Wolfgang Greiner

A single European currency for EQ-5D health states. Results from a six-country study

AbstractThe EQ-5D questionnaire is a widely used generic instrument for describing and valuing health that was developed by the EuroQol Group. A primary objective of the EuroQol Group is the investigation of values for health states in the general population in different countries. As part of the EuroQol enterprise 11 population surveys were carried out in six Western European countries (Finland, Germany, The Netherlands, Spain, Sweden and the UK) to value health states as defined by the EQ-5D using a standardised visual analogue scale (EQ-5D VAS). This contribution reports how a European set of general population preference weights was derived from the data collected in the 11 valuation studies. The scores from this set of preference weights can be applied to generate a VAS-based weighted health status index for all the potential 243 EQ-5D health states for use in multi-national studies. To estimate the preference weights a multi-level regression analysis was performed on 82,910 valuations of 44 EQ-5D health states elicited from 6,870 respondents. Stable and plausible solutions were found for the model parameters. ThenR2 value was 75%. The analysis showed that the major source of variance, apart from random error, was variance between individuals (28.3% of the total residual variance). These results suggest that VAS values for EQ-5D health states in six Western European countries can be described by a common model.

Validating the EQ-5D with time trade off for the German population

The aim of this survey study was to derive the societal values of the general public for the EuroQol EQ-5D. Using the same protocol as previously used in the United Kingdom, we compared the German values with the British. In face-to-face interviews a sample of 339 individuals in northern Germany valued 15 different health states from a sample of 36 states. Values were derived using the York MVH protocol for time trade-off (TTO) and a visual analogue scale (VAS). Values for all 243 health states of the EQ-5D were estimated by a regression model. The VAS values revealed close a resemblance to the British VAS results. German TTO values were higher than the British. This was especially the case for the worse health states. The results suggest that the TTO values are more related to national variables than values derived by VAS. The use of the TTO values of this investigation makes it possible to anticipate these cultural differences in studies carried out in Germany.

Economic evaluation of human papillomavirus screening in Germany

Cytology-based screening programs for cervical cancer have been effective in reducing cancer incidence and preventing premature deaths worldwide. However, there is concern about the relatively low sensitivity of current screening procedures. Although the causal association between infection with certain high-risk types of human papilloma virus (HPV) and the development of cervical cancer has been clearly established, testing for the major risk factor is not part of current screening practice. We created a tree decision model over time to evaluate different policy choices for implementing a population-based screening program. Results of the economic analysis indicate that testing with any implemented HPV DNA testing (stand alone or in combination with the Papanicolaou smear) is superior to cytology and measures presently in use. Additional costs per life-years gained cannot be reported because the HPV branches had fewer discounted overall costs (€222xa0million vs. €82 and €76xa0million, respectively), and they saved more life years (19,599 vs. 19,163 and 903, respectively) then the smear alternative. Any HPV DNA testing is preferable over the current state of the art performed in Germany. This is true not only for economic reasons but also for life-years gained. Therefore HPV DNA testing must become an essential component to back up the relatively weak sensitivity of the standard procedure.

Using competence network collaboration and decision-analytic modeling to assess the cost-effectiveness of interferon α-2b plus ribavirin as initial treatment of chronic hepatitis C in Germany

The objective of this study was to translate and apply a decision-analytic model for chronic hepatitis C (CHC) to the German health care context using competence network collaboration. The German Hepatitis C Model (GEHMO) competence network used a systematic multistep approach to identify and transfer a high quality Markov model for CHC to the German health care context. GEHMO was used to project lifetime clinical and economic outcomes and to determine the cost-effectiveness of initial antiviral therapy with interferon α-2b plus ribavirin from a societal perspective. In 40-year-old patients combination therapy for 24 and 48xa0weeks increased life expectancy by 1.6 and 2.3xa0years, respectively, compared with interferon alone for 48xa0weeks. The discounted incremental cost-utility ratios (ICUR) for combination therapy were €5,500 per quality-adjusted life-year gained (QALY) for 24xa0weeks and €6,800/QALY for 48xa0weeks of treatment. ICUR was €9,800/QALY for moving from 24 to 48xa0weeks of treatment. Combination therapy remained cost-effective in sensitivity analyses. In conclusion, combination therapy with interferon α-2b and ribavirin is effective and cost-effective compared with other well-accepted medical treatments. Competence network collaboration and decision modeling provide a useful and efficient approach to combine evidence from international studies with country-specific parameters.

