Delta Hat Limited, Nottingham, England, UK; Department of Statistical Science, University College London, London, England, UK.
Value Health. 2023 Sep;26(9):1389-1397. doi: 10.1016/j.jval.2023.04.012. Epub 2023 May 13.
Health-state utility values (HSUVs) directly affect estimates of Quality-Adjusted Life-Years and thus the cost-utility estimates. In practice a single preferred value (SPV) is often selected for HSUVs, despite meta-analysis being an option when multiple (credible) HSUVs are available. Nevertheless, the SPV approach is often reasonable because meta-analysis implicitly considers all HSUVs as equally relevant. This article presents a method for the incorporation of weights to HSUV synthesis, allowing more relevant studies to have greater influence.
Using 4 case studies in lung cancer, hemodialysis, compensated liver cirrhosis, and diabetic retinopathy blindness, a Bayesian Power Prior (BPP) approach is used to incorporate beliefs on study applicability, reflecting the authors' perceived suitability for UK decision making. Older studies, non-UK value sets, and vignette studies are thus downweighted (but not disregarded). BPP HSUV estimates were compared with a SPV, random effects meta-analysis, and fixed effects meta-analysis. Sensitivity analyses were conducted iteratively updating the case studies, using alternative weighting methods, and simulated data.
Across all case studies, SPVs did not accord with meta-analyzed values, and fixed effects meta-analysis produced unrealistically narrow CIs. Point estimates from random effects meta-analysis and BPP models were similar in the final models, although BPP reflected additional uncertainty as wider credible intervals, particularly when fewer studies were available. Differences in point estimates were seen in iterative updating, weighting approaches, and simulated data.
The concept of the BPP can be adapted for synthesizing HSUVs, incorporating expert opinion on relevance. Because of the downweighting of studies, the BPP reflected structural uncertainty as wider credible intervals, with all forms of synthesis showing meaningful differences compared with SPVs. These differences would have implications for both cost-utility point estimates and probabilistic analyses.
健康状态效用值（HSUVs）直接影响质量调整生命年（QALY）的估计，从而影响成本效用的估计。在实践中，尽管在有多个（可信的）HSUVs 可用时可以进行荟萃分析，但通常会选择单一偏好值（SPV）。然而，SPV 方法通常是合理的，因为荟萃分析隐含地认为所有 HSUVs 都同样相关。本文提出了一种将权重纳入 HSUV 综合的方法，使更相关的研究具有更大的影响力。
使用肺癌、血液透析、代偿性肝硬化和糖尿病视网膜病变失明的 4 个案例研究，使用贝叶斯功效先验（BPP）方法来纳入对研究适用性的信念，反映作者对英国决策的可接受性的看法。因此，较旧的研究、非英国价值集和情景研究被低估（但不是忽略）。BPP HSUV 估计与 SPV、随机效应荟萃分析和固定效应荟萃分析进行了比较。通过迭代更新案例研究、使用替代权重方法和模拟数据进行了敏感性分析。
在所有案例研究中，SPV 与荟萃分析值不一致，固定效应荟萃分析产生了不现实的狭窄置信区间。随机效应荟萃分析和 BPP 模型的点估计在最终模型中相似，尽管 BPP 反映了额外的不确定性，置信区间更宽，尤其是在可用的研究较少时。在迭代更新、权重方法和模拟数据中都观察到了点估计的差异。
BPP 的概念可以适用于综合 HSUVs，纳入对相关性的专家意见。由于对研究的低估，BPP 反映了结构不确定性，置信区间较宽，所有形式的综合都与 SPV 相比具有显著差异。这些差异将对成本效用点估计和概率分析产生影响。
