Health State Preference Weights for the Glasgow Outcome Scale Following Traumatic Brain Injury: A Systematic Review and Mapping Study

Abstract

Background: 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).

Objectives: To characterize existing HSPW estimates, and model the EuroQol five-dimensional questionnaire (EQ-5D) from the GOS, to inform parameterization of future economic models.

Methods: A 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.

Results: Six 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.

Conclusions: The 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.

Keywords: EuroQol-5D; Glasgow Outcome Scale; craniocerebral trauma; decision analysis models; economic models; health status indicators; mapping study; quality of life; quality-adjusted life-years; systematic review.

Fig. 1

PRISMA flowchart describing systematic review study selection. De-duplication was performed at the full-text stage and a one-to-one relationship subsequently existed between articles and studies. *Six unique GOS HSPWs reported in five articles. GOS, Glasgow Outcome Scale; HSPWs, health state preference weights; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Fig. 2

Distribution of EQ-5D at 12 months overall, and stratified by basic GOS category. EQ-5D, EuroQol five-dimensional questionnaire; GOS, Glasgow Outcome Scale.

Fig. 3

Mean predicted 12-month EQ-5D value for each basic GOS category at representative ages compared with observed mean values. Black symbols represent point estimates from the simple adjusted limited dependent variable mixture model for predicted mean EQ-5D values conditional on age (▲, <65 years old, ■, ≥65 years old) and basic GOS category (D, dead; VS, vegetative state; SD, severe disability; MD, moderate disability; GR, good recovery). Gray symbols represent corresponding mean observed EQ-5D values. Error bars report 95% CI for observed and predicted mean. CI, confidence interval; EQ-5D, EuroQol five-dimensional questionnaire; GOS, Glasgow Outcome Scale.

Fig. 4

Cumulative distribution functions for observed vs. predicted EQ-5D values from predictive models. The x-axis denotes the EQ-5D and the y-axis displays cumulative percentage of cases. EQ-5D, EuroQol five-dimensional questionnaire; GOS, Glasgow Outcome Scale.