The National Institute of Health and Care Excellence (NICE) in England has made an interim position statement about the use of the 5 level version of the EQ-5D for companies, academic groups, and others preparing evidence submissions for NICE.
The main recommendations are:
- The 3 level version (EQ-5D-3L) and the UK TTO value set are (still) the reference case for HTA submission
- If the 5 level is used (EQ-5D-5L), then apply the mapping function developed by van Hout et al. (2012) to convert it to the EQ-5D-3L for the reference-case analyses
- NICE supports sponsors of prospective clinical studies continuing to use the 5L version of EQ-5D descriptive system to collect data on quality of life.
Why has NICE issued this position statement now?
Our understanding is that the statement NICE has issued is its interim position on the EQ-5D-5L now, as the EQ-5D-5L value set for England was published in Heath Economics. In line with the recommendations of the McPherson report (2013), NICE will be seeking an independent validation before considering its final recommendation.
What are the differences between the EQ-5D-3L and the EQ-5D-5L and why might that be important?
There are two differences between the two questionnaires:
- The way they describe health is different: the EQ-5D-5L has five levels rather than three, and has improved the level labels, like ‘unable to walk’ in mobility replaces ‘confined to bed’.
- The way health states are valued is different: value sets for the EQ-5D-5L around the world, including the value set for England, have been produced using an international protocol developed by the EuroQol Group. The methods used for collecting and modelling the value sets are different than those used in valuing the EQ-5D-3L. Differences in values might also be expected because the studies which generated the EQ-5D-3L value sets were in some cases (e.g., the UK) conducted over two decades ago.
The overall difference between the EQ-5D-5L and the EQ-5D-3L will be a product of the differences in both description, valuation and changes in population views of health. A number of research projects are underway internationally, funded by the EuroQol Group, to better understand these differences and their implications for users of the instruments.
For more details on NICE’s position, see the statement on the NICE website. NICE plans to review this statement in August 2018. The five level value sets for other countries are not part of the NICE position statement and are not under review. If 5L value sets are not available, the mapping function developed by van Hout et al. (2012) is advised.