A systematic literature review of cardiovascular event utilities

Abstract

Cardiovascular disease (CVD) results in half of the non-communicable disease-related deaths worldwide. Rising treatment costs have increased the need for cost-utility models designed to compare the value of new and existing therapies. Cost-utility models require utilities, values representing the strength of preferences for various health states. This systematic literature review aimed to identify and evaluate utilities reported for stroke, myocardial infarction (MI) and angina. In total, 83 unique studies were identified that reported utilities for these events. Approximately two-thirds reported utility values for stroke, and most used the EuroQoL five dimension to derive utilities. Utility values were lower in patients who experienced cardiovascular (CV) events than in patients who did not. The utility estimates for each condition varied greatly, likely due to differences in assessment methodologies and patient populations. This variability must be considered when choosing values for cost-utility models. Comparisons among reported utilities are further complicated by inconsistent CV event definitions.

Keywords::

• angina
• cardiovascular
• myocardial infarction
• review
• stroke
• utility

Acknowledgements

The authors would like to thank Janet Dooley and Amara Tiebout for production assistance.

Financial & competing interests disclosure

D Smith, E Davies, E Wissinger, R Huelin & L Matza are all employees of Evidera, which received funding for this research from Amgen, Inc. K Chung is an employee of Amgen, Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Cardiovascular disease (CVD) leads to nearly half of all non-communicable disease-related deaths worldwide each year.

• • Rising costs for CVD treatments have increased the need for humanistic and economic evaluations that define the value of new and existing therapies.

• • Health utility values for stroke, myocardial infarction (MI) and angina are readily available in the published literature, but available values are associated with both strengths and limitations.

• • Studies conducted in multiple countries showed that cardiovascular (CV) events were associated with utility decrements.

• • The wide range of utility values reported for CV events likely stems from variation in utility assessment methodology, time elapsed between the cardiovascular event and subsequent utility assessment and the patient populations evaluated.

• • Care must be taken to consider the limitations of each study when determining which values to use in cost-utility analyses.

• • As new treatments are introduced, it will be imperative to evaluate their cost–effectiveness and utility/disutility in order to demonstrate their incremental value to patients, clinicians and third-party payers.

• • There is a need for utilities specifically representing the acute impact of CV events so that this impact can be quantified in models examining the value of interventions that may decrease the risk of CV events.

Notes