Longitudinal and cross sectional assessments of health utility in adults with HIV-AIDS: a systematic review and meta-analysisReport as inadecuate




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BMC Health Services Research

, 15:7

Quality, performance, safety and outcomes

Abstract

BackgroundUtility 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.

MethodsWe 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.

ResultsReliability 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 = 0.40 and 0.176 p = 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.

ConclusionThe 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.

KeywordsQuality of life Utility HIV Longitudinal meta-analysis Systematic review Bach Xuan Tran and Long Hoang Nguyen contributed equally to this work.

Electronic supplementary materialThe online version of this article doi:10.1186-s12913-014-0640-z contains supplementary material, which is available to authorized users.

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Author: Bach Xuan Tran - Long Hoang Nguyen - Arto Ohinmaa - Rachel Marie Maher - Vuong Minh Nong - Carl A Latkin

Source: https://link.springer.com/







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