Mapping Oswestry Disability Index Responses to EQ-5D-3L Utility Values: Are Cost-Utility Results Valid?

Ângela Jornada Ben; Sylvia Pellekooren; Judith E. Bosmans; Raymond W.J.G. Ostelo; Esther T. Maas; Mohamed El Alili; Maurits W. van Tulder; Frank J.P.M. Huygen; Teddy Oosterhuis; Adri T. Apeldoorn; Miranda L. van Hooff; Johanna M. van Dongen

doi:10.1016/j.jval.2023.01.020

Mapping Oswestry Disability Index Responses to EQ-5D-3L Utility Values: Are Cost-Utility Results Valid?

Ângela Jornada Ben^*
, Sylvia Pellekooren
, Judith E. Bosmans
, Raymond W.J.G. Ostelo
, Esther T. Maas
, Mohamed El Alili
, Maurits W. van Tulder
, Frank J.P.M. Huygen
, Teddy Oosterhuis
, Adri T. Apeldoorn
, Miranda L. van Hooff
, Johanna M. van Dongen

^*Corresponding author for this work

Anesthesiology

Vrije Universiteit Amsterdam
National Health Care Institute
University of Amsterdam
Noordwest Ziekenhuisgroep
Breederode Hogeschool
St. Martin Clinic
Radboud University Medical Center

Research output: Contribution to journal › Article › Academic › peer-review

5 Citations (Scopus)

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Abstract

Objectives: To develop and validate approaches for mapping Oswestry Disability Index responses to 3-level version of EQ-5D utility values and to evaluate the impact of using mapped utility values on cost-utility results compared with published regression models. Methods: Three response mapping approaches were developed in a random sample of 70% of 18 692 patients with low back pain: nonparametric approach (Non-p), nonparametric approach excluding logical inconsistencies (Non-peLI), and ordinal logistic regression (OLR). Performance was assessed in the remaining 30% using R-square (R²), root mean square error (RMSE), and mean absolute error (MAE). To evaluate whether MAEs and their 95% limits of agreement (LA) were clinically relevant, a minimally clinically important difference of 0.074 was used. Probabilities of cost-effectiveness estimated using observed and mapped utility values were compared in 2 economic evaluations. Results: The Non-p performed the best (R² = 0.43; RMSE = 0.22; MAE = 0.03; 95% LA = −0.40 to 0.47) compared with the Non-peLI (R² = 0.07; RMSE = 0.29; MAE = −0.15; 95% LA = −0.63 to 0.34) and OLR (R² = 0.22; RMSE = 0.26; MAE = 0.02; 95% LA = −0.49 to 0.53). MAEs were lower than the minimally clinically important difference for the Non-p and OLR but not for the Non-peLI. Differences in probabilities of cost-effectiveness ranged from 1% to 4% (Non-p), 0.1% to 9% (Non-peLI), and 0.1% to 20% (OLR). Conclusions: Results suggest that the developed response mapping approaches are not valid for estimating individual patients’ 3-level version of EQ-5D utility values, and—depending on the approach—may considerably affect cost-utility results. The developed approaches did not perform better than previously published regression-based models and are therefore not recommended for use in economic evaluations.

Original language	English
Pages (from-to)	873-882
Number of pages	10
Journal	Value in Health
Volume	26
Issue number	6
Early online date	10 Feb 2023
DOIs	https://doi.org/10.1016/j.jval.2023.01.020
Publication status	Published - Jun 2023

Bibliographical note

Funding Information:
Conflict of Interest Disclosures: Dr Ostelo reported receiving grants from ZonMw and WCF outside the submitted work. Dr Huygen reported receiving personal fees from Abbott and Grunenthal outside the submitted work. Dr Huygen has a patent P121304EP00 pending and a patent P121304NL00 pending. Dr Oosterhuis reported receiving grants from ZonMW, Ministry of Social Affairs and employment outside the submitted work. No other disclosures were reported.

Funding Information:
Conflict of Interest Disclosures: Dr Ostelo reported receiving grants from ZonMw and WCF outside the submitted work. Dr Huygen reported receiving personal fees from Abbott and Grunenthal outside the submitted work. Dr Huygen has a patent P121304EP00 pending and a patent P121304NL00 pending. Dr Oosterhuis reported receiving grants from ZonMW, Ministry of Social Affairs and employment outside the submitted work. No other disclosures were reported.Funding/Support: This study was internally funded by the Vrije Universiteit Amsterdam through the van Meenen middelen.

