An international compendium of health state utilities in people with HIV: a systematic review

Purpose

Measuring health-related quality of life across different health states for people with HIV (PWH) using direct or indirect preference-based values can inform decision-analytic models evaluating cost-effectiveness of different care strategies. This systematic literature review collates comprehensive international evidence on health state utility values (HSUVs) in PWH to inform economic modelling of antiretroviral therapies (ARTs).

Methods

This review aligns with PRISMA standards (PROSPERO: CRD42022346286). Searches from multiple sources (e.g. MEDLINE, EMBASE) identified HSUVs for PWH from 2000. We categorised HSUVs using ISPOR’s Task Force criteria from low (high bias risk) to high (low bias risk) quality, alongside National Institute for Health and Care Excellence (NICE) suitability grading from Grade 3 (did not meet necessary criteria) to 1 (no concerns). Tabular and narrative syntheses were undertaken.

Results

Overall, 53 studies from 22 countries were identified. Study sizes ranged from 32 to 4137 participants. HSUVs were from cross-sectional (n = 45) or longitudinal (n = 10) datasets, stratified by infection stage, CD4 count, viral load, and treatment status. EQ-5D three-level (n = 29) and five-level (n = 18) estimates were most common. Although 28 included studies were ‘high’ quality, most were Grade 3 for NICE suitability, mainly indicating that the HSUVs for these studies were not representative of a UK population. Extensive methodological and clinical heterogeneity precluded meta-analysis.

Conclusions

Greater clarity in treatment regimens, preference-weighting methods, and different HIV clinical stages could improve interpretation and applicability of HSUVs in economic models. Despite this, our compendium and taxonomy of HSUVs can inform ART economic modelling within relevant populations and different jurisdictions.