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

Figures & data

Table 1. Domains measured in common indirect utility tools.

EQ-5D	HUI-2	HUI-3	SF-6D
Mobility Self-care Usual activities Pain/discomfort Anxiety/depression	Mobility Sensation Emotion Cognitive Self-care Pain Fertility	Vision Hearing Speech Ambulation Dexterity Emotion Cognition Pain	Physical functioning Role participation Social functioning Bodily pain Mental health Vitality

Table 2. Inclusion/exclusion criteria.

	Inclusion	Exclusion
Health states	≥18 years with any of the following events:  • Stroke (including TIA)  • MI  • Angina (stable and unstable)  • HF	≤18 years and/or without CV conditions of interest
Outcomes	Any health state utility value	No health state utility value reported
Study design	Study generated the utility value (i.e. “primary” utility values)	Study reported previously published utility values (e.g. economic models or literature reviews)

Abbreviations. CV, cardiovascular; HF, heart failure; MI, myocardial infarction; TIA, transient ischemic attack.

Figure 1. Systematic review study attrition (PRISMA) diagram. Abbreviations. CV, cardiovascular; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Table 3. Characteristics of the 290 included articles.

	Stroke (n = 155)	HF (n = 100)	Angina^a (n = 50)	MI^a (n = 74)
Method of utility elicitation^b
EQ-5D	102 (66%)	70 (70%)	31 (62%)	45 (61%)
HUI	13 (8%)	10 (10%)	1 (2%)	6 (8%)
SF-6D	10 (6%)	6 (6%)	8 (16%)	6 (8%)
SG	14 (9%)	5 (5%)	4 (8%)	4 (5%)
TTO	16 (10%)	18 (18%)	9 (18%)	10 (14%)
Type of respondent
Patients	148 (95%)	91 (91%)	44 (88%)	68 (92%)
General population	8 (5%)	7 (7%)	5 (10%)	6 (8.1%)
Carers	7 (5%)	2 (2%)	0 (0%)	0 (0%)
Geographic setting
US	24 (15%)	30 (30%)	10 (20%)	16 (22%)
UK	33 (21%)	21 (21%)	9 (18%)	11 (15%)
Canada	20 (13%)	7 (7%)	6 (12%)	7 (9%)
Germany	5 (3%)	3 (3%)	4 (8%)	7 (9%)
Sweden	9 (6%)	8 (8%)	2 (4%)	3 (4%)
Australia	5 (3%)	3 (3%)	1 (2%)	4 (5%)
Spain	4 (3%)	8 (8%)	0 (0%)	0 (0%)
Netherlands	7 (5%)	3 (3%)	0 (0%)	0 (0%)
Norway	6 (4%)	0 (0%)	0 (0%)	2 (3%)
South Korea	7 (5%)	0 (0%)	4 (8%)	5 (7%)
Other countries	37 (24%)	17 (17%)	13 (26%)	18 (24%)

Abbreviations. EQ-5D, EuroQol–Five Dimensions; HF, heart failure; HUI, Health Utilities Index; MI, myocardial infarction; SF-6D, Short Form–Six Dimensions; SG, standard gamble; TTO, time trade-off.

A comprehensive listing of all studies included here can be found in the Supplemental Appendix.

Some totals may add to more than 100% in a column due to some studies evaluating more than one method, type of respondent, or country.

^a Acute coronary syndrome values are included in both the angina and MI columns.

^b Utility value reported on a 10-point scale.

Table 4. Average utility values in studies comparing methods of elicitation.

