Utility estimates for decision-analytic modeling in chronic heart failure--health states based on New York Heart Association classes and number of rehospitalizations.
OBJECTIVE
For economic evaluations of chronic heart failure (CHF) management strategies, utilities are not currently available for disease proxies commonly used in Markov models. Our objective was to estimate utilities for New York Heart Association (NYHA) classification and number of cardiovascular rehospitalizations.


METHODS
EuroQol 5D data from the Eplerenone Post-acute Myocardial Infarction Heart Failure Efficacy and Survival Study trial were used to estimate utilities as a function of NYHA classification and number of cardiovascular rehospitalizations.


RESULTS
In multivariate regression analyses adjusted for age (60 years), female sex and absence of further comorbidities, utilities for NYHA classes I-IV were 0.90, 0.83, 0.74, and 0.60 (P-value < 0.001 for trend). For cardiovascular rehospitalizations 0, 1, 2 and >or=3, the associated utilities were 0.88, 0.85, 0.84, and 0.82 (P-value < 0.001 for trend).


CONCLUSIONS
NYHA class and number of cardiovascular rehospitalizations are established proxies for CHF progression and can be linked to utilities when used as health states in a Markov model. NYHA class should be used when feasible.
Göhler
Alexander
A
Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. alex@mgh-ita.org
Geisler
Benjamin P
BP
Manne
Jennifer M
JM
Kosiborod
Mikhail
M
Zhang
Zefeng
Z
Weintraub
William S
WS
Spertus
John A
JA
Gazelle
G Scott
GS
Siebert
Uwe
U
Cohen
David J
DJ
D000368:Aged; D003661:Decision Support Techniques; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000517:prevention & control*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011788:Quality of Life; D055502:Secondary Prevention; D012720:Severity of Illness Index