Health State Utility Value in Chronic Obstructive Pulmonary Disease (COPD); The Challenge of Heterogeneity: A Systematic Review and Meta-Analysis

ABSTRACT

Chronic obstructive pulmonary disease (COPD) has a considerable impact on quality of life and well-being of patients. Health state utility value (HSUV) is a recognized measure for health economic appraisals and is extensively used as an indicator for decision-making studies. This study is a systematic review of literature aimed to estimate mean utility value in COPD using meta-analysis and explore degree of heterogeneity in the utility values across a variety of clinical and study characteristic. The literature review covers studies that used EQ-5D to estimate utility value for patient level research in COPD. Studies that reported utility values elicited by EQ-5D in COPD patients were selected for random-effect meta-analysis addressing inter-study heterogeneity and subgroup analyses. Thirty-two studies were included in the general utility meta-analysis. The estimated general utility value was 0.673 (95% CI 0.653 to 0.693). Meta-analyses of COPD stages utility values showed influence of airway obstruction on utility value. The utility values ranged from 0.820 (95% CI 0.767 to 0.872) for stage I to 0.624 (95% CI 0.571 to 0.677) for stage IV. There was substantial heterogeneity in utility values: I² = 97.7%. A more accurate measurement of utility values in COPD is needed to refine valid and generalizable scores of HSUV. Given the limited success of the factors studied to reduce heterogeneity, an approach needs to be developed how best to use mean utility values for COPD in health economic evaluation.

KEYWORDS:

• chronic disease
• Chronic Obstructive Pulmonary Disease (COPD)
• EQ-5D
• heterogeneity
• Quality of Life (QoL)
• utility

Acknowledgments

The authors thank Ms. Rachel Sore (Statistical Consulting Centre, University of Melbourne) for her contribution for statistical analysis.

Declaration of interest statement

The authors report no conflicts of interest. All the authors interpreted data, read and approved the final manuscript. The authors alone are responsible for the content and writing of the paper.

Funding

The first author, Foruhar Moayeri, received PhD scholarship funding from University of Melbourne Faculty of Medicine, Dentistry and Health Sciences.