Reference (year)	Health state	Sample size	Time point	Utility elicitation method
Studies comparing indirect methods				EQ-5D	SF-6D	HUI-2	HUI-3
Feeny et al.^35 (2012)	HF	36	Baseline	0.77 (0.18)	0.63 (0.11)	0.76 (0.22)	0.62 (0.32)
			6 months	0.76 (0.18)	0.66 (0.13)	0.76 (0.24)	0.65 (0.33)
Darlington et al.^33 (2007)	Stroke	80	2 months	0.69 (0.25)	0.69 (0.12)	NR	NR
			1 year	0.72 (0.22)	0.69 (0.12)	NR	NR
De Smedt et al.^34 (2014)	AMI	NR	NR	0.78 (0.66–1.00)^a	0.66 (0.62–0.80)^a	NR	NR
	Stroke	NR		0.69 (0.52–0.85)^a	0.66 (0.57–0.74)^a	NR	NR
Han et al.^36 (2012); Wu et al.^37 (2012); Wu^42 (2014)	Stable angina	411	NR	0.75 (0.19) (0.73–0.77)^b	0.68 (0.12) (0.67–0.69)^b	NR	NR
Pickard et al.^39 (2005); Pickard et al.^41 (2004)	Ischemic stroke	98	Baseline	0.31 (0.38)	0.55 (0.09)	0.51 (0.20)	0.19 (0.30)
			6 months	0.62 (0.33)	0.68 (0.15)	0.64 (0.23)	0.44 (0.35)
Stevanovic et al.^31 (2014)	HF	NR	NR	0.6385 (US) 0.7593 (UK)	0.6382	NR	NR
Barton et al.^38 (2008)	Stroke	62	NR	0.612 (0.318)	0.644 (0.162)	NR	NR
Haacke et al.^40 (2006)	Hemorrhagic stroke	5	2 years	0.74 (0.39)	NR	0.67 (0.28)	0.55 (0.50)
	Infarction and/or TIA	54		0.68 (0.33)	NR	0.61 (0.24)	0.36 (0.38)
	TIA	18		0.90 (0.16)	NR	0.86 (0.10)	0.79 (0.23)
Hebert^43 (2008)	HF patients in a nurse-led program	146	1 year	0.708	NR	NR	0.6619
	HF patients receiving usual care	140		0.6651	NR	NR	0.6122
Kaplan^44 (2011)	HF	160	From baseline to 1 month	+0.005 (0.14)^c	+0.022 (0.087)^c	+0.009 (0.16)^c	+0.012 (0.20)^c
			From 1 month to 6 months	–0.000 (0.16)^c	+0.014 (0.086)^c	+0.003 (0.15)^c	+0.020 (0.20)^c
Studies comparing indirect and direct methods				EQ-5D	SF-6D	TTO	SG
Stevanovic et al.^31 (2014)	HF	NR	NR	0.6385 (UK) 0.7593 (US)	0.6382	0.7287	NR
Kraai et al.^29 (2013)	HF	100	NR	0.68 (0.26)	NR	0.77 (0.26)	NR
Wannasiri and Kapol^32 (2011)	Stroke	284	NR	0.55	NR	NR	0.72
Sánchez et al.^30 (2010)	HF treated with peritoneal dialysis	17	6 months	0.6727	NR	0.675 (0.078)	NR
	HF treated conservatively	NR	NR	0.4305	NR	0.456 (0.213)	NR
Studies comparing direct methods				TTO		SG
Hallan et al.^10 (1999)	Minor stroke	158	NR	0.88 (0.64–0.98)^d		0.91 (0.69–0.99)^d
	Major stroke			0.51 (0.12–0.79)^d		0.61 (0.10–0.91)^d
Lalonde et al.^45 (1999)	Angina	30	6 or more months	80.3		92.4
Yi et al.^46 (2004)	HF	81	NR	0.8 (0.20)		0.91 (0.10)
Lewis et al.^47 (2001)	HF	99	3 or more months	0.65		0.64
Gage et al.^48 (1996)	Moderate stroke	70	NR	0.39		0.26
Nease et al.^49 (1995)	Chronic stable angina (CCS1)	38	>1 year in 80% of respondents	1.0^a		0.965^a
	Chronic stable angina (CCS2)	107		0.997^a		0.97^a
	Chronic stable angina (CCS3)	66		0.929^a		0.875^a

Abbreviations. AMI, acute myocardial infarction; CCS, Canadian Cardiovascular Society; CI, confidence interval; EQ-5D, EuroQol–Five Dimensions; HF, heart failure; HUI, Health Utilities Index; IQR, interquartile range; NR, not reported; SD, standard deviation; SF-6D, Short Form–Six Dimensions; SG, standard gamble; TTO, time trade-off; TIA, transient ischemic attack; UK, United Kingdom; US, United States.

Mean (SD) unless otherwise specified.

^a Median or median (IQR).

^b Mean (95% CI).

^c Mean difference (SD).

^d Median (10th–90th percentile).

Table 5. Median (IQR) utility values in studies comparing respondents for hypothetical health states measured with direct methods of elicitation.

Reference (year)	Method	Health state	Respondent type
			Stroke survivors (n = 41)	Healthy population (n = 66)	Non-stroke patients (n = 51)
Hallan et al.^10 (1999)	SG	Minor stroke for ages 20–44	NR	0.91	0.95
		Minor stroke for ages 45–64	0.95	0.90	0.95
		Minor stroke for ages 65–84	0.95	0.87	0.82
		Major stroke for ages 20–44	NR	0.52	0.74
		Major stroke for ages 45–64	0.85	0.54	0.64
		Major stroke for ages 65–84	0.99	0.59	0.51
			Atrial fibrillation patients with history of stroke (n = 20)	Atrial fibrillation patients without history of stroke (n = 50)
Gage et al.^48 (1996)	TTO	Minor stroke	0.95	0.94
		Moderate stroke	0.00	0.12
		Major stroke	0.00	0.00
			Stroke survivors (n = 75)	General population (n = 75)
Slot and Berge^11 (2009)	SG	Mild stroke	0.93 (0.90–0.98)	0.91 (0.88–0.95)
		Moderately severe stroke	0.78 (0.70–0.90)	0.68 (0.58–0.80)
		Severe stroke	0.18 (0.08–0.24)	0.11 (0.04–0.15)
			Stroke survivors (n = 11)	Health professionals (n = 20)	Non-stroke patients (n = 22)
Murphy et al.^54 (2001)	SG	Mild stroke	0.93 (0.50–0.98)	0.88 (0.75–0.98)	0.78 (0.48–0.98)
		Moderate stroke	0.73 (0.03–0.98)	0.68 (0.41–0.78)	0.30 (0.01–0.63)
		Severe stroke	0.40 (0.48–0.98)	0.14 (<0–0.45)	<0 (<0–0.48)

Abbreviations. IQR, interquartile range; NR, not reported; SG, standard gamble; TTO, time trade-off.

