Not all “quality-adjusted life years” are equal
Abstract Background There is evidence that utility elicitation methods used in the calculation of quality-adjusted life years (QALYs) yield different results. It is not clear how these differences impact economic evaluations. Methods Using a mathematical model incorporating data on efficacy, costs,...
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| Veröffentlicht in: | Journal of clinical epidemiology 2007-06, Vol.60 (6), p.616-624 |
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| creator | Marra, C.A Marion, S.A Guh, D.P Najafzadeh, M Wolfe, F Esdaile, J.M Clarke, A.E Gignac, M.A Anis, A.H |
| description | Abstract Background There is evidence that utility elicitation methods used in the calculation of quality-adjusted life years (QALYs) yield different results. It is not clear how these differences impact economic evaluations. Methods Using a mathematical model incorporating data on efficacy, costs, and utility values, we simulated the experiences of 100,000 hypothetical rheumatoid arthritis patients over 10 years (50,000 exposed to infliximab plus methotrexate [MTX] and 50,000 exposed to MTX alone). QALYs, were derived from the Health Utilities Index 2 and 3 (HUI2 and HUI3), the Short Form 6-D (SF-6D), and the Euroqol 5-D (EQ-5D). Incremental cost-utility ratios were determined using each instrument to calculate QALYs and the results were compared using cost-effectiveness acceptability curves. Results Using the different utility measurement methods, the mean difference in QALYs between the infliximab plus MTX and MTX groups ranged from a high of 1.95 QALYs (95% CI = 1.93–1.97) using the HUI3 to 0.89 QALYs (95% CI = 0.88–0.91) using the SF-6D. Adopting the commonly cited value of society's willingness to pay for a QALY of $50,000, 91% of the simulations favored the cost utility of infliximab plus MTX when using the HUI3 to calculate QALYs. However, when using the EQ-5D, HUI2, or the SF-6D utility values to calculate QALYS, the proportion of simulations that favored the cost utility of infliximab were 63%, 45%, and 12%, respectively. Conclusion Depending on the method for determining utility values used in the calculation of QALYs, very different incremental cost-utility ratios are generated. |
| doi_str_mv | 10.1016/j.jclinepi.2006.09.006 |
| format | Article |
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It is not clear how these differences impact economic evaluations. Methods Using a mathematical model incorporating data on efficacy, costs, and utility values, we simulated the experiences of 100,000 hypothetical rheumatoid arthritis patients over 10 years (50,000 exposed to infliximab plus methotrexate [MTX] and 50,000 exposed to MTX alone). QALYs, were derived from the Health Utilities Index 2 and 3 (HUI2 and HUI3), the Short Form 6-D (SF-6D), and the Euroqol 5-D (EQ-5D). Incremental cost-utility ratios were determined using each instrument to calculate QALYs and the results were compared using cost-effectiveness acceptability curves. Results Using the different utility measurement methods, the mean difference in QALYs between the infliximab plus MTX and MTX groups ranged from a high of 1.95 QALYs (95% CI = 1.93–1.97) using the HUI3 to 0.89 QALYs (95% CI = 0.88–0.91) using the SF-6D. Adopting the commonly cited value of society's willingness to pay for a QALY of $50,000, 91% of the simulations favored the cost utility of infliximab plus MTX when using the HUI3 to calculate QALYs. However, when using the EQ-5D, HUI2, or the SF-6D utility values to calculate QALYS, the proportion of simulations that favored the cost utility of infliximab were 63%, 45%, and 12%, respectively. Conclusion Depending on the method for determining utility values used in the calculation of QALYs, very different incremental cost-utility ratios are generated.</description><identifier>ISSN: 0895-4356</identifier><identifier>EISSN: 1878-5921</identifier><identifier>DOI: 10.1016/j.jclinepi.2006.09.006</identifier><identifier>PMID: 17493521</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Antibodies, Monoclonal - economics ; Antibodies, Monoclonal - therapeutic use ; Antirheumatic Agents - economics ; Antirheumatic Agents - therapeutic use ; Arthritis, Rheumatoid - economics ; Arthritis, Rheumatoid - rehabilitation ; Biological and medical sciences ; Cost-Benefit Analysis ; Cost-effectiveness ; Data Interpretation, Statistical ; Diseases of the osteoarticular system ; Drug therapy ; Drug Therapy, Combination ; Economic evaluation ; Epidemiology ; General aspects ; Humans ; Inflammatory joint diseases ; Infliximab ; Internal Medicine ; Markov Chains ; Medical sciences ; Methodology ; Methods ; Methotrexate - economics ; Methotrexate - therapeutic use ; Models, Statistical ; Mortality ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Quality of life ; Quality-Adjusted Life Years ; Rheumatoid arthritis ; Studies ; Survival Analysis ; Time Factors ; Utility values</subject><ispartof>Journal of clinical epidemiology, 2007-06, Vol.60 (6), p.616-624</ispartof><rights>Elsevier Inc.