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Wang Y, Xu Y, Shan H, Pan H, Chen J, Yang J. Health state utility values of type 2 diabetes mellitus and related complications: a systematic review and meta-regression. Health Qual Life Outcomes 2024; 22:74. [PMID: 39244536 DOI: 10.1186/s12955-024-02288-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/26/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND This study aimed to synthesize and quantitatively examine Health State Utility Values (HSUVs) for Type 2 Diabetes Mellitus (T2DM) and its complications, providing a robust meta-regression framework for selecting appropriate HSUV estimates. METHOD We conducted a systematic review to extract HSUVs for T2DM and its complications, encompassing various influencing factors. Relevant literature was sourced from a review spanning 2000-2020, supplemented by literature from PubMed, Embase, and the Web of Science (up to March 2024). Multivariate meta-regression was performed to evaluate the impact of measurement tools, tariffs, health status, and clinical and demographic variables on HSUVs. RESULTS Our search yielded 118 studies, contributing 1044 HSUVs. The HSUVs for T2DM with complications varied, from 0.65 for cerebrovascular disease to 0.77 for neuropathy. The EQ-5D-3L emerged as the most frequently employed valuation method. HSUV differences across instruments were observed; 15-D had the highest (0.89), while HUI-3 had the lowest (0.70) values. Regression analysis elucidated the significant effects of instrument and tariff choice on HSUVs. Complication-related utility decrement, especially in diabetic foot, was quantified. Age <70 was linked to increased HSUVs, while longer illness duration, hypertension, overweight and obesity correlated with reduced HSUVs. CONCLUSION Accurate HSUVs are vital for the optimization of T2DM management strategies. This study provided a comprehensive data pool for HSUVs selection, and quantified the influence of various factors on HSUVs, informing analysts and policymakers in understanding the utility variations associated with T2DM and its complications.
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Affiliation(s)
- Yubo Wang
- Department of Pharmacy, 1/F, Science and Technology Building, The First Affiliated Hospital of Xinjiang Medical University, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
- Xinjiang Key Laboratory of Clinical Drug Research, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Yueru Xu
- School of Pharmacy, Xinjiang Medical University, No.393 XinYi Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Huiting Shan
- Department of Pharmacy, 1/F, Science and Technology Building, The First Affiliated Hospital of Xinjiang Medical University, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
- Xinjiang Key Laboratory of Clinical Drug Research, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Huimin Pan
- Department of Pharmacy, 1/F, Science and Technology Building, The First Affiliated Hospital of Xinjiang Medical University, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
- Xinjiang Key Laboratory of Clinical Drug Research, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Ji Chen
- Department of Pharmacy, 1/F, Science and Technology Building, The First Affiliated Hospital of Xinjiang Medical University, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China.
- Xinjiang Key Laboratory of Clinical Drug Research, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China.
| | - Jianhua Yang
- Department of Pharmacy, 1/F, Science and Technology Building, The First Affiliated Hospital of Xinjiang Medical University, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China.
- Xinjiang Key Laboratory of Clinical Drug Research, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China.
