Use of low density lipoprotein particle number levels as an aid in statin treatment decisions for intermediate risk patients: a cost-effectiveness analysis

Using Published Health Utilities in Cost-Utility Analyses: Discrepancies and Issues in Cardiovascular Disease

Background

Health utilities are commonly used as quality weights to calculate quality-adjusted life years in cost-utility analysis (CUA). However, if published health utilities are not properly used, the credibility of CUA could be affected.

Objectives

To identify discrepancies in using published health utilities in CUAs for cardiovascular disease (CVD).

Methods

CVD CUAs in the Tufts Cost-Effectiveness Analysis Registry that reported health utilities were included in the analysis. References cited for health utilities in these CUAs were reviewed to identify the original health utility studies. The description and value of health utilities used in the CUA were compared with those reported in the original utility studies. Logistic regression was used to identify the factors that can predict the discrepancy.

Results

A total of 585 eligible CUAs published between 1977 and 2016 were identified and reviewed. Of these studies, 74.5% were published between 2007 and 2016. 442 CUAs that used a total of 2235 health utilities published in 203 original utility studies were included for the comparison. As compared with those utilities originally reported, only 596 (26.7%) health utilities had the same description and value, whereas 991 health utilities (44.3%) differed in both description and value. Of 1290 health utilities with a different description, 69.1% were due to different severity or disease. No explanation or justification was provided for 1171 (87.4%) of 1340 health utilities with different value.

Conclusions

There are concerning discrepancies in using published health utilities for CVD CUAs. Given the important role health utilities play in CUAs, authors of CUAs should always refer to the original studies for health utilities and be transparent about how published health utilities are selected and incorporated into CUAs.

Are Current Reporting Standards Used to Describe Health State Utilities in Cost-Effectiveness Models Satisfactory?

OBJECTIVE

The aims of this study were to examine current reporting standards of health state utilities (HSU) using a review of published cost-effectiveness analyses in cardiovascular disease and to explore the impact of variation in model inputs used in these on estimated quality-adjusted life-years (QALYs) and cost-effectiveness.

METHODS

Key health/economics bibliographic databases were searched to identify relevant articles published after 2014. Any narrative or values relating to the HSU used in the model were extracted and reviewed. The HSUs were systematically applied to an existing model to explore the influence of different values on QALYs and the incremental cost-effectiveness ratio.

RESULTS

Twenty-four peer-reviewed articles were identified. Only 2 studies referred to a literature review for the HSUs. Most (18 of 24) referenced previously published economic studies (as opposed to the original source) for at least 1 of the HSUs. Only 4 studies referenced the original sources and reported all of the HSUs accurately, and several did not provide all the HSUs. Little information was provided on the methods used to calculate QALYs, for example, the duration of time for acute HSUs, what the baseline HSU was, the method that was used to assign HSUs for subsequent different events, or how constant HSUs for clinical events were combined with age-adjusted baseline values. The huge differences in HSUs used in the studies produced substantial variations in the QALYs and incremental cost-effectiveness ratios generated from the cost-effectiveness model.

CONCLUSION

Current standards are poor, and there is a need for greater transparency in reporting the HSUs used in cost-effectiveness models.

Cost effectiveness of interventions to improve adherence to statin therapy in ASCVD patients in the United States

INTRODUCTION

Cardiovascular disease (CVD) is the leading cause of death in the United States, and high cholesterol is a leading risk factor for CVD. While statins are effective at reducing cholesterol, they are frequently underused in patients at highest risk of CVD. The objective of this study was to identify interventions which may improve adherence to statins and to assess their cost effectiveness within the US Medicare population.

METHODS

A literature review was undertaken to identify interventions to improve adherence in patients with CVD at highest risk of a recurrent event and to quantify non-adherence and the consequences of non-adherence to statins in this population. A Markov cost-utility model was developed to assess the cost effectiveness of these interventions.

RESULTS

Ten adherence interventions were identified in the literature, with 6 demonstrating statistically significant improvement in adherence. The six interventions were disease management, interactive voice response, nurse counselling, discharge letter, nurse/dietician counselling and electronic pill bottle with feedback. The model found the cost effectiveness of an intervention was highly dependent on its effectiveness and costs. Incremental cost effectiveness ratios ranged from $27,545/QALY for discharge letter with large adherence gain to $130,399/QALY for disease management program with small adherence gain.

CONCLUSION

Some interventions to improve adherence have been shown to be effective, but little attention has been paid to the costs. Further studies on adherence interventions should include economic evaluations.