Which multi-attribute utility instruments are recommended for use in cost-utility analysis? A review of national health technology assessment (HTA) guidelines

Abstract

Background: Several multi-attribute utility instruments (MAUIs) are available from which utilities can be derived for use in cost-utility analysis (CUA). This study provides a review of recommendations from national health technology assessment (HTA) agencies regarding the choice of MAUIs.

Methods: A list was compiled of HTA agencies that provide or refer to published official pharmacoeconomic (PE) guidelines for pricing, reimbursement or market access. The guidelines were reviewed for recommendations on the indirect calculation of utilities and categorized as: a preference for a specific MAUI; providing no MAUI preference, but providing examples of suitable MAUIs and/or recommending the use of national value sets; and recommending CUA, but not providing examples of MAUIs.

Results: Thirty-four PE guidelines were included for review. MAUIs named for use in CUA: EQ-5D (n = 29 guidelines), the SF-6D (n = 11), HUI (n = 10), QWB (n = 3), AQoL (n = 2), CHU9D (n = 1). EQ-5D was a preferred MAUI in 15 guidelines. Alongside the EQ-5D, the HUI was a preferred MAUI in one guideline, with DALY disability weights mentioned in another. Fourteen guidelines expressed no preference for a specific MAUI, but provided examples: EQ-5D (n = 14), SF-6D (n = 11), HUI (n = 9), QWB (n = 3), AQoL (n = 2), CHU9D (n = 1). Of those that did not specify a particular MAUI, 12 preferred calculating utilities using national preference weights.

Conclusions: The EQ-5D, HUI, and SF-6D were the three MAUIs most frequently mentioned in guidelines. The most commonly cited MAUI (in 85% of PE guidelines) was EQ-5D, either as a preferred MAUI or as an example of a suitable MAUI for use in CUA in HTA.

Keywords: Cost-utility analysis; Guidelines; Health technology assessment; Multi-attribute utility instruments; Pharmacoeconomics; Utility.

Fig. 1

Flow chart for inclusion of PE guidelines in the review. CUA cost-utility analysis, HTA health technology assessment, MAUI multi-attribute utility instrument, PE pharmacoeconomic

Fig. 2

MAUIs preferred or provided as an example across identified official PE guidelines. AQoL Assessment of Quality of Life, CHU9D Child Health Utility 9D, HUI Health Utility Index, MAUI multi-attribute utility instrument, QWB quality of well-being, SF-6D Short-Form 6-Dimension. Numbers sum to more than 34 because some guidelines cite more than one MAUI