Trends in the measurement of health utilities in published cost-utility analyses
Trends in the measurement of health utilities in published cost-utility analyses
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DOI：
10.1111/j.1524-4733.2006.00116.x
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发表时间：
2006-07-01
期刊：
影响因子：
4.5
通讯作者：
Neumann, Peter J.
中科院分区：
文献类型：
--
作者：
Brauer, Carmen A.;Rosen, Allison B.;Neumann, Peter J.
目标：卫生和医药成本效益问题小组建议编制一份用于成本效益分析的健康状况效用权重目录，并提出了方法学建议。本研究提供了截至2001年的效用权重注册表的更新（可在http://www.tufts-nemc.org/cearegistry上获得；以前在https://www.hsph.harvard.edu/cearegistry上获得），并记录了效用权重提取方法的最新变化。方法：我们检索英文医学文献中以每质量调整生命年成本（QALY）报告结果的原始cua。两名训练有素的读者独立审核每篇文章，提取有关健康状态描述、相应效用权重、提取方法和估计来源的数据。将1998 ~ 2001年的效用获取方法与1998年以前的效用获取方法进行了比较。结果：我们确定了1998年以后发表的306个cua，报告了1210个独立的健康相关效用估计，使我们目录中的权重总数达到2159个。最常见的是，健康状态与循环系统和肿瘤有关。方法差异很大：36%的作者使用直接启发（标准赌博、时间权衡或评分量表），23%的作者使用通用健康状况工具（EQ-5D、健康效用指数等），25%的作者根据临床判断估计权重。27%的数值使用了社区偏好。与1998年之前相比，1998年至2001年公布的公用事业数据更有可能是使用通用工具得出的，更有可能是从社区样本中得出的，而不太可能是从专家意见中得出的，没有正式采用的方法。结论：分析人员越来越多地使用通用的、偏好加权的工具，并依赖于基于社区的偏好。我们的效用权重目录为生产者和消费者提供了有用的参考工具，但也强调了在方法和透明度方面继续改进的必要性。
Objective: The Panel on Cost-Effectiveness in Health and Medicine recommended the compilation of a catalog of health state utility weights for use in cost-utility analyses (CUAs), and has given methodological recommendations. This study presents an update, through 2001, to our current registry of utility weights (available at http://www.tufts-nemc.org/cearegistry; previously at thttp://www.hsph.harvard.edu/cearegistry), and documents recent changes in methods used for utility weight elicitation.Methods: We searched the English-language medical literature for original CUAs reporting outcomes as cost per quality-adjusted life-year (QALY). Two trained readers independently audited each article, abstracting data on the health state descriptions, corresponding utility weights, methods of elicitation, and sources of the estimates. The utility elicitation methods from 1998 to 2001 were compared with the methods used to obtain utilities before 1998.Results: We identified 306 CUAs published after 1998, reporting 1210 separate health-related utility estimates, bringing the total in our catalog to 2159 weights. Most frequently, health states pertained to the circulatory system and oncology. Methods varied substantially: 36% of authors used direct elicitation (standard gamble, time trade-off or rating scale), 23% used generic health status instruments (EQ-5D, Health Utilities Index, etc.), and 25% estimated weights based on clinical judgment. Community preferences were used in 27% of the values. Compared with pre-1998, utilities published from 1998 to 2001 were more likely to be elicited using a generic instrument, more likely elicited from community samples, and less likely derived from expert opinion, with no formally employed methodology.Conclusions: Increasingly, analysts conducting CUAs are using generic, preference-weighted instruments, and relying on community-based preferences. Our catalog of utility weights provides a useful reference tool for producers and consumers of CUAs, but also highlights the continued need for improvement in methods and transparency.