Quality of Life in Chronic Kidney Disease (CKD): Results from a Systematic Review of CKD Models for Type 2 Diabetes
Author(s)
Pöhlmann J1, Bergenheim K2, Garcia Sanchez JJ3, Rao N3, Pollock R4
1Covalence Research Ltd, London, LON, UK, 2AstraZeneca R&D, Mölndal, Sweden, 3AstraZeneca, Cambridge, UK, 4Covalence Research Ltd, London, UK
Presentation Documents
Advanced stages of chronic kidney disease (CKD), particularly end-stage kidney disease (ESKD), are associated with substantial reductions in quality of life, which need to be captured in models of CKD. In the present study, we reviewed health state utility (HSU) values used in CKD models in type 2 diabetes (T2D) and assessed their consistency.
METHODS :A systematic literature review was conducted in PubMed, Embase, and the Cochrane Library in March 2021 to identify computer simulation models of CKD progression in T2D populations. HSUs were extracted and expressed as decrements relative to model-specific baseline (i.e. CKD-free) HSUs.
RESULTS : The review identified 26 CKD models in T2D that reported 103 distinct HSUs. Most HSUs were obtained using EQ-5D (3L=31, 5L=3), followed by time trade-off (26), and Quality of Wellbeing Scale (8), while 30 HSUs were either assumption-based or could not be assigned to an instrument. CKD-free, baseline states were assumed to be perfect (HSU=1) or near-perfect (HSU=0.95) health in seven models, while the remainder used published HSUs. The mean utility across baseline states was 0.853 (SD 0.113). Mean utility decrements increased with CKD severity, from 0.032 (standard deviation [SD] 0.107) for microalbuminuria to 0.033 (SD 0.04) for microalbuminuria, and 0.249 (SD 0.128) for ESKD. Mean decrements associated with renal replacement therapy were 0.07 (SD 0.041) after transplant and 0.278 (SD 0.09) on dialysis. CONCLUSIONS :HSUs used for modeling CKD in T2D were consistent with patterns identified in the literature; while early disease was associated with small utility decrements, severe disease, particularly ESKD, was associated with substantial reductions. These findings were broadly aligned with expectations, but the variance around HSUs for CKD-free and early disease states was high given the substantial amount of modeled time that may be accrued in these states.
Conference/Value in Health Info
Value in Health, Volume 24, Issue 12, S2 (December 2021)
Code
POSC353
Topic
Methodological & Statistical Research, Patient-Centered Research
Topic Subcategory
Health State Utilities
Disease
Urinary/Kidney Disorders