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Kennedy K, Sarohia G, Podbielski D, Pickard S, Tarride JE, Xie F. Systematic methodological review of health state values in glaucoma cost-utility analyses. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-023-01663-x. [PMID: 38411844 DOI: 10.1007/s10198-023-01663-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 12/21/2023] [Indexed: 02/28/2024]
Abstract
IMPORTANCE Describing the characteristics and sources of health state utility values and reporting practice in the literature of cost-utility analyses facilitates an understanding of the level of the transparency, validity, and generalizability of cost-utility analyses. Improving the quality of reporting will support investigators in describing the incremental value of emerging glaucoma interventions. OBJECTIVE To describe the state of practice among published glaucoma cost-utility analysis studies, focusing on valuation of health and the quality of reporting. EVIDENCE REVIEW We searched several databases including Medline, CINHAL, Embase, Web of Science, Scopus, Biosis previews, the Health Economic Evaluations Database, and the NHS Economic Evaluation Database (NHS EED). We included full-text, English, published cost-utility analyses of glaucoma interventions with quality-adjusted life years (QALYs) as the primary outcome measure to calculate incremental cost-utility ratios. Excluded studies were non-English language, reviews, editorials, protocols, or other types of economic studies (cost-benefit, cost-minimization, cost-effectiveness). Study characteristics, operational definitions of glaucoma health states and health state utilities were extracted. The original source of the health utility was reviewed to determine the scale of measurement and the source of preference weighting. Items from the Systematic Review of Utilities for Cost-Effectiveness (SpRUCE checklist) were used to assess the reporting and quality of health utilities in glaucoma CUA. FINDINGS 43 CUAs were included, with 11 unique sources of health utilities. A wide range of health utilities for the same Hodapp-Parrish-Anderson glaucoma health states were reported; ocular hypertension (0.84-0.95), mild (0.68-0.94), moderate (0.57-0.92), advanced (0.58-0.88), severe/blind (0.46-0.76), and bilateral blindness (0.26-0.5). Most studies reported the basis for using health utilities (34, 79%) and any assumptions or adjustments applied to the health utilities (22, 51%). Few studies reported a framework for assessing the relevance of health utilities to a decision context (8, 19%). Even fewer (3, 7%) applied a systematic search strategy to identify health utilities and used a structured assessment of quality for inclusion. Overall, reporting has not improved over time. CONCLUSIONS AND RELEVANCE This review describes that few CUAs describe important rationale for using health state utility values. Including additional details on the search, appraisal, selection, and inclusion process of health utility values improves transparency, generalizability and supports the assessment of the validity of study conclusions. Future investigations should aim to use health utilities on the same scale of measurement across health states and consider the source and relevance to the decision context/purpose of conducting that cost-utility study.
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Affiliation(s)
- Kevin Kennedy
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T1Z3, Canada.
| | - Gurkaran Sarohia
- Department of Ophthalmology and Visual Sciences, University of Alberta, 400, 10924, 107 Avenue, Edmonton, AB, T5H 0X5, Canada
| | | | - Simon Pickard
- College of Pharmacy-Pharmacy Systems Outcomes and Policy, University of Illinois Chicago, Chicago, USA
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
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Wiedmann L, Cairns J. Review of economic modeling evidence from NICE appraisals of rare disease treatments for spinal muscular atrophy. Expert Rev Pharmacoecon Outcomes Res 2023; 23:469-482. [PMID: 36947403 DOI: 10.1080/14737167.2023.2193690] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
INTRODUCTION The National Institute of Health and Care Excellence (NICE) in England has appraised three treatments for spinal muscular atrophy (SMA), namely, nusinersen, onasemnogene abeparvovec, and risdiplam. As rare disease treatments (RDTs) commonly face challenges in health technology assessment (HTA) processes due to their clinical and economic uncertainties, an in-depth review of these appraisals is useful to enable a deeper understanding of economic modelling considerations for SMA. AREAS COVERED This review is a detailed analysis of NICE appraisals for SMA and aims to compare the economic modelling evidence of the three RDTs. This is done by examining differences and similarities and by discussing critical outstanding issues across the economic evaluations of the appraisals. EXPERT OPINION This article aims to contribute to the development of evidence that can be used as guidance to inform resource allocation decisions for RDTs for SMA, but also to be a resource about approaches for the generation, analysis and interpretation of economic modelling evidence for RDTs more broadly.
