Systematic Review of Health State Utility Values Used in European Pharmacoeconomic Evaluations for Chronic Hepatitis C: Impact on Cost-Effectiveness Results

Abstract

BackgroundHealth state utility values (HSUVs) identified from utility elicitation studies are widely used in pharmacoeconomic evaluations for chronic hepatitis C (CHC) and are particularly instrumental in health technology assessment (HTA) evaluation like the National Institute for Health and Clinical Excellence (NICE). ObjectiveThe objective of this study is to identify HSUVs used in cost-utility analyses (CUAs) for CHC in Europe and evaluate the impact of HSUVs selection on cost-effectiveness results in terms of incremental cost per quality-adjusted life-year (QALY) gained (ICER). MethodsA systematic search of pharmacoeconomic evaluations for CHC was updated in Medline and Embase from the period of 2012-2017 to the period of 2017-2020. Data on health states, HSUVs and utility elicitation studies were extracted. The difference in HSUVs of the same health state in different CUAs and the difference between HSUVs of one health state and of the interlink health state in the same CUAs were calculated. A quality assessment was performed to evaluate the selection of HSUVs in CUAs. Sets of HSUVs identified were used in a re-constructed CUA model to assess the impact on ICER. ResultsTwenty-six CUAs conducted in European countries and referring to 17 utility elicitation studies were included. The difference in HSUVs of the same health states in different CUAs ranged from 0.021 (liver transplant) to 0.468 (decompensated cirrhosis). The difference between HSUVs of one health state and of the interlink health state of next disease severity level was calculated between health state of F0-F1/mild and F2-F3/moderate (n=11, 0.040 to 0.110), F2-F3/moderate and F4/compensated cirrhosis (n=18, 0.027 to 0.130), compensated cirrhosis and decompensated cirrhosis (n=22, 0.020 to 0.100), decompensated cirrhosis and hepatocellular carcinoma (n=24, 0.000 to 0.200), hepatocellular carcinoma and liver transplant in the first year (n=17, -0.329 to 0.170) and All rights reserved. No reuse allowed without permission.(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The impact of age on health utility values for older women with early-stage breast cancer: a systematic review and meta-regression

“…However, the results indicate that the sample of included studies may be potentially sufficient to pool and quantify the condition-specific association between age and health utility for older women with breast cancer. Searching Medline and Embase has a high ability to identify relevant studies (Bramer et al [ 58 ] report a 92.8% recall rate) and have been used effectively by other systematic reviews of HSUVs [ 59 ].…”

Allocating treatment resources for hepatitis C in the UK: a constrained optimization modelling approach

“…In the absence of comparative data on clinical and cost outcomes between PWID/MSM and the general population from long-term follow-up studies to populate the programming, a core Markov model [ 48–50 ] widely used with many local adaptations [ 51–61 ] for evaluating the chronic progression and treatment of CHC was further adapted to compare clinical and cost outcomes of CHC treatment among different populations in the UK setting. The structure of the core Markov model ( Figures 1 ) was kept as reported in the previous study [ 62 ]. Population-specific input including mortality, reinfection, and HRQoL was added in the core model.…”

“…Population-specific input including mortality, reinfection, and HRQoL was added in the core model. The local population-specific data was derived from a systematic review of economic evaluation models for the treatment of CHC [ 62 ] and extensive reviews of the epidemiologic burden of CHC among the general and high-risk populations [ 1–4 ]. The outcomes of the core Markov model including total lifetime treatment costs per patient and liver-related death rates with each strategy and without any treatment in each population were embedded in the constrained optimization programming to determine the optimal allocation.…”

“…The conceptualization of the decision problem was based on the clinical practice of CHC treatment and validated by a health economics expert (S.A.). The specification and value of parameters in constrained optimization modelling were selected based on the UK real-world evidence [ 8 , 10 , 18 , 66 , 78–81 ] identified by extensive reviews [ 1–4 ] and derived from the core Markov model in the UK setting populated with UK local data identified by the systematic review [ 62 ]. The numbers of liver-related deaths estimated by this model are consistent with those currently observed in the UK [ 82 ].…”

Differences in the Selection of Health State Utility Values by Sponsorship in Published Cost-Effectiveness Analyses

“…The selection of HSUVs is often a source of variation in value assessments, indicating that they can meaningfully affect policy and reimbursement decisions. [1][2][3][4] There is little understanding of how HSUVs are chosen, however, and insufficient detail is often reported about this selection process. 5,6 Various factors have contributed to substantial uncertainty in HSUVs.…”