Practical method for modeling utilities in concurrent health conditions
DOI:
https://doi.org/10.21115/JBES.v16.n3.p145-8Keywords:
cost-benefit analysis, concurrent symptoms, Markov chains, quality-adjusted life yearsAbstract
Objective: The Brazilian Methodological Guidelines on quality of life in economic analyses, published by the Brazilian Ministry of Health in January 2024, established, in contrast to recommendations from other international HTA agencies, that in cases of simultaneous health conditions, the minimum utility method should be prioritized to model quality-adjusted life years (QALY). The objective of this study was to explore a way to simplify the application of this method. Methods: A hypothetical Markov model was constructed considering individuals at risk for stroke and heart failure, with a lifetime horizon and a 5% discount rate. To simplify the use of the minimum utility methods, an adaptation of the transition matrix was proposed, allowing transitions only to health states with lower utility. Other traditional methods for combining health utilities, such as additive and multiplicative approaches, were compared to the minimum utility method. Results: The results showed that the minimum utility method generated a total of 5.053 QALY over the period, compared to 5.013 and 4.974 for the multiplicative and additive methods, respectively. Conclusions: The proposed solution of a simplified transition matrix, allowing transitions only to health states with lower utility, enabled the estimation of QALY using the minimum utility method more easily, aligning with the new Ministry of Health recommendations for addressing multiple simultaneous health conditions.
Downloads
References
Ara & Brazier, 2010. Populating an Economic Model with Health State Utility Values: Moving toward Better Practice. Value in Health. Volume 13 Number S 2010. Disponível em: https://www.valueinhealthjournal.com/article/S1098-3015(10)60090-3/pdf?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1098301510600903%3Fshowall%3Dtrue.
Dale W, Basu A, Elstein A, Meltzer D. Predicting utility ratings for joint health states from single health states in prostate cancer: empirical testing of 3 alternative Theories. MDM 2008;28:102– 12. Disponível em: https://journals.sagepub.com/doi/10.1177/0272989X07309639?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed.
Fu AZ, Kattan MW. Utilities should not be multiplied: evidence from the preference-based scores in the United States. Med Care 2008;46:984–90. Disponível em: https://journals.lww.com/lww-medicalcare/abstract/2008/09000/utilities_should_not_be_multiplied__evidence_from.14.aspx.
Ministério da Saúde 2014. Brasil. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Ciência e Tecnologia. Diretrizes metodológicas: Diretriz de Avaliação Econômica / Ministério da Saúde, Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Departamento de Ciência e Tecnologia. – 2. ed. – Brasília: Ministério da Saúde, 2014. Disponível em: https://www.gov.br/conitec/pt-br/midias/artigos_publicacoes/diretrizes/diretrizes_metodologicas_diretriz_avaliacao_economica.pdf/view.
Ministério da Saúde 2022. Brasil. Ministério da Saúde. Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde Departamento de Gestão e Incorporação de Tecnologias em Saúde: O uso de limiares de custo-efetividade nas decisões em saúde: recomendações da comissão nacional de incorporação de tecnologias no SUS. Disponível em: https://www.gov.br/conitec/pt-br/midias/artigos_publicacoes/20211202_relatorio_oficina_limiares.pdf.
Ministério da Saúde 2023. Brasil. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Ciência e Tecnologia. Diretrizes metodológicas: Diretrizes Metodológicas: Qualidade de Vida em Análises Econômicas/ Ministério da Saúde, Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Departamento de Ciência e Tecnologia. – 2. ed. – Brasília: Ministério da Saúde, 2023. Disponível em: https://rebrats.saude.gov.br/images/Documentos/2024/Diretrizes_Metodologicas_Qualidade_de_Vida_em_Analises_Economicas.pdf.
Santos et al., 2021. EQ-5D Brazilian population norms. Marisa Santos, Andrea L. Monteiro e Bráulio Santos. Health Qual Life Outcomes, 2021, 19:162. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190837/.
