EQ-5D health utilities: exploring ways to improve upon responsiveness in psoriasis

Figures & data

Table 1. Baseline demographics and clinical characteristics in patients from all UNCOVER studies and from UNCOVER-3 only—intent-to-treat patients with baseline DLQI >10.

	All UNCOVERstudies (n = 2085)	UNCOVER-3only^a (n = 681)
Age, years	45 ± 13	45 ± 13
Men, n (%)	1306 (62.6%)	424 (62.3%)
Race, n (%)
American Indian or Alaska Native	16 (0.8%)	9 (1.3%)
Asian	81 (3.9%)	22 (3.2%)
Black or African American	71 (3.4%)	22 (3.2%)
Native Hawaiian or Other Pacific Islander	5 (0.2%)	4 (0.6%)
White	1901 (91.3%)	619 (90.9%)
Other	9 (0.4%)	5 (0.7%)
Ethnicity
Hispanic or Latino	185 (8.9%)	117 (17.2%)
Geographic Region, n (%)
Asia	18 (0.9%)	0
North America	1062 (50.9%)	333 (48.9%)
Europe	888 (42.6%)	281 (41.3%)
Central America/South America	67 (3.2%)	67 (9.8%)
Australia	50 (2.4%)	0
Country, n (%)
US	706 (33.9%)	258 (37.9%)
Germany	402 (19.3%)	148 (21.7%)
Canada	356 (17.1%)	75 (11.0%)
UK	46 (2.2%)	0
Rest of World	575 (27.6%)	200 (29.4%)
Weight, kg	91.2 ± 23.8	90.8 ± 24.3
Weight category
<100 kg, n (%)	1427 (68.5%)	478 (70.3%)
≥100 kg, n (%)	656 (31.5%)	202 (29.7%)
BMI, kg/m^2	30.7 ± 7.5	30.7 ± 7.4
Psoriasis duration, years	18.2 ± 11.9	17.4 ± 12.2
Percentage of BSA involved	28.8 ± 18.2	29.1 ± 17.9
sPGA ≥4, n (%)	1139 (54.6%)	359 (52.7%)
Absolute baseline PASI^b
PASI <50	21.7 ± 8.9	21.9 ± 8.8
PASI 50 to <75	20.5 ± 8.5	21.5 ± 9.7
PASI 75 to <90	20.1 ± 7.6	20.5 ± 7.7
PASI 90 to <100	22.1 ± 8.2	22.5 ± 7.9
PASI 100	20.5 ± 7.9	21.5 ± 8.8
Overall	21.1 ± 8.3	21.6 ± 8.5
QIDS-SR16	5.8 ± 4.5	5.9 ± 4.5
Patients with nail psoriasis, n (%)	1349 (64.7%)	419 (61.5%)
NAPSI	26.1 ± 20.1	25.5 ± 19.8
DLQI	17.5 ± 5.0	17.5 ± 5.0
Itch NRS	7.6 ± 2.1	7.3 ± 2.3
Previous therapy, n (%)
Phototherapy	945 (45.3%)	263 (38.6%)
Non-biological systemic	1176 (56.4%)	347 (51.0%)
Biological	592 (28.4%)	106 (15.6%)

BMI, body mass index; BSA, body surface area; DLQI, Dermatology Life Quality Index; NAPSI, nail psoriasis severity index; NRS, numeric rating scale; PASI, psoriasis area and severity index; QIDS-SR16, quick inventory of depressive symptomology–self-rated; sPGA, static Physician’s Global Assessment.

Data are mean ± SD or n (%).

^a Patients in UNCOVER-3 were also administered the EQ-PSO questionnaire (n = 645).

^b Mean baseline PASI scores for patients by their respective Week 12 PASI improvement level.

Table 2. EQ-5D-5L and EQ-PSO responses at baseline and Week 12 by PASI improvement level—intent-to-treat patients with baseline DLQI >10.

