International systematic review of utility values associated with cardiovascular disease and reflections on selecting evidence for a UK decision-analytic model

Rob Hainsworth, Alexander J Thompson, Bruce Guthrie, Katherine Payne

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Purpose: Evaluating interventions for cardiovascular disease (CVD) requires estimates of its effect on utility. We aimed to (1) systematically review utility estimates for CVDs published since 2013, (2) critically appraise UK-relevant estimates and calculate corresponding baseline utility multipliers. Methods: We searched MEDLINE and Embase (22/04/2021) using CVD and utility terms. We screened results for primary studies reporting utility distributions for people with experience of heart failure, myocardial infarction, peripheral arterial disease, stable angina, stroke, transient ischemic attack or unstable angina. We extracted characteristics from studies included. For UK estimates based on the EuroQoL five dimension (EQ-5D) measure, we assessed risk of bias and applicability to a decision-analytic model, pooled arms/time-points as appropriate, and estimated baseline utility multipliers using predicted utility for age- and sex- matched populations without CVD. We sought utility sources from directly applicable studies with low risk of bias, prioritising plausibility of severity ordering in our base case model and highest population ascertainment in a sensitivity analysis.

Results: Most of the 403 studies identified used EQ-5D (n=217) and most assessed OECD populations (n=262), although measures and countries varied widely. UK studies using EQ-5D (n=29) produced very heterogeneous baseline utility multipliers for each type of CVD, precluding meta-analysis and implying different possible severity orderings. We could find sources which provided a plausible ordering of utilities whilst adequately representing health-states.

Conclusions: We catalogued international CVD utility estimates and calculated UK-relevant baseline utility multipliers. Modellers should consider unreported sources of heterogeneity, such as population differences, when selecting utility evidence from reviews.

Highlights
• Published systematic reviews have summarised estimates of utility associated with cardiovascular disease published up to 2013.
• We (1) reviewed utility estimates for seven types of cardiovascular disease published since 2013, (2) critically appraised UK-relevant studies and (3) estimated the effect of each cardiovascular disease on baseline utility.
• Our review (1) recommends a consistent and reliable set of baseline utility multipliers for seven types of cardiovascular disease and (2) provides systematically identified reference information for researchers seeking utility evidence for their own context.
Original languageEnglish
Number of pages18
JournalMedical Decision Making
Early online date4 Jan 2024
DOIs
Publication statusE-pub ahead of print - 4 Jan 2024

Keywords / Materials (for Non-textual outputs)

  • systematic review
  • utility values
  • cardiovascular disease
  • health-related quality of life
  • health economics
  • economic evaluation
  • cost-utility analysis
  • decision-analytic modelling
  • cost-effectiveness analysis

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