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We used combustion synthesis to produce phase pure GdOBr:Ce with varying Ce concentration. Several combinations of NH4Br and fuel concentration were tested before phase pure GdOBr:Ce was produced by using a 50% excess of NH4Br and a 50% lean concentration of fuel. In addition to the expected emissions from Ce and Gd, we also detected emissions from Eu3+ and Tb3+. Further research indicated that these extra rare earth emissions were due to impurities in the Gd2O3 starting material. While not the desired effect, we were able to monitor both Eu and Ce intensities as a function of Ce concentration in GdOBr. The Ce emission is seen to reach a maximum between 0.1 and 0.5 mol%. At higher Ce content, the Ce luminescence is quenched because of the concentration quenching effect and the higher concentration of O-H and N-H groups as revealed by IR spectra. Eu emission progressively decreases as Ce content increases from a combination of competition with Ce for charge capture in the RL process and the effect of OH and NH groups. As Ce concentration increases the RL intensity ratio of the bands of the Ce doublet changes even though the energy difference between the two bands (0.24 ± 0.1 eV) is compatible with the spin-orbit splitting of the ground level of Ce3+ (0.25 eV). Fitting results indicate that this relative change is not due to changes in self-absorption, and the effect may be due to changes in local symmetry of the Ce ion. (© 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [ABSTRACT FROM AUTHOR]

The main thermally stimulated luminescence glow peak in irradiated oxyorthosilicates occurs near 360-400 K and has been postulated to comprise an electron trapped at an oxygen vacancy (F+ center). We have used electron paramagnetic resonance spectroscopy to identify this defect in Ln2SiO5 : Ce (Ln = Lu and Y) and show that it consists of a single electron trapped at a non-silicon-bonded oxygen vacancy in both bulk and nanophosphor oxyorthosilicates. Both Lu- and Y-based nanophosphors form seven- and nine-oxygen coordinated structures (P21/c) whereas the bulk phosphors form six- and seven-oxygen coordinated structures (C2/c). In each case the F+ center predominately forms at the larger oxygen site. A typical resonance comprises a single Gaussian line broadened by hyperfine interaction with g-values near the free electron value and hyperfine coupling ~0.4 mT. The F+ center can be annealed and radiation-induced, consistent with the thermally stimulated luminescence glow peak behavior. [ABSTRACT FROM AUTHOR]

Background: Immune checkpoint inhibitors (ICIs) are increasingly used to treat several types of tumors. Impact of this emerging therapy on patients' health-related quality of life (HRQoL) is usually collected in clinical trials through standard questionnaires. However, this might not fully reflect HRQoL of patients under real-world conditions. In parallel, users' narratives from social media represent a potential new source of research concerning HRQoL.Objective: The aim of this study is to assess and compare coverage of ICI-treated patients' HRQoL domains and subdomains in standard questionnaires from clinical trials and in real-world setting from social media posts.Methods: A retrospective study was carried out by collecting social media posts in French language written by internet users mentioning their experiences with ICIs between January 2011 and August 2018. Automatic and manual extractions were implemented to create a corpus where domains and subdomains of HRQoL were classified. These annotations were compared with domains covered by 2 standard HRQoL questionnaires, the EORTC QLQ-C30 and the FACT-G.Results: We identified 150 users who described their own experience with ICI (89/150, 59.3%) or that of their relative (61/150, 40.7%), with 137 users (91.3%) reporting at least one HRQoL domain in their social media posts. A total of 8 domains and 42 subdomains of HRQoL were identified: Global health (1 subdomain; 115 patients), Symptoms (13; 76), Emotional state (10; 49), Role (7; 22), Physical activity (4; 13), Professional situation (3; 9), Cognitive state (2; 2), and Social state (2; 2). The QLQ-C30 showed a wider global coverage of social media HRQoL subdomains than the FACT-G, 45% (19/42) and 29% (12/42), respectively. For both QLQ-C30 and FACT-G questionnaires, coverage rates were particularly suboptimal for Symptoms (68/123, 55.3% and 72/123, 58.5%, respectively), Emotional state (7/49, 14% and 24/49, 49%, respectively), and Role (17/22, 77% and 15/22, 68%, respectively).Conclusions: Many patients with cancer are using social media to share their experiences with immunotherapy. Collecting and analyzing their spontaneous narratives are helpful to capture and understand their HRQoL in real-world setting. New measures of HRQoL are needed to provide more in-depth evaluation of Symptoms, Emotional state, and Role among patients with cancer treated with immunotherapy. [ABSTRACT FROM AUTHOR]