		EQ-5D-5L										EQ-PSO^a
Week 12 PASI improvement	Response	Mobility		Self-care		Usual activities		Pain		Anxiety		Skin irritation		Self-confidence
		Baseline	Week 12	Baseline	Week 12	Baseline	Week 12	Baseline	Week 12	Baseline	Week 12	Baseline	Week 12	Baseline	Week 12
PASI <50 (No Response) (n = 560)	1 – No Problems	50%	57%	76%	78%	44%	49%	10%	11%	47%	53%	1%	1%	36%	44%
	2 – Slight Problems	27%	24%	13%	13%	31%	29%	31%	38%	32%	28%	8%	15%	31%	32%
	3 – Moderate Problems	16%	14%	8%	7%	16%	16%	35%	32%	15%	14%	30%	33%	20%	12%
	4 – Severe Problems	8%	6%	3%	3%	8%	6%	20%	15%	5%	5%	41%	29%	9%	9%
	5 – Extreme Problems	0	<1%	0	0	1%	<1%	5%	4%	1%	2%	20%	22%	5%	3%
PASI 50 to <75 (n = 223)	1 – No Problems	53%	67%	79%	87%	46%	66%	12%	36%	54%	69%	1%	14%	23%	57%
	2 – Slight Problems	28%	21%	14%	11%	31%	26%	38%	40%	27%	19%	10%	49%	34%	30%
	3 – Moderate Problems	13%	8%	5%	<1%	18%	6%	33%	18%	13%	9%	31%	21%	30%	9%
	4 – Severe Problems	6%	4%	1%	<1%	3%	1%	12%	5%	3%	2%	34%	12%	8%	3%
	5 – Extreme Problems	<1%	0	<1%	<1%	2%	<1%	5%	1%	3%	<1%	23%	4%	5%	1%
PASI 75 to <90 (n = 354)	1 – No Problems	57%	73%	78%	91%	44%	75%	15%	45%	48%	69%	2%	22%	33%	65%
	2 – Slight Problems	22%	18%	16%	6%	35%	17%	30%	36%	32%	23%	7%	60%	31%	28%
	3 – Moderate Problems	16%	7%	5%	2%	16%	7%	33%	16%	14%	7%	32%	14%	25%	6%
	4 – Severe Problems	5%	2%	<1%	<1%	5%	2%	20%	2%	5%	2%	39%	2%	10%	2%
	5 – Extreme Problems	0	0	<1%	<1%	0	0	2%	<1%	1%	0	21%	2%	2%	0
PASI 90 to <100 (n = 488)	1 – No Problems	62%	76%	83%	94%	47%	79%	12%	52%	48%	72%	1%	32%	33%	65%
	2 – Slight Problems	22%	17%	10%	4%	31%	15%	33%	35%	32%	22%	9%	55%	32%	21%
	3 – Moderate Problems	12%	5%	5%	2%	16%	5%	35%	11%	14%	5%	33%	12%	23%	10%
	4 – Severe Problems	5%	2%	3%	0	5%	<1%	16%	2%	4%	1%	38%	2%	6%	3%
	5 – Extreme Problems	0	0	0	0	1%	0	4%	<1%	1%	<1%	19%	0	7%	<1%
PASI 100 (n = 460)	1 – No Problems	61%	80%	80%	95%	50%	84%	16%	60%	45%	73%	<1%	67%	29%	67%
	2 – Slight Problems	24%	13%	12%	4%	29%	12%	38%	28%	32%	19%	10%	27%	30%	22%
	3 – Moderate Problems	11%	6%	6%	<1%	16%	4%	29%	9%	18%	6%	29%	5%	29%	10%
	4 – Severe Problems	4%	<1%	2%	0	5%	<1%	15%	3%	4%	<1%	39%	<1%	6%	<1%
	5 – Extreme Problems	0	0	<1%	0	0	0	3%	<1%	1%	<1%	22%	0	6%	0

DLQI, Dermatology Life Quality Index; EQ-5D-5L, EuroQoL 5-Dimension Health Questionnaire – 5 levels; EQ-PSO, EuroQoL 5-Dimension Health Questionnaire – psoriasis-specific dimensions; PASI, psoriasis area and severity index.

^a EQ-PSO data are a sub-set of patients from UNCOVER-3 only (n = 645).

Figure 1. No problems on the EQ-5D-5L Dimensions—Overall Population From UNCOVER-1, UNCOVER-2, and UNCOVER-3. Change in the percentage of patients reporting no problems on each of the five dimensions of the EQ-5D-5L questionnaire over time by PASI improvement level. Percentage of patients reporting no problems at baseline are shown in grey and the percentage of patients reporting no problems at Week 12 are shown in black. Includes patients from UNCOVER -1, UNCOVER-2, and UNCOVER-3 with baseline DLQI >10 and non-missing EQ-5D-5L values (n = 2085). DLQI, Dermatology Life Quality Index; EQ-5D-5L, EuroQoL 5-Dimension Health Questionnaire–5 levels; PASI, psoriasis area and severity index.

