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Objective: To derive a US-based value set for the EQ-5D-5L questionnaire using an international, standardized protocol developed by the EuroQol Group.Methods: Respondents from the US adult population were quota-sampled on the basis of age, sex, ethnicity, and race. Trained interviewers guided participants in completing composite time trade-off (cTTO) and discrete choice experiment (DCE) tasks using the EuroQol Valuation Technology software and routine quality control measures. Data were modeled using a Tobit model for cTTO data, a mixed logit model for DCE data, and a hybrid model that combined cTTO and DCE data. Model performance was compared on the basis of logical ordering of coefficients, statistical significance, parsimony, and theoretical considerations.Results: Of 1134 respondents, 1062, 1099, and 1102 respondents provided useable cTTO, DCE, and cTTO or DCE responses, respectively, on the basis of quality control criteria and interviewer judgment. Respondent demographic characteristics and health status were similar to the 2015 US Census. The Tobit model was selected as the preferred model to generate the value set. Values ranged from -0.573 (55 555) to 1 (11 111), with 20% of all predicted health states scores less than 0 (ie, worse than dead).Conclusions: A societal value set for the EQ-5D-5L was developed that can be used for economic evaluations and decision making in US health systems. The internationally established, standardized protocol used to develop this US-based value set was recommended by the EuroQol Group and can facilitate cross-country comparisons. [ABSTRACT FROM AUTHOR]

Objective: The D1 model that was developed to predict US societal preferences for EQ-5D health states addressed several important conceptual and statistical issues. However, it has been criticized for being too complex, failing to account for the nonnormal distribution of health state values, and the transformation of preferences for worse-than-death health states before estimation. This research was conducted to develop an improved model for predicting median preferences for EQ-5D health states for the US population. Methods: Probability-weighted least absolute deviations regression was used to fit models to the time trade-off data collected in the US Valuation of the EQ-5D Health States study. No transformation was applied to the values for states considered worse than death. Several model specifications that differed with respect to explanatory variables were evaluated using two-sample cross-validation. Results: The best-fitting model included only fixed effects for moderate or severe problems in each of the 5 EQ-5D dimensions and excluded a constant. This specification yielded rank correlations between observed and predicted values and median observed and predicted values of 0.635 and 0.991, respectively, as well as a median absolute error of 0.026. The predicted median preferences ranged from 1.00 for full health, to –0.81 for the worst possible health state. Conclusions: Due to its simplicity and robustness, a median model is superior to other models for predicting US population preferences for EQ-5D health states. The predictions of this model are suggested for use in applications that require US societal health state values. [ABSTRACT FROM AUTHOR]

Objective: To describe community pharmacists' experiences with consumer demand for imported pharmaceuticals and their opinions about economic, policy, and patient care issues surrounding importation of medications and their willingness to procure these products from international sources, if legally permitted.Design: Cross-sectional study.Setting: Four states in the United States (Michigan, Minnesota, Illinois, and Florida).Participants: Community/outpatient pharmacists.Interventions: Telephone-based survey conducted in March 2004.Main Outcome Measures: Self-reported opinions of pharmacists on importation of prescription drugs.Results: Of 401 respondents, approximately 90% agreed that the Medicare prescription drug benefit would not diminish consumer interest in importation of medications, and a similar proportion agreed that interest was not limited to the elderly. A majority of pharmacists (69%) agreed that their primary concern about importation was the quality (i.e., purity) of the drugs. However, 57% of pharmacists agreed that drugs purchased through Canada would not pose a greater risk of medication-related problems if U.S. pharmacists oversaw the process and were available to provide patient monitoring and education. Pharmacists strongly favored regulatory actions that might decrease counterfeiting. Nearly one third (32%) of pharmacists believed that consumers should be allowed to purchase medications from Canada legally, while 44% of pharmacists believed that pharmacies should be able to procure prescription drugs from Canada legally. Almost 70% of pharmacists said that they would consider ordering medications from Canada, if legally permitted. Approximately one half of the pharmacists surveyed were concerned about job security as a result of the trend toward importation. This concern was significantly higher among pharmacy owners (chi-square [df= 1] = 9.82; P < .01).Conclusion: Pharmacists expressed concern about safety, liability, and the economic ramifications of prescription drug importation. More favorable opinions were expressed for situations in which imported drugs would be channeled through U.S. pharmacies. [ABSTRACT FROM AUTHOR]

This study assessed the content validity of generic and condition-specific preference-based measures (PBMs) with patients treated for cancer, evaluated against 10 Consensus-Based Standards for the Selection of Health Measurement Instruments criteria for good content validity, to best inform measurement strategies regarding the use of PBMs in oncology development programs and real-world applications. Individual, semistructured interviews were conducted with patients who received drug treatment for cancer in the United Kingdom (n = 47) and the United States (n = 49). During the interview, patients completed 3 generic PBMs (EQ-5D-5L, EuroQol Health and Wellbeing measure–Short Form, Château Santé Base) and 2 condition-specific PBMs (Quality of Life Utility-Core 10 Dimension, Functional Assessment of Cancer Therapy Eight Dimension [FACT-8D]). Interviews were conducted via teleconference, audio recorded, and transcribed verbatim. Transcripts were coded using thematic and content analysis methods. Condition-specific measures were evaluated as having better relevancy than generic PBMs. Overall, the FACT-8D was evaluated as holding the best content validity in terms of relevancy, and the EuroQol Health and Wellbeing measure–Short Form received the most favorable evaluation of relevancy for generic PBMs. All measures demonstrated comparable comprehensiveness, with all suggested by patients to be missing concepts. The EQ-5D-5L was evaluated best in terms of comprehensibility. This was followed by the Quality of Life Utility-Core 10 Dimension and FACT-8D; both received similar evaluations. All measures were generally seen by patients as adequate in capturing appropriate aspects of health-related quality of life for measuring cancer outcomes, although together condition-specific measures were evaluated as having better relevancy than generic PBMs. Further health-related quality of life instrument development is encouraged, particularly with regard to the longer-term detrimental impacts of cancer and treatment side effects. Other developments could include new cancer-specific tools inclusive of conventional health items, treatment impacts, and psychological items. • Generic preference-based measures (PBMs) are recommended to assess patient-reported outcomes across interventions and to allow for comparative assessments across unrelated health conditions and interventions. Generic PBMs may exclude dimensions relevant to specific conditions, whereas condition-specific PBMs can contain items related to specific symptoms. Recent work has identified several concepts that are relevant to health-related quality of life and psychological wellbeing, which are not measured by existing outcome measures. • Patients who had received drug treatment for cancer in the United Kingdom and the United States evaluated 3 generic and 2 condition-specific PBMs during qualitative interviews. All measures demonstrated comparable comprehensiveness, missing concepts considered by patients as important to measure for their cancer and cancer treatment experiences. Language and format were frequently challenged, with patients suggesting changes to multiple items across all measures. Recall periods were frequently raised as problematic because of the substantial variation in cancer symptoms within a given day or week. • Given the burden of cancer symptoms and drug treatment effects, capturing all relevant outcomes of people with cancer is necessary to inform accurate decision making for cancer technologies. Modification of existing measures should be considered with regard to measurement gaps identified. New cancer-specific tools could be considered, inclusive of conventional health items, treatment impacts, and psychological items. These developments have a large potential for impact given the high proportions of oncology health technology assessment submissions. [ABSTRACT FROM AUTHOR]