Health-state utilities in liver disease: A systematic review

Objectives. Health-state utilities are essential for cost-utility analysis. Few estimates exist for liver disease in the literature. The authors' aim was to conduct a systematic review of health-state utilities in liver disease, to look at the variation of study designs used, and to pool utilities for some liver disease states. Methods. A search of MEDLINE, EMBASE, and CINAHL from 1966 to September 2006 was conducted including key words related to liver disease and utility measuring tools. Articles were included if health-state utility tools or expert opinion were used. Variance-weighted mean utility estimates were pooled using metaregression adjusting for disease state and utility assessment method. Results. Thirty studies measured utilities of liver diseases/disease states. Half of these estimated utilities for hepatitis viruses: hepatitis A (n=1), hepatitis B (n=4), and hepatitis C (n=10). Others included liver transplant (n=6) and chronic liver disease (n= 5) populations. Twelve utility methods were used throughout. The EQ-5D (n=10) was most popular method, followed by visual analogue scale (n=9), time tradeoff (n=6), and standard gamble (n=4). Respondents were patients (n=16), an expert panel (n=10), non-liver diseases adults (n=2), patient and expert (n=1), and patient and healthy adult (n=1). Type of perspective included community (n=21), patient (n=4), and both (n=5). The pooled mean estimates in hepatitis C with moderate disease, compensated cirrhosis, decompensated cirrhosis, and post-liver transplant using the EQ-5D were 0.75, 0.75, 0.67, and 0.71, respectively. The change in these utilities using different methods were -0.07 (visual analogue scale), -0.01 (health utilities index version 3), +0.04 (standard gamble), +0.08 (health utilities index version 2), +0.12 (time tradeoff), and +0.15 (standard gamble-transformed visual analogue scale). Conclusions. The authors have created a valuable liver disease-based utility resource from which researchers and policy makers can easily view all available utility estimates from the literature. They have also estimated health-state utilities for major states of hepatitis C.