Quality of Life Research

, Volume 22, Issue 3, pp 665–675 | Cite as

Mapping the Oxford hip score onto the EQ-5D utility index

  • Rafael A. Pinedo-Villanueva
  • David Turner
  • Andrew Judge
  • James P. Raftery
  • Nigel K. Arden



To assess different mapping methods for the estimation of a group’s mean EQ-5D score based on responses to the Oxford hip score (OHS) questionnaire.


Four models were considered: a) linear regression using total OHS as a continuous regressor; b) linear regression employing responses to the twelve OHS questions as categorical predictors; c) two-part approach combining logistic and linear regression; and d) response mapping. The models were internally validated on the estimation data set, which included OHS and EQ-5D scores for total hip replacements, both before and six months after procedure for 1,759 operations. An external validation was also performed.


All models estimated the mean EQ-5D score within 0.005 of an observed health-state utility estimate, ordinary least squares (OLS) continuous being the most accurate and OLS categorical the most consistent. Age, gender and deprivation did not improve the models. More accurate estimations at the individual level were achieved for higher scores of observed OHS and EQ-5D.


Based on these results, when EQ-5D scores are not available, answers to the OHS questionnaire can be used to estimate a group’s mean EQ-5D with a high degree of accuracy.


EQ-5D Health utility Oxford hip score Hip replacement Outcomes mapping 



Oxford hip score


Total hip replacement


Ordinary least squares


Health-related quality of life


Transfer to utility regression


Mean absolute error



This study was funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research funding scheme. The views expressed in this paper are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Support was also received from the NIHR Biomedical Research Unit into Musculoskeletal Disease, Nuffield Orthopaedic Centre and University of Oxford. We would like to acknowledge Dr. Richard E. Field for kindly allowing us to use the data collected at the South West London Elective Orthopaedics Centre under his supervision and for reviewing the final draft. We are grateful to the COASt project group at the Nuffield Department of Orthopaedics, Rheumatology and Muskuloskeletal Sciences at the University of Oxford and especially Dr. Kassim Javaid and Dr. Amit Kiran for the helpful discussions on earlier versions of this paper. We would also like to thank Dr. Oliver Rivero-Arias from the Health Economics Research Centre at the University of Oxford for clarifications on the response mapping approach. An earlier version of this work was presented at the winter 2011 conference of the Health Economists’ Study Group at the University of York, and we are grateful for the comments received there.

Supplementary material

11136_2012_174_MOESM1_ESM.doc (156 kb)
Supplementary material 1 (DOC 134 kb)
11136_2012_174_MOESM2_ESM.docx (22 kb)
Supplementary material 2 (DOC 113 kb)


