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Health-State Utilities in Liver Disease: A Systematic Review

^* To whom correspondence should be addressed. E-mail: d.mclernon{at}abdn.ac.uk.

	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 MEDLINE, 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. Key words: health-state utility; liver disease; systematic review; meta-analysis; hepatitis C. (Med Decis Making XXXX;XX:xx–xx)

First published on April 18, 2008, doi:10.1177/0272989X08315240

Medical Decision Making 2008;28:582.

A more recent version of this article appeared on July 1, 2008


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