Estimating utility values for non-alcoholic steatohepatitis health states: a discrete choice experiment
Publication: Journal of Comparative Effectiveness Research
Abstract
Background: This study estimated utility values for non-alcoholic steatohepatitis (NASH). Previous studies have assumed that health-related quality of life does not vary between the early stages of NASH. Materials & Methods: Discrete choice experiment (DCE) surveys estimated the value of avoiding fibrosis progression. Patients also completed the EQ-5D-5L. Marginal rates of substitution estimated utility change associated with fibrosis progression. Results: DCE surveys were completed by the UK general public (n = 520) and patients with NASH (n = 154). The utility decline between fibrosis stages F1 and F4 decompensated was between -0.521 to -0.646 (depending on method). Conclusion: Three methods were used to estimate utilities for NASH, each one showed sensitivity to advancing fibrosis, including in the early stages, which is often considered asymptomatic.
Tweetable abstract
Preventing worsening in liver fibrosis can produce net gains in health and quality of life. This new research explores methods for valuing these gains in health
Plain language summary
What is this article about?
Nonalcoholic steatohepatitis (NASH) is a form of nonalcoholic fatty liver disease (NAFLD). In addition to excessive fat in the liver, NASH also includes liver inflammation and damage. Over time, NASH can cause permanent liver damage. As the condition worsens, it can have a more severe impact on patients' health-related quality of life. However, few studies have explored the impact of NASH on patients at different stages of the condition, particularly in the early stages. This study explored the impact of NASH on health-related quality of life at different disease stages.
What were the results?
Patients with NASH experience significant impacts on health-related quality of life, which becomes progressively worse as the condition worsens, even in the early stages of disease.
What do the results of the study mean?
The results show the importance patients with NASH and the public place on avoiding worsening NASH and the potential benefits of preventing worsening NASH. These results could also be used to estimate the cost-effectiveness of new NASH treatments.
Supplementary Material
File (appendix.docx)
- Download
- 855.05 KB
References
Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
Chalasani N, Younossi Z, Lavine JE et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology 55(6), 2005–2023 (2012).
• Information on the natural history of non-alcoholic steatohepatitis (NASH) as well as diagnosis and management guidelines.
2.
Younossi ZM, Loomba R, Anstee QM et al. Diagnostic modalities for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and associated fibrosis. Hepatology 68(1), 349–360 (2018).
3.
Garcia-Tsao G, Friedman S, Iredale J, Pinzani M. Now there are many (stages) where before there was one: in search of a pathophysiological classification of cirrhosis. Hepatology 51(4), 1445 (2010).
4.
Corte CD, Ferrari F, Villani A, Nobili V. Epidemiology and Natural History of NAFLD. J. Med. Biochem. 34(1), 13 (2015).
5.
Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 64(1), 73–84 (2016).
• A literature review of the global prevalence of nonalcoholic fatty liver disease (NAFLD) and NASH.
6.
Geier A, Rinella ME, Balp MM et al. Real-world burden of nonalcoholic steatohepatitis. Clin. Gastroenterol. Hepatol. 19(5), 1020–1029.e7 (2021).
• A cross-sectional survey examining resource use and burden of NASH indicated that the burden of NASH may be underestimated by previous studies.
7.
Sheka AC, Adeyi O, Thompson J, Hameed B, Crawford PA, Ikramuddin S. Nonalcoholic steatohepatitis: a review. JAMA 323(12), 1175–1183 (2020).
8.
Younossi ZM, Wong VWS, Anstee QM et al. Fatigue and pruritus in patients with advanced fibrosis due to nonalcoholic steatohepatitis: the impact on patient-reported outcomes. Hepatol. Commun. 4(11), 1637–1650 (2020).
9.
Kennedy-Martin T, Bae JP, Paczkowski R, Freeman E. Health-related quality of life burden of nonalcoholic steatohepatitis: a robust pragmatic literature review. J. Patient Rep. Outcomes. 2, 28 (2018).
• Literature review summarizing research on the health-related quality of life burden of NASH.
10.
Younossi ZM, Stepanova M, Anstee QM et al. Reduced patient-reported outcome scores associate with level of fibrosis in patients with nonalcoholic steatohepatitis. Clin. Gastroenterol. Hepatol. 17(12), 2552–2560.e10 (2019).
11.
O'Hara J, Finnegan A, Dhillon H et al. Cost of non-alcoholic steatohepatitis in Europe and the USA: The GAIN study. JHEP Rep. 2(5), 100142 (2020).
•• The study reports EQ-5D values for NASH patients (early: F0–F2 and advanced: F3–F4) from a multi-country study.
12.
Zhang E, Wartelle-Bladou C, Lepanto L, Lachaine J, Cloutier G, Tang A. Cost-utility analysis of nonalcoholic steatohepatitis screening. Eur. Radiol. 25(11), 3282–3294 (2015).
•• A cost-utility analysis evaluating NASH screening, using one utility value for patients in F1, F2 and F3.
13.
Herdman M, Gudex C, Lloyd A et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual. Life Res. 20(10), 1727–1736 (2011).
14.
Bansback N, Brazier J, Tsuchiya A, Anis A. Using a discrete choice experiment to estimate health state utility values. J. Health Econ. 31(1), 306–318 (2012).
15.
VERBI Software. MAXQDA 2020. (2019).
16.
