Health State Utility Values for Age-Related Macular Degeneration: Review and Advice

Abstract

Health state utility values are a major source of uncertainty in economic evaluations of interventions for age-related macular degeneration (AMD). This review identifies and critiques published utility values and methods for eliciting de-novo utility values in AMD. We describe how utility values have been used in health care decision making and provide guidance on the choice of utility values for future economic evaluations for AMD. Literature was searched using PubMed and health technology assessments (HTA) were searched using HTA agency websites to identify articles reporting utility values or approaches to derive utility values in AMD and articles applying utility values for use in health care decision making.s71 studies qualified for data extraction of which 22 were classified as containing utility values and/or elicitation methods relevant to AMD, while 49 were classified as using utility values in decision-making. A large number of studies have elicited utility values for AMD, although those applied to decision making have focused on a few of these. There is an appreciation of the challenges in the measurement and valuation of health states, with recent studies addressing challenges such as the insensitivity of generic health-related quality of life (HRQoL) questionnaires and utility in the worse seeing eye. We would encourage careful consideration when choosing utility values in decision making and an explicit critique of their applicability to the decision problem. Key Points for Decision Makers: There is a large body of literature describing utility values in AMD. Cost-utility analysis has been widely used to assess relative value of these interventions. A recent review of economic models comparing treatments for AMD identified 36 studies of which all but 3 reported costs per quality-adjusted life year (QALY). [2] QALYs are calculated by weighting each year of life lived using a utility score. Utility scores are anchored so that 1 is perfect health and 0 is equivalent to the state of death. Multiplying time in a health state by the health state utility value, 1 year of life lived in perfect health is equal to 1 QALY.[3]The term 'utility' in cost-utility analysis and its theory is based on von NeumannMorgenstern (vN-M) utility theory. The normative model for utility theory, the model for how a rational individual ought to behave, is that utility scores represent the strength of an individual's preference when faced with uncertainty for a given outcome, in this case a health state. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) scheme (Table 1) illustrates the included studies after title/abstract and full text reviews. Of the 206 studies identified, 113 studies were excluded after review of abstracts and titles. Reasons for exclusion included the topic not relating to utility, the disease not covering AMD, there being no primary data (e.g. letter or review) and the language not being English. After full text review, a further 23 studies were excluded due to the...

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