Estimating Quality of Life in Acute Venous Thrombosis

Abstract

Importance: Future funding for new treatments in venous thromboembolism will be guided by cost-utility analyses. There is little available information on the utility of acute venous thromboembolism, limiting the validity of economic analyses. Objective: To measure the quality of life in the health states relating to thromboembolism cost-utility analyses. Design: A prospective cohort study. Setting: A single-center, university-affiliated thrombosis clinic. Participants: Two hundred sixteen thrombosis clinic patients with a history of lower limb deep vein thrombosis (DVT) or pulmonary embolism (PE). Exposures: Participantsconsentedtotakeastandardgamble interview. Each participant rated the quality of life in acute DVT, acute PE, and bleeding complication health states. Main Outcomes and Measures: The standard gamble measured quality of life (utility value) for acute DVT, acute PE, major intracranial bleeding event, minor intracranial bleeding event, and gastrointestinal bleeding event. Results: Two hundred fifteen responses were included in the analysis. Twenty-six percent had experienced both PE and DVT; 54%, DVT alone; and 20%, PE alone. Fortytwo percent had experienced more than 1 episode of thrombosis, and 23% had had cancer-associated thrombosis. We found the median utility for acute DVT was 0.81 (interquartile range [IQR], 0.55-0.94); acute PE, 0.75 (IQR, 0.45-0.91); major intracranial bleeding event, 0.15 (IQR, 0.00-0.65); minor intracranial bleeding event, 0.75 (IQR, 0.55-0.92); and gastrointestinal bleeding event, 0.65 (IQR, 0.15-0.86). The median length of symptoms for DVT or PE was 1 week (IQR, Ͻ1-3 weeks). Conclusions and Relevance: To our knowledge, this is the largest published study on utilities in which the participants had personal experience of venous thromboembolism. We present unique information for economic analyses but have also identified future challenges for research in this area. Our summary results differ from those previously published, and we found wide variation in individual responses.

The clinical effectiveness and cost-effectiveness of cetuximab (review of technology appraisal no. 176) and panitumumab (partial review of technology appraisal no. 240) for previously untreated metastatic colorectal cancer: a systematic review and economic evaluation

“…Instead, we used the value of -0.190 reported by Hogg et al 184 This study was conducted A length of 1 week was applied to disutilities, in line with the approach used in the study by Freeman et al, 143 in which expert opinion indicated durations of a maximum of 7 days for grade 3/4 AEs. Freeman et al 143 state that this was broadly similar to the length of stay associated with AEs reported in Twelves et al 185 Some AEs may persist for > 7 days but with reduced severity and, in this analysis, grade 1/2 AEs were assumed to have no disutility.…”

Cost-effectiveness of edoxaban for the treatment of venous thromboembolism based on the Hokusai-VTE study

“…For example, a patient experiencing a CRNM bleeding event would have a disutility value of 0.09 subtracted from his/her baseline utility value. The disutility values for recurrent DVT, recurrent PE, non-ICH major bleeds and CRNM bleeds were obtained from previously published studies and VTE models [14][15][16][17][18] (Table 4).…”

Análisis coste-efectividad y coste-utilidad de apixaban frente a dabigatrán y rivaroxaban en el tratamiento y prevención secundaria del tromboembolismo venoso

“…La aparición de una hemorragia intracraneal o HPTEC se asoció con valores de utilidad de 0,330 [27] y 0,650 [28], respectivamente. Se consideraron también decrementos de utilidad asociados al desarrollo de eventos clínicos y sangrados, así como a la vía de administración del tratamiento anticoagulante, con un mayor impacto de la vía parenteral en la CVRS (Tabla 2) [27,[29][30][31][32][33].…”