The Use of Health State Utility Values in Decision Models

Abstract

Methodological issues of how to use health state utility values (HSUVs) in decision models arise frequently, including the most appropriate evidence to use as the baseline (e.g. the baseline HSUVs associated with avoiding a particular health condition or event), how to capture changes due to adverse events and how to appropriately capture uncertainty in progressive conditions where the expected change in quality of life is likely to be monotonically decreasing over time. As preference-based measures provide different values when collected from the same patient, it is important to ensure that all HSUVs used within a single model are obtained from the same instrument where ever possible. When people enter the model without the condition of interest (e.g. primary prevention of cardiovascular disease, screening or vaccination programmes), appropriate age- and gender-adjusted HSUVs from people without the particular condition should be used as the baseline. General population norms may be used as a proxy if the exact condition-specific evidence is not available. Individual discrete health states should be used for serious adverse reactions to treatment and the corresponding HSUVs sourced as normal. Care should be taken to avoid double counting when capturing the effects for both less severe adverse reactions (e.g. itchy skin rash or dry cough) and more severe adverse events (e.g. fatigue in oncology). Transparency in reporting standards for both the justification of the evidence used and any 'adjustments' is important to increase readers' confidence that the evidence used is the most appropriate available.

Mapping to Estimate Health-State Utility from Non–Preference-Based Outcome Measures: An ISPOR Good Practices for Outcomes Research Task Force Report

“…Rescaling and centering covariates around their sample mean can facilitate this. Uncertainty in the estimated coefficients and associated correlation is imperative to allow the reflection of parameter uncertainty in the CEA -the covariance matrix should therefore be routinely reported 36 to allow probabilistic sensitivity analysis (PSA) to be undertaken. In addition to parameter uncertainty, the use of a mapping function to impute data at the individual level (for example, when conducting an analysis alongside a clinical trial) requires that the individual level variation is also reflected.…”

International Regulations and Recommendations for Utility Data for Health Technology Assessment

“…However, with the exception of capturing uncertainty, they provide few recommendations or guidance relating to the other items relating to the use of utility data in the economic model. While this is not entirely unexpected, as they are not technical documents, these factors may have a substantial effect on the incremental cost-effectiveness ratio (ICER) [23,24].…”

Sourcing and Using Appropriate Health State Utility Values in Economic Models in Health Care

“…A series of technical support documents commissioned via the NICE's Decision Support Unit in 2010 provide some recommendations of good practice when using HSUVs [6,[21][22][23], and a recent textbook provides an up-to-date review of preference-based measures of health [24]. More recently, their use in DAMs has formed the focus of two International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force reports [7,8].…”