Clinical variables impacting on the estimation of utilities in chronic obstructive pulmonary disease

Abstract

Marc Miravitlles,1,2 Alicia Huerta,3 Manuel Valle,4 Patricia García-Sidro,5 Carles Forné,6 Carlos Crespo,6,7 José Luis López-Campos2,8 1Pneumology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain; 2CIBER de Enfermedades Respiratorias (CIBERES); 3Market Access Department, GlaxoSmithKline, Tres Cantos, Madrid, Spain; 4Pneumology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; 5Pneumology Department, Hospital Universitario de la Plana, Vila-real, Castellón, Spain; 6Health Economics and Outcome Strategies Department, Oblikue Consulting, Barcelona, Spain; 7Statistics Department, University of Barcelona, Barcelona, Spain; 8Unidad Médico Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain Purpose: Health utilities are widely used in health economics as a measurement of an individual’s preference and show the value placed on different health states over a specific period. Thus, health utilities are used as a measure of the benefits of health interventions in terms of quality-adjusted life years. This study aimed to determine the demographic and clinical variables significantly associated with health utilities for chronic obstructive pulmonary disease (COPD) patients. Patients and methods: This was a multicenter, observational, cross-sectional study conducted between October 2012 and April 2013. Patients were aged ≥40 years, with spirometrically confirmed COPD. Utility values were derived from the preference-based generic questionnaire EQ-5D-3L applying weighted Spanish societal preferences. Demographic and clinical variables associated with utilities were assessed by univariate and multivariate linear regression models. Results: Three hundred and forty-six patients were included, of whom 85.5% were male. The mean age was 67.9 (standard deviation [SD] =9.7) years and the mean forced expiratory volume in 1 second (%) was 46.2% (SD =15.5%); 80.3% were former smokers, and the mean smoking history was 54.2 (SD =33.2) pack-years. Median utilities (interquartile range) were 0.81 (0.26) with a mean value of 0.73 (SD =0.29); 22% of patients had a utility value of 1 (ceiling effect) and 3.2% had a utility value lower than 0. The factors associated with utilities in the multivariate analysis were sex (beta =-0.084, 95% confidence interval [CI]: -0.154; -0.013 for females), number of exacerbations the previous year (-0.027, 95% CI: -0.044; -0.010), and modified Medical Research Council Dyspnea Scale (mMRC) score (-0.123 [95% CI: -0.185; -0.061], -0.231 [95% CI: -0.301; -0.161], and -0.559 [95% CI: -0.660; -0.458] for mMRC scores 2, 3, and 4 versus 1), all P<0.05. Conclusion: Multivariate analysis showed that female sex, frequent exacerbations, and an increased level of dyspnea were the main factors associated with reduced utility values in patients with COPD. Keywords: COPD, health utility, health-related quality of life, multivariate linear regression