The Online Elicitation of Personal Utility Functions (OPUF) tool: a new method for valuing health states

Introduction Standard valuation methods, such as TTO and DCE are inefficient. They require data from hundreds if not thousands of participants to generate value sets. Here, we present the Online elicitation of Personal Utility Functions (OPUF) tool; a new type of online survey for valuing EQ-5D-5L health states using more efficient, compositional elicitation methods, which even allow estimating value sets on the individual level. The aims of this study are to report on the development of the tool, and to test the feasibility of using it to obtain individual-level value sets for the EQ-5D-5L. Methods We applied an iterative design approach to adapt the PUF method, previously developed by Devlin et al., for use as a standalone online tool. Five rounds of qualitative interviews, and one quantitative pre-pilot were conducted to get feedback on the different tasks. After each round, the tool was refined and re-evaluated. The final version was piloted in a sample of 50 participants from the UK. A demo of the EQ-5D-5L OPUF survey is available at: https://eq5d5l.me Results On average, it took participants about seven minutes to complete the OPUF Tool. Based on the responses, we were able to construct a personal EQ-5D-5L value set for each of the 50 participants. These value sets predicted a participants' choices in a discrete choice experiment with an accuracy of 80%. Overall, the results revealed that health state preferences vary considerably on the individual-level. Nevertheless, we were able to estimate a group-level value set for all 50 participants with reasonable precision. Discussion We successfully piloted the OPUF Tool and showed that it can be used to derive a group-level as well as personal value sets for the EQ-5D-5L. Although the development of the online tool is still in an early stage, there are multiple potential avenues for further research.

A Head-to-head Comparison of the EQ-5D-3L Index Scores Derived from the Two EQ-5D-3L Value Sets for China

Background: Two EQ-5D-3L (3L) value sets (developed in 2014 and 2018) co-exist in China. The study examined the level of agreement between index scores for all the 243 health states derived from them at both absolute and relative levels and compared the responsiveness of the two indices. Methods: Intraclass correlations coefficient (ICC) and Bland-Altman plot were adopted to assess the degree of agreement between the two indices at the absolute level. Health gains for 29,403 possible transitions between pairs of 3L health states were calculated to assess the agreement at the relative level. Their responsiveness for the transitions was assessed using Cohen effect size.Results：The mean (standard deviation, SD) value was 0.427 (0.206) and 0.649 (0.189) for the 3L2014 and 3L2018 index scores, respectively. Although the ICC value showed good agreement (i.e., 0.896), 88.9% (216/243) of the points were beyond the minimum important difference limit according to the Bland-Altman plot. The mean health gains for the 29,403 health transitions was 0.234 (3L2014 index score) and 0.216 (3L2018 index score). The two indices predicted consistent transitions in 23,720 (80.7%) of 29,403 pairs. For the consistent pairs, Cohen effective size value was 1.05 (3L2014 index score) or 1.06 (3L2018 index score); and the 3L2014 index score only yielded 0.007 more utility gains. However, the results based on the two measures varied substantially according to the direction and magnitude of health change. Conclusion：The 3L2014 and 3L2018 index scores are not interchangeable. The choice between them is likely to influence QALYs estimations.

Should the Preference-based Index Set of Values Be Country- or Disease-specific? An Analysis Using Data From Women With Symptoms of Overactive Bladder

Background: Overactive bladder (OAB) and urinary incontinence (UI) are common conditions among women. However, no studies have evaluated the utility value of this population using different country-specific value sets. We aimed to 1) verify the difference between the preference-based index extracted from the Short Form six dimensions (SF-6Dv1) questionnaire in women with OAB using different country-specific value sets; 2) translate and cross-culturally adapt the King's Health Questionnaire Five Dimension (KHQ-5D) into Brazilian Portuguese; and 3) examine the association between utility index obtained by the SF-6Dv1 and KHQ-5D. Methods: This cross-sectional study included 387 women over 18 years of age with OAB symptoms, divided into groups with and without UI. All participants answered the sociodemographic questionnaire, KHQ, KHQ-5D, and SF-6Dv1. To the statistical analysis a two-way mixed ANOVA was applied to verify the interaction between the presence of UI and utility index obtained from different country-specific value sets. Post-hoc multiple comparisons were applied following the main analysis. Spearman’s test was applied to verify the correlation between the utility values of SF-6Dv1 and KHQ-5D. The significance level was set at 5%. Results: We evaluated 298 women classified according to the presence of UI (119 without UI vs. 179 with UI). The main analysis showed a statistically significant interaction between the presence of UI and the utility index obtained from the different countries (p = 0.005, Cohen’s d= 0.02). The post-hoc analyses showed that there was a statistically significant main effect of the utility index obtained from different countries (p <0.001, d = 0.63) and in the presence of UI (p = 0.012, d = 0.02). The correlations between the utility indices obtained from different countries using the SF-6Dv1 and KHQ-5D were significant, positive, and small. Conclusions: The differences between the indices obtained in different countries and groups with and without UI, assessed using the SF-6Dv1, are shown. The correlation between general and specifics preference-based measures was small; therefore, the SF-6Dv1 should be used with caution in cost-utility studies for this population. We recommend that in women with OAB, the value set for GPBM be obtained in countries where cost utility is applied.

Developing Information Model of Central Line-Associated Bloodstream Infection (CLABSI) Prevention

CLABSIs are one of the most lethal and costly types of healthcare associated infections (HAIs). Regulatory organizations have mandated hospitals to submit monthly surveillance reports. However, there is an inaccuracy of presenting this report because of the lack of data standardization. This descriptive qualitative study aimed to develop a CLABSI prevention Information Model (IM) so the CLABSI prevention guidelines can be incorporated into structured nursing documentations. The flowsheet metadata stored in the Clinical Decision Repository was analyzed using an advanced analytics tool. The CLABSI prevention flowsheet data were mapped to 25 concepts, 45 data attributes and over 200 data value sets after organizing hierarchical structures. Seven domains of CLABSI prevention were identified in a CLABSI prevention IM. It would provide tangible benefits to create a practice reminder of the high risk for CLABSIs based on the nursing flowsheet data sets and multidisciplinary Electronic Health Record (EHR).

