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The Utility of 5 Hypothetical Health States in Heart Failure Using Time Trade-Off (TTO) and EQ-5D-5L in Korea

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Abstract

Background and Objective

Utility provides a preference for specific health state in economic evaluation, and they obtained from general population could be useful in respect of societal resource allocation. We aimed to investigate the utilities of health states for heart failure (HF), a major and growing public health problem, related to hospitalization and adverse drug effects by interrogating the general Korean population.

Methods

Five health states for patients with HF were developed based on literature reviews: stable chronic heart failure (SCHF), hospitalization, SCHF + cough, SCHF + hypotension, and SCHF + hyperkalemia. We selected 100 individuals from the general population through quota sampling by age, sex, and region, and conducted face-to-face interviews. We measured utilities for 5 hypothetical health states of HF using both time trade-off (TTO) and EuroQol-5 dimensions-5 levels (EQ-5D-5L). Repeated-measures analysis of variance compared the utilities between all health states for each instrument. To identify the factors affecting the utility, a linear mixed model (LMM) analysis was performed.

Results

The mean utility value for SCHF, SCHF + cough, SCHF + hypotension, SCHF + hyperkalemia, and hospitalization was calculated as 0.815, 0.732, 0.646, 0.548, and 0.360, respectively, by using TTO. The respective values using EQ-5D-5L were 0.871, 0.793, 0.710, 0.589, and 0.215. The utilities for HF significantly differed between all health states in each instrument (p < 0.001). In LMM analysis, hospitalization had a significantly negative effect on the utilities of both instruments.

Conclusions

The utilities decreased in order of SCHF, SCHF + cough, SCHF + hypotension, SCHF + hyperkalemia, and hospitalization. These results can be useful for decision making in resource allocation for HF interventions.

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References

  1. Lee JH, Lim NK, Cho MC, Park HY. Epidemiology of heart failure in Korea: present and future. Korean Circ J. 2016;46(5):658–64.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Roger VL. Epidemiology of heart failure. Circ Res. 2013;113(6):646–59.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Bennett SJ, Cordes DK, Westmoreland G, Castro R, Donnelly E. Self-care strategies for symptom management in patients with chronic heart failure. Nurs Res. 2000;49(3):139–45.

    Article  PubMed  CAS  Google Scholar 

  4. Morgan K, McGee H, Shelley E. Quality of life assessment in heart failure interventions: a 10-year (1996–2005) review. Eur J Cardiovasc Prev Rehabil. 2007;14(5):589–607.

    Article  PubMed  Google Scholar 

  5. Zambroski CH, Moser DK, Bhat G, Ziegler C. Impact of symptom prevalence and symptom burden on quality of life in patients with heart failure. Eur J Cardiovasc Nurs. 2005;4(3):198–206.

    Article  PubMed  Google Scholar 

  6. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2012;14(8):803–69.

    Article  PubMed  CAS  Google Scholar 

  7. McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371(11):993–1004.

    Article  PubMed  CAS  Google Scholar 

  8. Brignall K, Jayaraman B, Birring SS. Quality of life and psychosocial aspects of cough. Lung. 2008;186(Suppl 1):S55–8.

    Article  PubMed  Google Scholar 

  9. Thompson A. Hypotension: issues and management. PJ Online. 2011;1–4.

  10. Weller K, Groffik A, Magerl M, Tohme N, Martus P, Krause K, et al. Development and construct validation of the angioedema quality of life questionnaire. Allergy. 2012;67(10):1289–98.

    Article  PubMed  CAS  Google Scholar 

  11. Testa MA, Simonson DC. Assesment of quality-of-life outcomes. N Engl J Med. 1996;334(13):835–40.

    Article  PubMed  CAS  Google Scholar 

  12. Torrance GW. Utility approach to measuring health-related quality of life. J Chronic Dis. 1987;40(6):593–603.

    Article  PubMed  CAS  Google Scholar 

  13. Drummond MF, O’Brien B, Stodart G, Torrance GW. Methods for the economic evaluation of health care programmes. 3rd ed. Oxford: Oxford University Press; 2005. p. 137–88.

    Google Scholar 

  14. Whitehead SJ, Ali S. Health outcomes in economic evaluation: the QALY and utilities. Br Med Bull. 2010;96(1):5–21.

    Article  PubMed  Google Scholar 

  15. Bae S, Lee S, Bae EY, Jang S. Korean guidelines for pharmacoeconomic evaluation (second and updated version): consensus and compromise. Pharmacoeconomics. 2013;31(4):257–67.

    Article  PubMed  Google Scholar 

  16. Brazier J, Ratcliffe J, Salomon J, Tsuchiya A. Measuring and valuing health benefits for economic evaluation. 2nd ed. Oxford: Oxford University Press; 2016. p. 112–6.

    Book  Google Scholar 

  17. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18(8):891–975.

    Article  PubMed  Google Scholar 

  18. Sarwar CMS, Papadimitriou L, Pitt B, Piña I, Zannad F, Anker SD, et al. Hyperkalemia in heart failure. J Am Coll Cardiol. 2016;68(14):1575–89.

    Article  PubMed  CAS  Google Scholar 

  19. Parkerson GR Jr, Connis RT, Broadhead WE, Patrick DL, Taylor TR, Tse CK. Disease-specific versus generic measurement of health-related quality of life in insulin-dependent diabetic patients. Med Care. 1993;31(7):629–39.

    Article  PubMed  Google Scholar 

  20. Janssen MF, Pickard AS, Golicki D, Gudex C, Niewada M, Scalone L, et al. Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Qual Life Res. 2013;22(7):1717–27.

    Article  PubMed  CAS  Google Scholar 

  21. Kim SH, Jo MW, Ahn J, Shin S, Ock M, Park J, et al. The valuation of EQ-5D-5L health states in Korea. Value Health. 2014;17(7):A753.