  1. 1.
    Bozic, K. J., Saleh, K. J., Rosenberg, A. G., & Rubash, H. E. (2004). Economic evaluation in total hip arthroplasty: Analysis and review of the literature. The Journal of Arthroplasty, 19(2), 180–189.PubMedCrossRefGoogle Scholar
  2. 2.
    Maynard, A. (1991). Developing the health care market. The Economic Journal, 101(408), 1277–1286.CrossRefGoogle Scholar
  3. 3.
    Bourne, R. B., Rorabeck, C. H., Laupacis, A., Feeny, D., Wong, C., Tugwell, P., et al. (1994). A randomized clinical trial comparing cemented to cementless total hip replacement in 250 osteoarthritic patients: The impact on health related quality of life and cost effectiveness. Iowa Orthopaedic Journal, 14, 108–114.PubMedGoogle Scholar
  4. 4.
    Chang, R. W., Pellissier, J. M., & Hazen, G. B. (1996). A cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip. JAMA, 275(11), 858–865.PubMedCrossRefGoogle Scholar
  5. 5.
    Ethgen, O., & Reginster, J.-Y. (2004). Degenerative musculoskeletal disease. Annals of the Rheumatic Diseases, 63(1), 1–3.PubMedCrossRefGoogle Scholar
  6. 6.
    Murray, D., Carr, A., & Bulstrode, C. (1995). Which primary total hip replacement? Journal of Bone and Joint Surgery British, 77-B(4), 520–527.Google Scholar
  7. 7.
    National Joint Registry for England and Wales. (2010). 7th Annual Report.Google Scholar
  8. 8.
    Department of Health. (2008). Guidance on the routine collection of patient reported outcome measures (PROMs)—For the NHS in England 2009/10: Department of Health.Google Scholar
  9. 9.
    Murray, D. W., Fitzpatrick, R., Rogers, K., Pandit, H., Beard, D. J., Carr, A. J., et al. (2007). The use of the Oxford hip and knee scores. Journal of Bone and Joint Surgery British, 89-B(8), 1010–1014.Google Scholar
  10. 10.
    Dawson, J., Fitzpatrick, R., Carr, A., & Murray, D. (1996). Questionnaire on the perceptions of patients about total hip replacement. Journal of Bone and Joint Surgery British, 78-B(2), 185–190.Google Scholar
  11. 11.
    Dawson, J., Fitzpatrick, R., Frost, S., Gundle, R., McLardy-Smith, P., & Murray, D. (2001). Evidence for the validity of a patient-based instrument for assessment of outcome after revision hip replacement. Journal of Bone and Joint Surgery British, 83-B(8), 1125–1129.Google Scholar
  12. 12.
    Field, R. E., Cronin, M. D., & Singh, P. J. (2005). The Oxford hip scores for primary and revision hip replacement. Journal of Bone and Joint Surgery British, 87-B(5), 618–622.Google Scholar
  13. 13.
    Dolan, P., Gudex, C., Kind, P., & Williams, A. (1996). The time trade-off method: Results from a general population study. Health Economics, 5(2), 141–154.PubMedCrossRefGoogle Scholar
  14. 14.
    Brazier, J., Yang, Y., Tsuchiya, A., & Rowen, D. (2010). A review of studies mapping (or cross walking) non-preference based measures of health to generic preference-based measures. The European Journal of Health Economics, 11(2), 215–225.PubMedCrossRefGoogle Scholar
  15. 15.
    Bansback, N., Marra, C., Tsuchiya, A., Anis, A., Guh, D., Hammond, T., et al. (2007). Using the health assessment questionnaire to estimate preference-based single indices in patients with rheumatoid arthritis. Arthritis Care & Research, 57(6), 963–971.CrossRefGoogle Scholar
  16. 16.
    Grootendorst, P., Marshall, D., Pericak, D., Bellamy, N., Feeny, D., & Torrance, G. W. (2007). A model to estimate health utilities index mark 3 utility scores from WOMAC index scores in patients with osteoarthritis of the knee. The Journal of Rheumatology, 34(3), 534–542.PubMedGoogle Scholar
  17. 17.
    Browne, J., Jamieson, L., Lewsey, J., Meulen, J. V. d., Black, N., Cairns, J., et al. (2007). Patient reported outcome measures (PROMs) in elective surgery—Report to the Department of Health. Retrieved 17 November, 2010, from http://www.lshtm.ac.uk/php/hsrp/research/proms_report_12_dec_07.pdf.
  18. 18.
    Mortimer, D., & Segal, L. (2008). Comparing the incomparable? A systematic review of competing techniques for converting descriptive measures of health status into QALY-weights. Medical Decision Making, 28(1), 66–89.PubMedCrossRefGoogle Scholar
  19. 19.
    Gray, A. M., Rivero-Arias, O., & Clarke, P. M. (2006). Estimating the association between SF-12 responses and EQ-5D utility values by response mapping. Medical Decision Making, 26(1), 18–29.PubMedCrossRefGoogle Scholar
  20. 20.
    Tsuchiya, A., Brazier, J., McColl, E., & Parkin, D. (2002). Deriving preference-based single indices from non-preference based condition-specific instruments: Converting AQLQ into EQ5D indices: School of Health and Related Research, The University of Sheffield.Google Scholar
  21. 21.
    Crott, R., & Briggs, A. (2010). Mapping the QLQ-C30 quality of life cancer questionnaire to EQ-5D patient preferences. The European Journal of Health Economics, 11(4), 427–434.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Rafael A. Pinedo-Villanueva
    • 1
  • David Turner
    • 1
  • Andrew Judge
    • 2
  • James P. Raftery
    • 1
  • Nigel K. Arden
    • 2
  1. 1.Wessex Institute, University of SouthamptonSouthamptonUK
  2. 2.Oxford NIHR Musculoskeletal Biomedical Research UnitUniversity of OxfordOxfordUK

Personalised recommendations