Health State Utilities in Individuals with Goiter, Hypothyroidism, Hyperthyroidism and Graves’ Disease as an Example for Thyroid Disorders – A Systematic Review

Mladenovic, Marija; Buchberger, Maria; Qerimi, V.; Puntscher, Sibylle; Siebert, Uwe; Rochau, Ursula

doi:10.1016/j.jval.2017.08.479

Cited by 3 publications

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“…The mean utility value derived across these 6 health states of patients with active, moderate-severe TED was 0.44. This indicates a substantial level of disutility as compared with the value of 0.88 found in a study investigating QoL in hyperthyroid Graves disease and a chronic, mild TED subgroup . These utility values highlight the substantial impact TED imposes when compared with the US general population (0.85) .…”

Section: Discussionsupporting

confidence: 68%

“…This indicates a substantial level of disutility as compared with the value of 0.88 found in a study investigating QoL in hyperthyroid Graves disease and a chronic, mild TED subgroup. 24 These utility values highlight the substantial impact TED imposes when compared with the US general population (0.85). 22 Further, this mean utility value was nearly identical to that calculated with a weighted analysis using proportions of these health states found in 2 controlled trials.…”

Section: Discussionmentioning

confidence: 99%

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Utility Assessment of Moderate to Severe Thyroid Eye Disease Health States

et al. 2023

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ImportanceThyroid eye disease (TED) results in varying degrees of proptosis and diplopia negatively affecting quality of life (QoL), producing possibly substantial visual changes, disfigurement, and disability.ObjectiveTo determine the association of varying TED severities with QoL in a non-TED population by assessing health state utility scores.Design, Setting, and ParticipantsThis qualitative study, conducted from April 20, 2020, to April 29, 2021, assessed health states for active, moderate-severe TED, and values were elicited using time trade-off methods. Six health states of varying severity were determined from 2 placebo-controlled clinical trials (171 patients with TED and clinical activity score ≥4, ±diplopia/proptosis) and refined using interviews with US patients with TED (n = 6). Each health state description was validated by interviews with additional TED patient advocates (n = 3) and physician experts (n = 3). Health state descriptions and a QOL questionnaire were piloted and administered to a general population. Visual analog scales (VASs) were also administered to detect concurrence of the findings.Main Outcomes and MeasuresTED health state utility scores and whether they differ from one another were assessed using Shapiro-Wilk, Kruskal-Wallis, pairwise Wilcoxon rank sum, and paired t tests.ResultsA total of 111 participants completed time trade-off interviews. The mean (SD) utility value was 0.44 (0.34). The lowest (worse) mean utility value was observed in the most severe disease state (constant diplopia/large proptosis) with 0.30 (95% CI, 0.24-0.36), followed by constant diplopia/small proptosis (0.34; 95% CI, 0.29-0.40), intermittent or inconstant diplopia/large proptosis (0.43; 95% CI, 0.36-0.49), no diplopia/large proptosis (0.46; 95% CI, 0.40-0.52), and intermittent or inconstant diplopia/small proptosis (0.52; 95% CI, 0.45-0.58). The highest (best) mean value, 0.60 (95% CI, 0.54-0.67), was observed for the least severe disease state (no diplopia/small proptosis).Conclusions and RelevanceThese findings suggest that patients with active, moderate-severe TED may have substantial disutility, with increasing severity of proptosis/diplopia more likely to have detrimental associations with QoL. These health state scores may provide a baseline for determining QoL improvement in these TED health states (utility gains) treated with new therapies.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Utility Assessment of Moderate to Severe Thyroid Eye Disease Health States

et al. 2023

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“…In monetary terms, and based on a population EVSI of £3.64 m per year, the value of a clinical trial would be expected to exceed its cost within 1 year. 36 Literature searches did not identify any health utility measurement 20 or economic evaluations of liothyronine. Judgements on its cost-effectiveness in the UK appear to be made implicitly in policy guidelines, driven in large part by the significant difference in the current unit acquisition cost between liothyronine and levothyroxine.…”

Section: Discussionmentioning

confidence: 99%

“…19 Health utilities Literature searches did not identify any relevant health utility data. 20 Self-selecting people who reported to be clinically unresponsive to levothyroxine alone despite being biochemically euthyroid were recruited to a survey that was advertisement via social media, and hosted on the website of the charity Thyroid UK. Consent was obtained within the online form, following a full explanation of the purpose and nature of the survey.…”