</rights><rights>2007 Elsevier Inc.</rights><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c479t-51f557953f54393ee34ee4ea83e785282f385b2c86c7f3d58974ece1c043f1a23</citedby><cites>FETCH-LOGICAL-c479t-51f557953f54393ee34ee4ea83e785282f385b2c86c7f3d58974ece1c043f1a23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0895435606003593$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18788159$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17493521$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Marra, C.A</creatorcontrib><creatorcontrib>Marion, S.A</creatorcontrib><creatorcontrib>Guh, D.P</creatorcontrib><creatorcontrib>Najafzadeh, M</creatorcontrib><creatorcontrib>Wolfe, F</creatorcontrib><creatorcontrib>Esdaile, J.M</creatorcontrib><creatorcontrib>Clarke, A.E</creatorcontrib><creatorcontrib>Gignac, M.A</creatorcontrib><creatorcontrib>Anis, A.H</creatorcontrib><title>Not all “quality-adjusted life years” are equal</title><title>Journal of clinical epidemiology</title><addtitle>J Clin Epidemiol</addtitle><description>Abstract Background There is evidence that utility elicitation methods used in the calculation of quality-adjusted life years (QALYs) yield different results. It is not clear how these differences impact economic evaluations. Methods Using a mathematical model incorporating data on efficacy, costs, and utility values, we simulated the experiences of 100,000 hypothetical rheumatoid arthritis patients over 10 years (50,000 exposed to infliximab plus methotrexate [MTX] and 50,000 exposed to MTX alone). QALYs, were derived from the Health Utilities Index 2 and 3 (HUI2 and HUI3), the Short Form 6-D (SF-6D), and the Euroqol 5-D (EQ-5D). Incremental cost-utility ratios were determined using each instrument to calculate QALYs and the results were compared using cost-effectiveness acceptability curves. Results Using the different utility measurement methods, the mean difference in QALYs between the infliximab plus MTX and MTX groups ranged from a high of 1.95 QALYs (95% CI = 1.93–1.97) using the HUI3 to 0.89 QALYs (95% CI = 0.88–0.91) using the SF-6D. Adopting the commonly cited value of society's willingness to pay for a QALY of $50,000, 91% of the simulations favored the cost utility of infliximab plus MTX when using the HUI3 to calculate QALYs. However, when using the EQ-5D, HUI2, or the SF-6D utility values to calculate QALYS, the proportion of simulations that favored the cost utility of infliximab were 63%, 45%, and 12%, respectively. Conclusion Depending on the method for determining utility values used in the calculation of QALYs, very different incremental cost-utility ratios are generated.</description><subject>Antibodies, Monoclonal - economics</subject><subject>Antibodies, Monoclonal - therapeutic use</subject><subject>Antirheumatic Agents - economics</subject><subject>Antirheumatic Agents - therapeutic use</subject><subject>Arthritis, Rheumatoid - economics</subject><subject>Arthritis, Rheumatoid - rehabilitation</subject><subject>Biological and medical sciences</subject><subject>Cost-Benefit Analysis</subject><subject>Cost-effectiveness</subject><subject>Data Interpretation, Statistical</subject><subject>Diseases of the osteoarticular system</subject><subject>Drug therapy</subject><subject>Drug Therapy, Combination</subject><subject>Economic evaluation</subject><subject>Epidemiology</subject><subject>General aspects</subject><subject>Humans</subject><subject>Inflammatory joint diseases</subject><subject>Infliximab</subject><subject>Internal Medicine</subject><subject>Markov Chains</subject><subject>Medical sciences</subject><subject>Methodology</subject><subject>Methods</subject><subject>Methotrexate - economics</subject><subject>Methotrexate - therapeutic use</subject><subject>Models, Statistical</subject><subject>Mortality</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Quality of life</subject><subject>Quality-Adjusted Life Years</subject><subject>Rheumatoid arthritis</subject><subject>Studies</subject><subject>Survival Analysis</subject><subject>Time Factors</subject><subject>Utility