Abstract
BackgroundPeople with diabetic retinopathy tend to have lower levels of health-related quality of life than individuals with no retinopathy. Strategies for screening and treatment have been shown to be cost-effective. In order to reduce the bias in cost-effectiveness estimates, systematic reviews of health state utility values (HSUVs) are crucial for health technology assessment and the development of decision analytic models. A review and synthesis of HSUVs for the different stages of disease progression in diabetic retinopathy has not previously been conducted.Methods/DesignWe will conduct a systematic review of the available literature that reports HSUVs for people with diabetic retinopathy, in correspondence with current stage of disease progression and/or visual acuity. We will search Medline, EMBASE, Web of Science, Cost-Effectiveness Analysis Registry, Centre for Reviews and Dissemination Database, and EconLit to identify relevant English-language articles. Data will subsequently be synthesized using linear mixed effects modeling meta-regression. Additionally, reported disease severity classifications will be mapped to a four-level grading scale for diabetic retinopathy.DiscussionThe systematic review and meta-analysis will provide important evidence for future model-based economic evaluations of technologies for diabetic retinopathy. The meta-regression will enable the estimation of utility values at different disease stages for patients with particular characteristics and will also highlight where the design of the study and HSUV instrument have influenced the reported utility values. We believe this protocol to be the first of its kind to be published.Systematic review registrationPROSPERO CRD42014012891Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0006-6) contains supplementary material, which is available to authorized users.
Highlights
People with diabetic retinopathy tend to have lower levels of health-related quality of life than individuals with no retinopathy
The meta-regression will enable the estimation of utility values at different disease stages for patients with particular characteristics and will highlight where the design of the study and Health state utility value (HSUV) instrument have influenced the reported utility values
In modeling studies of diabetic retinopathy, some researchers choose HSUVs based on estimated visual acuity levels, rather than on the disease state itself [28,30]
Summary
It is common for modeling studies to use utility values from a single study deemed to be most relevant. We will identify the strengths and limitations of our review and make suggestions for future research This protocol is the first of its kind to be published, and the first to be registered prospectively. By creating a public record of the intended review process it is possible to maintain transparency in the process of selecting parameters to be used in decision analytic models of health technologies. We hope that this approach will become standard practice as part of the modeling process. DB helped determine the scope of the review, refined the search strategy, and revised the manuscript. All authors read and approved the final version of the manuscript
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