Global Assessment of Health Utilities Associated with Pneumococcal Disease in Adults: Targeted Literature Reviews.

BACKGROUND: Pneumococcal disease can significantly reduce quality of life (QoL). Health utilities are commonly used to assess QoL burden and calculate quality-adjusted life years (QALYs), which are critical inputs in cost-utility analyses (CUAs) to evaluate the economic value of pneumococcal vaccines. OBJECTIVES: This study aimed to synthesize utility values used in CUAs of pneumococcal vaccines in adult populations in North America and Europe and to summarize global utility studies on pneumococcal disease and post-meningitis sequelae (PMS) in adults. METHODS: Two targeted literature reviews were conducted in June 2024 using MEDLINE to identify CUAs of pneumococcal vaccines and original studies on health utilities for pneumococcal disease and PMS in adults. References from existing literature reviews on QoL associated with pneumococcal disease and CUAs of pneumococcal vaccines were also screened to identify additional original utility studies. Health utility input values applied in the CUAs were summarized, and the original source studies were reviewed. Utility and disutility inputs were converted to QALY decrements using disease durations reported in the CUAs. Methods and utility estimates from original utility studies were summarized for each health state. RESULTS: Sixty-five CUAs focusing on adults in North America and Europe were identified. These CUAs frequently reported utility values and QALY decrements. The ranges of reported and derived QALY decrements were 0.006-0.8 for unspecified invasive pneumococcal disease (IPD), 0.0013-0.1759 for meningitis, 0.0010-0.1759 for non-meningitis IPD, 0.0002-0.13 for inpatient pneumonia, and 0.0001-0.0115 for outpatient pneumonia. The ranges of reported utility values for PMS were 0.319-0.83 for neurological deficits and 0.635-0.91 for hearing loss. Twenty-five original utility studies in adults were identified, published between 1993 and 2022. Utility estimates from these studies showed considerable variability, with ranges of - 0.330 to 0.39 for meningitis, - 0.331 to 0.93 for non-meningitis IPD, - 0.054 to 0.71 for inpatient pneumonia, 0.35-0.825 for outpatient pneumonia, 0.217-0.89 for neurological deficits, and 0.433-0.89 for hearing loss. This variability was primarily attributable to differences in case definitions, preference weights, and geographical locations. CONCLUSIONS: This review identified substantial QoL burden associated with pneumococcal disease and PMS in adults; however, considerable variability in utility estimates exists. Utility inputs in CUAs of pneumococcal vaccines in adults often rely upon assumptions, pediatric studies, or utilities from other diseases, and there is relatively little data on the health utilities of IPD and neurological deficits in adults. Given the importance of health utilities in economic evaluations, CUAs should carefully select utility values by considering methodological robustness, the representativeness of health states, and the time frame over which health utilities are assessed and evaluate alternative sources and assumptions in sensitivity analyses.

Duke Scholars

Author Matthew Kelly Pediatrics, Infectious Diseases