title: Health-state utilities in liver disease: a systematic review.
abstract: OBJECTIVE
  Health-state utilities are essential for cost-utility analysis. Few estimates exist for liver disease in the literature. The authors' aim was to conduct a systematic review of health-state utilities in liver disease, to look at the variation of study designs used, and to pool utilities for some liver disease states.
  
  
  METHODS
  A search of MED-LINE, EMBASE, and CINAHL from 1966 to September 2006 was conducted including key words related to liver disease and utility measuring tools. Articles were included if health-state utility tools or expert opinion were used. Variance-weighted mean utility estimates were pooled using metaregression adjusting for disease state and utility assessment method.
  
  
  RESULTS
  Thirty studies measured utilities of liver diseases/disease states. Half of these estimated utilities for hepatitis viruses: hepatitis A (n = 1), hepatitis B (n = 4), and hepatitis C (n = 10). Others included liver transplant (n= 6) and chronic liver disease (n= 5) populations. Twelve utility methods were used throughout. The EQ-5D (n = 10) was most popular method, followed by visual analogue scale (n = 9), time tradeoff (n = 6), and standard gamble (n = 4). Respondents were patients (n= 16), an expert panel (n = 10), non-liver diseases adults ( n=2), patient and expert (n = 1), and patient and healthy adult (n = 1). Type of perspective included community (n=21), patient (n=4), and both (n = 5). The pooled mean estimates in hepatitis C with moderate disease, compensated cirrhosis, decompensated cirrhosis, and post-liver transplant using the EQ-5D were 0.75, 0.75, 0.67, and 0.71, respectively. The change in these utilities using different methods were -0.07 (visual analogue scale), -0.01 (health utilities index version 3), +0.04 (standard gamble), + 0.08 (health utilities index version 2), + 0.12 (time tradeoff), and + 0.15 (standard gamble-transformed visual analogue scale).
  
  
  CONCLUSIONS
  The authors have created a valuable liver disease- based utility resource from which researchers and policy makers can easily view all available utility estimates from the literature. They have also estimated health-state utilities for major states of hepatitis C.
authors.affiliation: Tayside Centre for General Practice, Health Informatics Centre, University of Aberdeen, Scotland, UK. d.mclernon@abdn.ac.uk
authors.forename: David J
authors.initials: DJ
authors.lastname: McLernon
authors.forename: John
authors.initials: J
authors.lastname: Dillon
authors.forename: Peter T
authors.initials: PT
authors.lastname: Donnan
mesh_terms: D003362:Cost-Benefit Analysis; D006305:Health Status Indicators; D006525:Hepatitis, Viral, Human; D006801:Humans; D008107:Liver Diseases / Q000191:economics; D011788:Quality of Life