Longitudinal and cross sectional assessments of health utility in adults with HIV/AIDS: a systematic review and meta-analysis

BMC Health Services Research

Carl A Latkin⁴  Vuong Minh Nong¹  Rachel Marie Maher¹  Arto Ohinmaa²  Long Hoang Nguyen³  Bach Xuan Tran¹ 

[1] Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam;School of Public Health, University of Alberta, Edmonton, Alberta, Canada;School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam;Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

关键词: Systematic review;    Longitudinal meta-analysis;    HIV;    Utility;    Quality of life;   

Others  :  1089851
DOI  :  10.1186/s12913-014-0640-z

 received in 2014-10-28, accepted in 2014-12-08,  发布年份 2015

【 摘 要 】

Background

Utility estimates are important health outcomes for economic evaluation of care and treatment interventions for patients with HIV/AIDS. We conducted a systematic review and meta-analysis of utility measurements to examine the performance of preference-based instruments, estimate health utility of patients with HIV/AIDS by disease stages, and investigate changes in their health utility over the course of antiretroviral treatment.

Methods

We searched PubMed/Medline, Cochrane Database of Systematic Review, NHS Economic Evaluation Database and Web of Science for English-language peer-reviewed papers published during 2000–2013. We selected 49 studies that used 3 direct and 6 indirect preference based instruments to make a total of 218 utility measurements. Random effect models with robust estimation of standard errors and multivariate fractional polynomial regression were used to obtain the pooled estimates of utility and model their trends.

Results

Reliability of direct-preference measures tended to be lower than other types of measures. Utility elicited by two of the indirect preference measures - SF-6D (0.171) and EQ-5D (0.114), and that of Time-Trade off (TTO) (0.151) was significantly different than utility elicited by Standard Gamble (SG). Compared to asymptomatic HIV patients, symptomatic and AIDS patients reported a decrement of 0.025 (p&#×2009;=&#×2009;0.40) and 0.176 (p&#×2009;=&#×2009;0.001) in utility scores, adjusting for method of assessment. In longitudinal studies, the pooled health utility of HIV/AIDS patients significantly decreased in the first 3 months of treatment, and rapidly increased afterwards. Magnitude of change varied depending on the method of assessment and length of antiretroviral treatment.

Conclusion

The study provides an accumulation of evidence on measurement properties of health utility estimates that can help inform the selection of instruments for future studies. The pooled estimates of health utilities and their trends are useful in economic evaluation and policy modelling of HIV/AIDS treatment strategies.

【 授权许可】

   
2015 Tran et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

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