Exploring the Impact of Changes in Health Valuation Post-COVID-19 Pandemic on an Existing Cost-Effectiveness Analysis

OBJECTIVES: A 2021 publication explored how the valuation of health changed after the COVID-19 pandemic, comparing EQ-5D responses from 2018 and 2021. On a 0-100 visual analogue scale, post-pandemic valuations of the best EQ-5D health state were 9 points lower, and were 10 points higher for the poorest health state. To assess the potential for these changes to impact health economic analysis, the application of these changes within a previously published cost-effectiveness analysis (CEA) was assessed.

METHODS: A published NICE CEA of deep brain stimulation (DBS), levodopa–carbidopa intestinal gel (LCIG) and best medical treatment (BMT) for the treatment of Parkinson’s disease was adapted and the utility values were adjusted to reflect the changes in valuation. The original utility values were predicted using regression analysis and decreased over time. The update assumed a 0.09 absolute reduction in the highest utility state, tapering down proportionally to no reduction at the midpoint of the utility values, before then increasing proportionally to a 0.10 absolute increase for the lowest utility state.

RESULTS: Estimated QALYs decreased by 0.350 (14%) for BMT, 0.338 (11%) for DBS and 0.349 (13%) for LCIG. However, LCIG still dominated DBS and there was only a modest change in the ICER for DBS vs BMT (£31,264.76 [original] vs £30,843.75 [adjusted]).

CONCLUSIONS: Accounting for changes in health valuation post-pandemic did not materially change the results of this CEA. Broad assumptions were required to apply published findings of extreme health states to other intermediate EQ-5D health states in this analysis. More research into changes in valuation of different EQ-5D health states is required to realize the wider impacts of these changes with respect to economic analysis.