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Health-related Quality of Life in Economic Evaluations for Osteoporosis

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  • Sherine E. Gabriel
  • Terry S. Kneeland
  • L. Joseph Melton
  • Megan M. Moncur
  • Bruce Ettinger
  • Anna N.A. Tosteson

Abstract

Objective. To determine whether the source of preference scores has an impact on the cost-effectiveness of osteoporosis interventions. Methods. Three groups of sub jects aged ≥50 years—199 women without fractures and 183 women with osteopo rotic fractures—were studied at two major medical centers. Medical history and co morbidity data were obtained from review of medical records. Health status was measured using the Medical Outcomes Study SF-36. Two preference-classification systems (i.e., quality of well-being scores estimated from SF-36 subscales and the Health Utilities Index) were also used. Preferences for current health and for hypo thetical health states were assessed using a time tradeoff and implemented with a computer-based utility instrument (U-Titer). Wilcoxon's rank-sum and signed-rank tests were used to compare preferences for current health among women with osteoporotic fractures with 1) directly assessed preferences for osteoporosis health states deline ated by outcome descriptions and 2) preference scores obtained from the preference- classification systems. The potential impact of the source of the preference scores was estimated using a Markov state-transition model. Results. The preference scores for hypothetical osteoporosis health states of the non-fracture subjects were approximately 50% lower than those of the women who had actually experienced the health state. Differences of this magnitude would change the estimated cost-effectiveness of a 15- year intervention (which for approximately $280 per year prevents hip fracture about as well as hormone-replacement therapy) from $25,000 per QALY gained when non- fracture subjects' preferences were used to $94,000 per QALY gained when fracture subjects' preferences were used. Preferences estimated using the Health Utilities Index and those directly measured in fracture subjects using the time tradeoff did not differ significantly. Conclusions. The Health Utilities Index preference-classification system may provide an efficient and inexpensive alternative to direct utility assessment in this patient group. However, there are important differences in the valuation of health states by women who have experienced osteoporotic fractures compared with women who have not. Cost-utility analyses based solely on fracture patients' preferences for os teoporotic health states may undervalue prevention. Key words: osteoporosis; quality of life; utility assessment; patients' preferences. (Med Decis Making 1999;19:141- 148)

Suggested Citation

  • Sherine E. Gabriel & Terry S. Kneeland & L. Joseph Melton & Megan M. Moncur & Bruce Ettinger & Anna N.A. Tosteson, 1999. "Health-related Quality of Life in Economic Evaluations for Osteoporosis," Medical Decision Making, , vol. 19(2), pages 141-148, April.
    • Handle: RePEc:sae:medema:v:19:y:1999:i:2:p:141-148
    DOI: 10.1177/0272989X9901900204
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    References listed on IDEAS

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    1. Dennis G. Fryback & Erik J. Dasbach & Ronald Klein & Barbara E.K. Klein & Norma Dorn & Kathy Peterson & Patrica A. Martin, 1993. "The Beaver Dam Health Outcomes study," Medical Decision Making, , vol. 13(2), pages 89-102, June.
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    1. Julie Sturza, 2010. "A Review and Meta-Analysis of Utility Values for Lung Cancer," Medical Decision Making, , vol. 30(6), pages 685-693, November.
    2. Karen E. Bremner & Christopher A. K. Y. Chong & George Tomlinson & Shabbir M. H. Alibhai & Murray D. Krahn, 2007. "A Review and Meta-Analysis of Prostate Cancer Utilities," Medical Decision Making, , vol. 27(3), pages 288-298, May.
    3. Duncan Mortimer & Leonie Segal, 2008. "Comparing the Incomparable? A Systematic Review of Competing Techniques for Converting Descriptive Measures of Health Status into QALY-Weights," Medical Decision Making, , vol. 28(1), pages 66-89, January.
    4. Christine McDonough & Anna Tosteson, 2007. "Measuring Preferences for Cost-Utility Analysis," PharmacoEconomics, Springer, vol. 25(2), pages 93-106, February.
    5. Anja Schwalm & You-Shan Feng & Jörn Moock & Thomas Kohlmann, 2015. "Differences in EQ-5D-3L health state valuations among patients with musculoskeletal diseases, health care professionals and healthy volunteers," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(8), pages 865-877, November.
    6. William Hollingworth & Richard A. Deyo & Sean D. Sullivan & Scott S. Emerson & Darryl T. Gray & Jeffrey G. Jarvik, 2002. "The practicality and validity of directly elicited and SF‐36 derived health state preferences in patients with low back pain," Health Economics, John Wiley & Sons, Ltd., vol. 11(1), pages 71-85, January.
    7. Joseph T. King Jr & Joel Tsevat & Mark S. Roberts, 2009. "Impact of the Scale Upper Anchor on Health State Preferences," Medical Decision Making, , vol. 29(2), pages 257-266, March.
    8. Peasgood, T & Ward, S & Brazier, J, 2010. "A review and meta-analysis of health state utility values in breast cancer," MPRA Paper 29950, University Library of Munich, Germany.

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