A Data-Driven Iterative Approach for Semi-automatically Assessing the Correctness of Medication Value Sets: A Proof of Concept Based on Opioids

Background Value sets are lists of terms (e.g., opioid medication names) and their corresponding codes from standard clinical vocabularies (e.g., RxNorm) created with the intent of supporting health information exchange and research. Value sets are manually-created and often exhibit errors. Objectives The aim of the study is to develop a semi-automatic, data-centric natural language processing (NLP) method to assess medication-related value set correctness and evaluate it on a set of opioid medication value sets. Methods We developed an NLP algorithm that utilizes value sets containing mostly true positives and true negatives to learn lexical patterns associated with the true positives, and then employs these patterns to identify potential errors in unseen value sets. We evaluated the algorithm on a set of opioid medication value sets, using the recall, precision and F1-score metrics. We applied the trained model to assess the correctness of unseen opioid value sets based on recall. To replicate the application of the algorithm in real-world settings, a domain expert manually conducted error analysis to identify potential system and value set errors. Results Thirty-eight value sets were retrieved from the Value Set Authority Center, and six (two opioid, four non-opioid) were used to develop and evaluate the system. Average precision, recall, and F1-score were 0.932, 0.904, and 0.909, respectively on uncorrected value sets; and 0.958, 0.953, and 0.953, respectively after manual correction of the same value sets. On 20 unseen opioid value sets, the algorithm obtained average recall of 0.89. Error analyses revealed that the main sources of system misclassifications were differences in how opioids were coded in the value sets—while the training value sets had generic names mostly, some of the unseen value sets had new trade names and ingredients. Conclusion The proposed approach is data-centric, reusable, customizable, and not resource intensive. It may help domain experts to easily validate value sets.

Making high-quality quantum microwave devices with van der Waals superconductors

Ultra low-loss microwave materials are crucial for enhancing quantum coherence and scalability of superconducting qubits. Van der Waals (vdW) heterostructure is an attractive platform for quantum devices due to the single-crystal structure of the constituent two-dimensional (2D) layered materials and the lack of dangling bonds at their atomically sharp interfaces. However, new fabrication and characterization techniques are required to determine whether these structures can achieve low loss in the microwave regime. Here we report the fabrication of superconducting microwave resonators using NbSe$_2$ that achieve a quality factor $Q > 10^5$. This value sets an upper bound that corresponds to a resistance of $\leq 192 \mu\Omega$ when considering the additional loss introduced by integrating NbSe$_2$ into a standard transmon circuit. This work demonstrates the compatibility of 2D layered materials with high-quality microwave quantum devices.

The remarkably frequent use of EQ-5D in non-economic research

Introduction EQ-5D is an instrument which has been utilized for a variety of purposes, including in health-economic appraisals as an input into quality-adjusted life year (QALY) calculations. Indeed, it is the most-widely applied instrument for health-economic appraisal worldwide, and is recommended for use in QALY calculations by many national Health Technology Assessment (HTA) agencies. There is also a growing body of evidence for its usefulness in a variety of settings other than economic appraisals, but such use has not been well-documented. This study addresses this issue and documents how EQ-5D has been applied in both the non-economic and economic contexts. Methods The PubMed database was searched using the terms ‘EQ-5D’, ‘EQ-5D AND cost’, and ‘EQ-5D AND cost AND QALY’ from 1 January 1980 to 31 December 2019. We concentrated on 2019 publications for more detailed analyses. All the data collected for 2019 were downloaded and collected in EndNote. For 2019 only, we classified economic and non-economic use based on the inclusion of ‘cost’. We also checked by manual inspection whether the search terms were suitable in correctly identifying economic and non-economic use. Variants of the non-economic use of EQ-5D were classified as follows: (a) as a quality of life outcome measure; (b) as a tool for methodological research; (c) methodological issues of EQ-5D itself; (d) comparisons with other quality of life questionnaires; (e) mapping studies; (f) value sets; (g) alongside costs but no QALY calculated; and (h) other. Results The first publication found was from 1990. Up to and including 2019, 10,817 publications were identified, of which more than two in three did not contain any reference to costs or QALYs. In 2019, a total of 1409 manuscripts were identified, of which 239 were specifically for EQ-5D-5L. Four hundred and seven (28.9%) included some form of ‘costs’ and 157 (11.1%) both ‘costs’ AND ‘QALYs’ terms. For EQ-5D-5L, the corresponding numbers were 104 (43.5%) and 29 (12.1%), respectively. After manually checking all the 1409 papers, three were duplicated records, which were omitted. In the remaining 1406 papers, only 40 (2.8%) contained the term ‘cost’, but not ‘cost per QALY’, and only 117 (8.3%) were identifiable as economic evaluations using the term ‘cost per QALY’. Most non-economic use of EQ-5D was as a quality-of-life outcome measure (72.8%). Other applications were: as a tool for methodological research (6.7%); comparison studies (3.7%); EQ-5D methodological issues (3.5%); containing costs but not QALYs (2.8%); mapping (1.3%); value sets (0.4%); and other papers (0.4%). Conclusions The majority of the studies retrieved, covering a wide variety of research areas, reported upon the non-economic use of EQ-5D. Despite being the most-used instrument worldwide for QALY calculations, economic appraisal accounted for only a small, but important, part of published use.