Background: Defining the transition from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive multiple sclerosis (SPMS) can be challenging and delayed. A digital tool (MSProDiscuss) was developed to facilitate physician-patient discussion in evaluating early, subtle signs of multiple sclerosis (MS) disease progression representing this transition.Objective: This study aimed to determine cut-off values and corresponding sensitivity and specificity for predefined scoring algorithms, with or without including Expanded Disability Status Scale (EDSS) scores, to differentiate between RRMS and SPMS patients and to evaluate psychometric properties.Methods: Experienced neurologists completed the tool for patients with confirmed RRMS or SPMS and those suspected to be transitioning to SPMS. In addition to age and EDSS score, each patient's current disease status (disease activity, symptoms, and its impacts on daily life) was collected while completing the draft tool. Receiver operating characteristic (ROC) curves determined optimal cut-off values (sensitivity and specificity) for the classification of RRMS and SPMS.Results: Twenty neurologists completed the draft tool for 198 patients. Mean scores for patients with RRMS (n=89), transitioning to SPMS (n=47), and SPMS (n=62) were 38.1 (SD 12.5), 55.2 (SD 11.1), and 69.6 (SD 12.0), respectively (P<.001, each between-groups comparison). Area under the ROC curve (AUC) including and excluding EDSS were for RRMS (including) AUC 0.91, 95% CI 0.87-0.95, RRMS (excluding) AUC 0.88, 95% CI 0.84-0.93, SPMS (including) AUC 0.91, 95% CI 0.86-0.95, and SPMS (excluding) AUC 0.86, 95% CI 0.81-0.91. In the algorithm with EDSS, the optimal cut-off values were ≤51.6 for RRMS patients (sensitivity=0.83; specificity=0.82) and ≥58.9 for SPMS patients (sensitivity=0.82; specificity=0.84). The optimal cut-offs without EDSS were ≤46.3 and ≥57.8 and resulted in similar high sensitivity and specificity (0.76-0.86). The draft tool showed excellent interrater reliability (intraclass correlation coefficient=.95).Conclusions: The MSProDiscuss tool differentiated RRMS patients from SPMS patients with high sensitivity and specificity. In clinical practice, it may be a useful tool to evaluate early, subtle signs of MS disease progression indicating the evolution of RRMS to SPMS. MSProDiscuss will help assess the current level of progression in an individual patient and facilitate a more informed physician-patient discussion. [ABSTRACT FROM AUTHOR]

