Valuing health related quality of life in Heart Failure: A systematic review of methods to derive quality-adjusted life years (QALYs) in trial-based cost-utility analyses

The accurate measurement of health-related quality of life (HRQoL) and the value of improving it for patients is essential for deriving quality-adjusted life years (QALYs) to inform treatment choice and resource allocation. The objective of this review was to identify and describe the approaches used to measure and value change in HRQoL in trial-based economic evaluations of heart failure interventions which derive QALYs as an outcome. Three databases (PubMed, CINAHL, Cochrane) were systematically searched. Twenty studies reporting economic evaluations based on 18 individual trials were identified. Most studies (n=17) utilised generic preference-based measures to describe HRQoL and derive QALYs, commonly the EQ-5D-3L. Of these, 3 studies (from the same trial) also used mapping from a condition-specific to a generic measure. The remaining 3 studies used patients’ direct valuation of their own health or physician-reported outcomes to derive QALYs. Only 7 of the 20 studies reported significant incremental QALY gains. Most interventions were reported as being likely to be cost-effective at specified willingness to pay thresholds. The substantial variation in the approach applied to derive QALYs in the measurement of and value attributed to HRQoL in heart failure requires further investigation as to the impact of this methodological variation on the QALY estimates that are derived.