Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience. King's College London, London, United Kingdom; Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience. King's College London, London, United Kingdom.
Value Health. 2020 Sep;23(9):1256-1267. doi: 10.1016/j.jval.2020.05.014. Epub 2020 Aug 1.
Patient preferences are increasingly important in informing clinical and policy decisions. Health-state utility values (HSUVs) are quantitative measures of people's preferences over different health states. In schizophrenia, there is no clarity about HSUVs across the symptoms' severity spectrum. This meta-analysis aims to synthesize the literature on HSUVs in people with schizophrenia.
We searched Medline, PsycInfo, Embase, EconLit, The Cochrane Library, and specialized databases. The studies reporting HSUVs in people with schizophrenia were selected and pooled in a random-effects meta-analysis. The primary outcome was the mean HSUV obtained from participants.
A total of 54 studies involving 87 335 participants were included. The pooled estimate using direct elicitation was a mean HSUV of 0.79 (95% CI: 0.70-0.88) for mild symptomatic states, 0.69 (95% CI: 0.54-0.85) in moderate states, and 0.34 (95% CI: 0.13-0.56) in severe states. Studies using indirect techniques resulted in a pooled mean HSUV of 0.73 (95% CI: 0.67-0.78) applying the EuroQol 5-dimension, 0.66 (95% CI: 0.62-0.71) in the Short-Form 6-dimension, and 0.59 (95% CI: 0.57-0.61) using the Quality of Well-Being scale. All the estimates resulted in considerable heterogeneity, partially reduced by meta-regression.
Our findings suggest that the severity of psychotic symptoms has an important effect on HSUVs in schizophrenia, with values mirroring patients with disabling physical conditions such as cancer and stroke. Decision makers should be aware of these results when including people's preferences in trials, models, and policy decisions.
患者偏好在为临床和政策决策提供信息方面越来越重要。健康状态效用值（HSUV）是衡量人们对不同健康状态偏好的定量指标。在精神分裂症中，对于整个症状严重程度范围内的 HSUV 尚不清楚。本荟萃分析旨在综合精神分裂症患者 HSUV 的文献。
我们检索了 Medline、PsycInfo、Embase、EconLit、The Cochrane Library 和专业数据库。选择并汇总了报告精神分裂症患者 HSUV 的研究进行随机效应荟萃分析。主要结局指标为参与者的平均 HSUV。
共纳入 54 项研究，涉及 87335 名参与者。使用直接 elicitation 的汇总估计值为轻度症状状态的平均 HSUV 为 0.79（95% CI：0.70-0.88），中度状态为 0.69（95% CI：0.54-0.85），重度状态为 0.34（95% CI：0.13-0.56）。使用间接技术的研究得出的平均 HSUV 汇总值为应用 EuroQol 5 维度的 0.73（95% CI：0.67-0.78），应用 Short-Form 6 维度的 0.66（95% CI：0.62-0.71），应用健康状况量表的 0.59（95% CI：0.57-0.61）。所有估计值均存在较大的异质性，部分通过元回归得到了缓解。
我们的研究结果表明，精神症状的严重程度对精神分裂症患者的 HSUV 有重要影响，其价值反映了患有癌症和中风等致残性身体疾病的患者的情况。决策者在将人们的偏好纳入试验、模型和政策决策时应考虑到这些结果。
