Time Trade-Off Utilities for Hereditary Angioedema Health and Caregiver States

Abstract

Background Hereditary angioedema (HAE) is an inherited chronic rare disease characterised by recurrent swelling attacks that are associated with significant physical and psychological burden. There is limited understanding of the effect of attack location on this burden and of caregiver burden. Objective Our objective was to capture the relative burden of HAE health and caregiver states, including different attack locations, through a time trade-off (TTO) analysis involving participants from the general public. Methods Qualitative interviews were undertaken to inform vignette development for the TTO study, including vignettes for abdominal, facial, hand and laryngeal attack health states, and an attack-free and caregiver state. Members of the general public in England rated vignettes in TTO interviews, which included a visual analogue scale (VAS) component. For the development of the health state vignettes, qualitative interviews with 15 patients, 5 caregivers and 1 clinical expert were performed. TTO analysis was based on vignette valuation completed by 100 members of the general public. Results The TTO values were as follows: attack-free, 0.783 (standard deviation [SD] 0.316); hand: 0.582 (SD 0.380); facial: 0.483 (SD 0.448); abdominal: 0.345 (SD 0.458); and laryngeal: 0.128 (SD 0.529). The caregiver rating was 0.762 (SD 0.303). V′ scores were similar and consistent with TTO values. Conclusion TTO utility values demonstrate that HAE places a significant burden on patients, which is influenced by attack location, and on caregivers. These utility weights can provide important information on quality of life for future economic evaluations of treatments.

Current challenges and future opportunities in patient‐focused management of hereditary angioedema: A narrative review

“…Furthermore, studies from China 53 and Denmark 85 showed that QoL was even lower in patients with a recent HAE attack. This is in line with markedly higher burden of HAE during an HAE attack versus attack‐free state as estimated by time trade‐off utility values reported in a study from the United Kingdom 88 . Therefore, better disease control and corresponding reduction in the number or frequency of HAE attacks may increase QoL, as shown in studies from China 53 and Germany 89 .…”

“…This is in line with markedly higher burden of HAE during an HAE attack versus attack‐free state as estimated by time trade‐off utility values reported in a study from the United Kingdom. 88 Therefore, better disease control and corresponding reduction in the number or frequency of HAE attacks may increase QoL, as shown in studies from China 53 and Germany. 89 It should, however, be noted that patients with HAE experience QoL impairment between HAE attacks, as well as during an attack: they report ongoing fear of another attack, and disease interference with education and career.…”