Variation in health state preferences across local and international populations: East doesn’t meet West CADTH symposium Panel Session April 12, 2016 Dr. Simon Pickard, University of Illinois at Chicago Dr. Jeffrey Johnson, University of Alberta Dr. Eleanor Pullenayegum, University of Toronto Dr. Feng Xie, McMaster University

Disclosures Simon Pickard Jeff Johnson Eleanor Pullenayegum Feng Xie Chair, Executive Committee, EQ Group Jeff Johnson Member, Board of Directors, EQ Research Foundation Eleanor Pullenayegum Member, EQ Group Feng Xie

Outline Background Comparing regional values in Canada Are there differences and do they matter? Insight international comparisons Symposium discussion (panel + audience)

PROs in HTA Preference-based measures of health, e.g. EQ-5D Health Utilities Index SF-6D Many applications Clinical trial outcomes Population health monitoring Quality of care via PROMs in health systems Societal preference-weights (“value sets”) facilitate QALY calculations in cost-utility analysis Inform resource allocation

CUA in HTA HTA: evidence-based, encourages standardization, supports explicit guidelines for decision making “A CUA should be used in the Reference Case where meaningful HRQL differences between the intervention and alternatives have been demonstrated, and where appropriate preference (utility) data are available. Preferences should be derived using valid approaches.” Guidelines for the economic evaluation of health technologies: Canada [3rd Edition]. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2006.

Preference-based measures Health Utilities Index Mark 2 & Mark 3 Sample: Hamilton, 1994 (VAS/SG) SF-6D Value sets available; no Canadian values EQ-5D EQ-5D-3L: many value sets available, including Canada (Bansback et al, 2012) EQ-5D-5L: many value sets available, including Canada (Xie et al, 2016) Based on a standardized, international protocol Enables comparison across countries

How generalizable? Represent the population of interest National healthcare -> societal preferences E.g. NICE, national decision making body. The Canadian context provinces are responsible for managing healthcare budgets Are there differences? Whose values are most appropriate? Internationally where we find differences? (sources of heterogeneity in preferences?) 3 presentations on this theme My privilege to introduce …

Canadian TTO Valuations of the EQ-5D-5L: East versus West Differences Jeffrey A. Johnson, PhD Professor, School of Public Health University of Alberta Member of Expert Committee on Drug Evaluation and Therapeutics for Alberta Health 2005 to 2015 Member, Board of Directors, EQ Research Foundation Co-PI for the Canadian EQ-5D-5L Valuation Study

Regional variation in health state preferences: does it exist and does it matter? Eleanor Pullenayegum, PhD Associate Professor, University of Toronto & Sick Kids Research Institute

Transforming latent utilities to health utilities: East doesn’t meet West Feng Xie, PhD Associate Professor, Centre for Health Services Research McMaster University

Panel Discussion What are some advantages to using regional value sets? disadvantages? What further work needs to be done if regional value sets are desired by some provinces? Who should make this decision? Is it acceptable from a federal standpoint? Do regional value sets better support healthcare principles important to Canadians, or diminish them? Are sources of heterogeneity driven by national culture, or characteristics that cut across borders, like religion, ethnicity, gender? Note that this issue of regional variation is not unique in principle to the EQ-5D.