Time trade-off (TTO) and discrete choice experiment (DCE) preference-elicitation techniques can be administered using face-to-face interviews (F2F), unassisted online (UO) surveys, or remote-assisted (RA) interviews. The objective of this study was to explore how the mode of administration affects the quality and reliability of preference-elicitation data. EQ-5D-5L health states were valued using composite TTO (cTTO) and DCE approaches by the UK general population. Participants were allocated to 1 of 2 study groups. Group A completed both F2F and UO surveys (n = 271), and group B completed both RA and UO surveys (n = 223). The feasibility of survey completion and the reliability and face-validity of data collected were compared across all modes of administration. Fewer participants reported receiving sufficient guidance on the cTTO tasks during the UO survey compared with the 2 assisted modes. Participants across all modes typically reported receiving sufficient guidance on the DCE tasks. cTTO data were less reliable from the UO survey compared with both assisted modes, but there were no differences in DCE data reliability. cTTO data from all modes demonstrated face-validity; however, the UO survey produced higher utilities for moderate and severe health states than both assisted modes. Both F2F and RA modes provided comparably reliable data. The reliability of DCE data is not affected by the mode of administration. Interviewer-assisted modes of administration (F2F or RA) yield more reliable cTTO data than unassisted surveys. Both F2F and RA surveys produced similar-quality data. • Preference-elicitation tasks can be administered using various modes of administration, ie, face-to-face (F2F), online remote assisted (RA), or online unassisted (UO). Existing literature suggests that the mode of administration of preference-elicitation tasks can influence the resulting data. • This study compared discrete choice experiment (DCE) and composite time trade-off (cTTO) data across all 3 modes of administration. This study adds to the literature by examining the quality of latent-scale DCE and cTTO data elicited via UO surveys compared with 2 different interviewer-assisted modes (F2F and RA). The study also strengthens existing findings from recent studies comparing F2F with RA interviews for conducting cTTO studies. • The findings from this study support conducting DCE studies to value health states using any mode of administration. cTTO data quality in this study was, however, affected by mode of administration; higher quality data were obtained from F2F and RA modes compared with UO. Interviewer-assisted modes are recommended for cTTO studies based on these findings, although future research should explore optimizing online cTTO surveys to potentially enable high quality data collection from UO settings. [ABSTRACT FROM AUTHOR]

This literature review provides an overview of meaningful change thresholds for the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30) and the Functional Assessment of Cancer Therapy – General (FACT-G) used across hematological cancers and solid tumors (melanoma, lung, bladder, and prostate). Embase, MEDLINE, and PubMed were searched to identify relevant oncology publications from 2016 to 2021. Label claims from the US Food and Drug Administration and the European Medicines Agency for 7 recently approved drugs (pembrolizumab, atezolizumab, glasdegib, gilteritinib, tisagenlecleucel, axicabtagene ciloleucel, and daratumumab plus hyaluronidase-fihj) were reviewed. Publications providing guidance on meaningful change thresholds for the QLQ-C30 displayed a growing trend away from broad "legacy" thresholds of 10 points for all QLQ-C30 scales), toward deriving "contemporary" thresholds (eg, subscale specific, population specific). Contemporary publications generally provide guidance on selecting thresholds for specific scales that account for improved or worsening thresholds (eg, QLQ-C30 subscales). This trend was not clear for FACT-G, with less new guidance available. Most clinical trials used in regulatory label submissions have used thresholds of 10 points for the QLQ-C30 subscales and 3 to 7 points for the FACT-G total score. Despite the availability of more recent guidelines, contemporary meaningful change thresholds seem slow to emerge in the published literature and regulatory labels. Trialists should consider using contemporary thresholds, rather than legacy thresholds, for QLQ-C30 endpoints. Thresholds derived for a similar patient-population should be used where available. Further work is required to provide these across a broader range of cancer sites. • Estimating thresholds for clinically meaningful change is important when using patient-reported outcomes in clinical research, and the method used to derive these thresholds has implications for their conceptual value and subsequent use in analyses. In addition, methodology for estimating meaningful change thresholds has progressed in recent years. This review provides a recent, unique snapshot of the role and evolution of meaningful change thresholds for 2 popular quality-of-life instruments (European Organisation for Research and Treatment of Cancer QLQ-C30 and the Functional Assessment of Cancer Therapy – General [FACT-G]) across a variety of cancers (hematological, melanoma, lung, bladder, and prostate), synthesizing clinical research, academic, and regulatory perspectives. In particular, this article provides a simplified framework to researchers for understanding the recent history of applied score interpretation in oncology for these instruments (ie, legacy, contemporary, and cancer-specific thresholds); it also reviews the application and derivation of thresholds and, finally, synthesizes these findings with regulatory usage through a review of the application of thresholds in clinical trials used in recent drug approvals. • This review contributes to the current literature by highlighting current practices and identifying patterns and trends for meaningful change thresholds for the European Organisation for Research and Treatment of Cancer QLQ-C30 and FACT-G as applied to oncology clinical trials and label claims. This review provides more consistency in application of threshold score interpretation across trials through providing readers with an understanding of the many variables that threaten such consistency (including use of group- or individual-level thresholds, different estimation methods, and differing application of these across trials and cancers). • Findings from this review foster an awareness of the link between current issues in score estimation methodology and subsequent estimated thresholds, which is relevant both to oncology researchers and those working toward regulatory approval of novel therapeutic products. Understanding these issues will help this field to move away from over-reliance on broad "legacy" thresholds and encourage researchers to use improved threshold estimates in consideration of specific patient populations, direction of change, and specific domains of the QLQ-C30 and FACT-G instruments. [ABSTRACT FROM AUTHOR]