Publisher Copyright:
© 2023

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1-s2.0-S1098301523000451-mainFinal published version, 1.01 MBLicence: CC BY-NC-ND

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Ben, Â. J., Pellekooren, S., Bosmans, J. E., Ostelo, R. W. J. G., Maas, E. T., El Alili, M., van Tulder, M. W., Huygen, F. J. P. M., Oosterhuis, T., Apeldoorn, A. T., van Hooff, M. L., & van Dongen, J. M. (2023). Mapping Oswestry Disability Index Responses to EQ-5D-3L Utility Values: Are Cost-Utility Results Valid? Value in Health, 26(6), 873-882. https://doi.org/10.1016/j.jval.2023.01.020

@article{d5301fafcc634fbeb9e81102a2de4c39,

title = "Mapping Oswestry Disability Index Responses to EQ-5D-3L Utility Values: Are Cost-Utility Results Valid?",

abstract = "Objectives: To develop and validate approaches for mapping Oswestry Disability Index responses to 3-level version of EQ-5D utility values and to evaluate the impact of using mapped utility values on cost-utility results compared with published regression models. Methods: Three response mapping approaches were developed in a random sample of 70\% of 18 692 patients with low back pain: nonparametric approach (Non-p), nonparametric approach excluding logical inconsistencies (Non-peLI), and ordinal logistic regression (OLR). Performance was assessed in the remaining 30\% using R-square (R2), root mean square error (RMSE), and mean absolute error (MAE). To evaluate whether MAEs and their 95\% limits of agreement (LA) were clinically relevant, a minimally clinically important difference of 0.074 was used. Probabilities of cost-effectiveness estimated using observed and mapped utility values were compared in 2 economic evaluations. Results: The Non-p performed the best (R2 = 0.43; RMSE = 0.22; MAE = 0.03; 95\% LA = −0.40 to 0.47) compared with the Non-peLI (R2 = 0.07; RMSE = 0.29; MAE = −0.15; 95\% LA = −0.63 to 0.34) and OLR (R2 = 0.22; RMSE = 0.26; MAE = 0.02; 95\% LA = −0.49 to 0.53). MAEs were lower than the minimally clinically important difference for the Non-p and OLR but not for the Non-peLI. Differences in probabilities of cost-effectiveness ranged from 1\% to 4\% (Non-p), 0.1\% to 9\% (Non-peLI), and 0.1\% to 20\% (OLR). Conclusions: Results suggest that the developed response mapping approaches are not valid for estimating individual patients{\textquoteright} 3-level version of EQ-5D utility values, and—depending on the approach—may considerably affect cost-utility results. The developed approaches did not perform better than previously published regression-based models and are therefore not recommended for use in economic evaluations.",

author = "Ben, \{{\^A}ngela Jornada\} and Sylvia Pellekooren and Bosmans, \{Judith E.\} and Ostelo, \{Raymond W.J.G.\} and Maas, \{Esther T.\} and \{El Alili\}, Mohamed and \{van Tulder\}, \{Maurits W.\} and Huygen, \{Frank J.P.M.\} and Teddy Oosterhuis and Apeldoorn, \{Adri T.\} and \{van Hooff\}, \{Miranda L.\} and \{van Dongen\}, \{Johanna M.\}",

note = "Funding Information: Conflict of Interest Disclosures: Dr Ostelo reported receiving grants from ZonMw and WCF outside the submitted work. Dr Huygen reported receiving personal fees from Abbott and Grunenthal outside the submitted work. Dr Huygen has a patent P121304EP00 pending and a patent P121304NL00 pending. Dr Oosterhuis reported receiving grants from ZonMW, Ministry of Social Affairs and employment outside the submitted work. No other disclosures were reported. Funding Information: Conflict of Interest Disclosures: Dr Ostelo reported receiving grants from ZonMw and WCF outside the submitted work. Dr Huygen reported receiving personal fees from Abbott and Grunenthal outside the submitted work. Dr Huygen has a patent P121304EP00 pending and a patent P121304NL00 pending. Dr Oosterhuis reported receiving grants from ZonMW, Ministry of Social Affairs and employment outside the submitted work. No other disclosures were reported.Funding/Support: This study was internally funded by the Vrije Universiteit Amsterdam through the van Meenen middelen. Publisher Copyright: {\textcopyright} 2023",

year = "2023",

month = jun,

doi = "10.1016/j.jval.2023.01.020",

language = "English",

volume = "26",

pages = "873--882",

journal = "Value in Health",

issn = "1098-3015",

publisher = "Elsevier Ltd.",

number = "6",

}

TY - JOUR

T1 - Mapping Oswestry Disability Index Responses to EQ-5D-3L Utility Values

T2 - Are Cost-Utility Results Valid?

AU - Ben, Ângela Jornada

AU - Pellekooren, Sylvia

AU - Bosmans, Judith E.

AU - Ostelo, Raymond W.J.G.

AU - Maas, Esther T.

AU - El Alili, Mohamed

AU - van Tulder, Maurits W.

AU - Huygen, Frank J.P.M.

AU - Oosterhuis, Teddy

AU - Apeldoorn, Adri T.

AU - van Hooff, Miranda L.

AU - van Dongen, Johanna M.

