Abstract
BackgroundValid and relevant estimates of health state preference weights (HSPWs) for Glasgow Outcome Scale (GOS) categories are a key input of economic models evaluating treatments for traumatic brain injury (TBI).ObjectivesTo characterize existing HSPW estimates, and model the EuroQol five-dimensional questionnaire (EQ-5D) from the GOS, to inform parameterization of future economic models.MethodsA systematic review of HSPWs for GOS categories following TBI was conducted using a highly sensitive search strategy implemented in an extensive range of information sources between 1975 and 2016. A cross-sectional mapping study of GOS health states onto the three-level EQ-5D UK tariff index values was also performed in patients with significant TBI (head region Abbreviated Injury Scale score ≥3) from the Victoria State Trauma Registry. A limited dependent variable mixture model was used to estimate the 12-month EQ-5D UK value set as a function of GOS category, age, and other explanatory variables.ResultsSix unique HSPWs from five eligible studies were identified. All studies were at high risk of bias with limited applicability. The magnitude of HSPWs differed significantly between studies. Three class mixture models demonstrated excellent goodness of fit to the observed Victoria State Trauma Registry data. GOS category, age at injury, sex, comorbidity, and major extracranial injury all had significant independent effects on mean EQ-5D utility values.ConclusionsThe few available HSPWs for GOS categories are challenged by potential biases and restricted generalizability. Mixture models are presented to provide HSPWs for GOS categories consistent with the National Institute for Health and Care Excellence reference case.
Highlights
Increasing health care demands, limited by finite health budgets, have necessitated economic evaluations of new health technologies to ensure efficient use of scarce resources [1]
Costeffectiveness is commonly assessed by comparing interventions in terms of costs and quality-adjusted life-years, comprising duration of life expectancy weighted by preferences for healthrelated quality of life (HRQOL) over this period [2]
Forty-one potentially eligible “near-miss” studies were collected on Glasgow Outcome Scale (GOS) and a preference-based health state description scale but were not included because health state preference weights (HSPWs) estimates were not reported
Summary
Increasing health care demands, limited by finite health budgets, have necessitated economic evaluations of new health technologies to ensure efficient use of scarce resources [1]. Valid and relevant estimates of health state preference weights (HSPWs) for Glasgow Outcome Scale (GOS) categories are a key input of economic models evaluating treatments for traumatic brain injury (TBI). A cross-sectional mapping study of GOS health states onto the three-level EQ-5D UK tariff index values was performed in patients with significant TBI (head region Abbreviated Injury Scale score Z3) from the Victoria State Trauma Registry. A limited dependent variable mixture model was used to estimate the 12-month EQ-5D UK value set as a function of GOS category, age, and other explanatory variables. Mixture models are presented to provide HSPWs for GOS categories consistent with the National Institute for Health and Care Excellence reference case.
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