Cost-Utility Analysis Using EQ-5D-5L Data: Does How the Utilities Are Derived Matter? [Editor's Choice]



To explore how the use of EQ-5D-5L value set and crosswalk from EQ-5D-5L to EQ-5D-3L (and use of 3L value set) would affect cost-effectiveness analysis results for England and six other countries (Canada, the Netherlands, China, Japan, South Korea, and Singapore).


Individual-level utilities derived from primary 5L data using both value set (5L) and crosswalk (c5L) approaches were applied to three Markov models assessing the cost-effectiveness of hemodialysis (HD) and peritoneal dialysis (PD) for end-stage renal disease (ESRD) patients to estimate incremental quality-adjusted life years (QALYs). The mathematic functions between incremental QALY and utility were derived.


5L- and c5L-based incremental QALYs were similar in the model for non-diabetic patients (range: 1.910–2.149, 1.922–2.121). 5L tends to generate more incremental QALYs than c5L in the model for diabetic patients (range: 1.454–1.633, 1.365–1.568) but fewer incremental QALYs in the model for all ESRD patients (range: 0.290–0.480, 0.315–0.493).


The value set and crosswalk approaches may not be used interchangeably in economic evaluation when EQ-5D-5L data are used to estimate utilities. Results of cost-effectiveness analysis using Markov models may be affected by both absolute utilities and their differences.


Fan Yang Nancy Devlin Nan Luo

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