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Affiliation(s)
- Lea Wiedmann
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Address: 15-17 Tavistock Place London WC1H 9SH UK
| | - John Cairns
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Address: 15-17 Tavistock Place London WC1H 9SH UK
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Dewilde S, Philips G, Paci S, Beauchamp J, Chiroli S, Quinn C, Day L, Larkin M, Palace J, Berrih-Aknin S, Claeys KG, Muppidi S, Mantegazza R, Saccà F, Meisel A, Bassez G, Murai H, Janssen MF. Patient-reported burden of myasthenia gravis: baseline results of the international prospective, observational, longitudinal real-world digital study MyRealWorld-MG. BMJ Open 2023; 13:e066445. [PMID: 36720569 PMCID: PMC9890761 DOI: 10.1136/bmjopen-2022-066445] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES Myasthenia gravis (MG) is a rare, chronic, autoimmune neuromuscular disease which can affect functional and mental aspects of health and health-related quality of life (HRQoL). This study aims to obtain detailed knowledge of the impact of MG on HRQoL in a broad population from the perspective of the patient. DESIGN Prospective, observational, digital, longitudinal real-world study. SETTING Adult patients with MG from seven countries (USA, Japan, Germany, UK, Italy, Spain and Canada) downloaded a mobile application onto their phones and entered data about themselves and their MG. OUTCOME MEASURES Data was collected using the following general and disease-specific patient-reported outcome measurements: EuroQol 5 Domains Health-Related Quality of Life Questionnaire (EQ-5D-5L), Myasthenia Gravis Activities of Daily Living (MG-ADL), Myasthenia Gravis Quality of Life 15-item revised scale (MG-QoL-15r), Hospital Anxiety and Depression Scale (HADS) and Health Utilities Index III (HUI3). Patients were categorised by their self-assessed Myasthenia Gravis Foundation of America (MGFA) class (I-V). RESULTS Baseline results of 841 participants (mean age 47 years, 70% women) are reported . The distribution across the MGFA classes was: 13.9%, 31.0%, 38.1%, 15.5% and 1.6% for classes I-V. The MGFA class was a strong predictor of all aspects of HRQoL, measured with disease-specific and with generic instruments. The domains in which patients with MG most frequently mentioned problems were usual activities, anxiety and depression, tiredness, breathing and vision. The mean total MG-ADL Score was positively associated with increasing MGFA classes: 2.7, 4.4, 6.3 and 8.4 for MGFA classes I-IV. Mean baseline EQ-5D-5L utility was also associated with MGFA classes and was 0.817, 0.766, 0.648 and 0.530 for MGFA class I-IV. CONCLUSIONS MG has a large impact on key aspects of health and HRQoL. The impact of this disease increases substantially with increasing disease severity.
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Affiliation(s)
| | | | - Sandra Paci
- Market Access & Patient Advocacy, argenx, Ghent, Belgium
| | - Jon Beauchamp
- Market Access & Patient Advocacy, argenx, Ghent, Belgium
| | | | | | | | | | | | - Sonia Berrih-Aknin
- INSERM, Institute of Myology, Center of Research in Myology, Sorbonne Université, Paris, France
| | - Kristl G Claeys
- Department of Neurology, KU Leuven University Hospitals, Leuven, Belgium
- Laboratory for Muscle Diseases and Neuropathies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Srikanth Muppidi
- Department of Neurology and Neurosciences, Stanford University, Stanford, California, USA
| | - Renato Mantegazza
- Fondazione IRCCS, Istituto Nazionale Neurologico Carlo Besta, Milano, Italy
- Associazione Italiana Miastenia e Malattie Immunodegenerative, Milan, Italy
| | - Francesco Saccà
- DNSRO Department, University of Naples Federico II, Napoli, Italy
| | - Andreas Meisel
- Neurology, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Guillaume Bassez
- Neuromuscular Diseases Reference Center, Pitié-Salpêtrière University Hospital, Paris, France
| | - Hiroyuki Murai
- Department of Neurology, International University of Health and Welfare, Narita, Japan
| | - M F Janssen
