HEALTH STATE UTILITIES BEFORE AND AFTER REVASCULARIZATION FOR ATHEROSCLEROTIC CARDIOVASCULAR DISEASE: A SYSTEMATIC LITERATURE REVIEW AND META-REGRESSION ANALYSIS
Author(s)
Kim Smolderen, PhD1, Vishal Bali, MS, PhD2, Lori Bash, PhD2, Thibaut Galvain, PhD3, Eric Druyts, MSc4, Andrew Frederickson, MS5, Robert Brett McQueen, BA, MA, PhD6.
1Yale School of Medicine, New Haven, CT, USA, 2Merck & Co., Inc., Rahway, NJ, USA, 3MSD Innovation & Development GmbH, Zurich, Switzerland, 4Pharmalytics Group, Vancouver, BC, Canada, 5Precision AQ, New York, NY, USA, 6University of Colorado Skaggs School of Pharmacy and Pharmaceutical Science, Aurora, CO, USA.
1Yale School of Medicine, New Haven, CT, USA, 2Merck & Co., Inc., Rahway, NJ, USA, 3MSD Innovation & Development GmbH, Zurich, Switzerland, 4Pharmalytics Group, Vancouver, BC, Canada, 5Precision AQ, New York, NY, USA, 6University of Colorado Skaggs School of Pharmacy and Pharmaceutical Science, Aurora, CO, USA.
OBJECTIVES: Revascularization is a key intervention to improve long-term outcomes in atherosclerotic cardiovascular disease (ASCVD), yet the experience of patients undergoing revascularization is not well understood. We aimed to synthesize EQ-5D-derived health state utilities before and after revascularization.
METHODS: A systematic literature review (SLR) was conducted using EMBASE, MEDLINE, CENTRAL, and EconLit (2004-2025) to identify studies reporting utilities in ASCVD; meta-analysis (MA) was conducted among studies reporting EQ-5D-derived utilities in adults undergoing revascularization. Variance-informed mean estimates were synthesized using random-effects MA by timepoint. Meta-regression (MR) modeled timepoint as a covariate with baseline (immediately before revascularization) as the reference. Follow-ups were grouped into 6- and 12-month (±1 month) timepoints. Subgroup analyses by geographic region (defined by the country-specific value set) were performed.
RESULTS: The SLR identified 8,753 abstracts and 375 included studies; 62 reported EQ-5D-derived utilities among adults undergoing coronary (n=43), peripheral (n=17), or carotid (n=2) revascularization. In coronary revascularization, pooled utilities were 0.767 (95% confidence interval: 0.742-0.792), 0.852 (0.820-0.884), and 0.835 (0.812-0.858) at baseline, 6- and 12-months. MR showed significant improvement over time (p<0.001), with increases vs baseline of +0.082 (0.034-0.130) and +0.081 (0.034-0.129) at 6- and 12-months. In peripheral revascularization, pooled utilities were 0.582 (0.484-0.680), 0.680 (0.536-0.823), and 0.652 (0.518-0.786) at baseline, 6- and 12-months. MR showed no significance. In carotid revascularization, a pooled estimate was only feasible at baseline: 0.778 (0.675-0.881). Regional subgroup analyses showed broadly similar pooled utilities across Europe, North America, and Asia.
CONCLUSIONS: EQ-5D utilities significantly improved after coronary revascularization and were numerically higher after peripheral revascularization. Utilities were numerically higher in coronary revascularization compared to peripheral revascularization. Findings suggest patient benefits may be better established for coronary procedures and further studies are needed for non-coronary procedures. The observed changes in pooled utilities may be broadly indicative of changes in patient-perceived health status over time.
METHODS: A systematic literature review (SLR) was conducted using EMBASE, MEDLINE, CENTRAL, and EconLit (2004-2025) to identify studies reporting utilities in ASCVD; meta-analysis (MA) was conducted among studies reporting EQ-5D-derived utilities in adults undergoing revascularization. Variance-informed mean estimates were synthesized using random-effects MA by timepoint. Meta-regression (MR) modeled timepoint as a covariate with baseline (immediately before revascularization) as the reference. Follow-ups were grouped into 6- and 12-month (±1 month) timepoints. Subgroup analyses by geographic region (defined by the country-specific value set) were performed.
RESULTS: The SLR identified 8,753 abstracts and 375 included studies; 62 reported EQ-5D-derived utilities among adults undergoing coronary (n=43), peripheral (n=17), or carotid (n=2) revascularization. In coronary revascularization, pooled utilities were 0.767 (95% confidence interval: 0.742-0.792), 0.852 (0.820-0.884), and 0.835 (0.812-0.858) at baseline, 6- and 12-months. MR showed significant improvement over time (p<0.001), with increases vs baseline of +0.082 (0.034-0.130) and +0.081 (0.034-0.129) at 6- and 12-months. In peripheral revascularization, pooled utilities were 0.582 (0.484-0.680), 0.680 (0.536-0.823), and 0.652 (0.518-0.786) at baseline, 6- and 12-months. MR showed no significance. In carotid revascularization, a pooled estimate was only feasible at baseline: 0.778 (0.675-0.881). Regional subgroup analyses showed broadly similar pooled utilities across Europe, North America, and Asia.
CONCLUSIONS: EQ-5D utilities significantly improved after coronary revascularization and were numerically higher after peripheral revascularization. Utilities were numerically higher in coronary revascularization compared to peripheral revascularization. Findings suggest patient benefits may be better established for coronary procedures and further studies are needed for non-coronary procedures. The observed changes in pooled utilities may be broadly indicative of changes in patient-perceived health status over time.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
PCR54
Topic
Patient-Centered Research, Study Approaches
Topic Subcategory
Patient-reported Outcomes & Quality of Life Outcomes
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)