A Comparison of Direct and Indirect Methods for the Estimation of Health Utilities from Clinical Outcomes

Mónica Hernández Alava · Allan Wailoo · Fred Wolfe · Kaleb D. Michaud

77 citations0/0 files storedMedical Decision Making

No readable copy stored yet — this record is metadata only.

No open-access location is known for this record yet.

Literature note Cite in a project Citation map

Health Systems, Economic Evaluations, Quality of Life Economic and Environmental Valuation Delphi Technique in Research

Abstract

BACKGROUND: Analysts frequently estimate health state utility values from other outcomes. Utility values like EQ-5D have characteristics that make standard statistical methods inappropriate. We have developed a bespoke, mixture model approach to directly estimate EQ-5D. An indirect method, "response mapping," first estimates the level on each of the 5 dimensions of the EQ-5D and then calculates the expected tariff score. These methods have never previously been compared. METHODS: We use a large observational database from patients with rheumatoid arthritis (N = 100,398). Direct estimation of UK EQ-5D scores as a function of the Health Assessment Questionnaire (HAQ), pain, and age was performed with a limited dependent variable mixture model. Indirect modeling was undertaken with a set of generalized ordered probit models with expected tariff scores calculated mathematically. Linear regression was reported for comparison purposes. Impact on cost-effectiveness was demonstrated with an existing model. RESULTS: The linear model fits poorly, particularly at the extremes of the distribution. The bespoke mixture model and the indirect approaches improve fit over the entire range of EQ-5D. Mean average error is 10% and 5% lower compared with the linear model, respectively. Root mean squared error is 3% and 2% lower. The mixture model demonstrates superior performance to the indirect method across almost the entire range of pain and HAQ. These lead to differences in cost-effectiveness of up to 20%. CONCLUSIONS: There are limited data from patients in the most severe HAQ health states. Modeling of EQ-5D from clinical measures is best performed directly using the bespoke mixture model. This substantially outperforms the indirect method in this example. Linear models are inappropriate, suffer from systematic bias, and generate values outside the feasible range.

Paper brief

Loading…

Cite this work

Citation unavailable for this work.

BibTeX RIS CSL-JSON

No public copy is stored for this record, so only the metadata is cited.

Citations in this library

Citation map →

Stored only when both papers are in the corpus — 77 citations exist upstream.

References

1983Limited-dependent and qualitative variables in econometrics 2005US Valuation of the EQ-5D Health States 2009A review of studies mapping (or cross walking) non-preference based measures of health to generic preference-based measures 2006Estimating the Association between SF-12 Responses and EQ-5D Utility Values by Response Mapping 2012Tails from the Peak District: Adjusted Limited Dependent Variable Mixture Models of EQ-5D Questionnaire Health State Utility Values 2009Mapping the Modified Rankin Scale (mRS) Measurement into the Generic EuroQol (EQ-5D) Health Outcome 2008Biologic drugs for rheumatoid arthritis in the medicare program: A cost‐effectiveness analysis

Explore the map →

Papers that cite the same references — the relational fallback while embeddings are still backfilling.

Imported from OpenAlex (CC0) — nothing here is generated.