1. 1 Could there be a single European EQ tariff? Jan J.V. Busschbach, Ph.D. Former address: –iMTA, Erasmus university Present address: –Medical Psychology and Psychotherapy »Erasmus Medical Center, Rotterdam »PO Box 1738 »3000 DR Rotterdam, The Netherlands –Psychotherapeutic center “De viersprong” »PO Box 7 »4660 AA Halsteren, The Netherlands –Busschbach@bmg.eur.nl

2. 2 The EuroQol Links values from the general public to 243 health states –5 dimensions, 3 levels Starting point of group: QoL-values differ over Europe –Different national TTO and VAS values are now available –Possibility to compare values from different countries MOBILITY –I have no problems in walking about –I have some problems in walking about –I am confined to bed SELF-CARE –I have no problems with self-care –I have some problems washing or dressing myself –I am unable to wash or dress myself USUAL ACTIVITIES (e.g. work, study, housework family or leisure activities) –I have no problems with performing my usual activities –I have some problems with performing my usual activities –I am unable to perform my usual activities PAIN/DISCOMFORT –I have no pain or discomfort –I have moderate pain or discomfort –I have extreme pain or discomfort ANXIETY/DEPRESSION –I am not anxious or depressed –I am moderately anxious or depressed –I am extremely anxious or depressed

3. 3 First comparisons in 1988 (EQ-6D)

4. 4 Comparisons in 1999 with (EQ-5D)

5. 5 TTO-values EQ-5D in 1999

6. 6 Problem & Hypotheses German TTO values higher than English and Spanish Explanation by exclusion –Culture »National nature of the inhabitants –Methods / investigators »Investigators use the same protocol –Sample »Back ground variable do matter »Back ground variables are distributed differently »Effect should disappear if we control for back ground variables co-variate analysis

7. 7 Samples differ in background variables The German sample is older and smarter But background variables do not explain the differences

8. 8 Conclusion (so fare) VAS does not differ –Not cultural determined TTO differs –Back ground variables do not appear to account for the difference found –TTO could be cultural determined But… country and investigator are linked –Differences between countries can be differences between investigators Prove of the pudding…replication within country

9. 9 Replication of York Study VAS Macran S Kind P. Valuing the EQ-5D health states using a modified MVH protocol. Proceedings Plenary Meeting of the EuroQol Group, Sitges, Spain, 6/11/1999.

10. 10 Replication of York Study TTO Macran S Kind P. Valuing the EQ-5D health states using a modified MVH protocol. Proceedings Plenary Meeting of the EuroQol Group, Sitges, Spain, 6/11/1999.

11. 11 Conclusion (end) VAS are not cultural determined TTO differs –Back ground variables do not account for all difference TTO are perhaps cultural determined –But differences between countries are also differences between investigators –Different investigators give different values Little proof that TTO-values differ in Europe Yes,…. there is room for an European tariff

12. 12 Euro Tariff Random effects regression model specifications, based on UK, German and Spanish values. State 11111 = 1.00. EuroQol book, Chapter 9, forthcoming BSE Constant0.9960.051 N3 *-0.2800.006 Mobility = 2-0.0850.004 Mobility = 3-0.3430.005 Self Care = 2-0.1120.004 Self Care = 3-0.2390.005 Usual activities = 2-0.0500.005 Usual activities = 3-0.1200.006 Pain/discomfort = 2-0.1130.004 Pain/discomfort = 3-0.3520.005 Anxiety/depression = 2-0.0660.004 Anxiety/depression = 3-0.2120.005 * Seen for an explanation of the N3 parameter Dolan, 1997.

13. 13 Negative values Negative values in York protocol are disputed Little theoretical consensus Difficult to handle Compare negative and positive values separately

14. 14 Positive values

15. 15 Negative values