Background: CheckMate 032 (NCT01928394) is an open-label, phase 1/2 trial evaluating the efficacy and safety of nivolumab monotherapy and nivolumab plus ipilimumab in patients with advanced or metastatic solid tumors. In this study, nivolumab alone or in combination with ipilimumab showed durable responses, encouraging survival, and manageable safety in patients with small cell lung cancer (SCLC) that progressed after ≥1 previous platinum-containing regimens. Objectives: An exploratory objective of the study is to describe changes in patient-reported health status using the EuroQoL-5 Dimensions (EQ-5D) instrument. Methods: The EQ-5D visual analog scale (VAS; scale: 0-100 [worst-best health]; minimally important difference [MID] = 7) was assessed in the treatment period at baseline (week 1 prior to study drug administration) and then every 2 weeks in the nivolumab (3 mg/kg) arm and at baseline and then every 3 weeks in the nivolumab (1 mg/kg) plus ipilimumab (3 mg/kg) arm through week 13, and in both arms at subsequent tumor assessments (every 6 weeks until week 24 and every 12 weeks thereafter). After treatment discontinuation, the EQ-5D was assessed at follow-up visits 1 and 2, and at survival visits. EQ-5D VAS mean and mean within-patient change from baseline were estimated at each assessment. Time to first deterioration (TTD) in health status was also evaluated. Results: In the nivolumab (n = 245) and nivolumab plus ipilimumab (n = 156) arms, EQ-5D VAS completion rates were 90% and 85%, respectively, at baseline and remained ≥60% at the last assessment (≥5 patients/arm; weeks 97 and 121, respectively). Baseline mean EQ-5D VAS scores for the nivolumab and nivolumab plus ipilimumab arms were 67.1 and 65.2, respectively, and similar to a lung cancer population norm (68). With monotherapy, EQ-5D VAS mean within-patient changes from baseline suggested health status stability while on treatment (estimated changes

This article discusses a recent methodological change to assess the additional benefit of drug intervention by the German Federal Joint Committee (Gemeinsamer Bundesausschuss), a key stakeholder in EUnetHTA21 (European Network for Health Technology Assessment joint consortium for future EU HTA regulation), methodological workstream. The German Federal Joint Committee (Gemeinsamer Bundesausschuss) set a universal individual response threshold at ≥ 15% of the scale range of the measurement instrument, for all patient-reported outcomes, to achieve an additional benefit rating for a given pharmaceutical intervention. This approach is originally based on a corresponding recommendation from the Institute for Quality and Efficiency in Health Care. The merits of this approach are reviewed from various perspectives, including the evidence basis, statistical and psychometric considerations, and regulatory perspectives by the ISPOR Clinical Outcomes Assessment Special Interest Group's multistakeholder group of authors (academia, contract research organizations, and industry). Particular focus is placed on the patient perspective within the Institute for Quality and Efficiency in Health Care approach. The article development incorporated feedback from ISPOR members during well-attended ISPOR US and European conference presentations and 2 formal rounds of written review. The authors concluded that the ≥ 15% response threshold is incongruent with previously defined and scientifically established thresholds and is not well-suited for universal implementation. Further scientific evidence and discussion among all stakeholders are needed, especially should this universal rule be considered in the context of future joint clinical assessments of health technologies in the European Union scheduled from 2025 onward. [ABSTRACT FROM AUTHOR]

