HEALTH STATE UTILITIES FOR CLINICAL EVENTS IN ATRIAL FIBRILLATION: A SYSTEMATIC REVIEW
Author(s)
Maria-Magdalena Balp, MASc, MD1, Shruthi Bethi, M.Pharm2, Rumjhum Agrawal, Sr., MPH, PharmD2, Simarjeet Kaur, Sr., PharmD2, Prashanth Kondaparthi, M.Pharm2, Siobhan Mairead Bourke, PhD3.
1Novartis Pharma AG, Basel, Switzerland, 2Novartis Healthcare Private Limited, Hyderabad, India, 3Novartis Ireland Ltd, Dublin, Ireland.
1Novartis Pharma AG, Basel, Switzerland, 2Novartis Healthcare Private Limited, Hyderabad, India, 3Novartis Ireland Ltd, Dublin, Ireland.
OBJECTIVES: Atrial fibrillation (AF) being associated with thromboembolic events requires anticoagulation, which may increase bleeding risk. Utility values for thromboembolic and bleeding events are key inputs in cost-effectiveness models. This systematic literature review identified and summarized utility and disutility values for prespecified AF-related clinical events.
METHODS: The review followed Cochrane Handbook methods. Embase, PubMed, and the Cochrane Library were searched from inception to September 2025. Eligible studies in adults with AF reported utility or disutility values for prespecified events, including stroke, bleeding, myocardial infarction (MI), systemic embolism, venous thromboembolism, and acute limb ischemia.
RESULTS: Five studies were included (sample sizes 57 to 10,706). Three reported utilities from direct elicitation methods, time trade-off (TTO) or standard gamble (SG), and two reported event-related disutilities using EQ-5D-3L or EQ-5D-5L. Stroke (n=3) and bleeding (n=2 utility studies; n=2 disutility studies) were the most frequently reported health states. Stroke-related utilities were 0.64 (SG) to 0.76 (TTO) for mild, 0.39 (TTO) for moderate, 0.11 (TTO) to 0.19 (SG) for severe stroke, 0.12 (TTO) for recurrent, 0.69 and 0.22 (SG) for minor and major neurological deficit, respectively. Bleeding-related utilities were 0.84 for major bleed, 0.67 and 0.49 for minor and major extracranial hemorrhage, respectively, and 0.17 for intracranial hemorrhage. Reported disutilities were −0.029 for major gastrointestinal and non-gastrointestinal bleeding, −0.010 for clinically relevant non-major bleeding, −0.016 for minor, and -0.031 for any bleeding. Only one study reported MI utility of 0.46, and no utilities reported for the other pre-specified events.
CONCLUSIONS: Few studies reported utilities for AF-related clinical events; definitions and methods varied substantially. Stroke severity was a major determinant of utility loss, and bleeding-related utilities differed by subtype and severity, with intracranial hemorrhage associated with the greatest loss. These findings suggest a need for alignment on stroke and bleeding definitions and robust event-specific utility evidence for all relevant clinical events.
METHODS: The review followed Cochrane Handbook methods. Embase, PubMed, and the Cochrane Library were searched from inception to September 2025. Eligible studies in adults with AF reported utility or disutility values for prespecified events, including stroke, bleeding, myocardial infarction (MI), systemic embolism, venous thromboembolism, and acute limb ischemia.
RESULTS: Five studies were included (sample sizes 57 to 10,706). Three reported utilities from direct elicitation methods, time trade-off (TTO) or standard gamble (SG), and two reported event-related disutilities using EQ-5D-3L or EQ-5D-5L. Stroke (n=3) and bleeding (n=2 utility studies; n=2 disutility studies) were the most frequently reported health states. Stroke-related utilities were 0.64 (SG) to 0.76 (TTO) for mild, 0.39 (TTO) for moderate, 0.11 (TTO) to 0.19 (SG) for severe stroke, 0.12 (TTO) for recurrent, 0.69 and 0.22 (SG) for minor and major neurological deficit, respectively. Bleeding-related utilities were 0.84 for major bleed, 0.67 and 0.49 for minor and major extracranial hemorrhage, respectively, and 0.17 for intracranial hemorrhage. Reported disutilities were −0.029 for major gastrointestinal and non-gastrointestinal bleeding, −0.010 for clinically relevant non-major bleeding, −0.016 for minor, and -0.031 for any bleeding. Only one study reported MI utility of 0.46, and no utilities reported for the other pre-specified events.
CONCLUSIONS: Few studies reported utilities for AF-related clinical events; definitions and methods varied substantially. Stroke severity was a major determinant of utility loss, and bleeding-related utilities differed by subtype and severity, with intracranial hemorrhage associated with the greatest loss. These findings suggest a need for alignment on stroke and bleeding definitions and robust event-specific utility evidence for all relevant clinical events.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE162
Topic
Economic Evaluation, Patient-Centered Research, Study Approaches
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)