Comparison of EQ-5D VAS valuations: analysis of background variables

Preference-based instruments for measuring HRQoL of life have been developed in different countries and applied in empirical research in a much wider range of countries. A major concern in this context has been whether the valuations (values or utility weights) elicited for the instrument in 1 country are applicable in another, that is, whether the valuations in terms of the relative values/utilities of different health states are similar or not. If they are, an instrument that has been valued in country A can be applied in country B without having to carry out a very cumbersome and expensive process of eliciting the valuations in country B. However, if the valuations differ, the use of an instrument with valuations from country A in country B, for example in the evaluation of health interventions, may lead to different results and a different order of preference among the interventions from those should valuations from country B have been available.

Gesundheitsreformen in Deutschland: Aktuelle Entwicklungen und Vierte Hürde

Die Gesundheitsausgaben steigen in Deutschland ebenso wie in allen Industrielandern in den vergangenen Jahrzehnten unvermindert an. Obwohl die Hohe dieser Ausgaben letztendlich von der gesellschaftlichen Zahlungsbereitschaft fur Gesundheit abhangt, wird diese Entwicklung in der offentlichen Diskussion kritisch begleitet. Zu der erhohten Aufmerksamkeit tragt auch die Tatsache bei, dass die Steigerungsraten der Ausgaben fur Gesundheitsleistungen jene des Bruttosozialproduktes der jeweiligen Lander deutlich ubersteigen. Wahrend in den 60er Jahren etwa 4% des Bruttosozialproduktes fur Gesundheitsleistungen aufgewendet worden sind, belauft sich dieser Anteil heute auf etwa 10%. Als Ursachen fur die Ausgabensteigerung wird im Allgemeinen neben demografischer Grunde, eine erhohte Anspruchshaltung, steigende Arzneimittelpreise und vor allem der medizinische Fortschritt verantwortlich gemacht. Im Zentrum der offentlichen Diskussion im Zusammenhang mit der Ausgabenentwicklung im Gesundheitssystem stehen haufig die Ausgaben fur Arzneimittel. Diese machen mit rund 16% der Gesamtausgaben der Krankenkassen fur Gesundheitsleistungen nach Ausgaben fur stationare und ambulante Leistungen den drittgrossten Posten aus (Basisdaten, 2002). Aufgrund der hoheren Steigerungsraten im Vergleich zu jenen Ausgaben fur arztliche Leistungen, ist jedoch davon auszugehen, das die Ausgaben fur Arzneimittel kurz- bis mittelfristig die Kosten ambulanter Behandlungen ubersteigen werden. Durch diese hoheren Zuwachsraten kann zumindest teilweise erklart werden kann, weshalb Beitragserhohungen fur Krankenversicherungen haufig auf gestiegene Ausgaben fur Arzneimittel zuruckgefuhrt werden. Weitere Grunde, warum die Ausgaben fur Arzneimittel haufig im Mittelpunkt der Kostendampfungsdiskussion stehen, sind die im Vergleich zu anderen Sektoren hohe Datentransparenz, die Moglichkeit zentraler Regulierungsmoglichkeiten, der sich andere Bereiche aufgrund der Selbstverwaltung und foderaler Strukturen entziehen und politische Beweggrunde, denen zufolge Regulierungen, die die pharmazeutische Industrie betreffen, gesellschaftlich eher akzeptabel seien, als solche, die im Krankenhaussektor wirksam waren (Vollmer, 2001).