use in economic evaluations.
AB - Objectives: To develop and validate approaches for mapping Oswestry Disability Index responses to 3-level version of EQ-5D utility values and to evaluate the impact of using mapped utility values on cost-utility results compared with published regression models. Methods: Three response mapping approaches were developed in a random sample of 70% of 18 692 patients with low back pain: nonparametric approach (Non-p), nonparametric approach excluding logical inconsistencies (Non-peLI), and ordinal logistic regression (OLR). Performance was assessed in the remaining 30% using R-square (R2), root mean square error (RMSE), and mean absolute error (MAE). To evaluate whether MAEs and their 95% limits of agreement (LA) were clinically relevant, a minimally clinically important difference of 0.074 was used. Probabilities of cost-effectiveness estimated using observed and mapped utility values were compared in 2 economic evaluations. Results: The Non-p performed the best (R2 = 0.43; RMSE = 0.22; MAE = 0.03; 95% LA = −0.40 to 0.47) compared with the Non-peLI (R2 = 0.07; RMSE = 0.29; MAE = −0.15; 95% LA = −0.63 to 0.34) and OLR (R2 = 0.22; RMSE = 0.26; MAE = 0.02; 95% LA = −0.49 to 0.53). MAEs were lower than the minimally clinically important difference for the Non-p and OLR but not for the Non-peLI. Differences in probabilities of cost-effectiveness ranged from 1% to 4% (Non-p), 0.1% to 9% (Non-peLI), and 0.1% to 20% (OLR). Conclusions: Results suggest that the developed response mapping approaches are not valid for estimating individual patients’ 3-level version of EQ-5D utility values, and—depending on the approach—may considerably affect cost-utility results. The developed approaches did not perform better than previously published regression-based models and are therefore not recommended for use in economic evaluations.
KW - EQ-5D
KW - Oswestry Disability Index
KW - low back pain
KW - response mapping
UR - https://www.scopus.com/pages/publications/85150252530
UR - https://www.ncbi.nlm.nih.gov/pubmed/36773782
U2 - 10.1016/j.jval.2023.01.020
DO - 10.1016/j.jval.2023.01.020
M3 - Article
C2 - 36773782
SN - 1098-3015
VL - 26
SP - 873
EP - 882
JO - Value in health
JF - Value in health
IS - 6
ER -