- Department of Medical Psychology and Psychotherapy, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Xiao R, Burks CA, Yau J, Derakhshan A, Liu RH, Senna MM, Yasuda MR, Jowett N, Lee LN. Health Utility Measures Among Patients with Androgenetic Alopecia After Hair Transplant. Aesthetic Plast Surg 2022; 47:631-639. [PMID: 35999465 DOI: 10.1007/s00266-022-03066-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/08/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Hair loss causes significant psychosocial distress to patients. Health utility measurements offer an objective, quantitative assessment of health-related quality of life (QOL). METHODS We performed a prospective cohort study on patients with hair loss between January 1, 2018 and December 31, 2020. Patient metrics were compared with layperson perception of alopecia, prospectively collected between August 1 and December 31, 2017. Health utility measures were quantified using the visual analog scale (VAS), standard gamble (SG), and time trade-off (TTO) in quality-adjusted life-years (QALYs) and relative to the minimal clinically important difference (MCID). Bonferroni correction to the significance threshold was performed. RESULTS Thirty-one patients with alopecia were compared with 237 laypeople. Patient metrics for female hair loss were all significantly lower than laypeople measures (VAS QALYs 0.65 ± 0.21 vs. 0.83 ± 0.18, p = 0.0001). Mean SG QALYs were lower for patients in the male alopecia state (0.86 ± 0.23 vs. 0.96 ± 0.12, p = 0.0278). Post-hair transplant improvement in TTO was significantly greater for patients (+ 0.08 ± 0.12 vs. + 0.02 ± 0.09, p = 0.0070) and significantly more often exceeded the MCID (45.2% vs. 16.9%, p = 0.0006). CONCLUSIONS Alopecia negatively impacts QOL, and the true patient experience is more taxing than what is perceived by laypeople. Hair transplantation improves QOL more for male patients than common perception. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Roy Xiao
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA.,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Ciersten A Burks
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA.,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Jenny Yau
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA
| | - Adeeb Derakhshan
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA.,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Rui Han Liu
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA.,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Maryanne M Senna
- Department of Dermatology, Lahey Hospital & Medical Center, Boston, MA, USA.,Lahey Hair Loss Center of Excellence and Research Unit, Boston, MA, USA
| | - Mariko R Yasuda
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Nate Jowett
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA.,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA
| | - Linda N Lee
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA. .,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA. .,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA.
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Moler-Zapata S, Grieve R, Lugo-Palacios D, Hutchings A, Silverwood R, Keele L, Kircheis T, Cromwell D, Smart N, Hinchliffe R, O'Neill S. Local Instrumental Variable Methods to Address Confounding and Heterogeneity when Using Electronic Health Records: An Application to Emergency Surgery. Med Decis Making 2022; 42:1010-1026. [PMID: 35607984 PMCID: PMC9583279 DOI: 10.1177/0272989x221100799] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Electronic health records (EHRs) offer opportunities for comparative
effectiveness research to inform decision making. However, to provide useful
evidence, these studies must address confounding and treatment effect
heterogeneity according to unmeasured prognostic factors. Local instrumental
variable (LIV) methods can help studies address these challenges, but have
yet to be applied to EHR data. This article critically examines a LIV
approach to evaluate the cost-effectiveness of emergency surgery (ES) for
common acute conditions from EHRs. Methods This article uses hospital episodes statistics (HES) data for emergency
hospital admissions with acute appendicitis, diverticular disease, and
abdominal wall hernia to 175 acute hospitals in England from 2010 to 2019.