Section: Open Accessmentioning

confidence: 99%

Liothyronine for hypothyroidism: a candidate for disinvestment or in need of further research? A value of information analysis

et al. 2021

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ObjectiveMedicines with limited evidence of effectiveness are prime candidates for disinvestment. However, investment in further research may be preferable to deimplementation, given that the absence of evidence is not evidence of absence, and research can inform formulary decisions. A case in point is liothyronine, which is sometimes prescribed to levothyroxine-treated patients who continue to experience hypothyroid symptoms. It is a putative low value medicine, associated with uncertainties in both clinical and cost-effectiveness. The aim was to assess the cost-effectiveness of liothyronine in this context, and estimate the value of conducting further research.DesignCost utility and value of information analyses.SettingPrimary care within the National Health Service in the UK.ParticipantsFifty-four levothyroxine-treated patients with persistent symptoms of hypothyroidism.InterventionsLiothyronine plus levothyroxine versus levothyroxine alone.Primary and secondary outcome measuresIncremental cost per quality-adjusted life year (QALY) gained, and the expected monetary value of sample information.Results20/54 (37%) of patients who responded to the survey reported severe problems in carrying out usual activities of everyday living and 12/54 (22%) reported severe anxiety or depression symptoms. Mean (SD) utility was 0.53 (0.23). The differences in expected total, 10-year costs and QALYs between a treatment strategy of liothyronine/levothyroxine combination therapy, and levothyroxine alone, was £12 053 and 1.014, respectively. The incremental cost-effectiveness ratio of £11 881 per QALY gained was sensitive to the price of liothyronine. The probability of liothyronine/levothyroxine combination therapy being cost effective at a threshold of £20 000 per QALY was 0.56. The value of reducing uncertainty in the efficacy of treatment was £3.64 m per year in the UK.ConclusionsA definitive clinical trial to confirm clinical effectiveness may be preferable to immediate disinvestment, and would be justified given the value of the information gained far exceeds the cost.

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“…Utilities are measured on a cardinal scale between 0 (death) and 1 (full health) reflecting patient preferences for a given state of health. We conducted a comprehensive systematic literature review in PubMed/MEDLINE, Tufts CEA Registry, NHS EED, and Cochrane to identify studies that reported health state utilities for several health states associated with iodine deficiency (34,35). The identified studies report health utility values related to hypothyroidism (n = 7), hyperthyroidism (n = 2), goiter (n = 1), thyroid nodules (n = 11), thyroid cancer (n = 16), and intellectual disability (n = 5).…”

Section: Utilitiesmentioning

confidence: 99%

Benefits and Harms of a Prevention Program for Iodine Deficiency Disorders: Predictions of the Decision-Analytic EUthyroid Model

Schaffner

Mühlberger

Conrads-Frank

et al. 2021

Thyroid

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Background: Iodine deficiency is one of the most prevalent causes of intellectual disability and can lead to impaired thyroid function and other iodine deficiency disorders (IDDs). Despite progress made on eradicating iodine deficiency in the last decades in Europe, IDDs are still prevalent. Currently, evidence-based information on the benefit/harm balance of IDD prevention in Europe is lacking. We developed a decision-analytic model and conducted a public health decision analysis for the long-term net benefit of a mandatory IDD prevention program for the German population with moderate iodine deficiency, as a case example for a European country. Methods: We developed a decision-analytic Markov model simulating the incidence and consequences of IDDs in the absence or presence of a mandatory IDD prevention program (iodine fortification of salt) in an open population with current demographic characteristics in Germany and with moderate ID. We collected data on the prevalence, incidence, mortality, and quality of life from European studies for all health states of the model. Our primary net-benefit outcome was quality-adjusted life years (QALYs) predicted over a period of 120 years. In addition, we calculated incremental life years and disease events over time. We performed a systematic and comprehensive uncertainty assessment using multiple deterministic one-way sensitivity analyses. Results: In the base-case analysis, the IDD prevention program is more beneficial than no prevention, both in terms of QALYs and life years. Health gains predicted for the open cohort over a time horizon of 120 years for the German population (82.2 million inhabitants) were 33 million QALYs and 5 million life years. Nevertheless, prevention is not beneficial for all individuals since it causes additional hyperthyroidism (2.7 million additional cases). Results for QALY gains were stable in sensitivity analyses. Conclusions: IDD prevention via mandatory iodine fortification of salt increases quality-adjusted life expectancy in a European population with moderate ID, and is therefore beneficial on a population level. However, further ethical aspects should be considered before implementing a mandatory IDD prevention program. Costs for IDD prevention and treatment should be determined to evaluate the cost effectiveness of IDD prevention.

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Health State Utilities in Individuals with Goiter, Hypothyroidism, Hyperthyroidism and Graves’ Disease as an Example for Thyroid Disorders – A Systematic Review

Cited by 3 publications

References 0 publications

Utility Assessment of Moderate to Severe Thyroid Eye Disease Health States

Utility Assessment of Moderate to Severe Thyroid Eye Disease Health States

Liothyronine for hypothyroidism: a candidate for disinvestment or in need of further research? A value of information analysis

Benefits and Harms of a Prevention Program for Iodine Deficiency Disorders: Predictions of the Decision-Analytic EUthyroid Model

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