Figure 2. No problems on the EQ-PSO Dimensions—Population From UNCOVER-3 Only. Change in the percentage of patients reporting no problems on each of the five dimensions of the EQ-PSO questionnaire over time by PASI improvement level. Percentage of patients reporting no problems at baseline are shown in grey and the percentage of patients reporting no problems at Week 12 are shown in black. Includes patients from UNCOVER-3 only with baseline DLQI >10 and non-missing EQ-PSO values (n = 645). DLQI, Dermatology Life Quality Index; EQ-PSO, EuroQoL 5-Dimension Health Questionnaire—psoriasis-specific dimensions; PASI, psoriasis area and severity index.

Table 3. EQ-5D VAS descriptive analysis at baseline and week 12 by PASI improvement level in patients from all UNCOVER studies—intent-to-treat patients with baseline DLQI >10.

Week 12 PASI improvement	Baseline EQ-5D VAS^a	Change in EQ-5D VAS (Baseline to Week 12)^b
	Mean ± SD	LS Mean [95% CI]
PASI <50 (No Response)	64.2 ± 22.70	0.55 [−1.23; 2.33]
PASI 50 to <75	66.1 ± 22.17	7.52 [4.71; 10.34]
PASI 75 to <90	67.1 ± 21.66	10.77 [8.53; 13.01]
PASI 90 to <100	66.4 ± 21.57	14.07 [12.16; 15.98]
PASI 100	67.3 ± 20.76	14.77 [12.81; 16.74]
Overall	66.1 ± 21.81	9.33 [8.38; 10.29]

CI, confidence interval; DLQI, Dermatology Life Quality Index; EQ-5D VAS, EuroQoL 5-Dimension Health Questionnaire – visual analog scale; LS, least squares; PASI, psoriasis area and severity index; SD, standard deviation.

^a Observed values.

^b Estimated values via analysis of variance (ANOVA) using the last observation carried forward approach (LOCF).

Table 4. LS mean health utility improvement from baseline by PASI improvement level.

Week 12 PASI improvement	Adalimumab^a	Apremilast^b	Ustekinumab^c	Secukinumab^d	Ixekizumab^e
	EQ-5D-3LUKDLQI >10	EQ-5D-3LUKDLQI >10	EQ-5D-3LUKDLQI >10	EQ-5D-3LUKDLQI >10	EQ-5D-3LCrosswalk UKDLQI >10	EQ-5D-3LCrosswalk USDLQI >10	EQ-5D-5LEnglandDLQI >10	EQ-PSOUKDLQI >10
Baseline	na	na	na	na	0.660	0.748	0.761	0.696
PASI <50 (No Response)	0.063	0.050	0.04	0.109	0.029 [0.010; 0.048]	0.018 [0.003; 0.036]	0.029 [0.012; 0.046]	0.027 [0.000; 0.055]
PASI 50 to <75	0.178	0.17	0.17	0.193	0.125 [0.094; 0.155]	0.08 [0.059; 0.108]	0.094 [0.068; 0.120]	0.102 [0.065; 0.139]
PASI 75 to <90	0.178	0.19	0.22	0.226	0.166 [0.142; 0.190]	0.121 [0.102; 0.140]	0.130 [0.109; 0.151]	0.151 [0.122; 0.180]
PASI 90 to <100^f	0.308	0.21	0.25	0.264	0.184 [0.163; 0.204]	0.130 [0.114; 0.146]	0.139 [0.122; 0.157]	0.141 [0.115; 0.166]
PASI 100	na	na	na	na	0.189 [0.167; 0.210]	0.135 [0.118; 0.151]	0.141 [0.123; 0.160]	0.200 [0.173; 0.226]

DLQI, Dermatology Life Quality Index; EQ-5D-3L, EuroQoL 5-Dimension Health Questionnaire – 3 levels; EQ-5D-5L, EuroQoL 5-Dimension Health Questionnaire – 5 levels; EQ-PSO, EuroQoL 5-Dimension Health Questionnaire – psoriasis-specific dimensions; LS, least squares; na, not applicable; PASI, psoriasis area and severity index.

^a From 2008 health technology assessment (HTA)²¹.

^b From 2015 HTA¹⁸.

^c From 2009 HTA¹⁹.

^d From 2015 HTA²⁰.

^e Utilities are estimated across treatment groups, regardless of dose or study drug assignment. Values at baseline are observed overall means; values by PASI improvement at Week 12 are estimated LS means and 95% confidence intervals.

^f PASI 100 improvement level data are included with PASI 90 to <100 improvement level data for adalimumab, apremilast, ustekinumab, and secukinumab.

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