RESULTS ( 1 ) EQ-5D was valid and responsive for skin conditions and most cancers ; in vision , its performance varied according to aetiology ; and performance was poor for hearing impairments .
The HUI3 performed well for hearing and vision disorders .
It also performed well in cancers although evidence was limited and there was no evidence in skin conditions .
Response mapping using all the domain scores was the best performing model for the EORTC QLQ-C30 .
In an exploratory analysis , a limited dependent variable mixture model performed better than an equivalent linear model .
3 ) The exploratory valuation study found that bolt-on items for vision , hearing and tiredness had a significant impact on values of the health states , but the direction and magnitude of differences depended on the severity of the health state .
The vision bolt-on item had a statistically significant impact on EQ-5D health state values and a full valuation model was estimated .
EQ-5D performs well in studies of cancer and skin conditions .
Mapping techniques provide a solution to predict EQ-5D values where EQ-5D has not been administered .
For conditions where EQ-5D was found to be inappropriate , including some vision disorders and for hearing , bolt-ons provide a promising solution .
BACKGROUND The National Institute for Health and Care Excellence recommends the use of generic preference-based measures ( GPBMs ) of health for its Health Technology Assessment s ( HTAs ) .
However , these data may not be available or appropriate for all health conditions .
OBJECTIVES To determine whether GPBMs are appropriate for some key conditions and to explore alternative methods of utility estimation when data from GPBMs are unavailable or inappropriate .
( 2 ) Potential modelling approaches to ' map ' EQ-5D values from condition-specific and clinical measures of health [ European Organisation for Research and Treatment of Cancer Quality -of-life Question naire Core 30 ( EORTC QLQ-C30 ) and Functional Assessment of Cancer Therapy - General Scale ( FACT-G ) ] are compared for predictive ability and goodness of fit using two separate data sets . (
Changes in Quality of Life and the Cost-Utility Associated with Cochlear Implantation in Patients with Large Vestibular Aqueduct Syndrome
Objective A group of 20 patients with large vestibular aqueduct syndrome was identified at the Indiana University School of Medicine . The major objective of this study was to explore the improvements in quality of life associated with cochlear implantation in patients with large vestibular aqueduct syndrome , as well as the cost-utility of cochlear implantation in this group . Setting A total of 70 patients were identified with large vestibular aqueduct syndrome through analysis of thin-section computed tomography of the temporal bone over the past 6 years at this medical center . Data collected from the medical records for each patient included demographic data , hearing-related statistics , implantation data , and audiometric data . Sixteen children and adults with large vestibular aqueduct syndrome had undergone cochlear implantation before the beginning of this study , and the remaining 54 children and adults were identified as undergoing treatment of progressive or fluctuant sensorineural hearing loss . Health utility indexes used in this analysis were taken through the use of the Ontario Health Utility Index , Mark III . The range of costs used for cost-utility analysis was derived from the costs of cochlear implantation at this medical center , as well as from costs associated with implantation published in the medical literature . Methods Participants were selected from the total population of patients with large vestibular aqueduct syndrome at this center who were postlingually deafened and who currently had severe hearing loss . Two groups were formed . These groups comprised either  cochlear implant patients with large vestibular aqueduct syndrome  or  patients  with  large vestibular aqueduct syndrome currently using hearing aids . Ten of the 16 cochlear implant patients and 10 of the remaining 54 patients with large vestibular aqueduct syndrome met these criteria . Mark III health utility indexes were distributed to patients in each group and scored . Those health utility indexes not completed by the patients were scored by proxy , using the audiologist at this center who was the most familiar with the patient . Changes in quality of life associated with cochlear implantation were derived by comparison of the health utility index results of the two groups . Cost-utility measures were then made using discounted costs per quality -of-life years ( QALYs ) ( 5 % ) , and a sensitivity analysis was performed that evaluated changes in scoring done by proxy . The cost-utility results were then compared with the cost-utilities derived from similar studies and associated with other disease states . Results Although both groups of patients had significant hearing loss , the hearing aid group had a better mean pure-tone average . The mean pure-tone average for the hearing aid group was 70.8 dB ( SD 24.4 ) , and the mean pure-tone average for the cochlear implant group was 107.0 dB ( SD 21.7 ) . Seven of the 20 health utility indexes were scored by proxy . Results from the base case indicate a 0.20 gain in health utility from cochlear implantation ( hearing aid = 0.62 , cochlear implant = 0.82 , p = 0.037 ) , result ing in a discounted cost per QALY of $ 12,774 . Sensitivity analysis of the proxy scoring indicated that decreasing the hearing score one level on the health utility index result ed in a gain in health utility with cochlear implantation of 0.15 , result ing in a discounted cost per QALY of $ 17,832 . A decrease of the hearing score by two levels on the health utility survey result ed in no significant gain in quality of life with cochlear implantation . Conclusion This study found an improvement in quality of life associated with cochlear implantation in postlingually deafened patients with large vestibular aqueduct syndrome . By weighing this improvement in quality of life against the significant difference noted between the pure-tone averages of each group , further strength can be given to this conclusion . This gain in quality of life , as well as the results derived for the cost-utility of cochlear implantation , was similar to that in previous published studies of cochlear implantation in all types of patients . These results also indicate a favorable cost-utility when compared with published data about other disease states . As patients with large vestibular aqueduct syndrome progress to profound levels of hearing loss , these results indicate that cochlear implantation can be offered as a beneficial , life-improving therapy
RESULTS ( 1 ) EQ-5D was valid and responsive for skin conditions and most cancers ; in vision , its performance varied according to aetiology ; and performance was poor for hearing impairments .
The HUI3 performed well for hearing and vision disorders .
It also performed well in cancers although evidence was limited and there was no evidence in skin conditions .
Response mapping using all the domain scores was the best performing model for the EORTC QLQ-C30 .
In an exploratory analysis , a limited dependent variable mixture model performed better than an equivalent linear model .
3 ) The exploratory valuation study found that bolt-on items for vision , hearing and tiredness had a significant impact on values of the health states , but the direction and magnitude of differences depended on the severity of the health state .
The vision bolt-on item had a statistically significant impact on EQ-5D health state values and a full valuation model was estimated .
EQ-5D performs well in studies of cancer and skin conditions .
Mapping techniques provide a solution to predict EQ-5D values where EQ-5D has not been administered .
For conditions where EQ-5D was found to be inappropriate , including some vision disorders and for hearing , bolt-ons provide a promising solution .
BACKGROUND The National Institute for Health and Care Excellence recommends the use of generic preference-based measures ( GPBMs ) of health for its Health Technology Assessment s ( HTAs ) .
However , these data may not be available or appropriate for all health conditions .
OBJECTIVES To determine whether GPBMs are appropriate for some key conditions and to explore alternative methods of utility estimation when data from GPBMs are unavailable or inappropriate .
( 2 ) Potential modelling approaches to ' map ' EQ-5D values from condition-specific and clinical measures of health [ European Organisation for Research and Treatment of Cancer Quality -of-life Question naire Core 30 ( EORTC QLQ-C30 ) and Functional Assessment of Cancer Therapy - General Scale ( FACT-G ) ] are compared for predictive ability and goodness of fit using two separate data sets . (