Mapping Oswestry Disability Index Responses to EQ-5D-3L Utility Values: Are Cost-Utility Results Valid?

Ângela Jornada Ben, Sylvia Pellekooren, Judith E. Bosmans, Raymond W.J.G. Ostelo, Esther T. Maas, Mohamed El Alili, Maurits W. van Tulder, Frank J.P.M. Huygen, Teddy Oosterhuis, Adri T. Apeldoorn, Miranda L. van Hooff, Johanna M. van Dongen

Research output: Contribution to journalArticleAcademicpeer-review


OBJECTIVES: To develop and validate approaches for mapping Oswestry Disability Index (ODI) responses to EQ-5D-3L utility values and to evaluate the impact of using mapped utility values on cost-utility results compared to published regression models.

METHODS: Three response mapping approaches were developed in a random sample of 70% of 18,692 patients with low back pain: non-parametric approach (Non-p), non-parametric approach excluding logical inconsistencies (Non-peLI), and ordinal logistic regression (OLR). Performance was assessed in the remaining 30% using R-square (R2), Root Mean Square Error (RMSE), and Mean Absolute Error (MAE). To evaluate whether MAEs and their 95% limits of agreement (95%LA) were clinically relevant, a minimally clinically important difference (MCID) of 0.074 was used. Probabilities of cost-effectiveness estimated using observed and mapped utility values were compared in two economic evaluations.

RESULTS: The Non-p performed best (R2=0.43; RMSE=0.22; MAE=0.03; 95%LA=-0.40;0.47) compared to the Non-peLI (R2=0.07; RMSE=0.29; MAE=-0.15; 95%LA=-0.63;0.34), and ORL (R2=0.22; RMSE=0.26; MAE=0.02; 95%LA=-0.49;0.53). MAEs were lower than the MCID for the Non-p and OLR, but not for the Non-peLI. Differences in probabilities of cost-effectiveness ranged from 1-4% (Non-p), 0.1-9% (Non-peLI), and 0.1-20% (OLR).

CONCLUSIONS: Results suggest that the developed response mapping approaches are not valid for estimating individual patients' EQ-5D-3L utility values, and - depending on the approach - may considerably impact cost-utility results. The developed approaches did not perform better than previously published regression-based models and are therefore not recommended for use in economic evaluations.

Original languageEnglish
Pages (from-to)873-882
Number of pages10
JournalValue in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research
Issue number6
Early online date9 Feb 2023
Publication statusPublished - Jun 2023


  • EQ-5D
  • Oswestry Disability Index
  • low back pain
  • response mapping

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