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The Implications of Using US-Specific EQ-5D Preference Weights for Cost-Effectiveness Evaluation

Department of Community and Preventive Medicine, University of Rochester School of Medicine, Rochester, New York, katia_noyes{at}urmc.rochester.edu

Andrew W. Dick, PhD

Department of Community and Preventive Medicine, University of Rochester School of Medicine, Rochester, New York, The RAND Corporation, Pittsburgh, Pennsylvania

Robert G. Holloway, MD, MPH

Department of Community and Preventive Medicine, University of Rochester School of Medicine, Rochester, New York, Department of Neurology, University of Rochester School of Medicine, Rochester, New York

Objective. The objective of this study is to examine the effect of country-specific EQ-5D preference weights on the cost-effectiveness (CE) of initial pramipexole versus levodopa strategy in patients with Parkinson disease (PD). Methods. A total of 301 subjects with PD were randomized to initial pramipexole or levodopa and followed every 3 months over a 4-year period. Subjects' health-related quality of life (HRQOL) was measured using EQ-5D, and their health preferences were calculated using both the UK and US sets of weights. The effectiveness of pramipexole was defined as the additional quality-adjusted life-years (QALY) gained compared to levodopa and was estimated as the area between the treatment-specific HRQOL profiles adjusted for baseline difference. Results. Using the original UK weights, the incremental effectiveness was 0.155 QALYs, which resulted in the incremental CE ratio (ICER) of $42,989/QALY and a probability that pramipexole was cost-effective relative to levodopa of 0.57, 0.77, and 0.82 when a QALY was valued at $50,000, $100,000, and $150,000, respectively. Using the US-specific weights resulted in lower incremental effectiveness (0.062 QALYs), higher ICER ($108,498/QALY), and a lower probability that pramipexole was cost-effective compared to levodopa at any valuation of QALY (0.23 for $50,000, 0.48 for $100,000, and 0.58 for $150,000). Conclusions. Country-specific preference weights in clinical-economic trials might have important effects on estimates of incremental cost-effectiveness. Using US preference weights rather than UK preference weights reduced the probability that pramipexole was cost-effective compared to levodopa.

Key Words: Key words: Parkinson disease • EQ-5D • quality of life • cost-effectiveness • pramipexole • levodopa. (Med Decis Making 2007;27:327—334)

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