Systematic review of health state utility values used in pharmacoeconomic evaluations for chronic hepatitis C: impact on cost-effectiveness results

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 liver transplant in the first year and in subsequent years (n=17, −0.340 to 0.000). The utility elicitation study selected by most CUAs (n=11)was recommended as the source of HSUVs, as least for the CUAs conducted in the UK, based on the results of quality assessment. Seven sets of HSUVs were generated to fit the re-constructed model and changed the results of incremental analysis from being cost-effective to not cost-effective (ICER raging from £2,460 to £24,954 per QALY gained), and to dominated in the UK setting.ConclusionsThe CUAs for CHC were found to apply various HSUVs from different utility elicitation studies in the same health state. This variability of HSUVs has the potential to significantly affect ICER and ICER-based reimbursement decision. A rigorous selection of HSUVs in CUAs to inform healthcare resource allocation is suggested for future studies of CUAs and guideline development.

Preference for Alternate-Day Versus Conventional In-Center Dialysis: A Health Utility Elicitation

Background: Mortality rates for patients on hemodialysis (HD) continue to be high, in particular, following the long interdialytic period, yet thrice-weekly conventional HD (CHD) is still an almost universal regimen. Alternate-day dialysis (ADD) may have advantages over the current schedule because it would eliminate the long interdialytic break. A preliminary, as yet unpublished, patient simulation and cost-utility analysis compared CHD versus ADD and demonstrated that the economic attractiveness of ADD was sensitive, in particular, to patients’ preference for ADD versus CHD. To date, this preference has not been elicited. Objective: To elicit utilities for both CHD and ADD using 3 standard elicitation methods among a prevalent cohort of patients on CHD. Design: This study is a single-center survey of patient preferences (utilities). Setting: This study took place within the dialysis units of Sunnybrook Health Centre, a university-affiliated teaching hospital in Toronto, Ontario, Canada, which encompasses 174 patients on in-center HD. Patients: Those older than 18 years of age, on thrice-weekly HD, were included in this study. Measurements: Descriptive statistics were used to summarize patient characteristics and the utility values generated. A multiple linear regression was performed to determine an association between participant characteristics and the utility ratio. Methods: Via standardized face-to-face interviews by a single investigator, 3 utility elicitation methods, visual analogue scale (VAS), time trade-off (TTO), and standard gamble (SG), were administered to generate utilities for each patient for their current health state of CHD (thrice-weekly). After completing this task, we provided each patient with a concise summary regarding the current literature on how ADD may impact their health. Finally, patients were asked to envision their health while on an ADD regimen while repeating the VAS, TTO, and SG. Results: We recruited 65 participants. The mean utilities of CHD versus ADD were similar for all 3 methods. Visual analogue scale, TTO, and SG had utility values of 0.6 ± 0.2, 0.6 ± 0.3, and 0.7 ± 0.3, and 0.6 ± 0.2, 0.7 ± 0.3, and 0.7 ± 0.3 for CHD and ADD, respectively. The ratio for CHD to ADD was 1.1 ± 0.4, 1.1 ± 0.5, and 1.0 ± 0.2 for VAS, TTO, and SG, respectively. Limitations: Small sample size from a single center, where not all participants agreed to participate, wide variability in participant responses and requiring patients to conceptually imagine life on ADD may have affected our results. Conclusions: Compared with CHD, there was no difference in the preference toward ADD which demonstrates promise that adopting an alternate-day schedule may be acceptable to patients. Furthermore, with the generation of a utility for ADD, this will allow for more precise estimates in future simulation studies of the economic attractiveness of ADD. Trial registration: Not required as this article is not a systematic review nor does it report the results of a health care intervention.

Systematic review and evidence synthesis of non-cervical human papillomavirus-related disease health system costs and quality of life estimates

BackgroundMany economic evaluations of human papillomavirus vaccination should ideally consider multiple disease outcomes, including anogenital warts, respiratory papillomatosis and non-cervical cancers (eg, anal, oropharyngeal, penile, vulvar and vaginal cancers). However, published economic evaluations largely relied on estimates from single studies or informal rapid literature reviews.MethodsWe conducted a systematic review of articles up to June 2016 to identify costs and utility estimates admissible for an economic evaluation from a single-payer healthcare provider’s perspective. Meta-analyses were performed for studies that used same utility elicitation tools for similar diseases. Costs were adjusted to 2016/2017 US$.ResultsSixty-one papers (35 costs; 24 utilities; 2 costs and utilities) were selected from 10 742 initial records. Cost per case ranges were US$124–US$883 (anogenital warts), US$6912–US$52 579 (head and neck cancers), US$12 936–US$51 571 (anal cancer), US$17 524–34 258 (vaginal cancer), US$14 686–US$28 502 (vulvar cancer) and US$9975–US$27 629 (penile cancer). The total cost for 14 adult patients with recurrent respiratory papillomatosis was US$137 601 (one paper).Utility per warts episode ranged from 0.651 to 1 (12 papers, various utility elicitation methods), with pooled mean EQ-5D and EQ-VAS of 0.86 (95% CI 0.85 to 0.87) and 0.74 (95% CI 0.74 to 0.75), respectively. Fifteen papers reported utilities in head and neck cancers with range 0.29 (95% CI 0.0 to 0.76) to 0.94 (95% CI 0.3 to 1.0). Mean utility reported ranged from 0.5 (95% CI 0.4 to 0.61) to 0.65 (95% CI 0.45 to 0.75) (anal cancer), 0.59 (95% CI 0.54 to 0.64) (vaginal cancer), 0.65 (95% CI 0.60 to 0.70) (vulvar cancer) and 0.79 (95% CI 0.74 to 0.84) (penile cancer).ConclusionsDifferences in values reported from each paper reflect variations in cancer site, disease stages, study population, treatment modality/setting and utility elicitation methods used. As patient management changes over time, corresponding effects on both costs and utility need to be considered to ensure health economic assumptions are up-to-date and closely reflect the case mix of patients.