Air impermeability has been observed in low-density aerogel and cryogel materials, which has led to a series of experiments to investigate the feasibility of an air buoyant vacuum vessel, as well as the fabrication and testing of sub-buoyant prototypes. Bulk samples of silica aerogel were shown to isolate vacuum from ambient air for several hours with optimal vacuum isolation occurring at a density of approximately 85 mg cm−3. It was demonstrated using polyimide aerogel and cryogel materials that the ability of these foam materials to provide an air impermeable layer between vacuum and atmosphere, in spite of being comprised of mostly void space, is related to material stiffness. It is hypothesized that this behavior is due to local deformation of the random nanostructure of the material. Spherical shell vacuum vessels were produced using the polyimide cryogel, and less than 133 Pa vacuum containment was demonstrated under active pumping. In order to approach the non-buoyant to buoyant transition for these vacuum vessels, a polyimide composite was produced using helical fibers for which preliminary mechanical testing was performed. [ABSTRACT FROM AUTHOR]

• Patient-reported outcomes were assessed using EQ-5D and LCSS-Meso measures in CheckMate 743. • Nivolumab + ipilimumab maintained overall health status in patients vs chemo. • The risk of deterioration in symptoms was decreased with nivolumab + ipilimumab vs chemo. • Nivolumab + ipilimumab delayed time to definitive deterioration in quality-of-life vs chemo. • PRO data confirm clinical benefit of 1L nivolumab + ipilimumab vs chemo in unresectable MPM. In CheckMate 743 (NCT02899299), nivolumab + ipilimumab significantly prolonged overall survival in patients with unresectable malignant pleural mesothelioma (MPM). We present patient-reported outcomes (PROs). Patients (N = 605) were randomized to nivolumab + ipilimumab or chemotherapy. Changes in disease-related symptom burden and health-related quality of life (HRQoL) were evaluated descriptively using the Lung Cancer Symptom Scale (LCSS)-Mesothelioma (Meso) average symptom burden index (ASBI), LCSS-Meso 3-item global index (3-IGI), 3-level EuroQol 5-dimensional (EQ-5D-3L) visual analog score (VAS), and EQ-5D-3L utility index. PROs were assessed at baseline and every 2 (nivolumab + ipilimumab) or 3 weeks (chemotherapy) through 12 weeks, every 6 weeks through 12 months, every 12 weeks thereafter, and at specified follow-ups. Mixed-effect model repeated measures (MMRM) and time to deterioration analyses were conducted. Completion rates were generally >80%. LCSS-Meso ASBI mean changes from baseline trended to improve over time with nivolumab + ipilimumab and deteriorate with chemotherapy, but did not meet clinically important difference thresholds [±10 score change]. EQ-5D-3L VAS mean scores improved over time with nivolumab + ipilimumab; by week 60, patients had scores consistent with United Kingdom normal population values. MMRM analyses favored nivolumab + ipilimumab for all individual symptoms except cough. Nivolumab + ipilimumab delayed time to definitive deterioration in HRQoL (hazard ratio 0.52 [95% confidence interval 0.36–0.74]) and showed a trend in symptom delay versus chemotherapy. Nivolumab + ipilimumab decreased the risk of deterioration in disease-related symptoms and HRQoL versus chemotherapy and maintained QoL in patients with unresectable MPM. [ABSTRACT FROM AUTHOR]

