Measuring and valuing health-related quality of life (HRQOL) in cancer
Health-related quality of life (HRQOL) instruments can broadly be divided into two groups, profile measures and preference-based measures (PBMs). The two types of instruments represent two different approaches to HRQOL assessment, namely measuring versus valuing health. They serve different research purposes – while HRQOL profile measures, such as the EORTC QLQ-C30 and its modules, deliver HRQOL outcomes in clinical research, health economics research relies on PBMs for HRQOL information. The EORTC Quality of Life Utility – Core 10 Dimensions (QLU-C10D) is a PBM which can be directly scored from the items of the QLQ-C30, i.e. it is a preference-based scoring algorithm that allows using information from the QLQ-C30 as both a HRQOL profile for clinical research questions and a PBM for health economic research. Preference-based (or utility) scoring is usually done from a societal perspective, i.e. the values assigned to health states are derived from the general population of the country where health costs arise for the society.
The QLU-C10D has been developed by the Multi-attribute utility in Cancer (MauCa) consortium in collaboration with the EORTC QLG.
The QLU-C10D user manual provides some theoretical background on this different measurement concepts, gives detailed information and guidance on the proper legal and scientific use of the EORTC QLU-C10D, including different modes of administration, scoring procedures, and results reporting.
The EORTC QLU-C10D is now available here.
Use of the QLU-C10D
The conditions for using the EORTC QLU-C10D follow those for the EORTC QLQ-C30.
Specific conditions for use of the EORTC QLU-C10D are:
- Completion of a User Agreement * EORTC QLU-C10D is used along with the QLQ-C30
- EORTC QLU-C10D needs to be scored according to the official algorithms and value sets as provided below – we recommend using values sets on data collected in the same country as health values were derived from whenever possible
Overview of available value sets for the QLU-C10D
| Country | Year | Reference |
|---|---|---|
| Australia | 2018 | King MT, Viney R, Pickard AS, Rowen D, Aaronson NK, Brazier JE, Cella D, Costa DSJ, Fayers PM, Kemmler G, McTaggart-Cowan H, Mercieca-Bebber R, Peacock S, Street DJ, Young TA, Norman R. (2018) Australian utility weights for the EORTC QLU-C10D, a multi- attribute utility instrument derived from the cancer-specific quality of life questionnaire, EORTC QLQ-C30. Pharmacoeconomics 36(2):225-238 |
| Austria | 2020 | Gamper EM, King MT, Norman R, Efficace F, Cottone F, Holzner B, Kemmler GW. (2020) EORTC QLU-C10D value sets for Austria, Italy, and Poland. Quality of Life Research 29(9):2485-2495 |
| Canada | 2019 | McTaggart-Cowan H, King MT, Norman R, Costa D, Pickard AS, Regier D, Viney R, Peacock S. (2019) The EORTC QLU-C10D: The Canadian Valuation Study and Algorithm to Derive Cancer-Specific Utilities From the EORTC QLQ-C30. MDM Policy and Practice 4(1):2381468319842532 |
| France | 2020 | Nerich V, Gamper EM, Norman R, King M, Holzner B, Kemmler G. (2021) French value set of the QLU-C10D, a Cancer-Specific Utility Measure Derived from the QLQ-C30. Applied Health Economics and Health Policy, 19(2), 191-202. |
| Germany | 2019 | Kemmler G, Gamper E, Nerich V, Norman R, Viney R, Holzner B, King MT. (2019) German value sets for the EORTC QLU-C10D, a cancer-specific utility instrument based on the EORTC QLQ-C30. Quality of Life Research 28(12):3197-3211 |
| Italy | 2020 | Gamper EM, King MT, Norman R, Efficace F, Cottone F, Holzner B, Kemmler GW. (2020) EORTC QLU-C10D value sets for Austria, Italy, and Poland. Quality of Life Research 29(9):2485-2495 |
| Netherlands | 2021 | Jansen F, Verdonck-de Leeuw IM, Gamper E, Norman R, Holzner B, King M, Kemmler G. (2021) Dutch utility weights for the EORTC cancer-specific utility instrument: the Dutch EORTC QLU-C10D. Quality of Life Research, 30(7), 2009-2019 (2021). |
| Poland | 2020 | Gamper EM, King MT, Norman R, Efficace F, Cottone F, Holzner B, Kemmler GW. (2020) EORTC QLU-C10D value sets for Austria, Italy, and Poland. Quality of Life Research 29(9):2485-2495 |
| Spain | 2021 | Finch, A. P., Gamper, E., Norman, R., Viney, R., Holzner, B., King, M., & Kemmler, G. (2021). Estimation of an EORTC QLU-C10 Value Set for Spain Using a Discrete Choice Experiment. PharmacoEconomics, 39(9), 1085-1098. |
| UK | 2019 | Norman R, Mercieca-Bebber R, Brazier JE, Cella D, Pickard AS, Rowen D, Street DJ, Viney R, King MT. (2019) UK utility weights for the EORTC QLU-C10D. Health Economics 28(12):1385-1401 |
| USA | 2021 | Revicki D, King MT, Viney R, Pickard AS, Mercieca-Bebber R, Shaw JW, Norman R. (2021) United States utility algorithm for the EORTC QLU-C10D, a multi-attribute utility instrument based on a cancer- specific quality of life instrument. Medical Decision Making, 41(4), 485-501. |
Developing new QLU-C10D value sets
The EORTC QLG and the MauCa consortium encourage and support the development of additional national QLU-C10D value sets and may also be performed by researchers/research groups outside the EORTC; in order to create official EORTC values sets they need to comply with the standardised methodology that is in place. The EORTC QLD and the MauCa-Consortium need to approve the valuation protocol. Please contact the EORTC QLD and/ or the MauCa-Consortium if you are interested in developing EORTC QLU-C10D value sets.
QLU-C10D normative data
General population norms for the QLU-C10D allow the comparison of utilities between cancer patients and a comparative group reflecting a reality, i.e. a population necessarily containing people with various (chronic) diseases, rather than a hypothetically completely healthy population. They may therefore provide an adequate baseline in economic modelling and a comparator for survivorship studies. Additionally, normative utility scores can facilitate comparisons across countries, regions and cultures, enabling the detection of health inequities in subgroups of the population.
The available general population norms are listed below:
- Pilz M, Nolte S, Liegl G , King M, Norman R, McTaggart-Cowan H, Bottomley A, Rose M, Kemmler G, Holzner B, Gamper EM; EORTC Quality of Life Group. The European Organisation for Research and Treatment of Cancer Quality of Life Utility-Core 10 Dimensions: Development and Investigation of General Population Utility Norms for Canada, France, Germany, Italy, Poland, and the United Kingdom. Value Health 2022 Dec 23;S1098-3015(22)04783-0.
FAQ on QLU-C10D
- The QLU-C10D scoring procedures only needs 13 of the 30 items of the QLQ-C30. Can I administer only these 13 items without the others?
No – the user agreement foresees the administration of the entire QLQ-C30 questionnaire - Can I present QLU-C10D health profiles?
We recommend using the QLQ-C30 scores when aiming at presenting HRQOL profiles as the full scales are more reliable than the single items. - There is no value set for my country of interest. What shall I do?
Depending on the research question one of the existing value sets may be applied – argumentation why and limitations of this approach need to be clearly outlined. Approach the EORTC QLD/QLG if you are interested in developing an additional value set.
Questions about the EORTC QLU-C10D and use of the instrument can be sent here.