values</subject><issn>0895-4356</issn><issn>1878-5921</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFks1u1DAUhS0EokPhFapICHYJ17Ed2xsEqviTKlgAa8t1riUHTzK1k0qz64PAy_VJcDSDRuqG1dl89_j43EvIBYWGAu3eDM3gYhhxF5oWoGtAN0UekQ1VUtVCt_Qx2YDSouZMdGfkWc4DAJUgxVNyRiXXTLR0Q9jXaa5sjNX93e-bxcYw72vbD0uesa9i8Fjt0aZ8f_ensgkrXJnn5Im3MeOLo56Tnx8__Lj8XF99-_Tl8v1V7bjUcy2oF0JqwbzgTDNExhE5WsVQKtGq1jMlrlunOic964XSkqND6oAzT23Lzsnrg-8uTTcL5tlsQ3YYox1xWrKRwBVnsIIvH4DDtKSxZDMUGKOqEwwK1R0ol6acE3qzS2Fr075AZi3VDOZfqWYt1YA2RcrgxdF-ud5ifxo7tliAV0fAZmejT3Z0IZ-4shJFhS7cuwOHpbXbgMlkF3B02IeEbjb9FP6f5e0Di5UK5dVfuMd8-rfJrQHzfT2B9QKgA2AlAvsL4kOstg</recordid><startdate>20070601</startdate><enddate>20070601</enddate><creator>Marra, C.A</creator><creator>Marion, S.A</creator><creator>Guh, D.P</creator><creator>Najafzadeh, M</creator><creator>Wolfe, F</creator><creator>Esdaile, J.M</creator><creator>Clarke, A.E</creator><creator>Gignac, M.A</creator><creator>Anis, A.H</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7QP</scope><scope>7RV</scope><scope>7T2</scope><scope>7T7</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20070601</creationdate><title>Not all “quality-adjusted life years” are equal</title><author>Marra, C.A ; Marion, S.A ; Guh, D.P ; Najafzadeh, M ; Wolfe, F ; Esdaile, J.M ; Clarke, A.E ; Gignac, M.A ; Anis, A.H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c479t-51f557953f54393ee34ee4ea83e785282f385b2c86c7f3d58974ece1c043f1a23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Antibodies, Monoclonal - economics</topic><topic>Antibodies, Monoclonal - therapeutic use</topic><topic>Antirheumatic Agents - economics</topic><topic>Antirheumatic Agents - therapeutic use</topic><topic>Arthritis, Rheumatoid - economics</topic><topic>Arthritis, Rheumatoid - rehabilitation</topic><topic>Biological and medical sciences</topic><topic>Cost-Benefit Analysis</topic><topic>Cost-effectiveness</topic><topic>Data Interpretation, Statistical</topic><topic>Diseases of the osteoarticular system</topic><topic>Drug therapy</topic><topic>Drug Therapy, Combination</topic><topic>Economic evaluation</topic><topic>Epidemiology</topic><topic>General aspects</topic><topic>Humans</topic><topic>Inflammatory joint diseases</topic><topic>Infliximab</topic><topic>Internal Medicine</topic><topic>Markov Chains</topic><topic>Medical sciences</topic><topic>Methodology</topic><topic>Methods</topic><topic>Methotrexate - economics</topic><topic>Methotrexate - therapeutic use</topic><topic>Models, Statistical</topic><topic>Mortality</topic><topic>Public health. 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It is not clear how these differences impact economic evaluations. Methods Using a mathematical model incorporating data on efficacy, costs, and utility values, we simulated the experiences of 100,000 hypothetical rheumatoid arthritis patients over 10 years (50,000 exposed to infliximab plus methotrexate [MTX] and 50,000 exposed to MTX alone). QALYs, were derived from the Health Utilities Index 2 and 3 (HUI2 and HUI3), the Short Form 6-D (SF-6D), and the Euroqol 5-D (EQ-5D). Incremental cost-utility ratios were determined using each instrument to calculate QALYs and the results were compared using cost-effectiveness acceptability curves. Results Using the different utility measurement methods, the mean difference in QALYs between the infliximab plus MTX and MTX groups ranged from a high of 1.95 QALYs (95% CI = 1.93–1.97) using the HUI3 to 0.89 QALYs (95% CI = 0.88–0.91) using the SF-6D. Adopting the commonly cited value of society's willingness to pay for a QALY of $50,000, 91% of the simulations favored the cost utility of infliximab plus MTX when using the HUI3 to calculate QALYs. However, when using the EQ-5D, HUI2, or the SF-6D utility values to calculate QALYS, the proportion of simulations that favored the cost utility of infliximab were 63%, 45%, and 12%, respectively. Conclusion Depending on the method for determining utility values used in the calculation of QALYs, very different incremental cost-utility ratios are generated.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>17493521</pmid><doi>10.1016/j.jclinepi.2006.09.006</doi><tpages>9</tpages></addata></record> |
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| subjects | Antibodies, Monoclonal - economics Antibodies, Monoclonal - therapeutic use Antirheumatic Agents - economics Antirheumatic Agents - therapeutic use Arthritis, Rheumatoid - economics Arthritis, Rheumatoid - rehabilitation Biological and medical sciences Cost-Benefit Analysis Cost-effectiveness Data Interpretation, Statistical Diseases of the osteoarticular system Drug therapy Drug Therapy, Combination Economic evaluation Epidemiology General aspects Humans Inflammatory joint diseases Infliximab Internal Medicine Markov Chains Medical sciences Methodology Methods Methotrexate - economics Methotrexate - therapeutic use Models, Statistical Mortality Public health. Hygiene Public health. Hygiene-occupational medicine Quality of life Quality-Adjusted Life Years Rheumatoid arthritis Studies Survival Analysis Time Factors Utility values |
| title | Not all “quality-adjusted life years” are equal |
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