For each emergency admission, the instrumental variable for ES receipt was
each hospital’s ES rate in the year preceding the emergency admission. The
LIV approach provided individual-level estimates of the incremental
quality-adjusted life-years, costs and net monetary benefit of ES, which
were aggregated to the overall population and subpopulations of interest,
and contrasted with those from traditional IV and risk-adjustment
approaches. Results The study included 268,144 (appendicitis), 138,869 (diverticular disease),
and 106,432 (hernia) patients. The instrument was found to be strong and to
minimize covariate imbalance. For diverticular disease, the results differed
by method; although the traditional approaches reported that, overall, ES
was not cost-effective, the LIV approach reported that ES was cost-effective
but with wide statistical uncertainty. For all 3 conditions, the LIV
approach found heterogeneity in the cost-effectiveness estimates across
population subgroups: in particular, ES was not cost-effective for patients
with severe levels of frailty. Conclusions EHRs can be combined with LIV methods to provide evidence on the
cost-effectiveness of routinely provided interventions, while fully
recognizing heterogeneity. Highlights
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Affiliation(s)
- Silvia Moler-Zapata
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Grieve
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - David Lugo-Palacios
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - A Hutchings
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Luke Keele
- University of Pennsylvania, Philadelphia, USA
| | - Tommaso Kircheis
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - David Cromwell
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.,Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Neil Smart
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Stephen O'Neill
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Chataway J, Murphy N, Khurana V, Schofield H, Findlay J, Adlard N. Secondary progressive multiple sclerosis: a systematic review of costs and health state utilities. Curr Med Res Opin 2021; 37:995-1004. [PMID: 33733976 DOI: 10.1080/03007995.2021.1904860] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: To identify evidence in the literature presenting the economic and humanistic (based on health state utility values [HSUVs]) burden of multiple sclerosis (MS) and report the incremental burden of secondary progressive MS (SPMS) compared with relapsing-remitting MS (RRMS).Methods: Electronic databases (Embase, MEDLINE, MEDLINE In-Process, Cochrane Library) and other relevant repositories were systematically searched from the date of inception until November 2019 for evidence on the economic burden of MS, or HSUVs in patients with MS. Data were extracted from studies investigating cost data or HSUVs for patients with SPMS compared with RRMS.Results: In total, 25 studies were identified that reported data on the economic and HSUV burden of SPMS versus RRMS: 18 studies reported cost data and nine presented HSUVs. Overall, costs associated with SPMS were consistently higher than those for RRMS. Major cost drivers appeared to shift following transition from RRMS to SPMS, with higher direct medical costs associated with RRMS than with SPMS, while the opposite was true for direct non-medical costs and indirect costs. In all studies presenting HSUVs specifically in patients with SPMS, the disease burden was greater (indicated by lower HSUV scores or a negative regression coefficient vs RRMS) for patients with SPMS than for those with RRMS. Fatigue and psychological stress (including depression) were identified as key drivers of this reduced health-related quality of life (HRQoL).Conclusions: Our findings indicate that SPMS is associated with higher costs and more substantial HRQoL decrements than RRMS. These results highlight the substantial unmet need for effective treatments that can slow disease progression in patients with SPMS, which, in turn, would reduce the rate of HRQoL deterioration and increasing healthcare costs.
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Affiliation(s)
- Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
| | | | - Vivek Khurana
- Patient Access Solutions, Novartis Corporation (Malaysia) Sdn. Bhd, Petaling Jaya, Malaysia
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Association between knee symptoms, change in knee symptoms over 6-9 years, and SF-6D health state utility among middle-aged Australians. Qual Life Res 2021; 30:2601-2613. [PMID: 33942204 DOI: 10.1007/s11136-021-02859-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Health state utilities (HSUs) are an input metric for estimating quality-adjusted life-years (QALY) in cost-utility analyses. Currently, there is a paucity of data on association of knee symptoms with HSUs for middle-aged populations. We aimed to describe the association of knee symptoms and change in knee symptoms with SF-6D HSUs and described the distribution of HSUs against knee symptoms' severity. METHODS Participants (36-49-years) were selected from the third follow-up (completed 2019) of Australian Childhood Determinants of Adult Health study. SF-6D HSUs were generated from the participant-reported SF-12. Association between participant-reported WOMAC knee symptoms' severity, change in knee symptoms over 6-9 years, and HSUs were evaluated using linear regression models. RESULTS For the cross-sectional analysis, 1,567 participants were included; mean age 43.5 years, female 54%, BMI ± SD 27.18 ± 5.31 kg/m2. Mean ± SD HSUs for normal, moderate, and severe WOMAC scores were 0.820 ± 0.120, 0.800 ± 0.120, and 0.740 ± 0.130, respectively. A significant association was observed between worsening knee symptoms and HSUs in univariable and multivariable analyses after adjustment (age and sex). HSU decrement for normal-to-severe total-WOMAC and WOMAC-pain was - 0.080 (95% CI - 0.100 to - 0.060, p < 0.01) and - 0.067 (- 0.085 to - 0.048, p < 0.01), exceeding the mean minimal clinically important difference (0.04). Increase in knee pain over 6-9 years was associated with a significant reduction in HSU. CONCLUSION In a middle-aged population-based sample, there was an independent negative association between worse knee symptoms and SF-6D HSUs. Our findings may be used by decision-makers to define more realistic and conservative baseline and ongoing HSU values when assessing QALY changes associated with osteoarthritis interventions.
