PRM169 - The Selection of Appropriate Health State Utility Values (Hsuvs) for Health Technology Assessment (Hta): Lessons To Be Learnt

Abstract

Incorporation of health-related quality of life (HRQoL) evidence into economic models is a requirement of many countries for the purposes of Health Technology Assessment (HTA), and therefore appropriate health state utility values (HSUVs) are often sought. The objective of this review was to: (i) identify and summarise the principal limitations of HSUVs used in recent submissions appraised by the National Institute for Health and Care Excellence (NICE) and (ii) produce a categorical checklist that can be used by manufacturers to reduce uncertainty when selecting HSUVs for HTA. Evidence appraisal documents for the 50 most recently published technologies assessed by NICE were retrieved in June 2014. Economic models were assessed and utility inputs reviewed. Critiques of the utilities reported by the evidence review group or final appraisal committee were extracted, reviewed and categorised. Of the appraisals reviewed (43 single technology appraisals (TAs) and 7 multiple TAs), utility inputs were either sourced from the literature (n=27), published mapping algorithms (n=11), de novo mapping algorithms (n=2), or derived from clinical trials (n=10). The concerns expressed by review groups can be categorised into four categories: (i) generalisability – relevance of HSUVs to UK clinical practice, deviation from NICE scope, and the use of other countries’ valuations for health states; (ii) HSUV selection – inadequate justification of HSUVs, and lack of consideration for covariates and disutilities; (iii) mapping algorithms – use of non-validated or non-peer-reviewed publications, incomplete reporting of key model information, and ambiguity regarding selection and justification of mapping function; (iv) risk of bias – sample size, instrument response rates, and general study quality identified as factors affecting HSUV validity. The selection of appropriate HSUVs is critical to reduce uncertainty in economic models. A checklist based on critiques of recent HTAs will be a useful tool for manufacturers when selecting relevant HRQoL parameters.