Estimating a preference-based index from the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM): valuation of CORE-6D

JE Brazier, D Rowan


Background: The Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE- OM) is used to evaluate the effectiveness of psychological therapies in people with common mental disorders. The objective of this study was to estimate a preference-based index for this population using CORE-6D, a health state classification system derived from CORE-OM consisting of a 5-item emotional component and a physical item, and to demonstrate a novel method for generating states that are not orthogonal.
Methods: Rasch analysis was used to identify 11 plausible ‘emotional’ health states from CORE-6D (rather than conventional statistical design that would generate implausible states). By combining these with the 3 response levels of the physical item of CORE-6D, 33 plausible health states can be described, of which 18 were selected for valuation. An interview valuation survey of 220 members of public in South Yorkshire, UK, was undertaken using the time-trade-off method to value the 18 health states; regression analysis was subsequently used to predict values for all possible states described by CORE-6D.
Results: A number of multivariate regression models were built to predict values for the 33 plausible health states of CORE-6D, using the Rasch logit value of the emotional health state and the response level of the physical item as independent variables. A cubic model with high predictive value (adjusted R2 0.990) was finally selected, which can be used to predict utility values for all 927 states described by CORE-6D.
Conclusion: The CORE-6D preference-based index will enable the assessment of cost- effectiveness of interventions for people with common mental disorders using existing and prospective CORE-OM datasets. The new method for generating states may be useful for other instruments with highly correlated dimensions.