Health State Utility Values in Schizophrenia: A Systematic Review and Meta-Analysis

Abstract

Patient preferences are increasingly important in informing clinical and policy decisions. Health-state utility values (HSUVs) are quantitative measures of people's preferences over different health states. In schizophrenia, there is no clarity about HSUVs across the symptoms' severity spectrum. This meta-analysis aims to synthesize the literature on HSUVs in people with schizophrenia.Methods: We searched Medline, PsycInfo, Embase, EconLit, The Cochrane Library, and specialized databases. The studies reporting HSUVs in people with schizophrenia were selected and pooled in a random-effects meta-analysis. The primary outcome was the mean HSUV obtained from participants.Results: A total of 54 studies involving 87 335 participants were included. The pooled estimate using direct elicitation was a mean HSUV of 0.79 (95% CI: 0.70-0.88) for mild symptomatic states, 0.69 (95% CI: 0.54-0.85) in moderate states, and 0.34 (95% CI: 0.13-0.56) in severe states. Studies using indirect techniques resulted in a pooled mean HSUV of 0.73 (95% CI: 0.67-0.78) applying the EuroQol 5-dimension, 0.66 (95% CI: 0.62-0.71) in the Short-Form 6-dimension, and 0.59 (95% CI: 0.57-0.61) using the Quality of Well-Being scale. All the estimates resulted in considerable heterogeneity, partially reduced by meta-regression. Conclusion:Our findings suggest that the severity of psychotic symptoms has an important effect on HSUVs in schizophrenia, with values mirroring patients with disabling physical conditions such as cancer and stroke. Decision makers should be aware of these results when including people's preferences in trials, models, and policy decisions.

Quality appraisal for systematic literature reviews of health state utility values: a descriptive analysis

“…Around a third of the SLR authors (33%) used all three QA dimensions (reporting, RoB [methodological] and relevancy) to appraise the quality of studies eliciting HSUVs. Of the 40 SLRs that appraised quality, 16 (42%) were based on NICE/ISPOR tools [ 9 , 26 , 46 – 59 ].…”

“…Furthermore, the terminology used to describe the QA process varied considerably among the SLRs. Terms such as quality appraisal or assessment [ 9 , 23 , 24 , 48 , 49 , 51 , 53 , 55 , 57 – 60 , 73 – 78 ], critical appraisal [ 47 ], risk of bias assessment [ 25 , 62 , 63 , 72 , 79 – 82 ], relevancy and quality assessment [ 52 , 56 ], assessment of quality and data appropriateness [ 50 ], methodological quality assessment [ 26 , 27 , 46 , 54 , 61 , 69 ], reporting quality [ 71 , 83 ] credibility checks and methodological review [ 70 ] were used loosely and interchangeably. One study [ 84 ] mentioned three terms, RoB, methodological quality and reporting quality, in their description of the QA process.…”

“…First, this is evident in some of the SLRs [ 89 – 92 ] that did not appraise the quality of contributing studies and cited a lack of a gold standard as the main barrier to conducting such. Second, most of the SLRs that appraised quality did this by customising elements from the different checklist(s) [ 24 , 27 , 75 , 79 , 80 ], or using standardised tools designed to evaluate quality in other types of studies, and not primarily for eliciting HSUVs [ 23 , 27 , 52 , 62 ], and GPRs [ 9 , 26 , 46 , 47 , 50 , 54 – 56 , 61 , 63 , 74 , 84 ]. In this regard, we estimated that SLR authors used, on average, two QA tools, checklists or GPRs (Max = 9) to construct their customised QA tools, with only 14/40 (35%) SLRs using one tool [ 24 , 25 , 49 , 51 , 53 , 57 – 60 , 73 , 75 , 79 , 80 , 82 ].…”

“…All analyses on SLRs that appraised quality were further stratified by considering separately: 1) the 16 SLRs [ 9 , 26 , 46 – 59 ] that either adapted or used one or more of the 6 QA tools, checklists and GPRs were considered to be NICE, ISPOR and related publications report [ 4 , 10 , 12 , 16 – 18 ] (hereafter ‘ QA based on NICE/ISPOR tools’ ) and 2) the 24 SLRs that adapted, customised or used other QA tools, checklists and GPRs (hereafter “ QA based on other tools ”). Similarly, all analyses on QA tools, checklists and GPRs were further stratified by considering separately: 1) the 6 QA tools, checklists that are considered to be NICE, ISPOR and related publications [ 4 , 10 , 12 , 16 – 18 ] (hereafter ‘NICE/ISPOR tools’ ) and 2) 29 QA tools, checklists and GPRs (hereafter “ Other tools ”).…”

Cost-effectiveness of early intervention in psychosis in low- and middle-income countries: economic evaluation from São Paulo, Brazil

“…The HSUVs were selected based on a systematic review of HSUVs in schizophrenia conducted by our research team and published elsewhere (Aceituno et al. , 2020b ). Total QALYs accrued in each strategy were calculated as the overall sum of the products of HSUVs and duration of occupancy in each health state across the entire time horizon.…”