EQ-5D Utilities for Patients With Nonalcoholic Steatohepatitis (NASH): A Comparison of Historical Utilities to a Recent Real-World Multi-Country Patient Survey

OBJECTIVES: To describe EQ-5D utilities previously reported in the literature and compare them to real-world EQ-5D utilities for NASH patients from a multi-country patient survey.

METHODS: A structured literature review (SLR) of EQ-5D utilities in NASH patients was conducted. Mean EQ-5D utilities from these studies were compared to data from the Adelphi NASH Disease Specific Programme (DSP)™, a real-world, cross-sectional survey of patients with NASH in France, Germany, Italy, Spain, UK, and USA conducted in Q1 2018 and Q1 2019, respectively. After applying matched inclusion/exclusion criteria to the DSP population, matching-adjusted indirect comparison analysis was used to balance DSP data with each of the SLR studies on age, sex, comorbidities, and fibrosis stage. EQ-5D utilities were compared using t-tests. Analysis was repeated using relevant country-specific EQ-5D scoring tariffs.

RESULTS: Ten studies with varied recruitment criteria, patient demographics and clinical characteristics were identified in the SLR. Reported mean (SD) utilities ranged from 0.67 (SD not reported) to 0.83 (0.14). Utilities from studies requiring biopsy-confirmed NASH diagnosis ranged from 0.70 (SD not reported) to 0.83 (0.14). Utilities from studies not requiring biopsy-confirmed diagnosis ranged from 0.67 (SD not reported) to 0.83 (0.21). In balanced comparisons, DSP mean utilities ranged from 0.63 (0.18) to 0.91 (0.14) and were often higher or lower (p<0.05) than corresponding SLR utilities. The statistical significance and difference range (from -0.20 to 0.19) were sometimes dependent on the country-specific scoring tariff.

CONCLUSIONS: There is a range of utilities reported both in the literature and balanced DSP data. These differences may be due to inclusion/exclusion criteria, sampling methodology or the country-specific EQ-5D tariff. Therefore, these factors warrant consideration when making cost-effectiveness decisions based on estimated EQ-5D utilities, highlighting the importance of country-specific EQ-5D tariffs and of conducting sensitivity analysis.