Estimating EQ-5D Weights from other Trial Outcome Measures for Use in Cost-Effectiveness Studies: An Example in Patients with Frozen Shoulder

Abstract

Background

Health-related quality of life (HRQoL) weights, such as EQ-5D, needed for conducting economic evaluations in frozen shoulder populations are currently lacking. The present study examines the feasibility of using mapping methodology to estimate HRQoL, obtain quality-adjusted life-years (QALYs) and undertake a cost-effectiveness analysis to help inform decision-making.

Methods

Patient-level data from a randomized trial in a similar population were used to undertake a mapping exercise evaluating a variety of regression modelling techniques. The Short-Form-36 component summary scores and pain visual analogue scale scores were mapped to EQ-5D. The best fit model was selected and the predicted weights were used for estimating QALYs and cost-effectiveness results.

Results

The selected model explained 41% (R ²) of the variation in EQ-5D weights and the estimates for interventions ranged from 0.5025 to 0.6619 at baseline and from 0.6903 to 0.7600 at 3 months. The QALYs (gained) ranged from 0.1518 to 0.1715 and the estimates of cost-effectiveness were up to £400 per QALY for steroid injection compared to physical therapy with steroid injection.

Discussion

Few studies in frozen shoulder populations include HRQoL weights. We have shown that mapping can potentially take advantage of datasets in similar populations and estimate HRQoL outcomes and subsequently cost-effectiveness. The results may be uncertain but can be helpful in informing the discussion around cost-effectiveness and future areas of research.

Keywords

Get full access to this article

View all access options for this article.

References

1 National Institute for Health and Clinical Excellence. Guide to the methods of technology appraisal. London: National Institute for Health and Clinical Excellence, 2008.

2 Woolf

Erwin

March

. The need to address the burden of musculoskeletal conditions. Best Pract Res Clin Rheumatol 2012; 6:183–224.

3 Sarah Parsons

Ingram

Clarke-Cornwell

Symmons

DPM

. A Heavy Burden the occurrence and impact of musculoskeletal conditions in the United Kingdom today. The University of Manchester, 2011. http://www.medicine.manchester.ac.uk/musculoskeletal/aboutus/publications/heavyburden.pdf.

4 Woolf

Pfleger

. Burden of major musculoskeletal conditions. Special Theme – Bone and Joint Decade 2000–2010. Bull World Health Organ 2003; 81:646–56.

5 Hurst

Kind

Ruta

Hunter

Stubbings

. Measuring health-related quality of life in rheumatoid arthritis: Validity, responsiveness and reliability of EuroQol (EQ-5D). Br J Rheumatol 1997; 36:551–9.

6 Salaffi

Carotti

Ciapetti

Gasparini

Grassi

. Comparison of utility measurement using EQ-5D and SF-6D preference-based generic instruments in patients with rheumatoid arthritis. Clin Exp Rheumatol 2011; 29:661–71.

7 Geraets

Goossens

de Brujn

. Cost-effectiveness of a graded exercise therapy program for patients with chronic shoulder complaints. J Technol Assess Health Care 2005; 22:76–83.

8 Bergman

Winter

van Tulder

. Manipulative therapy in addition to usual medical care accelerates recovery of shoulder complaints at higher costs: Economic outcomes of a randomized trial. BMC Musculoskelet Disord 2010; 11:200.

9 James

Stokes

Thomas

Dziedzic

Hay

. A cost consequence analysis of local corticosteroid injection and physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care. Rheumatology 2005; 44:1447–51.

10.

10 Ottenheijm

RPG

Joore

Walenkamp

GHIM

. The Maastricht Ultrasound Shoulder pain trial (MUST): Ultrasound imaging as a diagnostic triage tool to improve management of patients with non-chronic shoulder pain in primary care. BMC Musculoskelet Disord 2011; 12:154.

11.

11 Watson

Helliwell

Morton

. Shoulder acute pain in primary healthcare: Is retraining effective for GP principals? SAPPHIRE – a randomized controlled trial. Rheumatology 2008; 47:1795–802.

12.

