Health Utilities and Disutilities Associated With Complications of Type 1 Diabetes: A Systematic Review and...

Health economic models for type 1 diabetes (T1D) typically require utilities or disutilities associated with diabetes-related complications. We conducted a systematic review of studies reporting utilities and disutilities associated with T1D-related complications and assessed their methodological quality to identify a set of preferred disutilities.

We searched 6 databases from inception to 30 April 2024. Data were extracted on study design, participant characteristics, complications, utility measurement methods, and reported values. Study quality was assessed based on sample size, population representativeness, appropriateness of the value sets, and statistical methods. Preferred disutilities for economic evaluations were selected from higher-quality studies.

From the 14 122 records identified, 25 were included for data extraction. Most studies identified complications via self-reporting (n = 12) or clinical assessment (n = 9). Of 22 studies analyzing health utilities derived from multiattribute utility instruments, only 8 used value sets from the same countries as the study cohorts, and 14 did not report the value sets used. We derived disutilities for 66 complications/conditions. Fifteen studies used statistical models to estimate disutilities for 44 complications. Disutilities for several complications varied widely, eg, stroke (-0.470 to -0.015), end-stage renal disease (-0.340 to -0.021), and diabetic neuropathy (-0.358 to -0.045). Quality assessment yielded preferred disutilities for 26 complications.

This review provides a comprehensive database of utilities and disutilities for T1D complications and a recommended set of disutilities for economic evaluations. Because of methodological and patient heterogeneity, these values should be used cautiously, with careful alignment between modeled health states and source study characteristics.