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Grazziotin LR, Currie G, Kip MMA, IJzerman MJ, Twilt M, Lee R, Marshall DA. Health State Utility Values in Juvenile Idiopathic Arthritis: What is the Evidence? PHARMACOECONOMICS 2020; 38:913-926. [PMID: 32390065 DOI: 10.1007/s40273-020-00921-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The objectives of this systematic review were to identify health state utility values (HSUV) of children and adults with juvenile idiopathic arthritis in the literature and to assess whether HSUV were appropriately reported and could be used to inform parameter inputs for a model-based cost-utility analysis to inform decision making. METHODS MEDLINE, EMBASE, PsycINFO, EconLit and CINAHL databases were searched in July 2019. Inclusion criteria were studies using preference-based instruments, targeting children or adults with juvenile idiopathic arthritis, and in the English language. The quality of studies was assessed using a modified checklist that included relevant sources of bias and assessment of quality of HSUV valuation and measurement. A descriptive analysis was conducted, including assessment on reporting of population characteristics and stratification of HSUV by potential health states or population subgroup. RESULTS From 620 identified articles, ten reported HSUV. Seven studies reported HSUV of children with juvenile idiopathic arthritis, and three of adults with a history of juvenile idiopathic arthritis. Population disease activity status and drug treatment were reported in less than half of the studies. Six (out of ten) studies stratified HSUV results for at least one of the potential health state categories, but they represent very specific situations or interventions (e.g. patients receiving different types of physiotherapy or treated with etanercept over time). CONCLUSIONS We have identified critical gaps in the literature reporting HSUV in patients with juvenile idiopathic arthritis including a lack of HSUV measures for distinct health states, particularly in adults with a history of juvenile idiopathic arthritis. The current reported HSUV data in juvenile idiopathic arthritis are insufficient for a full cost-utility analysis with a short or lifetime horizon.
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Affiliation(s)
- Luiza Raquel Grazziotin
- Department of Community Health Sciences, Room 3C56, Health Research Innovation Centre, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Gillian Currie
- Department of Community Health Sciences, Room 3C56, Health Research Innovation Centre, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michelle M A Kip
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Maarten J IJzerman
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Marinka Twilt
- Division of Rheumatology, Department of Pediatrics, Cumming School of Medicine, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Raymond Lee
- Alberta Health Services, Calgary, AB, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Room 3C56, Health Research Innovation Centre, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
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10
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Abt NB, Quatela O, Heiser A, Jowett N, Tessler O, Lee LN. Association of Hair Loss With Health Utility Measurements Before and After Hair Transplant Surgery in Men and Women. JAMA FACIAL PLAST SU 2019; 20:495-500. [PMID: 30242313 DOI: 10.1001/jamafacial.2018.1052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Androgenetic alopecia is a highly prevalent condition across both sexes and can be surgically corrected through hair transplant. Health utility scores, which represent quantitative estimates of individual preferences for a given state of health, are a measure of health-related quality of life. The health utility scores for sex-specific alopecia and the posttransplant state have not previously been quantified. Objective To obtain health utility measurements for the objective assessment of sex-specific alopecia and hair transplant surgery and to analyze layperson perception of alopecia compared with other chronic health conditions. Design, Setting, and Participants A prospective clinical study was conducted from August 1 to December 31, 2017, at the Harvard Decision Science Laboratory. Adult casual observers (n = 308) completed an internet-based health utility questionnaire. Health states were presented using still patient images and a description of 5 health states, including