Synthesized estimates of health-related quality of life in post-acute coronary syndrome ranged from 0.64 to 0.92, and in stable angina from 0.64 to 0.89, with large between-study heterogeneity.
Meta-Analysis (n=30,575)
What are the synthesized instrument-specific preference-based quality of life values in patients with coronary heart disease?
There is large heterogeneity in preference-based HRQoL values for CHD depending on the instrument used, which should be accounted for in cost-utility analyses.
BACKGROUND: There are numerous health-related quality of life (HRQol) measurements used in coronary heart disease (CHD) in the literature. However, only values assessed with preference-based instruments can be directly applied in a cost-utility analysis (CUA). OBJECTIVE: To summarize and synthesize instrument-specific preference-based values in CHD and the underlying disease-subgroups, stable angina and post-acute coronary syndrome (post-ACS), for developed countries, while accounting for study-level characteristics, and within- and between-study correlation. METHODS: A systematic review was conducted to identify studies reporting preference-based values in CHD. A multivariate meta-analysis was applied to synthesize the HRQoL values. Meta-regression analyses examined the effect of study level covariates age, publication year, prevalence of diabetes and gender. RESULTS: A total of 40 studies providing preference-based values were detected. Synthesized estimates of HRQoL in post-ACS ranged from 0.64 (Quality of Well-Being) to 0.92 (EuroQol European"tariff"), while in stable angina they ranged from 0.64 (Short form 6D) to 0.89 (Standard Gamble). Similar findings were observed in estimates applying to general CHD. No significant improvement in model fit was found after adjusting for study-level covariates. Large between-study heterogeneity was observed in all the models investigated. CONCLUSIONS: The main finding of our study is the presence of large heterogeneity both within and between instrument-specific HRQoL values. Current economic models in CHD ignore this between-study heterogeneity. Multivariate meta-analysis can quantify this heterogeneity and offers the means for uncertainty around HRQoL values to be translated to uncertainty in CUAs.
Stevanović et al. (Thu,) conducted a meta-analysis in Coronary heart disease (stable angina and post-acute coronary syndrome) (n=30,575). Preference-based quality of life instruments was evaluated on Synthesized estimates of preference-based HRQoL values. Synthesized estimates of health-related quality of life in post-acute coronary syndrome ranged from 0.64 to 0.92, and in stable angina from 0.64 to 0.89, with large between-study heterogeneity.