Health State Utilities of Patients with Heart Failure: A Systematic Literature Review

Tanna, Gian Luca Di; Urbich, Michael; Wirtz, Heidi S.; Potrata, Barbara; Heisen, Marieke; Bennison, C.; Brazier, John

doi:10.1007/s40273-020-00984-6

Cited by 28 publications

(15 citation statements)

References 95 publications

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“…Owing to the simultaneous lack of evidence on the health utility of HFrEF and HFpEF in China, the published literature was chosen. The visual analogue scale and time trade-off were used to calculate the utility scores of HFrEF and HFpEF ( Di Tanna et al, 2021 ). Additionally, a higher rate of hospitalisations leads to a greater utility decrease; thus, each HF-related hospitalisation would reduce the utility by 0.1 ( King et al, 2016 ) ( Table 1 ).…”

Section: Methodsmentioning

confidence: 99%

Cost-utility analysis of empagliflozin in heart failure patients with reduced and preserved ejection fraction in China

Tang

Sang²

2022

Front. Pharmacol.

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Objective: EMPEROR-Reduced and EMPEROR-Preserved studies showed the benefits of empagliflozin along with a reduction in cardiovascular death or hospitalisation for heart failure (HF). Our aim was to evaluate the economics and effectiveness of adding empagliflozin to the standard therapy for HF with reduced ejection fraction (HFrEF) and HF preserved ejection fraction (HFpEF) in China.Methods: A multistate Markov model was constructed to yield the clinical and economic outcomes of adding empagliflozin to the standard therapy for 65-year-old patients with HFrEF and HFpEF. A cost-utility analysis was conducted, mostly derived from the EMPEROR-Reduced study, EMPEROR-Preserved study, and national statistical database. All costs and outcomes were discounted at the rate of 5% per annum. The primary outcomes were total and incremental costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Sensitivity analyses were also performed.Results: In the HFrEF population, the 10-year incremental cost was $827.52 and the 10-year incremental QALY was 0.15 QALYs, resulting in an ICER of $5,612.06/QALY, which was below the WTP of $12,652.5/QALY. In the HFpEF population, compared with the control group, the incremental cost was $1,271.27, and the incremental QALY was 0.11 QALYs, yielding an ICER of 11,312.65 $/QALY, which was also below the WTP of $12,652.5/QALY. In the HFrEF and HFpEF populations, the results of a one-way sensitivity analysis showed that the risk of cardiovascular death in both groups was the most influential parameter. In the HFrEF population, a probability sensitivity analysis (PSA) revealed that when the WTP thresholds were $12,652.5/QALY and $37,957.5/QALY, the probabilities of being cost-effective with empagliflozin as an add-on were 59.4% and 72.6%, respectively. In the HFpEF population, the PSA results revealed that the probabilities of being cost-effective with empagliflozin as an add-on were 53.1% and 72.2%, respectively.Conclusion: Considering that the WTP threshold was $12,652.5/QALY, adding empagliflozin to standard therapy was proven to be a slightly more cost-effective option for the treatment of HFrEF and HFpEF from a Chinese healthcare system perspective, which promoted the rational use of empagliflozin for HF.

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Section: Methodsmentioning

confidence: 99%

Cost-utility analysis of empagliflozin in heart failure patients with reduced and preserved ejection fraction in China

Tang

Sang²

2022

Front. Pharmacol.

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“…A one-off disutility of −0.078 was also applied for any cycle in which HF hospitalization occurred. 18…”

Section: Utilitiesmentioning

confidence: 99%

Cost-Effectiveness of Empagliflozin in Patients With Heart Failure and Preserved Ejection Fraction

