Health state utilities associated with major clinical events in the context of secondary hyperparathyroidism and chronic kidney disease requiring dialysis

Health and Quality of Life Outcomes

Vasily Belozeroff⁶  Philip McFarlane¹  David Mendelssohn⁵  Steven Soroka³  Jacqueline Kostelec²  David H. Feeny⁷  Gavin Worth⁸  Louis S. Matza²  Evan W. Davies⁴ 

[1] Division of Nephrology, St. Michael’s Hospital, Toronto, ON, Canada;Outcomes Research, Evidera, Bethesda, MD, USA;Department of Medicine, Dalhousie University, Halifax, NS, Canada;Outcomes Research, Evidera, London, W6 8DL, UK;Department of Nephrology, Humber River Hospital, Toronto, ON, Canada;Amgen, Inc, Thousand Oaks, CA, USA;Department of Economics, McMaster University, Hamilton, ON, Canada;Amgen (Europe) GmbH, Zug, Switzerland

关键词: Standard gamble;    End-stage renal disease;    Secondary hyperparathyroidism;    Chronic kidney disease;    Utility;   

Others  :  1218514
DOI  :  10.1186/s12955-015-0266-9

 received in 2014-12-15, accepted in 2015-05-15,  发布年份 2015

【 摘 要 】

Background

Patients with chronic kidney disease (CKD) and secondary hyperparathyroidism (SHPT) who require dialysis are at increased risk for cardiovascular events and bone fractures. To assist in economic evaluations, this study aimed to estimate the disutility of these events beyond the impact of CKD and SHPT.

Methods

A basic one-year health state was developed describing CKD and SHPT requiring dialysis. Further health states added acute events (cardiovascular events, fractures, and surgical procedures) or chronic post-event effects. Acute health states described a year including an event, and chronic health states described a year subsequent to an event. General population participants in Canada completed time trade-off interviews from which utilities were derived. Pairwise comparisons were made between the basic state and event, and between comparable health states.

Results

A total of 199 participants (54.8% female; mean age = 46.3 years) completed interviews. Each health state had ≥130 valuations. The mean (SD) utility of the basic health state was 0.60 (0.34). For acute events, mean utility differences versus the basic state were: myocardial infarction, −0.06; unstable angina, −0.05; peripheral vascular disease (PVD) with amputation, −0.33; PVD without amputation, −0.11; heart failure, −0.14; stroke, −0.30; hip fracture, −0.14; arm fracture, −0.04; parathyroidectomy, +0.02; kidney transplant, +0.06. Disutilities for chronic health states were: stable angina, −0.09; stroke, −0.27; PVD with amputation, −0.30; PVD without amputation, −0.12; heart failure, −0.14.

Conclusions

Cardiovascular events and fractures were associated with lower utility scores, suggesting a perceived decrease in quality of life beyond the impact of CKD and SHPT.

【 授权许可】

   
2015 Davies et al.

【 图 表 】

Fig. 1.

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