N1 - Funding Information: Conflict of Interest Disclosures: Dr Ostelo reported receiving grants from ZonMw and WCF outside the submitted work. Dr Huygen reported receiving personal fees from Abbott and Grunenthal outside the submitted work. Dr Huygen has a patent P121304EP00 pending and a patent P121304NL00 pending. Dr Oosterhuis reported receiving grants from ZonMW, Ministry of Social Affairs and employment outside the submitted work. No other disclosures were reported. Funding Information: Conflict of Interest Disclosures: Dr Ostelo reported receiving grants from ZonMw and WCF outside the submitted work. Dr Huygen reported receiving personal fees from Abbott and Grunenthal outside the submitted work. Dr Huygen has a patent P121304EP00 pending and a patent P121304NL00 pending. Dr Oosterhuis reported receiving grants from ZonMW, Ministry of Social Affairs and employment outside the submitted work. No other disclosures were reported.Funding/Support: This study was internally funded by the Vrije Universiteit Amsterdam through the van Meenen middelen. Publisher Copyright: © 2023

PY - 2023/6

Y1 - 2023/6

N2 - Objectives: To develop and validate approaches for mapping Oswestry Disability Index responses to 3-level version of EQ-5D utility values and to evaluate the impact of using mapped utility values on cost-utility results compared with published regression models. Methods: Three response mapping approaches were developed in a random sample of 70% of 18 692 patients with low back pain: nonparametric approach (Non-p), nonparametric approach excluding logical inconsistencies (Non-peLI), and ordinal logistic regression (OLR). Performance was assessed in the remaining 30% using R-square (R2), root mean square error (RMSE), and mean absolute error (MAE). To evaluate whether MAEs and their 95% limits of agreement (LA) were clinically relevant, a minimally clinically important difference of 0.074 was used. Probabilities of cost-effectiveness estimated using observed and mapped utility values were compared in 2 economic evaluations. Results: The Non-p performed the best (R2 = 0.43; RMSE = 0.22; MAE = 0.03; 95% LA = −0.40 to 0.47) compared with the Non-peLI (R2 = 0.07; RMSE = 0.29; MAE = −0.15; 95% LA = −0.63 to 0.34) and OLR (R2 = 0.22; RMSE = 0.26; MAE = 0.02; 95% LA = −0.49 to 0.53). MAEs were lower than the minimally clinically important difference for the Non-p and OLR but not for the Non-peLI. Differences in probabilities of cost-effectiveness ranged from 1% to 4% (Non-p), 0.1% to 9% (Non-peLI), and 0.1% to 20% (OLR). Conclusions: Results suggest that the developed response mapping approaches are not valid for estimating individual patients’ 3-level version of EQ-5D utility values, and—depending on the approach—may considerably affect cost-utility results. The developed approaches did not perform better than previously published regression-based models and are therefore not recommended for use in economic evaluations.

AB - Objectives: To develop and validate approaches for mapping Oswestry Disability Index responses to 3-level version of EQ-5D utility values and to evaluate the impact of using mapped utility values on cost-utility results compared with published regression models. Methods: Three response mapping approaches were developed in a random sample of 70% of 18 692 patients with low back pain: nonparametric approach (Non-p), nonparametric approach excluding logical inconsistencies (Non-peLI), and ordinal logistic regression (OLR). Performance was assessed in the remaining 30% using R-square (R2), root mean square error (RMSE), and mean absolute error (MAE). To evaluate whether MAEs and their 95% limits of agreement (LA) were clinically relevant, a minimally clinically important difference of 0.074 was used. Probabilities of cost-effectiveness estimated using observed and mapped utility values were compared in 2 economic evaluations. Results: The Non-p performed the best (R2 = 0.43; RMSE = 0.22; MAE = 0.03; 95% LA = −0.40 to 0.47) compared with the Non-peLI (R2 = 0.07; RMSE = 0.29; MAE = −0.15; 95% LA = −0.63 to 0.34) and OLR (R2 = 0.22; RMSE = 0.26; MAE = 0.02; 95% LA = −0.49 to 0.53). MAEs were lower than the minimally clinically important difference for the Non-p and OLR but not for the Non-peLI. Differences in probabilities of cost-effectiveness ranged from 1% to 4% (Non-p), 0.1% to 9% (Non-peLI), and 0.1% to 20% (OLR). Conclusions: Results suggest that the developed response mapping approaches are not valid for estimating individual patients’ 3-level version of EQ-5D utility values, and—depending on the approach—may considerably affect cost-utility results. The developed approaches did not perform better than previously published regression-based models and are therefore not recommended for use in economic evaluations.

UR - https://www.scopus.com/pages/publications/85150252530

U2 - 10.1016/j.jval.2023.01.020

DO - 10.1016/j.jval.2023.01.020

M3 - Article

C2 - 36773782

AN - SCOPUS:85150252530

SN - 1098-3015

VL - 26

SP - 873

EP - 882

JO - Value in Health

JF - Value in Health

IS - 6

ER -

Mapping Oswestry Disability Index Responses to EQ-5D-3L Utility Values: Are Cost-Utility Results Valid?

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