Objectives: This study developed, and established the content validity, of a conversation aid tool (CAT) for use in clinical practice with renal cell carcinoma (RCC) patients who receive a curative nephrectomy and are at high-risk of recurrence. The CAT was pilot tested in a sample of RCC patients to establish whether the CAT increases knowledge of RCC, treatment options (such as adjuvant therapy), and care options.Methods: A cross-sectional, mixed methods design was used involving initial, exploratory interviews with RCC patients, RCC specialists and a steering group. Further content validation interviews were conducted with RCC patients and specialists. A web-based survey was conducted with RCC patients (N = 60), to compare the CAT versus a standard of care (SOC) consultation comparator tool on patient knowledge.Results: Findings from exploratory interviews were used to develop the CAT. Content validation interviews demonstrated that the CAT was well understood and relevant to RCC patients. The web-based survey demonstrated that viewing the CAT significantly improved participants knowledge of RCC, and care options, when compared to the SOC.Conclusion: The findings highlight that the CAT is a relevant, comprehensive and well-understood tool for use in the post-nephrectomy consultation.Practice Implications: Use of the CAT may increase patient knowledge of RCC and care options. [ABSTRACT FROM AUTHOR]

Inspired by a first episode of schizophrenia following within a week of stage hypnosis, we examined relations between schizotypy and hypnotizability with the Harvard Group Scale of Hypnotic Susceptibility (HGSHS), showing positive associations with 15 items mostly consisting of positive aspects of schizotypy. Here this was re-examined in two further samples. First, with the more cognitively loaded Stanford Hypnotic Susceptibility Scale, Form C, administered individually to Italian, female psychology students. In the second the HGSHS was administered to British medical student volunteers in stress reduction studies. In the first replication 12 correlations were disclosed, all with positive features of schizotypy, nine consisting of unreality experiences, with six items relating to psychic experiences. In the second replication of the 13 positive associations, seven were negative items belonging to the withdrawn syndrome, with six belonging to the social anxiety subscale, a non-specific feature of schizotypy. Across the series of studies, all but one item was interpreted as consistent with associations between hypnotizability and positive schizotypy and social anxiety. Though the items mostly varied from study to study, and despite sampling and scale differences, the outcome clearly merits large scale studies to investigate further the relation between hypnotic susceptibility and psychopathology. [ABSTRACT FROM AUTHOR]

Background: The minimal important difference (MID) is a useful tool to interpret changes in patients' health-related quality of life. This study aims to estimate MIDs for interpreting within-patient change for both components of the EQ-5D-5L questionnaire [EQ-Visual Analogue Scale (EQ-VAS) and utility index] and domains of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) for cancer patients., Methods: Data were obtained from the Cancer 2015 dataset, a longitudinal cohort of Australian cancer patients. Anchor-based approaches were used to estimate MIDs for the EQ-5D-5L index-based utility index [Australia and the United States (US) tariff sets], EQ-VAS scores, and the EORTC QLQ-C30. Clinical [Eastern Cooperative Oncology Group (ECOG) performance status] and patient-reported (items 29 and 30 of the EORTC QLQ-C30 and the EQ-VAS) anchors were assessed for appropriateness by their correlation strength. Clinical change groups (CCGs) were defined a priori for improvement and deterioration based on estimates used in previous literature. MIDs were estimated via linear regression and distribution-based methods., Results: For the index-based utility scores in Australia, the anchor-defined MID estimates were 0.01 to 0.06 for improvement and - 0.04 to -0.03 for deterioration, with a weighted value of 0.03 for improvement and deterioration. The EQ-VAS MID estimate was 5 points for both improvement and deterioration. For the EORTC QLQ-C30, changes of at least 3.64 (improvement) and - 4.28 (deterioration) units on the physical functioning scale, 6.31 (improvement) and - 7.11 (deterioration) units on the role functioning scale, 4.65 (improvement) and - 3.41 (deterioration) units on the emotional functioning scale, and 5.41 (improvement) and - 5.56 (deterioration) units on the social functioning scale were estimated to be meaningful., Conclusion: This study identified lower MIDs for the EQ-5D-5L utility index, EQ-VAS, and EORTC QLQ-C30 domain scores, than those reported previously. The use of a real-world cancer-specific panel dataset may reflect smaller MID estimates that are more applicable to cancer patients in the clinical practice, rather than using MIDs that have been estimated from clinical trials., (© 2024. The Author(s).)

