Affiliation:
1. Tayside Centre for General Practice, Health Informatics Centre,
2. Department of Digestive Diseases and Clinical Nutrition, University of Dundee, Scotland
3. Tayside Centre for General Practice, Health Informatics Centre
Abstract
Objectives. Health-state utilities are essential for cost-utility analysis. Few estimates exist for liver disease in the literature. The authors' aim was to conduct a systematic review of health-state utilities in liver disease, to look at the variation of study designs used, and to pool utilities for some liver disease states. Methods. A search of MED-LINE, EMBASE, and CINAHL from 1966 to September 2006 was conducted including key words related to liver disease and utility measuring tools. Articles were included if health-state utility tools or expert opinion were used. Variance-weighted mean utility estimates were pooled using metaregression adjusting for disease state and utility assessment method. Results. Thirty studies measured utilities of liver diseases/disease states. Half of these estimated utilities for hepatitis viruses: hepatitis A (n = 1), hepatitis B (n = 4), and hepatitis C (n = 10). Others included liver transplant (n= 6) and chronic liver disease (n= 5) populations. Twelve utility methods were used throughout. The EQ-5D (n = 10) was most popular method, followed by visual analogue scale (n = 9), time tradeoff (n = 6), and standard gamble (n = 4). Respondents were patients (n= 16), an expert panel (n = 10), non— liver diseases adults ( n= 2), patient and expert (n = 1), and patient and healthy adult (n = 1). Type of perspective included community (n= 21), patient (n= 4), and both (n = 5). The pooled mean estimates in hepatitis C with moderate disease, compensated cirrhosis, decompensated cirrhosis, and post— liver transplant using the EQ-5D were 0.75, 0.75, 0.67, and 0.71, respectively. The change in these utilities using different methods were - 0.07 (visual analogue scale), - 0.01 (health utilities index version 3), + 0.04 (standard gamble), + 0.08 (health utilities index version 2), + 0.12 (time tradeoff), and + 0.15 (standard gamble— transformed visual analogue scale). Conclusions. The authors have created a valuable liver disease— based utility resource from which researchers and policy makers can easily view all available utility estimates from the literature. They have also estimated health-state utilities for major states of hepatitis C.