Variation in health state preferences across local

and international populations:

East doesn’t meet WestCADTH symposium

Panel SessionApril 12, 2016

Dr. Simon Pickard, University of Illinois at ChicagoDr. Jeffrey Johnson, University of AlbertaDr. Eleanor Pullenayegum, University of TorontoDr. Feng Xie, McMaster University

Disclosures• Simon Pickard

– Chair, Executive Committee, EQ Group• Jeff Johnson

– Member, Board of Directors, EQ Research Foundation

• Eleanor Pullenayegum– Member, EQ Group

• Feng Xie– Member, EQ Group

Outline

• Background • Comparing regional values in Canada • Are there differences and do they matter?• Insight international comparisons • Symposium discussion (panel + audience)

PROs in HTA• Preference-based measures of health, e.g.

– EQ-5D– Health Utilities Index– SF-6D

• Many applications– Clinical trial outcomes– Population health monitoring– Quality of care via PROMs in health systems

• Societal preference-weights (“value sets”) facilitate QALY calculations in cost-utility analysis– Inform resource allocation

CUA in HTA

• HTA: evidence-based, encourages standardization, supports explicit guidelines for decision making

• “A CUA should be used in the Reference Case where meaningful HRQL differences between the intervention and alternatives have been demonstrated, and where appropriate preference (utility) data are available. Preferences should be derived using valid approaches.”

– Guidelines for the economic evaluation of health technologies: Canada [3rd Edition]. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2006.

Preference-based measures

• Health Utilities Index Mark 2 & Mark 3• Sample: Hamilton, 1994 (VAS/SG)

• SF-6D• Value sets available; no Canadian values

• EQ-5D– EQ-5D-3L: many value sets available, including

Canada (Bansback et al, 2012)– EQ-5D-5L: many value sets available, including

Canada (Xie et al, 2016)• Based on a standardized, international protocol • Enables comparison across countries

How generalizable?

• Represent the population of interest• National healthcare -> societal preferences

– E.g. NICE, national decision making body. • The Canadian context

– provinces are responsible for managing healthcare budgets

– Are there differences? – Whose values are most appropriate?

• Internationally where we find differences? (sources of heterogeneity in preferences?)

• 3 presentations on this theme

Canadian TTO Valuations of the EQ-5D-5L:

East versus West Differences

Jeffrey A. Johnson, PhDProfessor, School of Public HealthUniversity of Alberta

Regional variation in health state preferences:

does it exist and does it matter?

Eleanor Pullenayegum, PhDAssociate Professor, University of Toronto & Sick Kids Research Institute

Transforming latent utilities to health utilities:

East doesn’t meet West

Feng Xie, PhDAssociate Professor, Centre for Health Services ResearchMcMaster University

• What are some advantages to using regional value sets? disadvantages?

• What further work needs to be done if regional value sets are desired by some provinces?

• Who should make this decision? • Is it acceptable from a federal standpoint?• Do regional value sets better support healthcare

principles important to Canadians, or diminish them?

• Are sources of heterogeneity driven by national culture, or characteristics that cut across borders, like religion, ethnicity, gender?

Panel Discussion