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 . (
A Randomized Controlled Clinical Trial of Palliative Therapies for Patients With Inoperable Esophageal Cancer
OBJECTIVES : A dramatic rise in incidence , an aging population , and expensive palliative treatments have led to an escalating burden on clinicians managing inoperable esophageal cancer with only limited evidence of effectiveness . This study compares the clinical effectiveness and cost-effectiveness of self-exp and ing metal stents ( SEMSs ) with other palliative therapies to aid clinicians in making an evidence -based treatment choice . METHODS : We conducted a prospect i ve , multicenter , r and omized , controlled , clinical trial with 215 patients followed until death or study closure . The primary outcome measures were dysphagia , quality of life ( QL ) 6 weeks following treatment , and total cost of treatment . Secondary outcome measures included treatment-associated morbidity , mortality , survival , and cost-effectiveness . An intention-to-treat analysis was carried out . RESULTS : There was a significant difference in mean dysphagia grade between treatment arms 6 weeks following treatment ( P=0.046 ) , with worse swallowing reported by rigid stent – treated patients ( mean dysphagia score difference=−0.49 ; 95 % confidence interval ( CI ) −0.10 to −0.89 , P=0.014 ) . Global QL scores were lower at both 1 and 6 weeks following treatment for patients treated by SEMSs ( mean difference QL index week 1=−0.66 ; 95 % CI : −0.02 to −1.30 , P=0.04 ; mean difference QL index week 6=−1.01 ; 95 % CI −0.30 to −1.72 , P=0.006 ) . These findings were associated with higher post-procedure pain scores in the SEMS patient group ( mean difference of the European Organisation for Research and Treatment of Cancer QLQ C-30 pain symptom score at week 1=11.13 ; 95 % CI : 2.89–19.4 ; P=0.01 ) . Although mean EQ-5D QL values differed between the treatments ( P<0.001 ) , this difference dissipated following generation of quality -adjusted life year values . Total costs varied between treatment arms but these findings canceled out when SEMSs were compared with non-SEMS therapies ( 95 % CI −845.15–1,332.62 ) . These results were robust to sensitivity analysis . There were no differences in the in-hospital mortality or early complication rates , but late complications were more frequent after rigid stenting ( risk ratio=2.47 ; 95 % CI 1.88–3.04 ) . There was a survival advantage for non-stent-treated patients ( log-rank statistic=4.21 , P=0.04 ) . CONCLUSIONS : The treatment choice for patients with inoperable esophageal cancer should be between a SEMS or a non-stent treatment after consideration has been given to both patient and tumor characteristics and clinician and patient preferences
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 . (