A Systematic Review and Critical Assessment of Health State Utilities

Doyle, Scott; Lloyd, Andrew; Moore, Lee; Ray, Joshua; Gray, Alastair

doi:10.2165/11599420-000000000-00000

Cited by 8 publications

(13 citation statements)

References 30 publications

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“…Most previous studies on the health preference scores of diabetic patients employed EQ-5D [20, 51, 25, 52], one study in Singapore population (60% of the study subjects were Chinese) used SF-6D [11]. The SF-6D scores were 0.79 for non-diabetic subjects and 0.78 for uncomplicated DM in Singapore population [11], and the difference was not significant.…”

Section: Discussionmentioning

confidence: 99%

Health-related quality of life and health preference of Chinese patients with diabetes mellitus managed in primary care and secondary care setting: decrements associated with individual complication and number of complications

Jiao

Wong

Gangwani

et al. 2017

Health Qual Life Outcomes

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BackgroundHealth-related quality of life (HRQoL) and health preference of patients with diabetes mellitus (DM) are essential in health economic evaluations but data on Chinese population is rare. This study aims to evaluate HRQoL and health preference of diabetic patients with different diabetic complications in Chinese population.MethodsA cross-sectional study was conducted in 1275 patients with DM, including 518 subjects with various DM-related complications. HRQoL and health preference were estimated using SF-12 and SF-6D questionnaires, respectively. Disease status of DM and complications were identified from documented clinical diagnosis. Multivariable regression was used to investigate the effects of specific complications on HRQoL and health preference, adjusting for socio-demographic and clinical parameters.ResultsThe presence of any diabetic complication was associated with lower physical component summary (−3.81 points, P < 0.01), and end-stage renal disease (ESRD) showed greatest reduction (−7.05 points, P < 0.01). Mental component summary and mental health (MH) scores were not decreased in any of the diabetic complications. The health preference score for diabetic subjects without complications was 0.882 (95% CI, 0.778 to 0.989). The reductions of health preference score were significant for stroke (−0.042, 95% CI -0.072 to −0.012), ESRD (−0.055, 95% CI -0.093 to −0.017), and sight-threatening diabetic retinopathy (STDR) (−0.043, 95% CI -0.075 to −0.010), while heart disease had an insignificant reduction (−0.017, 95% CI -0.042 to 0.008).ConclusionsThe presence of any of the four major diabetic complications (heart disease, stroke, ESRD and STDR) was associated with lower HRQoL and health preference scores. Findings of this study facilitated the cost-effectiveness studies of alternative management strategies for prevention of diabetic complications in Chinese population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-017-0699-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Health-related quality of life and health preference of Chinese patients with diabetes mellitus managed in primary care and secondary care setting: decrements associated with individual complication and number of complications

Jiao

Wong

Gangwani

et al. 2017

Health Qual Life Outcomes

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“…Many investigators have assessed the cross-sectional relationship between body mass index (BMI) and health utility scores [7–9] and have reported changes in health utility scores for each kg/m 2 unit difference in BMI [10–13] or difference in weight category [14–18]. A few investigators have prospectively assessed improvements in health utility scores for each kilogram lost [19,20] or percent of weight lost over 1 year [21].…”

Section: Introductionmentioning

confidence: 99%

The impact of weight loss on health-related quality-of-life: implications for cost-effectiveness analyses

