Plain Language Summary

What is it about?

The National Institute for Health and Care Excellence (NICE) in England uses EQ-5D to measure health-related quality of life when deciding whether new medicines should be funded by the National Health Service (NHS). Two versions exist: an older 3-level (3L) and a newer 5-level (5L) version designed to be more sensitive. This study examined how adopting a new United Kingdom (UK) value set for the 5L version would affect cost-effectiveness results in a sample of technology appraisals previously undertaken using the 3L version. The researchers systematically converted health state mean utility values from 3L to 5L and recalculated the model results, demonstrating that switching to the 5L new value set could have substantial impacts depending on whether treatments extend life or improve quality of life.

How was the research conducted?

Researchers obtained the decision models from 39 NICE technology appraisals published between 2016 and 2024. They extracted all health state utility values and converted them from 3L to 5L using statistical mapping based on 50,000 respondents who completed both versions. The study examined the appraisals for cancer treatments (17 cases) and non-cancer treatments (22 cases), categorized by whether they extended survival or only improved quality of life. This method allowed assessment of the impacts on real-world policy by using actual decision models.

What were the results?

Health state utility values almost universally increased when converted to the 5L system using the new UK value set, with larger increases for more severe health states. For cancer treatments extending survival, quality-adjusted life-years (QALYs) increased by 12.5% on average, making them more cost-effective. Conversely, for non-cancer treatments improving quality of life without extending survival, QALYs decreased by 37.5%, making them substantially less cost-effective. For non-cancer treatments improving quality of life with survival extension, results were mixed.

Why are the results important?

Despite widespread clinical adoption of the 5L descriptive system, a value set for the UK has been accepted only recently. Adopting the new 5L UK value set into the NICE methods of technology appraisals could have significant implications, of which decision makers in England, including NICE, should be informed. Extension of life is valued more highly when using 5L, and life-extending treatments appear more cost-effective compared to those which only improve quality of life. These signals of how different components of health gain are valued could influence drug pricing and strategic decisions by the pharmaceutical industry.

What are the strengths and weaknesses of this study?

The study's strength is using actual decision models from real appraisals, providing valuable policy insights. The main limitations are that results rely on statistical mapping rather than 5L data directly collected in clinical studies, introducing uncertainty despite sophisticated methods, and that the case studies selected do not necessarily represent the NICE technology program as a whole. Follow-up studies could examine multinational trials and whether findings generalize to other countries using different scoring systems.

^{Note: This content was created with assistance from artificial intelligence (AI) and has been reviewed and edited by ISPOR staff. For more information or for inquiries on ISPOR’s AI policy, click here or contact us at info@ispor.org.}