title: Multivariate Meta-Analysis of Preference-Based Quality of Life Values in Coronary Heart Disease.
abstract: BACKGROUND
  There are numerous health-related quality of life (HRQol) measurements used in coronary heart disease (CHD) in the literature. However, only values assessed with preference-based instruments can be directly applied in a cost-utility analysis (CUA).
  
  
  OBJECTIVE
  To summarize and synthesize instrument-specific preference-based values in CHD and the underlying disease-subgroups, stable angina and post-acute coronary syndrome (post-ACS), for developed countries, while accounting for study-level characteristics, and within- and between-study correlation.
  
  
  METHODS
  A systematic review was conducted to identify studies reporting preference-based values in CHD. A multivariate meta-analysis was applied to synthesize the HRQoL values. Meta-regression analyses examined the effect of study level covariates age, publication year, prevalence of diabetes and gender.
  
  
  RESULTS
  A total of 40 studies providing preference-based values were detected. Synthesized estimates of HRQoL in post-ACS ranged from 0.64 (Quality of Well-Being) to 0.92 (EuroQol European"tariff"), while in stable angina they ranged from 0.64 (Short form 6D) to 0.89 (Standard Gamble). Similar findings were observed in estimates applying to general CHD. No significant improvement in model fit was found after adjusting for study-level covariates. Large between-study heterogeneity was observed in all the models investigated.
  
  
  CONCLUSIONS
  The main finding of our study is the presence of large heterogeneity both within and between instrument-specific HRQoL values. Current economic models in CHD ignore this between-study heterogeneity. Multivariate meta-analysis can quantify this heterogeneity and offers the means for uncertainty around HRQoL values to be translated to uncertainty in CUAs.
authors.affiliation: University of Groningen, Department of Pharmacy, Unit of Pharmacoepidemiology and Pharmacoeconomics (PE2), Groningen, The Netherlands.
authors.forename: Jelena
authors.initials: J
authors.lastname: Stevanović
authors.affiliation: Toronto Health Economics and Technology Assessment (THETA), Toronto, Canada.|University of Toronto, Faculty of Medicine, Institute of Health Policy, Management and Evaluation, Toronto, Canada.
authors.forename: Petros
authors.initials: P
authors.lastname: Pechlivanoglou
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Cardiology, Thorax Center, Groningen, The Netherlands.
authors.forename: Marthe A
authors.initials: MA
authors.lastname: Kampinga
authors.affiliation: University of Groningen, University Medical Centre Groningen, Department of Epidemiology, Groningen, The Netherlands.
authors.forename: Paul F M
authors.initials: PF
authors.lastname: Krabbe
authors.affiliation: University of Groningen, Department of Pharmacy, Unit of Pharmacoepidemiology and Pharmacoeconomics (PE2), Groningen, The Netherlands.
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Postma
mesh_terms: D054058:Acute Coronary Syndrome / Q000523:psychology / Q000628:therapy; D000368:Aged; D000787:Angina Pectoris / Q000523:psychology / Q000628:therapy; D002755:Choice Behavior; D003327:Coronary Disease / Q000191:economics / Q000523:psychology* / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D015999:Multivariate Analysis; D057240:Patient Preference; D011594:Psychometrics; D011788:Quality of Life; D012044:Regression Analysis; D011795:Surveys and Questionnaires