The Development of an EQ-5D Value Set for India using an Extended Design (DEVINE) study is a major milestone in India’s journey toward evidence-based healthcare decisions.(1) The DEVINE study, authorized by India’s central Health Technology Assessment (HTA) agency, introduced the country’s first EQ-5D-5L value set, which is customized to Indian societal preferences.(2) This is momentous as the EQ-5D-5L instrument, a regulated tool to quantify health-related quality of life (HRQoL), necessitates country-specific value sets to precisely indicate how people value different health states. These value sets are essential for calculating Quality-Adjusted Life Years (QALYs), to eventually support cost-effectiveness analyses and resource allocation in healthcare.(3, 4)
The study, methodically designed to show India’s huge socio-demographic diversity, was performed across five states using a multistage stratified random sampling method. It surveyed 3,548 adult respondents, the largest ever in an EQ-5D-5L valuation effort undertaken globally. Researchers used computer-assisted personal interviews, merging composite Time Trade-Off (cTTO) and Discrete Choice Experiment (DCE) tasks to obtain health preferences. The study peculiarly used an extended design evaluating 150 distinctive health states, almost twice the number usually integrated in such studies, improving the accuracy and statistical strength of the resulting model. The final value set incorporated a hybrid model, assigning utility values from -0.923 (depicting health states worse than death) to 1 (perfect health), with damages in pain/discomfort being the most significant driver of disutility.(1, 5)
The DEVINE study also introduced the first set of EQ-5D-5L population norms for India. The mean utility score across the population was 0.848, while the average self-rated health score on the Visual Analog Scale (VAS) was 75.18. These scores showed strong differences by age and gender. Males under 20 years of age showed the highest average utility (0.936), while females over 70 reported the lowest (0.488), depicting a sharp deterioration in perceived health among elderly women. Pain/discomfort and anxiety/depression were the most regularly reported problems, impacting more than half the survey respondents, underscoring the immediate need for direct interventions in these areas.(1, 5)
The DEVINE study findings highlight the crucial significance of culturally appropriate valuation tools in guidling national health policy. Many Indian health economic assessments till now have relied on value sets created in high-income countries, which often fail to address India’s distinct cultural, social, and healthcare realities. The DEVINE value set facilitates researchers and policymakers to perform cost-effectiveness evaluations that relate to the local population values, allowing for more precise prioritization of interventions; particularly in settings with limited or inconsistent access to healthcare resources. Therefore, the ability to guide funds toward the most impactful interventions can substantially enhance population health outcomes.(1, 5)
Additionally, the newly developed population standards help guiding future health studies, allowing researchers to evaluate disease burden more accurately across different demographics. These instruments establish a basis for a more methodical approach to HTA in India, reinforcing the country’s institutional competence to meticulously assess heath technologies and programs. As HTA becomes increasingly integrated into the policy-making framework, the DEVINE study’s inputs will help facilitate transparent and equitable healthcare and funding decisions that are grounded in Indian realities.(1, 5)
By creating a vigorous EQ-5D-5L value set and population norms for India, the DEVINE study has enhanced academic knowledge while offering actionable insights for policymakers. It depicts a shift toward valuing the lived experiences of Indian populations in economic assessments and supports the broader vision of attaining Universal Health Coverage by means of informed resource allocation. Essentially, DEVINE provides India with the measurements required to enhance healthcare delivery, ensuring highest possible value with health gains against every rupee spent.
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References
- Jyani G, Sharma A, Prinja S, et al. Development of an EQ-5D Value Set for India Using an Extended Design (DEVINE) Study: The Indian 5-Level Version EQ-5D Value Set. Value Health. 2022; 25(7):1218-1226.
- Downey LE, Mehndiratta A, Grover A, et al. Institutionalising health technology assessment: establishing the medical technology assessment board in India. BMJ Glob Health. 2017; 2:e000259.
- Devlin N, Parkin D, Janssen B. Methods for Analysing and Reporting EQ-5D Data [Internet]. Cham (CH): Springer; 2020. Chapter 1, An Introduction to EQ-5D Instruments and Their Applications. 2020 Jul 21. [Accessed online on 25th June]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK565680/doi: 10.1007/978-3-030-47622-9_1
- EQ-5D-5L. EUROQOL. [Accessed online on 25th June]. Available from: https://euroqol.org/information-and-support/euroqol-instruments/eq-5d-5l/
- Jyani G, Prinja S, Kar SS, et al. Valuing health- related quality of life among the Indian population: a protocol for the Development of an EQ- 5D Value set for India using an Extended design (DEVINE) Study. BMJ Open 2020; 10:e039517.