Differences in utility elicitation methods in cardiovascular disease: a systematic review

Abstract

Aims: Utility values inform estimates of the cost-effectiveness of treatment for cardiovascular disease (CVD), but values can vary depending on the method used. The aim of this systematic literature review (SLR) was to explore how methods of elicitation impact utility values for CVD.

Materials and methods: This review identified English-language articles in Embase, MEDLINE, and the gray literature published between September 1992 and August 2015 using keywords for “utilities” and “stroke”, “heart failure”, “myocardial infarction”, or “angina”. Variability in utility values based on the method of elicitation, tariff, or type of respondent was then reported.

Results: This review screened 4,341 citations; 290 of these articles qualified for inclusion in the SLR because they reported utility values for one or more of the cardiovascular conditions of interest listed above. Of these 290, the 41 articles that provided head-to-head comparisons of utility methods for CVD were reviewed. In this sub-set, it was found that methodological differences contributed to variation in utility values. Direct methods often yielded higher scores than did indirect methods. Within direct methods, there were no clear trends in head-to-head studies (standard gamble [SG] vs time trade-off); but general population respondents often provided lower scores than did patients with the disease when evaluating the same health states with SG methods. When comparing indirect methods, the EQ-5D typically yielded higher values than the SF-6D, but also showed more sensitivity to differences in health states.

Conclusions: When selecting CVD utility values for an economic model, consideration of the utility elicitation method is important, as this review demonstrates that methodology of choice impacts utility values in CVD.

Keywords:

• Cardiovascular disease
• stroke
• myocardial infarction
• heart failure
• angina
• utilities
• standard gamble
• time trade-off
• EQ-5D

Transparency

Declaration of funding

This study was funded by Amgen Inc.

Declaration of financial/other relationships

MB is an employee of Evidera. AS was an employee of Evidera at the time of this study and is currently a consultant for Pacira Pharmaceuticals and Takeda Pharmaceuticals. PPT is a consultant to Akcea, Amarin, Amgen, Kowa, Merck, Regeneron-Sanofi, and Gemphire and on the speakers bureaus for Amarin, Amgen, Kowa, Merck, Novo Nordisk, and Regeneron-Sanofi. SRG is an employee of Amgen Inc. and owns Amgen stock/stock options. L-IC was an employee of Amgen Inc. and holds Amgen stock/stock options. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors acknowledge Annalise M. Nawrocki, PhD, of Amgen Inc. for medical writing and editorial assistance.