Zhou

Liew

Kaye

et al. 2022

Circ: Cardiovascular Quality and Outcomes

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BACKGROUND: Empagliflozin is the first medication to demonstrate clinical benefit in patients with heart failure with preserved ejection fraction, but its cost-effectiveness is unknown. We aimed to evaluate the cost-effectiveness of adding empagliflozin to standard therapy in patients with heart failure with preserved ejection fraction. METHODS: A Markov model from the perspective of the Australian health care system was constructed to compare empagliflozin plus standard care to standard care alone among a hypothetical cohort of patients with heart failure with preserved ejection fraction. Clinical probabilities were derived from The EMPEROR-Preserved (Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction). Costs and utilities were derived from published sources. The main outcome was the incremental cost-effectiveness ratio per quality-adjusted life-year gained. Deterministic and probabilistic sensitivity analyses were performed to assess model uncertainty. Costs and benefits were discounted at 5% annually. RESULTS: Over a lifetime, the addition of empagliflozin to standard care prevented 167 heart failure hospitalizations and 155 heart failure-related urgent care visits for every 1000 patients treated and increased mean quality-adjusted survival by 0.16 quality adjusted life-years per patient. Mean lifetime costs in the empagliflozin and standard care groups were AUD$63 218 and AUD$58 478 per patient, respectively. This resulted in an incremental cost-effectiveness ratio of AUD$29 202 per quality adjusted life-year gained. In probabilistic sensitivity analyses, empagliflozin was cost-effective in 85% of 10 000 Monte Carlo simulations at a willingness-to-pay threshold of AUD$50 000 per quality adjusted life-year gained. CONCLUSIONS: In patients with heart failure with preserved ejection fraction, adding empagliflozin to standard care is likely to be cost-effective when compared with standard care alone in the Australian health care setting.

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“…Furthermore, the terminology used to describe the QA process varied considerably among the SLRs. Terms such as quality appraisal or assessment [ 9 , 23 , 24 , 48 , 49 , 51 , 53 , 55 , 57 – 60 , 73 – 78 ], critical appraisal [ 47 ], risk of bias assessment [ 25 , 62 , 63 , 72 , 79 – 82 ], relevancy and quality assessment [ 52 , 56 ], assessment of quality and data appropriateness [ 50 ], methodological quality assessment [ 26 , 27 , 46 , 54 , 61 , 69 ], reporting quality [ 71 , 83 ] credibility checks and methodological review [ 70 ] were used loosely and interchangeably. One study [ 84 ] mentioned three terms, RoB, methodological quality and reporting quality, in their description of the QA process.…”

Section: Resultsmentioning

confidence: 99%

Quality appraisal for systematic literature reviews of health state utility values: a descriptive analysis

Muchadeyi

Hernandez-Villafuerte

Schlander

2022

BMC Med Res Methodol

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Background Health state utility values (HSUVs) are an essential input parameter to cost-utility analysis (CUA). Systematic literature reviews (SLRs) provide summarized information for selecting utility values from an increasing number of primary studies eliciting HSUVs. Quality appraisal (QA) of such SLRs is an important process towards the credibility of HSUVs estimates; yet, authors often overlook this crucial process. A scientifically developed and widely accepted QA tool for this purpose is lacking and warranted. Objectives To comprehensively describe the nature of QA in published SRLs of studies eliciting HSUVs and generate a list of commonly used items. Methods A comprehensive literature search was conducted in PubMed and Embase from 01.01.2015 to 15.05.2021. SLRs of empirical studies eliciting HSUVs that were published in English were included. We extracted descriptive data, which included QA tools checklists or good practice recommendations used or cited, items used, and the methods of incorporating QA results into study findings. Descriptive statistics (frequencies of use and occurrences of items, acceptance and counterfactual acceptance rates) were computed and a comprehensive list of QA items was generated. Results A total of 73 SLRs were included, comprising 93 items and 35 QA tools and good recommendation practices. The prevalence of QA was 55% (40/73). Recommendations by NICE and ISPOR guidelines appeared in 42% (16/40) of the SLRs that appraised quality. The most commonly used QA items in SLRs were response rates (27/40), statistical analysis (22/40), sample size (21/40) and loss of follow up (21/40). Yet, the most commonly featured items in QA tools and GPRs were statistical analysis (23/35), confounding or baseline equivalency (20/35), and blinding (14/35). Only 5% of the SLRS used QA to inform the data analysis, with acceptance rates of 100% (in two studies) 67%, 53% and 33%. The mean counterfactual acceptance rate was 55% (median 53% and IQR 56%). Conclusions There is a considerably low prevalence of QA in the SLRs of HSUVs. Also, there is a wide variation in the QA dimensions and items included in both SLRs and extracted tools. This underscores the need for a scientifically developed QA tool for multi-variable primary studies of HSUVs.

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Health State Utilities of Patients with Heart Failure: A Systematic Literature Review

Cited by 28 publications

References 95 publications

Cost-utility analysis of empagliflozin in heart failure patients with reduced and preserved ejection fraction in China

Cost-utility analysis of empagliflozin in heart failure patients with reduced and preserved ejection fraction in China

Cost-Effectiveness of Empagliflozin in Patients With Heart Failure and Preserved Ejection Fraction

Quality appraisal for systematic literature reviews of health state utility values: a descriptive analysis

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