Ara, Roberta and Brazier, John (2009): Populating an economic model with health state utility values: moving towards better practice. Published in: Value in Health , Vol. 13, No. 5 (2010): pp. 509-518.
Download (234Kb) | Preview
Background: When estimating health state utility values (HSUV) for multiple health conditions, the alternative models used to combine these data can produce very different values. Results generated using a baseline of perfect health are not comparable with those generated using a baseline adjusted for not having the health condition taking into account age and gender. Despite this, there is no guidance on the preferred techniques that should be used and very little research describing the effect on cost per QALY results.
Methods: Using a cardiovascular disease (CVD) model and cost per QALY thresholds, we assess the consequence of using different baseline health state utility profiles (perfect health, individuals with no history of CVD, general population) in conjunction with three models (minimum, additive, multiplicative) frequently used to estimate proxy scores for multiple health conditions.
Results: Assuming a baseline of perfect health ignores the natural decline in quality of life associated with co-morbidities, over-estimating the benefits of treatment to such an extent it could potentially influence a threshold policy decision. The minimum model biases results in favour of younger aged cohorts, while the additive and multiplicative technique produces similar results.
Although further research in additional health conditions is required to support our findings, this pilot study highlights the urgent need for analysts to conform to an agreed reference case and provides initial recommendations for better practice. We demonstrate that in CVD, if data are not available from individuals without the health condition, HSUVs from the general population provide a reasonable approximation.
|Item Type:||MPRA Paper|
|Original Title:||Populating an economic model with health state utility values: moving towards better practice|
|Keywords:||health-state utility; health economics methods; methodology; decision models; health surveys|
|Subjects:||I - Health, Education, and Welfare > I3 - Welfare and Poverty > I31 - General Welfare
I - Health, Education, and Welfare > I1 - Health > I19 - Other
I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy; Regulation; Public Health
|Depositing User:||Sarah McEvoy|
|Date Deposited:||06. Apr 2011 22:36|
|Last Modified:||16. Feb 2013 06:42|
National Institute of Health and Clinical Excellence (2008). Guide to the methods of technology appraisal. 2008.
Fryback DG, Lawrence WG (1997). Dollars may not buy as many QALYs as we think: A problem with defining quality of life adjustments. Med Decis Making 17;276-84.
Ward S, Lloyd Jones M, Pandor A, et al (2007). A systematic review and economic evaluation of statins for the prevention of coronary events. Health Technol Assess 11(14):1-160, iii-iv.
Bansback N, Ara R, Ward S, Anis A, Choi HK (2009). Statin therapy in rheumatoid arthritis: a cost-effectiveness and value-of-information analysis. Pharmacoeconomics 27(1):25-37.
Bond DE, Freedberg KA (2001). Combining utility measurements exploring different approaches. Dis Manage Health Outcomes 9(9):507-16.
Flanagan W, McIntosh CN, Le Petit C, Berthelot JM (2006). Deriving utility scores for co-morbid conditions: a test of the multiplicative model for combining individual condition scores. Population Health Metrics 4:13.
Fu AZ, Kattan MW (2008). Utilities should not be multiplied: evidence from the preference-based scores in the United States. Med Care 46(9):984-90.
Dale W, Basu A, Elstein A, Meltzer D (2008). Predicting utility ratings for joint health states from single health states in prostate cancer: empirical testing of 3 alternative theories. Med Decis Making 28:102-12.
Briggs AH (2000). Handling uncertainty in cost-effectiveness models. Pharmacoeconomics 17:479-500.
Ara R, Tumur I, Pandor A, et al (2008). Ezetimibe for the treatment of hypercholesterolaemia: a systematic review and economic evaluation. Health Technol Assess 12(21):iii, xi-xiii, 1-212.
Joint Health Surveys Unit of Social and Community Planning Research and University College London, Health Survey for England, 2003 [computer file]. 3rd Edition. Colchester, Essex: UK Data Archive [distributor], 2005. SN: 5098.
Joint Health Surveys Unit of Social and Community Planning Research and University College London, Health Survey for England, 2006 [computer file]. 3rd Edition. Colchester, Essex: UK Data Archive [distributor], 2008. SN: 5809.
Dolan P, Gudex C, Kind P, Williams A (1996). The time trade-off method: results from a general population study. Health Econ. 5(2):141–54.
Ara R, Brazier J, Young T (2007). Health related quality of life by age, gender or history of cardiovascular disease: results from the Health Survey for England 2003 and 2006. Discussion paper (http://www.sheffield.ac.uk)
Brazier J, Ratcliffe J, Salomon J, Tsuchiya A (2007). Measuring and valuing health benefits for economic evaluation. Oxford: Oxford University Press.
Saarni SI, Suvisaaria J, Sintonen H, et al (2007). The health-related quality-of-life impact of chronic conditions varied with age in general population. Journal of Clinical Epidemiology 60(12):1288-97.