Abstract
BackgroundThe objective of this study was to obtain utilities by means of EQ-5D-5L for different health states in patients with knee osteoarthritis (KOA) or hip osteoarthritis (HOA) in Spain, and to compare these values with those used in foreign studies with the aim of discussing their transferability for their use in economic evaluations conducted in Spain.MethodsPrimary study: Observational prospective study of KOA or HOA patients in Spain. Sociodemographic and clinical characteristics were collected to characterize the sample. Utilities were elicited using the EQ-5D-5L questionnaire. ANOVA and bivariable analyses were conducted to identify differences between health states. Literature review: Using the bibliographic databases NSH EED and CEA Registry, we conducted searches of model-based cost utilities analyses of technologies in KOA or HOA patients. Health states and utilities were extracted and compared with values obtained from the Spanish sample.ResultsThree hundred ninety-seven subjects with KOA and 361 subjects with HOA were included, with average utilities of 0.544 and 0.520, respectively. In both samples, differences were found in utilities according to level of pain, stiffness and physical function (WOMAC) and severity of symptoms (Oxford scales), so that the worst the symptoms, the lower the utilities. The utilities after surgery were higher than before surgery. Due to limitations from our study related to sample size and observational design, it was not possible to estimate utilities for approximately half the health states included in the published models because they were directly related to specific technologies. For almost 100% of health states of the selected studies we obtained very different utilities from those reported in the literature.ConclusionsTo our knowledge this is the first article with detailed utilities estimated using the EQ-5D-5L in Spain for KOA and HOA patients. In both populations, utilities are lower for worse health states in terms of level of pain, stiffness and physical function according to WOMAC, and according to the Oxford scales. Most utilities obtained from the Spanish sample are lower than those reported in the international literature. Further studies estimating utilities from local populations are required to avoid the use of foreign sources in economic evaluations.
Highlights
The objective of this study was to obtain utilities by means of EQ-5D-5L for different health states in patients with knee osteoarthritis (KOA) or hip osteoarthritis (HOA) in Spain, and to compare these values with those used in foreign studies with the aim of discussing their transferability for their use in economic evaluations conducted in Spain
body mass index (BMI) Body mass index, standard deviation (SD) Standard deviation, WOMAC Western Ontario and McMaster Universities Osteoarthritis Index p-values represents the significance of differences between groups by means of ANOVA except for (*) P-value comparing with the whole sample’s utility value (0.544), and (**) P-value comparing sample before and after (6 months) the prosthesis Superscript letters indicate differences among the subgroups according to Tamhane’s T2 post hoc test for multiple comparisons at P-value< 0.01 care health centers, the remainder were recruited in hospital
Regarding clinical questionnaires, differences were found between all subgroups (P < 0.0001), that is, the less joint problems, the higher utilities
Summary
The objective of this study was to obtain utilities by means of EQ-5D-5L for different health states in patients with knee osteoarthritis (KOA) or hip osteoarthritis (HOA) in Spain, and to compare these values with those used in foreign studies with the aim of discussing their transferability for their use in economic evaluations conducted in Spain. Osteoarthritis entails a social and economic burden in terms of health-related quality of life (HRQoL) [2, 3] and cost of the disease [2, 4]. Estimated expenses for KOA or HOA are equal to 0.5% of Spain’s GDP [5] Health problems with such an impact on society and the existent technologies for those health problems deserve to be the focus of health technology assessment and economic evaluation to inform the evidence-based decision making by health authorities. In Spain the most recent estimated threshold is 25,000 €/QALY, so any new technology with an incremental cost-effectiveness ratio over this threshold should not be adopted according to this study [9]
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