Health state utility values ranges across varying stages and severity of type 2 diabetes-related complications: A systematic review

Abstract

Introduction: Health state utility values (HSUV) for Type 2 diabetes mellitus (T2DM) complications are useful in economic evaluations to determine cost effectiveness of an intervention. However, there is a lack of reference ranges for different severity and stages of individual complications. This study aimed to provide an overview of HSUV decrement ranges for common T2DM complications focusing on different severity and stages of complications.

Method: A systematic search was conducted in MEDLINE, SCOPUS, WEB OF SCIENCE. (Jan 2000 to April 2022). Included studies for HSUV estimates were from outpatient setting, regardless of treatment types, complication stages, regions and HRQoL instruments. Health Related Quality of Life (HRQoL) outcomes was to be presented as HSUV decrement values, adjusted according to social demographics and comorbidities. Adjusted HSUV decrements were extracted and compiled according to individual complications. After which, subsequently grouped into mild or severe category for comparison.

Results: Searches identified 35 studies. The size of the study population ranged from 160 to 14,826. The HSUV decrement range was widest for cerebrovascular disease (stroke): -0.0060 to -0.0780 for mild stroke and -0.035 to -0.266 for severe stroke; retinopathy: mild (-0.005 to -0.0862), moderate (-0.0030 to -0.1845) and severe retinopathy (-0.023 to -0.2434); amputation: (-0.1050 to -0.2880). Different nature of complication severity defined in studies could be categorized into: those with acute nature, chronic with lasting effects, those with symptoms at early stage or those with repetitive frequency or episodes.

Discussion: Overview of HSUV decrement ranges across different stages of each T2DM diabetes-related complications shows that chronic complications with lasting impact such as amputation, severe stroke with sequelae and severe retinopathy with blindness were generally associated with larger HSUV decrement range. Considerable heterogeneities exist across the studies. Promoting standardized complication definitions and identifying the most influential health state stages on HSUV decrements may assist researchers for future cost-effectiveness studies.

Fig 1. PRISMA flow diagram.

Note: PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Fig 2. Overview of HSUV decrement range by valuation instruments.

Note. standard gamble (SG); time-trade off (TTO); 5-level EQ-5D version, (ED-5D-5L); Short-form 6-dimensional (SF-6D); Self-administered Quality of Well-Being Index (QWB-SA); Health Utilities Index Mark 3 (HUI-3).

Fig 3. Overview of HSUV decrement ranges, by complication type.

(A) macrovascular complications (B) microvascular complications (C) hypoglycemia.

Fig 4. HSUV decrement values for cardiovascular complications, stratified according to different stages: Angina, myocardial infarction or undefined.

Fig 5. HSUV decrement values for cerebrovascular complications, stratified according to different stages: Mild stroke, severe stroke or undefined.

Fig 6. HSUV decrement values for diabetic nephropathy complications, stratified according to different stages: Proteinuria, broadly defined nephropathy or ESRF.

Fig 7. HSUV decrement values for diabetic retinopathy complications, stratified according to different stages: Mild, moderate, severe retinopathy, undefined retinopathy.

Fig 8. HSUV decrement values for severe neuropathy and undefined neuropathy.

Fig 9. HSUV decrement values for foot ulcer and amputation complications.

Fig 10. HSUV decrement values for mild, moderate, severe and very severe hypoglycemia.

Fig 11. Different nature of complication severity which may affect HSUV decrement ranges.