This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (3) Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Winkelmayer, W. C. Articles by Avorn, J. Search for Related Content PubMed PubMed Citation Articles by Winkelmayer, W. C. Articles by Avorn, J. Social Bookmarking                         What's this?

Assessing Health State Utilities in Elderly Patients at Cardiovascular Risk

Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, wwinkelmayer{at}partners.org

Joshua S. Benner, PharmD, ScD

Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston

Robert J. Glynn, ScD, PhD

Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston

Sebastian Schneeweiss, MD, ScD

Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston

Philip S. Wang, MD, DrPH

Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston

M. Alan Brookhart, PhD

Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston

Raisa Levin

Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston

Joseph D. Jackson, PhD

Bristol-Myers Squibb, Princeton, New Jersey

Jerry Avorn, MD

Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston

Background. Health state preferences can be a crucial component of cost-effectiveness analyses, but off-the-shelf health state utilities specifically for older people are not available.Objectives. Among participants in PROSPER, a trial of pravastatin in patients >70 years, the authors assessed utilities for the health states that were relevant for the trial’s cost-utility analysis.Subjects and Methods. The authors cross-sectionally administered the Health Utilities Index, Mark 3 (HUI) to all PROSPER participants to assess each patient’s health state at the time of interview; they then used the scale’s multiattribute utility function to estimate the resulting utilities. The population was then stratified into 3 health states, and the mean utility function for each was calculated: recent myocardial infarction (MI, within 3 months), previous MI (>3 months), or no prior MI. Linear and logistic regression were used to control for potential demographic and clinical characteristics. Results. Of the 5804 patients enrolled in the trial, 4677 were administered the HUI instrument. The likelihood of having a complete HUI response set decreased with higher age ( P < 0.001) but not with the other variables studied. A complete utility score could be calculated for 3390 participants. Of these, 2755 (81.3%) had no history of MI, 546 (16.1%) had an MI>3 months previously, and 89 (2.6%) had an MI within 3 months. The mean (median) utilities were virtually identical for these states: 0.75 (0.84), 0.74 (0.84), and 0.74 (0.84), respectively. From multivariate analyses, utilities decreased with higher age and the presence of several other comorbidities (diabetes, stroke, peripheral vascular disease); women had lower utilities than men (all P < 0.01).Conclusions. In this large implementation of the HUI in elderly patients, the instrument did not detect any differences in estimated utilities related to having a MI. Potential causes of nondiscrimination for MI include the possibility that competing comorbidities may reduce the impact of MI on quality of life in this age group, as well as the possibility that a standard instrument derived from and validated in younger populations may not perform as well in elderly people.

Key Words: clinical trials • myocardial infarction • pravastatin • health-related quality of life • utility assessment

Medical Decision Making, Vol. 26, No. 3, 247-254 (2006)
DOI: 10.1177/0272989X06288685


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				D. Greenberg and J. S. Pliskin Using Health State Classification Systems for Utility Elicitation in the Elderly Med Decis Making, May 1, 2006; 26(3): 220 - 222. [PDF]

				A. M. Stiggelbout Health State Classification Systems: How Comparable Are Our Cost-Effectiveness Ratios? Med Decis Making, May 1, 2006; 26(3): 223 - 225. [PDF]