Vol.:(0123456789) 1 3 Quality of Life Research https://doi.org/10.1007/s11136-017-1748-5 Quality of life after hip, vertebral, and distal forearm fragility fractures measured using the EQ-5D-3L, EQ-VAS, and time-trade-of: results from the ICUROS Axel Svedbom 1  · Fredrik Borgström 2  · Emma Hernlund 1  · Oskar Ström 2  · Vidmantas Alekna 3  · Maria Luisa Bianchi 4  · Patricia Clark 5  · Manuel Díaz Curiel 6,7  · Hans Peter Dimai 8  · Mikk Jürisson 9  · Anneli Uusküla 9  · Margus Lember 9  · Riina Kallikorm 9  · Olga Lesnyak 10,11  · Eugene McCloskey 12  · Olga Ershova 13  · Kerrie M. Sanders 14  · Stuart Silverman 15  · Marija Tamulaitiene 3  · Thierry Thomas 16  · Anna N. A. Tosteson 17  · Bengt Jönsson 18  · John A. Kanis 14,19 Accepted: 26 November 2017 © Springer International Publishing AG, part of Springer Nature 2017 Abstract Introduction The International Costs and Utilities Related to Osteoporotic fractures Study is a multinational observational study set up to describe the costs and quality of life (QoL) consequences of fragility fracture. This paper aims to estimate and compare QoL after hip, vertebral, and distal forearm fracture using time-trade-of (TTO), the EuroQol (EQ) Visual Analogue Scale (EQ-VAS), and the EQ-5D-3L valued using the hypothetical UK value set. Methods Data were collected at four time-points for fve QoL point estimates: within 2 weeks after fracture (including pre- fracture recall), and at 4, 12, and 18 months after fracture. Health state utility values (HSUVs) were derived for each fracture type and time-point using the three approaches (TTO, EQ-VAS, EQ-5D-3L). HSUV were used to estimate accumulated QoL loss and QoL multipliers. Results In total, 1410 patients (505 with hip, 316 with vertebral, and 589 with distal forearm fracture) were eligible for analy- sis. Across all time-points for the three fracture types, TTO provided the highest HSUVs, whereas EQ-5D-3L consistently provided the lowest HSUVs directly after fracture. Except for 13–18 months after distal forearm fracture, EQ-5D-3L gener- ated lower QoL multipliers than the other two methods, whereas no equally clear pattern was observed between EQ-VAS and TTO. On average, the most marked diferences between the three approaches were observed immediately after the fracture. Conclusions The approach to derive QoL markedly infuences the estimated QoL impact of fracture. Therefore the choice of approach may be important for the outcome and interpretation of cost-efectiveness analysis of fracture prevention. Keywords Osteoporosis · Fracture · Health-related quality of life · Health utility Introduction Valuation of health has long been a field of interest in health policy research and is integral for the prioritization of resources in health care [1]. Cost-efectiveness analysis (CEA) compares the relative costs and efects of treatment options and provides a rational approach to optimize health care spending [2]. Cost-utility analysis (CUA) is a special case of cost-efectiveness analysis where efectiveness is measured as quality-adjusted life years (QALYs) [3]. Qual- ity-adjusted life years capture both duration and quality of life (QoL) and therefore provide a value of health benefts that can be compared across diseases and health states [4]. CUA has become the recommended practice for economic evaluation in health policy research and preference-based QoL values (Health state utility values, HSUVs) are pre- ferred for estimation of QALYs in CUA [3, 5]. Health state utility values can be obtained using direct or indirect methods [6]. Direct methods derive HSUVs by mapping preferences directly on to a QoL index. The Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11136-017-1748-5) contains supplementary material, which is available to authorized users. * Axel Svedbom axel.svedbom@mapigroup.se Extended author information available on the last page of the article