EQ-5D-5L in Multiple Sclerosis: Estimated Utility Values, Minimal (Clinically) Important Changes, and Direct and...

Area of Science:

• Health Economics
• Neurology
• Patient-Reported Outcomes

Background:

• Existing studies show a wide range of EQ-5D-5L utility values in multiple sclerosis (MS).
• A recent systematic review highlighted the lack of published anchor-based estimates for Minimal Important Change (MIC) of the EQ-5D-5L in MS.
• There is a need for reliable reference values and MIC estimates specific to MS populations.

Purpose of the Study:

• To derive age- and sex-specific health utility reference values for the EQ-5D-5L in a large UK sample of individuals with MS.
• To determine the anchor-based Minimal Important Change (MIC) for the EQ-5D-5L in people with MS.
• To identify predictors of health status in MS using a Structural Equation Model (SEM).

Main Methods:

• Utilized data from the Trajectories of Outcomes in Neurological Conditions-MS study (n=5509).
• Calculated age, sex, and disability-subtype specific EQ-5D-5L utility estimates.
• Employed multiple regression and SEM to identify health status predictors and an anchor-based method for MIC calculation.

Main Results:

• Mean EQ-5D-5L utility in the MS sample was 0.682, with significant age and sex gradients.
• SEM indicated that higher self-efficacy improved EQ-5D-5L, while cognitive problems, progressive disease, fatigue, bladder issues, and stigma decreased it.
• The anchor-based MIC was 0.146, varying significantly by MS subtype and recent relapse history.

Conclusions:

• Health utility values in MS are lower than in the general English population.
• Factors influencing utility values, such as self-efficacy and disease symptoms, are potentially amenable to clinical intervention.
• A uniform MIC for EQ-5D-5L in MS is not appropriate; it should account for subtype and relapse history.