Objectives: Patients with type-2 diabetes mellitus (T2DM) are at increased risk of stroke or myocardial infarction (MI) resulting in decrements in their health-related quality of life. A systematic literature review identified estimates of utility decrements for these events in patients with T2DM to better understand the impact of avoiding or delaying them with treatment.
Methods Electronic databases (2001-2011) and conference abstracts (2009-2011) in English were searched for utility-elicitation studies in T2DM and for cost-effectiveness analyses that included disutility estimates for stroke and MI.
Results: Nine utility-estimation studies using data from 11 countries were identified. Seven of these studies presented results adjusted for confounding variables including age and other comorbidities. Of those, two also adjusted for time since the event or event severity. Disutilities ranged from 0.035 to 0.129 for MI and from 0.044 to 0.269 for stroke. One study presented disutilities for an event experienced the previous year (MI, 0.081 - 0.129; stroke, 0.091 - 0.181) and >1 year ago (MI, 0.042 - 0.078; stroke, 0.069 - 0.269). The study presenting estimates by event severity adjusted for confounding variables had disutilities of 0.044 for stroke or transient ischemic attack without disability and 0.072 for stroke with residual disability. Of the 15 economic evaluations identified that included estimates of disutilities for MI and/or stroke, 12 used values from one of the utility-estimation studies described above. Two used disutilities from US studies in patients with any type of diabetes, and one used general population disutilities.
Conclusions The wide range of utility estimates for MI or stroke in T2DM patients could impact the results of cost-effectiveness analyses for new treatments that avoid or delay these events and calls for research to create consistent estimates, accounting for event severity and valuing event sequelae over time, such as poststroke disability.
