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SF-6D and EQ-5D result in widely divergent incremental cost-effectiveness ratios in a clinical trial of older women: implications for health policy decisions

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Abstract

Summary

Using two instruments (SF-6D and EQ-5D) to estimate quality adjusted life years (QALYs), we conducted an economic evaluation of a 12-month randomized controlled trial with a 12-month follow-up study in older women to evaluate the value for money of two doses of resistance training compared with balance and tone classes. We found that the incremental QALYs estimated from the SF-6D were two- to threefold greater than those estimated from the EQ-5D.

Introduction

Decision makers must continually choose between existing and new interventions. Hence, economic evaluations are increasingly prevalent. The impact of quality-adjusted life year (QALY) estimates using different instruments on the incremental cost-effectiveness ratios (ICERs) is not well understood in older adults. Thus, we compared ICERs, in older women, estimated by the EuroQol-5D (EQ-5D) and the Short Form-6D (SF-6D) to discuss implications on decision making.

Methods

Using both the EQ-5D and the SF-6D, we compared the incremental cost per QALY gained in a randomized controlled trial of resistance training in 155 community-dwelling women aged 65 to 75 years. The 12-month randomized controlled trial included a subsequent 12-month follow-up. Our focus, the follow-up study, included 123 of the 155 participants from the Brain Power study; 98 took part in the economic evaluation (twice-weekly balance and tone exercises, n = 28; once-weekly resistance training, n = 35; twice-weekly resistance training, n = 35). Our primary outcome measure was the incremental cost per QALY gained of once- or twice-weekly resistance training compared with balance and tone exercises.

Results

At cessation of the follow-up study, the incremental QALY was −0.051 (EQ-5D) and −0.144 (SF-6D) for the once-weekly resistance training group and −0.081 (EQ-5D) and −0.127 (SF-6D) for the twice-weekly resistance training group compared with balance and tone classes.

Conclusion

The incremental QALYs estimated from the SF-6D were two- to threefold greater than those estimated from the EQ-5D. Given the large magnitude of difference, the choice of preference-based utility instrument may substantially impact health care decisions.

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Acknowledgments

The authors would like to thank the Vancouver South Slope YMCA management and members who enthusiastically supported the study by allowing access to participants for the training intervention. Teresa Liu-Ambrose is a Michael Smith Foundation for Health Research Scholar and a Canadian Institute for Health Research New Investigator. Carlo A. Marra is a Canada Research Chair in Pharmaceutical Outcomes. Jennifer C. Davis is funded by a Canadian Institute for Health Research Postdoctoral Fellowship.

Conflicts of interest

The Vancouver Foundation (BCMSF, Operating Grant to Dr. Liu-Ambrose) and the Michael Smith Foundation for Health Research (MSFHR, Establishment Grant to Dr. Liu-Ambrose) provided funding for this study. Research was supported by the CIHR Emerging Team Grant (Centre Hip Health and Mobility): A Team Approach to Mobility in Vulnerable Seniors. Dr. Liu-Ambrose is a Michael Smith Foundation for Health Research Scholar, a Canadian Institutes of Health Research New Investigator and a Heart and Stroke Foundation of Canada’s Henry J. M. Barnett Scholar. Dr. Davis is funded by a Canadian Institutes of Health Research and Michael Smith Foundation for Health Research Postdoctoral Fellowship.

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Correspondence to J. C. Davis.

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Specific remarks

Decision makers must continually choose between existing and new interventions. The incremental quality-adjusted life years estimated from the SF-6D were two- to threefold greater than those estimated from the EQ-5D. Given the large magnitude of difference, the choice of preference-based utility instrument may substantially impact health care decisions.

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Davis, J.C., Liu-Ambrose, T., Khan, K.M. et al. SF-6D and EQ-5D result in widely divergent incremental cost-effectiveness ratios in a clinical trial of older women: implications for health policy decisions. Osteoporos Int 23, 1849–1857 (2012). https://doi.org/10.1007/s00198-011-1770-3

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  • DOI: https://doi.org/10.1007/s00198-011-1770-3

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