Evaluating the Use, Performance, and Acceptability of Utility Measurement Approaches in Geographic Atrophy: A Severe Vision Disorder

OBJECTIVES: Geographic atrophy (GA) is an advanced stage of dry age-related macular degeneration (AMD) which leads to progressive and irreversible vision loss and impairments in health-related quality of life (HRQL). While utility data are required for cost-utility analyses of treatments, evidence suggests that generic HRQL measures such as EQ-5D may be insensitive to visual impairment. This review aimed to explore utility measurement approaches in GA and how this was incorporated into modelling.

METHODS: Four searches were conducted to identify published utility data in GA or dry AMD, (subsequently expanded to include review articles also in wet AMD) (1), or in clinical trials (2), psychometric evidence for utility measures (and Visual Function Questionnaire-25 [VFQ-25]) in GA or dry AMD (3) and health technology assessment (HTA) appraisals in relevant vision disorders (4). Where applicable, records were screened against the review eligibility criteria. Data were extracted and summarized using a narrative synthesis.

RESULTS: Six studies in GA were identified, but only one reported de novo data from a HRQL measure (EQ-5D). This study showed no sensitivity to vision loss. Review articles in AMD (n=11) found some evidence to support sensitivity of EQ-5D and Health Utilities Index-3 (HUI-3). The clinical trial review identified one ongoing trial with no results reported. The psychometrics review found seven studies supporting the VFQ-25 in GA, and one small study using EQ-5D which reported no supportive data for use in GA. HTA appraisals (n=11) included utilities derived mostly using vignettes (which were often criticized) or the HUI-3 or EQ-5D.

CONCLUSIONS: New and better methods are needed for accurately measuring the impact of GA on HRQL to support economic evaluation. This review found that most evaluations cited poor quality evidence from research conducted twenty years ago.