Project title: Developing Preference-based Outcome Measures for Meaningful Health Economic Analyses in Hand Surgery

Grant Holder: Luke Geoghegan

Position: NIHR ACF & ST3 Plastic Surgery

Date of award

Sep 2022

Date of report

Jul 2024

Grant Awarded (i.e. £10,000)

£10,000

Is this an interim, or final, report

Interim

Lay Summary

Health utilities describe the desirability of a health state. Utilities form the quality component of quality-adjusted life years (QALYs). QALYs are used to compare the cost-effectiveness of interventions. Utilities are commonly determined using generic preference-based measures, such as the EQ-5D. However, previous work has demonstrated that the EQ-5D has poor responsiveness in patients with hand conditions. This means interventions may be undervalued in comparative cost-effectiveness analyses. One solution to this is the development of hand-specific preference-based measures. We asked members of the UK public to rate the desirability of health states described by a commonly used patient reported outcome questionnaire, the Patient Evaluation Measure (PEM). We have now produced a value set for the PEM, meaning that health utilities can be determined through patient responses to a hand-specific questionnaire.

Summary of progress /findings

Previous work conducted by our group has shown that the EQ-5D has poor responsiveness in patients with hand conditions. One solution to this is the development of mapping algorithms to predict health utility values from hand-specific patient reported outcome measures. However, we have shown that even bespoke mapping algorithms carry high clinically relevant error. The aim of our project was to determine how members of the UK population value health states described by the PEM.

We analysed PEM response data from the UK Hand Registry and identified 18 logical health states experienced by patients using a modified Rasch-vignette approach. Preferences for the health states described by the PEM were determined using a moderated, online time-trade off experiment with members of the UK population (n= 48). Health state utility scores ranged from -0.5 to 1; five states described by the PEM were deemed worse than death with utility scores <0.

We have developed a preference-based index (value set) for the PEM. This enables utility values to be generated from PEM response scores, meaning generic measures such as the EQ-5D are not required to compare the cost-utility of interventions for hand conditions. Our preference-based index can be applied retrospectively and prospectively to generate QALYs for people with hand conditions. Economic analyses using this may affect the appraisal of new health technologies and the commissioning of hand surgery. 

What is the relevance/value of this research to hand surgery

Delivering value-based hand surgery is essential in a budget constrained national health service with limited resource and growing demand for services. Defining a preference-based hand-specific PROM will inform shared decision making at the individual patient level. Our work will permit cost-effectiveness analysis of interventions using existing datasets such as the UKHR and in future NIHR-funded RCTs. This will enable us to better define the clinical value of interventions for hand conditions. This will have significant implications on the appraisal of new health technologies and the commissioning of hand surgery services on a national level.

Please list presentations based on work performed in this study

Deriving a Value Set for the Patient Evaluation Measure to use in Place of the EQ-5D in Health Economic Analysis

Geoghegan L, Harrison C, Trickett R, Gape N, Rodrigues J

BSSH Autumn Scientific Meeting. November 2023. Glasgow, UK.

Please list publications based on work performed in this study

• Pending submission

Please state what additional research this study has/is leading to

• Data from this project will inform further cost-effectiveness analyses of interventions for electively managed hand conditions using data from the UKHR.

Please list any further funding or grant applications (with outcome), which have resulted from the award of this grant

•  N/A

How has this grant awards helped your career development?

• The BSSH Pump Priming award has been essential for the development of a value set for the PEM.
• This work has enabled me to refine skills in psychometric analyses, cost-utility analyses and the conduct of health economic experiments.
• We hope to utilise our findings in conjunction with novel developments in PROM assessment to develop novel methods for utility derivation on a national scale.