OBJECTIVES: Cost-utility analyses for secondary cardiovascular prevention require health state utility values in order to calculate quality-adjusted life-years (QALYs) for each health state. This review aimed to identify and describe the utility values associated with unspecified/unstable angina and revascularisation reported in the available literature.

METHODS: An SLR was conducted to identify English publications in Embase^®, MEDLINE^® and the grey literature published in the last 10 years (2008-2017). Two reviewers independently conducted the screening, data abstraction, and the quality assessment with a third reviewer consulted in case of any discrepancies. All types of original research studies reporting utilities data associated with angina/revascularisation were included. Studies providing utility values only for stable angina were excluded.

RESULTS: Twenty-seven studies (sample size: 49 to 18,017) met the inclusion criteria (revascularisation: 17 studies; angina: 10 studies). Majority of them used EQ-5D assessment method (N=22; revascularisation: 16; angina: 6) and were conducted in Europe (N=12; revascularisation: 9; angina: 3) and North America (N=6; revascularisation: 3; angina: 3). In general, utility values as per type of revascularisation (either percutaneous coronary intervention [PCI] or coronary artery bypass graft [CABG]) did not show significant differences, particularly within same studies. However, the mean values widely varied across the included studies (overall [N=17]: 0.33-0.90; PCI [N=10]: 0.33-0.86; CABG [N=9]: 0.69-0.90). Majority of the studies reported improvement in utility values over time (6/8 studies). Utility values for angina, irrespective of geographical location, ranged from 0.51 to 0.81 (EQ-5D [N=6]: 0.51-0.81; SF-6D [N=2]: 0.62-0.78; other scales [N=2]: 0.66-0.74). Severity of angina was associated with lower utility values.

CONCLUSIONS: Overall, angina and revascularisation have a negative impact on the reported health utilities. Careful interpretation of published values is advised, given the heterogeneity of methodologies, patient populations and timing of utilities assessment reported in the available literature. Nevertheless, our results can be a valuable resource for future cost-utility analyses.