Utility values in diabetic kidney disease: a literature review

Abstract

Objective:

To summarize the published literature on utilities for health states associated with diabetic kidney disease (DKD), including end-stage renal disease (ESRD).

Research design and methods:

A literature review was conducted (MEDLINE, MEDLINE in process, EMBASE, NHS EED, HEED, CEA Registry, EconLit, RePEc, and HTA) to identify relevant articles published between January 2000 and July 2013. Results were assessed for relevance by two reviewers in line with the study protocol.

Main outcome measures:

For eligible studies, data extracted included patient population, health states, methods used to elicit utility values, and the source of the preference values.

Results:

Twelve studies satisfied the inclusion criteria. They reported various utility and/or disutility scores for different DKD health states using a range of patient populations, utility approaches, and sources of preference values. The most common study country was the USA. Most of the studies collected data at one time point, but two had a longitudinal design. Three different utility instruments – EuroQoL (EQ-5D), Quality of Well-Being Scale (QWB), and 15-dimensional (15D) – were used to elicit utilities indirectly. The Time Trade-Off (TTO) approach was used in one study; another undertook a meta-analysis of published utility studies. Utilities were identified for different health states including DKD, ESRD–no dialysis, ESRD–dialysis, and transplant. One study reported utilities for patients by type of transplant. There was variation in values for the same health state between studies, and none of the studies reported utilities for the different stages of DKD. In the studies that undertook a comparison, utility values for those with DKD were generally found to be lower than those without DKD.

Conclusions:

This literature review highlights that at present utility scores (or disutility penalties) exist for relatively few health states in DKD. Further studies are needed to produce accurate and comprehensive utility scores that differentiate between different DKD health states.

Keywords::

• Cost
• utility analysis
• Diabetes mellitus
• Diabetic nephropathies
• Review
• Utilities

Transparency

Declaration of funding

Kennedy Martin Health Outcomes Limited received financial support from Eli Lilly and Company for this study.

Declaration of financial/other relationships

R.P. has disclosed that she is an employee of Eli Lilly and Company. T.K.-M. has disclosed that she is an owner and employee of Kennedy-Martin Health Outcomes Limited. S.R. has disclosed that she worked for Kennedy-Martin Health Outcomes Limited on this project.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Mick Arber provided expert input on the search strategies and also ran the searches. Alison Terry provided medical writing and analysis support.