12 McKenna

Bojke

Manca

. Shoulder acute pain in primary health care: Is retraining GPs effective? The SAPPHIRE randomized trial: A cost-effectiveness analysis. Rheumatology 2009; 48:558–63.

13.

13 Vitale

Vitale

Zivin

. Rotator cuff repair: An analysis of utility scores and cost-effectiveness. J Shoulder Elbow Surg 2007; 16:181–7.

14.

14 Manca

Epstein

Torgerson

. Randomized trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: Cost-effectiveness analysis. Int J Technol Assess Health Care 2006; 22:67–75.

15.

15 Lewis

James

Stokes

. An economic evaluation of three physiotherapy treatments for non-specific next disorders alongside a randomised trial. Rheumatology 2007; 11:1701–8.

16.

16 Tosh

Longworth

George

. Utility values in National Institute for Health and Clinical Excellence (NICE) technology appraisals. Value Health 2011; 14:102–9.

17.

17 Maund

Craig

Suekarran

. Management of frozen shoulder: A systematic review and cost-effectiveness analysis. Health Technol Assess 2012; 16:1–264.

18.

18 van den Hout

Vermeulen

Rozing

Vliet Vlieland

TPM

. Impact of adhesive capsulitus and economic evaluation of high-grade and low-grade mobilisation techniques. Aust J Physiother 2005; 51:141–9.

19.

19 Chuang

Whitehead

. Mapping for economic evaluation. Br Med Bull 2011; 101:1–15.

20.

20 Stergioulas

. Low-power laser treatment in patients with frozen shoulder: Preliminary results. Photomed Laser Surg 2008; 26:99–105. Arthritis Rheum 2003; 48:829–38.

21.

21 Carette

Moffet

Tardif

. Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: A placebo-controlled trial. Arthritis Rheum 2003; 48:829–37.

22.

22 Dogru

Basaran

Sarpel

. Effectiveness of therapeutic ultrasound in adhesive capsulitis. Joint Bone Spine 2008; 75:445–50.

23.

23 Brazier

Yang

Tsuchiya

Rowen

. A review of studies mapping (or cross walking) non-preference based measures to generic preference-based measures. Eur J Health Econ 2010; 11:215–25.

24.

24 Dawson

Sheppard

Carr

. An overview of factors relevant to undertaking research and reviews on the effectiveness of treatment for frozen shoulder. Shoulder Elbow 2010; 2:232–7.

25.

25 Kuye

Jain

Warner

Herndon

Warner

JJP

. Economic evaluations in shoulder pathologies: A systematic review of the literature. J Shoulder Elbow Surg 2012; 21:367–75.

26.

26 Longworth

Rowen

. NICE DSU technical support document 10: the use of mapping methods to estimate health state utility values. 2011. http://nicedsu.org.uk. (date last accessed 12th May 2012).

27.

27 Pertrou

Gray

. Economic evaluation alongside randomised controlled trials: Design, conduct, analysis, and reporting. Collecting data at the same time as evidence of effectiveness maximised the information available for analysis but requires proper consideration at the design stage. Br Med J 2011; 342:d1548.

28.

28 Versteegh

Rowen

Brazier

Stolk

. Mapping onto Eq-5 D for patients in poor health. Health Qual Life Outcomes 2010; 8:141.

29.

29 Paul

Lewis

Shadforth

. A comparison of four shoulder-specific questionnaires in primary care. Ann Rheum Dis 2004; 63:1293–9.

30.

30 Harrison

Bansback

Marra

. Valuing health for clinical and economic decisions: Directions relevant for rheumatologists. J Rheumatol 2011; 38:1770–5.

31.

31 Tugwell

Boers

Brooks

. OMERACT: An international initiative to improve outcome measurement in rheumatology. Trials 2007; 8:38.

32.

32 Kirwan

Tugwell

. Overview of the patient perspective at OMERACT 10 – conceptualising methods for developing patient-reported outcomes. J Rheumatol 2011; 38:1699–701.

33.

33 Starkie

Briggs

Chambers

Jones

. Predicting EQ-5D values using the SGRQ. Value Health 2011; 14:354–60.

34.

34 Dolan

. Modeling valuations for EuroQol health states. Med Care 1997; 35:1095–108.