monocular blindness, binocular blindness, male alopecia, female alopecia, and male posttransplant state. Main Outcomes and Measures Health utility measures of sex-specific alopecia, posttransplant state, and monocular and binocular blindness were measured by visual analog scale (VAS), standard gamble (SG), and time trade-off (TTO) in quality-adjusted life-years (QALYs). Groups were analyzed with 1-way analysis of variance and post hoc Tukey pairwise comparison. Results The 308 participants included 157 (51.0%) women with a mean (SD) age of 30.8 (13.5) years. Mean (SD) health utility measures included 0.85 (0.18) QALYs for the VAS, 0.93 (0.17) QALYs for the SG, and 0.93 (0.17) QALYs for the TTO in male alopecia; 0.83 (0.19) QALYs for the VAS, 0.92 (0.17) QALYs for the SG, and 0.91 (0.18) QALYs for the TTO in female alopecia; and 0.93 (0.11) QALYs for the VAS, 0.95 (0.15) QALYs for the SG, and 0.95 (0.16) QALYs for the TTO in a man in the posttransplant state. The mean (SD) health utility of monocular blindness was 0.76 (0.17) QALYs for the VAS, 0.87 (0.21) QALYs for the SG, and 0.86 (0.20) QALYs for the TTO. The health utility score for the posttransplant state was significantly improved compared with the health utility score for alopecia in both sexes (female VAS: +0.10 [95% CI, 0.06-0.14; P < .001]; male VAS, +0.08 [95% CI, 0.04-0.12; P < .001]). Hair loss in women and men demonstrated significantly lower QALYs on the VAS compared with the posttransplant state (female: -0.10 [95% CI, -0.14 to -0.06; P < .001]; male: -0.08 [95% CI, -0.12 to -0.04; P < .001]). Conclusions and Relevance Alopecia has a meaningful negative influence on health utility measures in both sexes. Hair transplant surgery significantly increases health utility measures compared with untreated alopecia in both sexes as rated among layperson observers. Level of Evidence NA.
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Affiliation(s)
- Nicholas B Abt
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Olivia Quatela
- Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Alyssa Heiser
- Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Nate Jowett
- Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Oren Tessler
- Department of Otorhinolaryngology, Louisiana State University School of Medicine, New Orleans
| | - Linda N Lee
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston.,Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston
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11
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Thompson AJ, Sutton M, Payne K. Estimating Joint Health Condition Utility Values. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:482-490. [PMID: 30975400 DOI: 10.1016/j.jval.2018.09.2843] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/03/2018] [Accepted: 09/26/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To predict health state utility values (HSUVs) for individuals with up to 4 conditions simultaneously. METHODS Person-level data were taken from the General Practice Patient Survey, a national survey of adult patients registered with general practices in England. Individuals reported whether they had any 1 of 16 chronic conditions and completed the 3-level EuroQol 5-dimensional questionnaire. Four nonparametric methods (additive, multiplicative, minimum, and the adjusted decrement estimator) and 1 parametric estimator (the linear index) were used to predict HSUVs for individuals with a joint health condition (JHC). Predicted and actual utility scores were compared for precision using root mean square error and mean absolute error. Bias was assessed using mean error. RESULTS The analysis included 929,565 individuals, of which 30.5% had at least 2 conditions. Of the nonparametric estimators, the multiplicative approach produced estimates with the lowest bias and most precision for 2 JHCs. For populations with a long-term mental health condition within the JHC, the multiplicative approach overestimated utility scores. All nonparametric methods produced biased results when estimating HSUVs for 3 or 4 JHCs. The linear index generally produced unbiased results with the highest precision. CONCLUSIONS The multiplicative approach was the best nonparametric estimator when estimating HSUVs for 2 JHCs. None of the nonparametric approaches for estimating HSUVs can be recommended with more than 2 JHCs. The linear index was found to have good predictive properties but needs external validation before being recommended for routine use.