Background: Malignant pleural mesothelioma (MPM) is a rare and usually fatal malignancy frequently linked to occupational asbestos exposures and associated with poor prognosis and considerable humanistic burden. The study aimed to develop conceptual models of the health-related quality of life (HRQoL) impact on patients with and receiving treatment for MPM, and the burden on their caregivers., Methods: This multi-country study (Australia and United Kingdom) adopted a qualitative methodology to conduct semi-structured, independent interviews with people with MPM (n = 26), current caregivers (n = 20), and caregivers of people who had recently died because of MPM (n = 4). Participants were recruited using a purposive sampling approach and interviews conducted via telephone between January 2021 and January 2022. Transcripts were analysed using thematic analysis and used to construct conceptual models., Results: Patient analysis yielded four overarching themes: (1) debilitating burden of breathlessness and fatigue; (2) physical mesothelioma symptoms experienced by patients; (3) distress of MPM on the self and family; and (4) treatment is worth 'having a go' despite the potential impact on symptoms. Caregiver analysis yielded five core themes: (1) daily life limited by caregiving duties; (2) emotional well-being and the need for support; (3) the relational role shift to caregiver; (4) time spent providing care negatively impacts work and productivity; and (5) positive aspects and outcomes of caregiving., Conclusions: This study highlights the substantial daily and emotional HRQoL impact that MPM symptoms have on patients and caregivers. Both groups reduced work, productivity, and social and leisure activities. There was evidence of positive HRQoL impacts as a result of immunotherapy and radiotherapy, but less for chemotherapy. Caregiver impacts were intensified during the end-of-life period and persisted following patient death. Evident is a need for increased psychological support, information, and advice for caregivers, increased during the end-of-life period., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objectives: Estimates of minimally important differences (MID) can assist interpretation of data collected using patient-reported outcomes (PRO), but variability exists in the emphasis placed on MIDs in health technology assessment (HTA) guidelines. This study aimed to identify to what extent information on the MID of a commonly used PRO, the EQ-5D, is required and utilised by selected HTA agencies., Methods: Technology appraisal (TA) documents from HTA agencies in England, France, Germany, and the US between 2019 and 2021 were reviewed to identify documents which discussed MID of EQ-5D data as a clinical outcome assessment (COA) endpoint., Results: Of 151 TAs utilising EQ-5D as a COA endpoint, 58 (38%) discussed MID of EQ-5D data. Discussion of MID was most frequent in Germany, in 75% (n = 12/16) of Gemeinsamer Bundesausschuss (G-BA) and 44% (n = 34/78) of Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, (IQWiG) TAs. MID was predominantly applied to the EQ-VAS (n = 50), most frequently using a threshold of > 7 or > 10 points (n = 13). G-BA and IQWiG frequently criticised MID analyses, particularly the sources of MID thresholds for the EQ-VAS, as they were perceived as being unsuitable for assessing the validity of MID., Conclusion: MID of the EQ-5D was not frequently discussed outside of Germany, and this did not appear to negatively impact decision-making of these HTA agencies. While MID thresholds were often applied to EQ-VAS data in German TAs, analyses were frequently rejected in benefit assessments due to concerns with their validity. Companies should pre-specify analyses of continuous data in statistical analysis plans to be considered for treatment benefit assessment in Germany., (© 2024. The Author(s).)