The measurement and valuation of health outcomes

The NICEQoL project is designed to review the standard methods of assessment used by the National Institute of Health and Clinical Excellence (NICE) to establish the impact of health interventions upon health-related quality of life (HRQL), and to develop new methods where appropriate. The validity and reliability of generic measures of HRQL will be reviewed in four key clinical areas: visual impairments, hearing impairments, skin conditions, and cancer. The project will also include the use and development of methods to link data from condition-specific to generic measures of health-related quality of life (also known as ‘mapping’ or ‘cross-walking’). In addition, the project will explore new methods for developing ‘bolt-on’ extensions to the EQ-5D instrument (the preferred instrument of NICE for assessing health-related quality of life for economic evaluation). The additional sensitivity of the ‘bolt-on’ measures to the EQ-5D will be assessed and new valuation sets provided. The project is being conducted in collaboration with researchers at the University of Sheffield.

Dr Louise Longworth has been involved in producing Technical Support Documents for the NICE Technology Appraisal programme on the inclusion of health-related utility data into NICE appraisals. The documents are aimed at analysts producing submissions for the NICE programme and at those who are involved in reviewing NICE submissions, however most of the methodological guidance has wider application for HTA more generally. With Prof John Brazier from University of Sheffield, Dr Louise Longworth has authored guidance on the implications of the reference case for the incorporation of health-related utility data in NICE submissions. She has also authored guidance on the use of mapping to estimate health-related utility data with Dr Donna Rowen also from the University of Sheffield. The Technical Support Documents are available from the NICE Decision Support Unit website.
 

HERG on behalf of MATCH (Multidisciplinary Assessment of Technology Centre for Healthcare) is conducting a research project exploring public views regarding healthcare services using stated preference methods. The aim of this study is to elicit preferences from the general public towards different health care interventions which have been differentiated according to the cause of the condition and who is ‘responsible’ for its cause. The study will elicit direct valuations from members of the general public using person trade off or ‘matching’ method via a large internet survey. Attitudinal questions and ranking exercise based upon perceptions of risk will also be carried out in order to understand why the public value different safety contexts differently.

The EQ-5D is the preferred method of assessing and valuing health for economic evaluation by NICE. It is a generic instrument that can describe a range of different levels of quality of life. A large general population survey was conducted by researchers at the University of York in 1994 in order to develop a ‘tariff’ of preference weights for the different levels of health described by the EQ-5D instrument. The PRET study will assess different methods of valuing and modelling states of health described by the EQ-5D instrument. It is anticipated that the results of the study will help inform the re-evaluation of the EQ-5D population value set used in NICE appraisals. It is being led by Prof Aki Tsuchiya at the University of Sheffield and further details are available from the PRET website.

This research systematically and critically reviews evidence on the value of quality of life impacts of Health Care Acquired Infection (HCAI) and its interventions. All papers containing health-related utility values for treating and preventing HCAI were included from a search of 8 databases and 3 key infection journals. Utility values will be investigated by: type of economic analysis, sources and methods of elicitation (literature, empirical, judgement) and fidelity to stated methods, type and severity of infection, impact of and recovery from surgical procedures and co-morbidities, age of patients and impact on recommendation regarding intervention studied. Early results indicate a high degree of autonomy was practiced by researchers in determining utility values of HCAI and that methods are often not transparent.

PhD Research: ongoing
Contact: Timea Helter (Supervisors: Prof Julia Fox-Rushby and Dr Joanne Lord)

The research aims to contribute to the theory behind the qualitative work associated with the attribute development for Discrete Choice Experiments, by contrasting and comparing different methods of analysing and refining complex information with the purpose of deriving a manageable number of attributes. The research project uses the area of alcohol misuse as an example, and aims to ascertain what the most valued impacts of alcohol misuse policies and interventions are, by indicating what factors are accountable in QALYs, and demonstrating what is missing from the QALY valuation.