    Article  PubMed  CAS  Google Scholar 

  22. Attema AE, Edelaar-Peeters Y, Versteegh MM, Stolk EA. Time trade-off: one methodology, different methods. Eur J Health Econ. 2013;14(Suppl 1):S53–64.

    Article  PubMed  Google Scholar 

  23. Reenen M, Janssen B. EQ-5D-5L user guide: basic information on how to use the EQ-5D-5L instrument. EuroQoL Group. 2015. https://euroqol.org/wp-content/uploads/2016/09/EQ-5D-5L_UserGuide_2015.pdf. Accessed 2 Sept 2016.

  24. Kim S-H, Ahn J, Ock M, Shin S, Park J, Luo N, et al. The EQ-5D-5L valuation study in Korea. Qual Life Res. 2016;25(7):1845–52.

    Article  PubMed  Google Scholar 

  25. Kiernan MS, Wentworth D, Francis G, Martinez FA, Dickstein K, Komajda M, et al. Predicting adverse events during angiotensin receptor blocker treatment in heart failure: results from the HEAAL trial. Eur J Heart Fail. 2012;14(12):1401–9.

    Article  PubMed  CAS  Google Scholar 

  26. Sztramko R, Chau V, Wong R. Adverse drug events and associated factors in heart failure therapy among the very elderly. Can Geriatr J. 2011;14(4):79–92.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Yao G, Freemantle N, Calvert MJ, Bryan S, Daubert J-C, Cleland JG. The long-term cost-effectiveness of cardiac resynchronization therapy with or without an implantable cardioverter-defibrillator. Eur Heart J. 2007;28(1):42–51.

    Article  PubMed  CAS  Google Scholar 

  28. Griffiths A, Paracha N, Davies A, Branscombe N, Cowie M. Sculpher M The cost effectiveness of ivabradine in the treatment of chronic heart failure from the UK National Health Service perspective. Heart. 2014;100:1031–6.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Kardiol Pol. 2016;74(10):1037–147.

    Article  PubMed  Google Scholar 

  30. Whitehead SJ, Ali S. Health outcomes in economic evaluation: the QALY and utilities. Br Med Bull. 2010;96:5–21.

    Article  PubMed  Google Scholar 

  31. Nafees B, Cowie M, Patel C, Deschaseaux C, Brazier J, Lloyd A. Health state utilities in chronic heart failure in the UK. Value Health. 2014;17(7):A493.

    Article  PubMed  CAS  Google Scholar 

  32. Drummond M, Brixner D, Gold M, Kind P, McGuire A, Nord E, Group CD. Toward a consensus on the QALY. Value Health. 2009;12(Suppl 1):S31–5.

    Article  PubMed  Google Scholar 

  33. Weinstein MC, Torrance G, McGuire A. QALYs: the basics. Value Health. 2009;12(Suppl 1):S5–9.

    Article  PubMed  Google Scholar 

  34. Eisele M, Blozik E, Stork S, Trader JM, Herrmann-Lingen C, Scherer M. Recognition of depression and anxiety and their association with quality of life, hospitalization and mortality in primary care patients with heart failure - study protocol of a longitudinal observation study. BMC Fam Pract. 2013;14:180.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Konstam V, Moser DK, De Jong MJ. Depression and anxiety in heart failure. J Card Fail. 2005;11(6):455–63.

    Article  PubMed  Google Scholar 

  36. Polikandrioti M, Goudevenos J, Michalis LK, Koutelekos J, Kyristi H, Tzialas D, et al. Factors associated with depression and anxiety of hospitalized patients with heart failure. Hell J Cardiol. 2015;56(1):26–35.

    Google Scholar 

  37. Nafees B, Stafford M, Gavriel S, Bhalla S, Watkins J. Health state utilities for non-small cell lung cancer. Health Qual Life Outcomes. 2008;6:84.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Lloyd A, Nafees B, Narewska J, Dewilde S, Watkins J. Health state utilities for metastatic breast cancer. Br J Cancer. 2006;95(6):683–90.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  39. Luo N, Teng TK, Tay WT, Anand IS, Kraus WE, Liew HB, et al. Multinational and multiethnic variations in health-related quality of life in patients with chronic heart failure. Am Heart J. 2017;191:75–81.

    Article  PubMed  PubMed Central  Google Scholar 

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Author notes

  1. Sung-Hyun Hong and Jae-Yeon Lee: Co-first authors made equal contributions.

Authors and Affiliations

  1. School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, South Korea

    Sung-Hyun Hong, Jae-Yeon Lee, Sun-Kyeong Park, Jin Hyun Nam, Hyun Jin Song & Eui-Kyung Lee

  2. VIAplus, 315 Techno Innovation Park, 237 Sangidaehak-ro, Siheung, Gyeonggi-do, 15073, South Korea

    Sun-Young Park

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  1. Sung-Hyun Hong
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Correspondence to Eui-Kyung Lee.

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Funding

This study was funded by Novartis Korea Ltd. The sponsor did not engage in study design; in the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the article for publication.

Conflict of interest

Sung-Hyun Hong, Jae-Yeon Lee, Sun-Kyeong Park, Jin Hyun Nam, Hyun Jin Song, Sun-Young Park, and Eui-Kyung Lee declare that they have no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board of Sungkyunkwan University (approval number: 2015-12-004-001). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Hong, SH., Lee, JY., Park, SK. et al. The Utility of 5 Hypothetical Health States in Heart Failure Using Time Trade-Off (TTO) and EQ-5D-5L in Korea. Clin Drug Investig 38, 727–736 (2018). https://doi.org/10.1007/s40261-018-0659-8

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  • DOI: https://doi.org/10.1007/s40261-018-0659-8

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