Table 6. Average EQ-5D utility values in studies comparing tariffs.

				Tariff
Reference (year) country	Health state	Sample size	Time point	US (Shaw^73 2005)	UK (Dolan^74 1997)
Lee et al.^52 (2010) Taiwan	Ischemic stroke (lacunar infarction)	170	NR	0.8 (0.2)	0.9 (0.2)
	Ischemic stroke (non-lacunar infarction)	263		0.7 (0.3)	0.8 (0.3)
	Intracerebral hemorrhage	53		0.6 (0.3)	0.7 (0.3)
Lewis et al.^47 (2014) Multiple	MI with additional CV event	597	NR	0.76 (0.22)	0.70 (0.29)
	MI without additional CV event	1,785	NR	0.83 (0.17)	0.80 (0.23)
Eurich et al.^50 (2006) Multiple	HF	298	NR	0.74 (0.17)	0.66 (0.26)
	HF +2 NYHA classes	2	Baseline	0.78 (0.11)	0.75 (0.19)
			6 weeks	0.82 (0.06)	0.79 (0.14)
	HF +1 NYHA class	50	Baseline	0.76 (0.16)	0.68 (0.25)
			6 weeks	0.77 (0.16)	0.70 (0.24)
	HF with no change in NYHA class	206	Baseline	0.74 (0.18)	0.66 (0.27)
			6 weeks	0.77 (0.16)	0.71 (0.22)
	HF –1 NYHA class	40	Baseline	0.73 (0.18)	0.65 (0.27)
			6 weeks	0.74 (0.17)	0.65 (0.25)
				US (Wijeysundera^75 2011)^a	UK (Goldsmith^76 2010)^a
Kohn et al.^51 (2014) Multiple	Chronic stable angina (all patients)	548	6 weeks	0.75 (0.69–0.80)^b	0.68 (0.62–0.77)^b
	No angina symptoms	28		0.89 (0.84–0.92)^b	0.87 (0.77–0.91)^b
	Monthly angina symptoms	188		0.80 (0.75–0.85)^b	0.76 (0.70–0.81)^b
	Weekly angina symptoms	283		0.72 (0.68–0.76)^b	0.65 (0.61–0.70)^b
	Daily angina symptoms	49		0.65 (0.61–0.69)^b	0.54 (0.52–0.61)^b
				US (unspecified)	UK (unspecified)
Stevanovic et al.^31 (2014) Multiple	HF	NR	NR	0.6385	0.7593
				Sweden (Burstrom^77 2014)	UK (Dolan^74 1997)
Berg et al.^53 (2015) Sweden	HF	5,334	Baseline	0.828 (0.135)	0.696 (0.302)
		3,495	12 months	0.846 (0.126)	0.732 (0.275)
				Malaysia (Yusof^78 2012)	UK (Dolan^74 1997)
Azmi^79 (2015) Malaysia	ACS	104	Baseline	0.75	0.63
		53	12 months	0.82	0.72

Abbreviations. ACS, acute coronary syndrome; CV, cardiovascular; EQ-5D EuroQol–Five Dimensions; HF, heart failure; IQR, interquartile range; MI, myocardial infarction; NR, not reported; NYHA, New York Heart Association; SD, standard deviation; UK, United Kingdom; US, United States.

Mean (SD) unless otherwise specified.

^a Kohn et al.⁵¹ mapped EQ-5D scores from the Seattle Angina Questionnaire.

^b Median (IQR).

Table 7. Mean (SD) utility values in studies comparing patient and caregiver proxy assessments of patient’s health status via indirect methods of elicitation.

Reference (year)	Health state	Time point	Method	Patients	Caregivers
Pickard et al.^41 (2004)	Ischemic stroke	Baseline	EQ-5D	0.31 (0.38)	0.24 (0.39)
			HUI-3	0.21 (0.30)	0.21 (0.36)
		1 month	EQ-5D	0.55 (0.36)	0.51 (0.36)
			HUI-3	0.42 (0.36)	0.36 (0.35)
		3 months	EQ-5D	0.61 (0.30)	0.56 (0.33)
			HUI-3	0.45 (0.34)	0.42 (0.36)
		6 months	EQ-5D	0.62 (0.34)	0.59 (0.35)
			HUI-3	0.44 (0.37)	0.44 (0.39)
Franceschini et al.^55 (2003)	Stroke	NR	EQ-5D	57.4 (22.1)	54.3 (22.2)
Hung et al.^56 (2007)	Stroke	NR	HUI-3	+0.008^a

Abbreviations. EQ-5D, EuroQol–Five Dimensions; HUI, Health Utilities Index; NR, not reported; SD, standard deviation.

^a Mean difference.

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