Switching from EQ-5D-3L to EQ-5D-5L in England: the impact in NICE technology appraisals.

OBJECTIVE: To estimate the impact of using EQ-5D 5-level (5L) in a sample of National Institute for Health and Care Excellence (NICE) Technology Appraisals (TAs) originally undertaken using the EQ-5D 3-level (3L).

METHODS: For TA case studies published between 2016 and 2024 we extracted utility values used in the cost effectiveness models and mapped them to 5L using the eq5dmap model with a new value set for England. Results using 3L and mapped 5L values were compared for oncology, non-oncology with life extension, and non-oncology without life extension interventions.

RESULTS: We selected 39 appraisal decisions. In almost all cases, EQ-5D values increased after being mapped to 5L, with the magnitude of the increase being greater for more severe initial 3L health values. The impact of using mapped 5L values to model results differed according to the intervention group: absolute incremental QALYs increased (mean=12.5%) and ICERs decreased (mean=11.1%) in the oncology group (n = 17), whilst the opposite and larger effect was observed in the non-oncology without a survival gain group (n=11, decrease in incremental QALYs = 37.5%, increase in ICER = 61.4%). Results were mixed for the non-oncology interventions with a survival gain (n = 11).

CONCLUSIONS: Mapping from 3L to 5L increases utility values, with magnitude of change being greater for more severe health states. The impact on estimates of cost effectiveness varies according to the extent of quality of life versus length of life improvement but can be very substantial.