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Affiliation(s)
- Alexander J Thompson
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK.
| | - Matthew Sutton
- Health Organisation, Policy and Economics, Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
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12
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Joshi N, Hensen M, Patel S, Xu W, Lasch K, Stolk E. Health State Utilities for Acute Myeloid Leukaemia: A Time Trade-off Study. PHARMACOECONOMICS 2019; 37:85-92. [PMID: 30136178 DOI: 10.1007/s40273-018-0704-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVES Acute myeloid leukaemia (AML) is an aggressive haematological cancer associated with significant humanistic impact. The current study assessed how the general public in the United Kingdom (UK) values AML health states. METHODS The composite time trade-off (cTTO) methodology was employed to elicit health state utilities in AML. Pertinent AML literature related to symptom and quality-of-life impact including physical, functional and emotional well-being, as well as the safety profile of AML treatments, were taken into consideration for drafting health state descriptions. Ten health states included in the study were newly diagnosed AML, induction, consolidation, maintenance, long-term follow-up, relapsed/refractory, stem-cell transplant (SCT) procedure, SCT recovery, SCT long-term follow-up with complications and SCT long-term follow-up without complications. The descriptions were validated by haematologists and nurse specialists for clinical accuracy and completeness. A total of 210 individuals from the general UK population participated in the cTTO interviews. Descriptive statistics were computed for health state utility values. RESULTS The mean age of the participants was 44.0 years (standard deviation [SD] 14.9, range 18-81) and comprised 129 (61.4%) female participants. The utility values ranged from 0.94 (SD 0.13) for SCT long-term follow-up without complications to - 0.21 (SD 0.62) for the SCT procedure. CONCLUSIONS The study provides health utilities for a range of AML health states, with the SCT procedure health state being valued worse than death. The utilities obtained in this study can be employed as inputs in cost-effectiveness analyses of AML therapies.
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Affiliation(s)
| | - Marja Hensen
- Pharmerit International, Rotterdam, The Netherlands
| | - Sachin Patel
- Oncology (Haematology, Cell, and Gene), Novartis UK, Camberley, Surrey, UK
| | - Weiwei Xu
- Pharmerit International, Rotterdam, The Netherlands
| | | | - Elly Stolk
- The EuroQol Research Foundation, Rotterdam, The Netherlands
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13
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Affiliation(s)
- Jonathan Karnon
- School of Public Health, University of Adelaide, Adelaide, Australia.
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14
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Rowen D, Azzabi Zouraq I, Chevrou-Severac H, van Hout B. International Regulations and Recommendations for Utility Data for Health Technology Assessment. PHARMACOECONOMICS 2017; 35:11-19. [PMID: 29052162 DOI: 10.1007/s40273-017-0544-y] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Recommendations and guidelines for the collection, generation, source and usage of utility data for health technology assessment (HTA) vary across different countries, with no international consensus. Many international agencies generate their own guidelines providing details on their preferred methods for HTA submissions, and there is variability in both what they recommend and the clarity and amount of detail provided in their guidelines. This article provides an overview of international regulations and recommendations for utility data in HTA for a selection of key HTA countries: Australia, Canada, France, Germany, the Netherlands, Spain (Catalonia), Sweden and the UK (England/Wales and Scotland). International guidelines are typically clear and detailed for the selection of countries assessed regarding the source description of health states (e.g. generic preference-based measure) and who should provide preference weights for these health states (e.g. general population for own country). Many guidelines specify the use of off-the-shelf generic preference-based measures, and some further specify a measure, such as EQ-5D. However, international guidelines are either unclear or lack detailed guidance regarding the collection (e.g. patients report own health), source (e.g. clinical trial) and usage (e.g. adjusting for comorbidities) of utility values. It is argued that there is a need for transparent and detailed international guidelines on utility data recommendations to provide decision makers with the best possible evidence. Where this is not possible it is recommended that best practice should be used to inform the collection, source and usage of utility values in HTA.
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Affiliation(s)
- Donna Rowen
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Ismail Azzabi Zouraq
- Takeda Pharmaceuticals International AG, Thurgauerstrasse 130, 8152, Glattpark-Opfikon (Zurich), Switzerland
| | - Helene Chevrou-Severac
- Takeda Pharmaceuticals International AG, Thurgauerstrasse 130, 8152, Glattpark-Opfikon (Zurich), Switzerland
| | - Ben van Hout
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
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