Johnson FR, Lancsar E, Marshall D et al. Constructing experimental designs for discrete-choice experiments: report of the ISPOR Conjoint Analysis Experimental Design Good Research Practices Task Force. Value Health. 16(1), 3–13 (2013).
17.
Bridges JFP, Hauber AB, Marshall D et al. Conjoint analysis applications in health–a checklist: a report of the ISPOR Good Research Practices for Conjoint Analysis Task Force. Value Health. 14(4), 403–413 (2011).
18.
Anstee QM, Neuschwander-Tetri BA, Wong VWS et al. Cenicriviroc for the treatment of liver fibrosis in adults with nonalcoholic steatohepatitis: AURORA Phase 3 study design. Contemp. Clin. Trials. 89, 105922 (2020).
19.
OCALIVA 5 mg film-coated tablets – Summary of Product Characteristics (SmPC) - (emc). https://www.medicines.org.uk/emc/product/2561/smpc
20.
Nonalcoholic Fatty Liver Disease & NASH. NIDDK, https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash
21.
Aggio D, Gallop K, Wittrup-Jensen V, Farsani S, Acaster S. ISPOR – A Qualitative Study of the Symptoms and Health-Related Quality of Life Impact Experienced by Patients Diagnosed with NASH (Non-Alcoholic Steatohepatitis). https://www.ispor.org/heor-resources/presentations-database/presentation/euro2021-3408/113771
22.
ChoiceMetrics. Ngene 1.2 USER MANUAL & REFERENCE GUIDE The Cutting Edge in Experimental Design.
23.
Doward LC, Balp MM, Twiss J et al. Development of a patient-reported outcome measure for non-alcoholic steatohepatitis (NASH-CHECK): results of a qualitative study. Patient. 14(5), 533 (2021).
24.
Lo SH, Sharma R, Costentin CE et al. Patient preferences for advanced hepatocellular carcinoma treatment: a multicountry stated preference study. Future Oncol. 17(32), 4275–4287 (2021).
25.
Williams K, Aggio D, Chen P, Anokhina K, Lloyd AJ, Wang Y. Utility values associated with atypical hemolytic uremic syndrome-related attributes: a discrete choice experiment in five countries. Pharmacoeconomics 39(8), 901–912 (2021).
26.
Marshall D, Bridges JFP, Hauber B et al. Conjoint analysis applications in health – how are studies being designed and reported?: an update on current practice in the published literature between 2005 and 2008. Patient. 3(4), 249–256 (2010).
27.
Van Hout B, Janssen MF, Feng Y et al. Interim scoring for the EQ-5D-5L: Mapping the EQ-5D-5L to EQ-5D-3L value sets. Value Health. 15(5), 708–715 (2012).
28.
Pickard AS, Law EH, Jiang R et al. United States valuation of EQ-5D-5L health states using an international protocol. Value Health. 22(8), 931–941 (2019).
29.
Hole AR. Fitting mixed logit models by using maximum simulated likelihood. Stata J. 7(3), 388–401 (2007).
30.
National life tables, UK – Office for National Statistics. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/bulletins/nationallifetablesunitedkingdom/2014to2016
31.
2011 Census data - Office for National Statistics. https://www.ons.gov.uk/census/2011census/2011censusdata
32.
Adult Health in Great Britain, 2013 - Office for National Statistics. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/compendium/opinionsandlifestylesurvey/2015-03-19/adulthealthingreatbritain2013
33.
David K, Kowdley KV, Unalp A et al. Quality of life in adults with nonalcoholic fatty liver disease: baseline data from the nonalcoholic steatohepatitis clinical research network. Hepatology 49(6), 1904–1912 (2009).
Information & Authors
Information
Published In
Copyright
© 2024 Boehringer Ingelheim GmbH. This work is licensed under the Creative Commons Attribution 4.0 License
History
Received: 22 March 2023
Accepted: 12 December 2023
Published online: 16 January 2024
Keywords:
Topics
Authors
Metrics & Citations
Metrics
Article Usage
Article usage data only available from February 2023. Historical article usage data, showing the number of article downloads, is available upon request.
Citations
How to Cite
Estimating utility values for non-alcoholic steatohepatitis health states: a discrete choice experiment. (2024) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2023-0033
Export citation
Select the citation format you wish to export for this article or chapter.
Citing Literature
- Andrew H Briggs, Ziyi Lin, Daniel Aggio, Villum Wittrup-Jensen, Salvador Augustin, John Schneider, Andrew Lloyd, Understanding the Humanistic Burden of Metabolic Dysfunction-Associated Steatohepatitis Liver Disease in the US Population: Age/Sex Stratified Analysis of Morbidity and Mortality, PharmacoEconomics - Open, 10.1007/s41669-025-00635-6, (2026).
- Xinran Liu, Chang Luo, Shitong Xie, Jing Wu, Health Utility Decrement of Injection Treatment-Related Attributes Using Time Trade-Off Among Type 2 Diabetes Patients: A Vignette-Based Study, PharmacoEconomics - Open, 10.1007/s41669-025-00615-w, 10, 1, (167-178), (2025).
- Aurora Barberá, Trenton M. White, Anish K. Arora, Linda Henry, Jeffrey V. Lazarus, Zobair M. Younossi, Patient-Reported Outcomes in Metabolic Dysfunction-Associated Steatotic Liver Disease, Seminars in Liver Disease, 10.1055/a-2435-2091, 45, 02, (210-220), (2024).