et al. 2013

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Purpose To assess the impact of weight loss on health-related quality-of-life (HRQL), to describe the factors associated with improvements in HRQL after weight loss, and to assess the relationship between obesity as assessed by body mass index (BMI) and HRQL before and after weight loss. Methods We studied 188 obese patients with BMI ≥32 kg/m2 with one or more comorbidities or ≥35 kg/m2. All patients had baseline and follow-up assessments of BMI and HRQL using the EuroQol (EQ-5D) and its visual analog scale (VAS) before and after 6 months of medical weight loss that employed very low calorie diets, physical activity, and intensive behavioral counseling. Results At baseline, age was 50 ± 8 years (mean ± SD), BMI was 40. 0 ± 5.0 kg/m2, EQ-5D-derived health utility score was 0.85 ± 0.13, and VAS-reported quality-of-life was 0.67 ± 0.18. At 6 months follow-up, BMI decreased by 7.0 ± 3.2 kg/m2, EQ-5D increased by 0.06 (interquartile range (IQR) 0.06 – 0.17), and VAS increased by 0.14 (IQR 0.04 – 0.23). In multivariate analyses, improvement in EQ-5D and VAS were associated with lower baseline BMI, greater reduction in BMI at follow-up, fewer baseline comorbidities, and lower baseline HRQL. For any given BMI category, EQ-5D and VAS tended to be higher at follow-up than at baseline. Conclusion Measured improvements in HRQL between baseline and follow-up were greater than predicted by the reduction in BMI at follow-up. If investigators use cross-sectional data to estimate changes in HRQL as a function of BMI, they will underestimate the improvement in HRQL associated with weight loss and underestimate the cost-utility of interventions for obesity treatment.

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“…We also did not conduct quality assessments of studies included in our meta‐analyses and, therefore, cannot comment on the rigour or reliability of study inclusions. The lack of standard systems or validated checklists for grading the quality of health state utility values for inclusion in meta‐analysis is both a limitation and an area for future research . Owing to the small number of study inclusions and the lack of a validated quality assessment tool, we assumed that the quality across all included studies was of an equal standard, and this may in fact not have been the case.…”

Section: Discussionmentioning

confidence: 99%

“…Heterogeneity was regarded as substantial when I 2 exceeded 40% or the Q statistic was significant at p < 0.10 . Formal quality assessment of primary studies eliciting utility values was not undertaken, given a lack of standard systems or checklists for grading the quality of health state utility values . We examined potential publication and small study bias visually using funnel and Doi plots, where a symmetrical plot suggests no or little bias .…”

Section: Methodsmentioning

confidence: 99%

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Utility values for childhood obesity interventions: a systematic review and meta‐analysis of the evidence for use in economic evaluation

et al. 2018

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Rigorous estimates of preference-based utilities are important inputs into economic evaluations of childhood obesity interventions, yet no published review currently exists examining utility by weight status in paediatric populations. A comprehensive systematic literature review and meta-analysis was therefore undertaken, pooling data on preference-based health state utilities by weight status in children using a random-effects model. Tests for heterogeneity were performed, and publication bias was assessed. Of 3,434 potentially relevant studies identified, 11 met our eligibility criteria. Estimates of Cohen's d statistic suggested a small effect of weight status on preference-based utilities. Mean utility values were estimated as 0.85 (95% uncertainty interval [UI] 0.84-0.87), 0.83 (95% UI 0.81-0.85), 0.82 (95% UI 0.79-0.84) and 0.83 (95% UI 0.80-0.86) for healthy weight, overweight, obese and overweight/obese states, respectively. Meta-analysis of studies reporting utility values for both healthy weight and overweight/obese participants found a statistically significant weighted mean difference (0.015, 95% UI 0.003-0.026). A small but statistically significant difference was also estimated between healthy weight and overweight participants (0.011, 95% UI 0.004-0.018). Study findings suggest that paediatric-specific benefits of obesity interventions may not be well reflected by available utility measures, potentially underestimating cost-effectiveness if weight loss in childhood/adolescence improves health or well-being.

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A Systematic Review and Critical Assessment of Health State Utilities

Abstract: A relatively large number of utilities have been collected in weight change and T2DM. Many of these utility values are not suitable for inclusion in a NICE submission. A better way of reviewing the methodological quality of utilities is needed.

Cited by 8 publications

References 30 publications

Health-related quality of life and health preference of Chinese patients with diabetes mellitus managed in primary care and secondary care setting: decrements associated with individual complication and number of complications

Health-related quality of life and health preference of Chinese patients with diabetes mellitus managed in primary care and secondary care setting: decrements associated with individual complication and number of complications

The impact of weight loss on health-related quality-of-life: implications for cost-effectiveness analyses

Utility values for childhood obesity interventions: a systematic review and meta‐analysis of the evidence for use in economic evaluation

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