Health utility values associated with pharmaceutical treatment process attributes: a systematic review and...

Area of Science:

• Pharmacoeconomics
• Health Economics
• Health-Related Quality of Life (HRQoL)

Background:

• Patient preferences for treatment process attributes (e.g., administration route, frequency, time) are crucial for adherence and HRQoL when clinical profiles are similar.
• Existing research on the utility impact of these attributes is heterogeneous and often confounded, hindering precise quantification of independent effects.
• Understanding these independent effects is vital for accurate pharmacoeconomic evaluations and patient-centered treatment decisions.

Purpose of the Study:

• To systematically review and deconstruct confounding biases in the assessment of treatment process attributes' impact on health utility.
• To isolate the independent effects of administration route, frequency, and duration on health utility values using multivariable meta-regression.
• To provide robust evidence for pharmacoeconomic evaluations by controlling for key confounders.

Main Methods:

• Systematic literature search following PRISMA guidelines across major databases (PubMed, Cochrane, Web of Science, EBSCO) up to December 2024.
• Inclusion of original research reporting health utility values (0-1 scale) associated with pharmaceutical treatment process attributes.
• Analysis of disutility values using random-effects models and construction of multivariable meta-regression models to control for disease type and respondent population.

Main Results:

• Nineteen studies with 81 utility values were included. The injectable route (vs. oral) significantly decreased utility (β = -0.092, p < 0.001).
• Administration durations exceeding 1 hour also significantly reduced utility (β = -0.172, p < 0.005). Disease severity was a major predictor, with neoplasms showing lower utility than metabolic conditions.
• An apparent 'frequency paradox' in unadjusted analysis was identified as a statistical artifact confounded by administration route; no independent effect of frequency remained.

Conclusions:

• Injectable administration and prolonged administration duration are significant independent drivers of health disutility.
• The perceived negative impact of dosing frequency is a confounding artifact of the administration route, not an independent effect.
• A holistic, multivariable approach is essential in pharmacoeconomic evaluations to avoid erroneous conclusions due to confounding bias.