Elicitation of health state utilities across six global markets

Development of health states and execution of time trade off (TTO) interviews to provide utility inputs to a cost effectiveness model


The challenge

Our client needed to generate utility inputs for their cost effectiveness model to support Health Technology Assessment (HTA) submissions in six markets (UK, France, Spain, Canada, Australia and Japan), but had two key challenges:

  1. The impact of disease flares could not be adequately captured within phase III trials using the preferred method of capturing utilities – the EQ-5D instrument.
  2. The disease of interest is a highly heterogeneous condition in terms of organ manifestation and symptom presentation.

The solution

The involvement of both patient and physician insight was key to ensuring that health states, designed for the direct elicitation of utilities, would be representative. We therefore conducted:

  • Interviews with patients (in the UK and Japan) to provide insight into the symptoms and impact of the disease flares on their daily lives.
  • Interviews with specialists and specialist nurses to provide insight into the clinical manifestations of the disease and the severity of flares.
  • Validation of health state descriptions with an independent panel of experts to ensure health states were representative of ‘typical’ patients.

Following the health state development, we conducted 100 face-to-face utility elicitation interviews with members of the general public in each of the six markets in parallel. We trained and managed local vendors in each market and provided around-the-clock support for the local teams to ensure effective and efficient delivery.

Key results

We managed the execution of the project from study design to communication of the results, working closely with local vendors to ensure a streamlined and high quality delivery across the markets.

Our study identified robust health state utilities for each market, generated via the TTO methodology, to use within cost effectiveness analyses for local HTA submissions.

Value to the client

Our rigorous health state development processes helped to maximise the credibility of the health states in a very heterogeneous disease whilst also building KOL relationships and fostering external interest in the project.

The findings were published in 2015:
Pollard, C., et al. “Elicitation of health state utilities associated with varying severities of flares in Systemic Lupus Erythematosus.”  Health and quality of life outcomes 13.1 (2015): 66.

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