title: Acute and chronic impact of cardiovascular events on health state utilities.
abstract: BACKGROUND
  Cost-utility models are frequently used to compare treatments intended to prevent or delay the onset of cardiovascular events. Most published utilities represent post-event health states without incorporating the disutility of the event or reporting the time between the event and utility assessment. Therefore, this study estimated health state utilities representing cardiovascular conditions while distinguishing between acute impact including the cardiovascular event and the chronic post-event impact.
  
  
  METHODS
  Health states were drafted and refined based on literature review, clinician interviews, and a pilot study. Three cardiovascular conditions were described: stroke, acute coronary syndrome (ACS), and heart failure. One-year acute health states represented the event and its immediate impact, and post-event health states represented chronic impact. UK general population respondents valued the health states in time trade-off tasks with time horizons of one year for acute states and ten years for chronic states.
  
  
  RESULTS
  A total of 200 participants completed interviews (55% female; mean age = 46.6 y). Among acute health states, stroke had the lowest utility (0.33), followed by heart failure (0.60) and ACS (0.67). Utility scores for chronic health states followed the same pattern: stroke (0.52), heart failure (0.57), and ACS (0.82). For stroke and ACS, acute utilities were significantly lower than chronic post-event utilities (difference = 0.20 and 0.15, respectively; both p < 0.0001).
  
  
  CONCLUSIONS
  Results add to previously published utilities for cardiovascular events by distinguishing between chronic post-event health states and acute health states that include the event and its immediate impact. Findings suggest that acute versus chronic impact should be considered when selecting scores for use in cost-utility models. Thus, the current utilities provide a unique option that may be used to represent the acute and chronic impact of cardiovascular conditions in economic models comparing treatments that may delay or prevent the onset of cardiovascular events.
authors.affiliation: Outcomes Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, USA. Louis.matza@evidera.com.
authors.forename: Louis S
authors.initials: LS
authors.lastname: Matza
authors.affiliation: Outcomes Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, USA. Katie.devine@evidera.com.
authors.forename: Katie D
authors.initials: KD
authors.lastname: Stewart
authors.affiliation: Global Health Economics, Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA, USA. sgandra@amgen.com.
authors.forename: Shravanthi R
authors.initials: SR
authors.lastname: Gandra
authors.affiliation: Neurology Associates of Santa Barbara, 219 Nogales Avenue, Suite F, Santa Barbara, CA, USA. prdelio@me.com.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Delio
authors.affiliation: Division of Cardiology, National Jewish Health, 1400 Jackson Street, Denver, CO, USA. FensterB@NJHealth.org.
authors.forename: Brett E
authors.initials: BE
authors.lastname: Fenster
authors.affiliation: Outcomes Research, Evidera, Metro Building, 6th Floor, No. 1 Butterwick, London, UK. evan.davies@evidera.com.
authors.forename: Evan W
authors.initials: EW
authors.lastname: Davies
authors.affiliation: Outcomes Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, USA. Jessica.jordan@evidera.com.
authors.forename: Jessica B
authors.initials: JB
authors.lastname: Jordan
authors.affiliation: Global Health Economics, Amgen (Europe), Dammstrasse 23, P.O. Box 1557, CH-6301, Zug, Switzerland. mickaell@amgen.com.
authors.forename: Mickael
authors.initials: M
authors.lastname: Lothgren
authors.affiliation: Department of Economics, McMaster University, KTH 426, Hamilton, ON, Canada. dafeeny@telus.net.
authors.forename: David H
authors.initials: DH
authors.lastname: Feeny
mesh_terms: D054058:Acute Coronary Syndrome / Q000191:economics; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000191:economics; D006801:Humans; D007407:Interviews as Topic; D008131:London; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D010865:Pilot Projects; D036301:Qualitative Research; D011788:Quality of Life; D012606:Scotland; D020521:Stroke / Q000191:economics; D055815:Young Adult