Acute and chronic impact of cardiovascular events on health state utilities

BMC Health Services Research

David H Feeny⁷  Mickael Lothgren¹  Jessica B Jordan³  Evan W Davies⁵  Brett E Fenster⁴  Philip R Delio⁶  Shravanthi R Gandra²  Katie D Stewart³  Louis S Matza³ 

[1] Global Health Economics, Amgen (Europe), Dammstrasse 23, Zug, CH-6301, Switzerland;Global Health Economics, Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA, USA;Outcomes Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, USA;Division of Cardiology, National Jewish Health, 1400 Jackson Street, Denver, CO, USA;Outcomes Research, Evidera, Metro Building, 6th Floor, No. 1 Butterwick, London, UK;Neurology Associates of Santa Barbara, 219 Nogales Avenue, Suite F, Santa Barbara, CA, USA;Department of Economics, McMaster University, Hamilton, KTH 426, ON, Canada

关键词: Time trade-off;    Cost-utility;    Stroke;    Heart failure;    Acute coronary syndrome;    Cardiovascular disease;    Utility;   

Others  :  1174787
DOI  :  10.1186/s12913-015-0772-9

 received in 2014-06-27, accepted in 2015-02-27,  发布年份 2015

【 摘 要 】

Background

Cost-utility models are frequently used to compare treatments intended to prevent or delay the onset of cardiovascular events. Most published utilities represent post-event health states without incorporating the disutility of the event or reporting the time between the event and utility assessment. Therefore, this study estimated health state utilities representing cardiovascular conditions while distinguishing between acute impact including the cardiovascular event and the chronic post-event impact.

Methods

Health states were drafted and refined based on literature review, clinician interviews, and a pilot study. Three cardiovascular conditions were described: stroke, acute coronary syndrome (ACS), and heart failure. One-year acute health states represented the event and its immediate impact, and post-event health states represented chronic impact. UK general population respondents valued the health states in time trade-off tasks with time horizons of one year for acute states and ten years for chronic states.

Results

A total of 200 participants completed interviews (55% female; mean age = 46.6 y). Among acute health states, stroke had the lowest utility (0.33), followed by heart failure (0.60) and ACS (0.67). Utility scores for chronic health states followed the same pattern: stroke (0.52), heart failure (0.57), and ACS (0.82). For stroke and ACS, acute utilities were significantly lower than chronic post-event utilities (difference = 0.20 and 0.15, respectively; both p < 0.0001).

Conclusions

Results add to previously published utilities for cardiovascular events by distinguishing between chronic post-event health states and acute health states that include the event and its immediate impact. Findings suggest that acute versus chronic impact should be considered when selecting scores for use in cost-utility models. Thus, the current utilities provide a unique option that may be used to represent the acute and chronic impact of cardiovascular conditions in economic models comparing treatments that may delay or prevent the onset of cardiovascular events.

【 授权许可】

   
2015 Matza et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

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