title: Health state utilities associated with major clinical events in the context of secondary hyperparathyroidism and chronic kidney disease requiring dialysis.
abstract: BACKGROUND
  Patients with chronic kidney disease (CKD) and secondary hyperparathyroidism (SHPT) who require dialysis are at increased risk for cardiovascular events and bone fractures. To assist in economic evaluations, this study aimed to estimate the disutility of these events beyond the impact of CKD and SHPT.
  
  
  METHODS
  A basic one-year health state was developed describing CKD and SHPT requiring dialysis. Further health states added acute events (cardiovascular events, fractures, and surgical procedures) or chronic post-event effects. Acute health states described a year including an event, and chronic health states described a year subsequent to an event. General population participants in Canada completed time trade-off interviews from which utilities were derived. Pairwise comparisons were made between the basic state and event, and between comparable health states.
  
  
  RESULTS
  A total of 199 participants (54.8% female; mean age = 46.3 years) completed interviews. Each health state had ≥130 valuations. The mean (SD) utility of the basic health state was 0.60 (0.34). For acute events, mean utility differences versus the basic state were: myocardial infarction, -0.06; unstable angina, -0.05; peripheral vascular disease (PVD) with amputation, -0.33; PVD without amputation, -0.11; heart failure, -0.14; stroke, -0.30; hip fracture, -0.14; arm fracture, -0.04; parathyroidectomy, +0.02; kidney transplant, +0.06. Disutilities for chronic health states were: stable angina, -0.09; stroke, -0.27; PVD with amputation, -0.30; PVD without amputation, -0.12; heart failure, -0.14.
  
  
  CONCLUSIONS
  Cardiovascular events and fractures were associated with lower utility scores, suggesting a perceived decrease in quality of life beyond the impact of CKD and SHPT.
authors.affiliation: Outcomes Research, Evidera, W6 8DL, London, UK. evan.davies@evidera.com.
authors.forename: Evan W
authors.initials: EW
authors.lastname: Davies
authors.affiliation: Outcomes Research, Evidera, Bethesda, MD, USA. Louis.matza@evidera.com.
authors.forename: Louis S
authors.initials: LS
authors.lastname: Matza
authors.affiliation: Amgen (Europe) GmbH, Zug, Switzerland. gworth@amgen.com.
authors.forename: Gavin
authors.initials: G
authors.lastname: Worth
authors.affiliation: Department of Economics, McMaster University, Hamilton, ON, Canada. dafeeny@telus.net.
authors.forename: David H
authors.initials: DH
authors.lastname: Feeny
authors.affiliation: Outcomes Research, Evidera, Bethesda, MD, USA. Jacqueline.kostelec@evidera.com.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Kostelec
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, NS, Canada. steven.soroka@cdha.nshealth.ca.
authors.forename: Steven
authors.initials: S
authors.lastname: Soroka
authors.affiliation: Department of Nephrology, Humber River Hospital, Toronto, ON, Canada. dmendy@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Mendelssohn
authors.affiliation: Division of Nephrology, St. Michael's Hospital, Toronto, ON, Canada. phil.mcfarlane@utoronto.ca.
authors.forename: Philip
authors.initials: P
authors.lastname: McFarlane
authors.affiliation: Amgen, Inc, Thousand Oaks, CA, USA. vasilyb@amgen.com.
authors.forename: Vasily
authors.initials: V
authors.lastname: Belozeroff
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D050723:Fractures, Bone / Q000523:psychology; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000453:epidemiology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology; D011788:Quality of Life / Q000523:psychology*; D006435:Renal Dialysis / Q000523:psychology* / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000523:psychology*; D012307:Risk Factors; D020521:Stroke / Q000523:psychology