Quality of life and time trade-off utility measures in patients with coronary artery disease. Cost-Effectiveness of the Diabetes Care Protocol, a Multifaceted Computerized Decision Support Diabetes Management Intervention That Reduces Cardiovascular Risk An Economic Evaluation of Four Work Site Based Cardiovascular Risk Factor Interventions A cardiovascular disease policy model that predicts life expectancy taking into account socioeconomic deprivation Cost-effectiveness of cardiac rehabilitation program delivery models in patients at varying cardiac risk, reason for referral, and sex Cardiovascular Risk Factor Screening Satisfaction in the Heart of New Ulm Project Learning and coping strategies versus standard education in cardiac rehabilitation: a cost-utility analysis alongside a randomised controlled trial Can Utility-Weighted Health-Related Quality-of-Life Estimates Capture Health Effects of Quality Improvement for Depression? Impact of personalized cardiovascular disease risk estimates on physical activity-a randomized controlled trial. Performance of the ASSIGN cardiovascular disease risk score on a UK cohort of patients from general practice Derivation of Utility Values from European Organization for Research and Treatment of Cancer Quality of Life-Core 30 Questionnaire Values in Lung Cancer Impact of cardiovascular counseling and screening in Hodgkin lymphoma survivors. Estimating Utility Values for Health States of Type 2 Diabetic Patients Using the EQ-5D (UKPDS 62) Patient utilities in fibromyalgia and the association with other outcome measures. Cost-effectiveness modelling of telehealth for patients with raised cardiovascular disease risk: evidence from a cohort simulation conducted alongside the Healthlines randomised controlled trial Impact of socioeconomic deprivation on screening for cardiovascular disease risk in a primary prevention population: a cross-sectional study Cost-utility estimates in depression: does the valuation method matter?
BACKGROUND Contemporary clinical trials commonly measure quality of life and medical costs to establish whether therapies are both effective and cost effective . Cost-effectiveness analysis , however , requires a measure of patient utility or preferences for various health states . Because utilities are not often measured directly , we sought to develop a method of translating st and ard quality -of-life scales into a patient utility measure . METHODS Five hundred fifty-three patients enrolled in the Bypass Angioplasty Revascularization Investigation Study of Economics and Quality of Life completed a battery of  quality -of-life measures  and a time trade-off utility assessment  an average of 7.3 years after r and om assignment . RESULTS The mean time trade-off score was 8.54 ( SD = 2.53 ) out of a maximum of 10 ; median score was 9.95 . The distribution of scores was skewed , with 12 % of patients at the highest possible score of 10 . Patients with recurrent angina had significantly lower time trade-off scores than patients without angina ( mean 7.03 vs 8.70 , P < .05 ) . Time trade-off scores were moderately correlated with each quality -of-life measure ( Spearman coefficients 0.38 - 0.52 ) . Time trade-off scores could be predicted by combinations of 4 ( r2 = 0.29 ) , 5 ( r2 = 0.31 ) , or 6 ( r2 = 0.32 ) variables . CONCLUSIONS Time trade-off utility scores can be inferred from commonly used quality -of-life measures . Angina significantly reduces patient utility scores OBJECTIVE The Diabetes Care Protocol ( DCP ) , a multifaceted computerized decision support diabetes management intervention , reduces cardiovascular risk of type 2 diabetic patients . We performed a cost-effectiveness analysis of DCP from a Dutch health care perspective . RESEARCH DESIGN AND METHODS A cluster r and omized trial provided data of DCP versus usual care . The 1-year follow-up patient data were extrapolated using a modified Dutch microsimulation diabetes model , computing individual lifetime health-related costs , and health effects . Incremental costs and effectiveness ( quality -adjusted life-years [ QALYs ] ) were estimated using multivariate generalized estimating equations to correct for practice -level clustering and confounding . Incremental cost-effectiveness ratios ( ICERs ) were calculated and cost-effectiveness acceptability curves were created . Stroke costs were calculated separately . Subgroup analyses examined patients with and without cardiovascular disease ( CVD+ or CVD− patients , respectively ) . RESULTS Excluding stroke  , DCP patients lived longer ( 0.14 life-years , P = NS ) , experienced more QALYs ( 0.037 , P = NS ) , and incurred higher total costs ( € 1,415 , P = NS ) , result ing in an ICER of € 38,243 per QALY gained . The likelihood of cost-effectiveness given a willingness-to-pay threshold of € 20,000 per QALY gained is 30 % . DCP had a more favorable effect on CVD+ patients ( ICER = € 14,814 ) than for CVD− patients ( ICER = € 121,285 ) . Coronary heart disease costs were reduced ( € −587 , P < 0.05 ) . CONCLUSIONS DCP  reduces cardiovascular risk , result ing in only a slight improvement in QALYs , lower CVD costs , but higher total costs , with a high cost-effectiveness ratio . Cost-effective care can be achieved by focusing on cardiovascular risk factors in type 2 diabetic patients with a history of CVD We used outcome data from a r and omized work site intervention trial to examine the cost-effectiveness of four cardiovascular disease ( CVD ) risk reduction programs : health risk assessment ( HRA ) , risk factor education ( RFE ) , behavioral counseling ( BC ) , and behavioral counseling plus incentives ( BCI ) . Composite CVD risk scores were derived from measures of serum total cholesterol , blood pressure , number of cigarettes smoked , body mass index , and aerobic capacity . The economic evaluation of the programs focused on the subset of costs most sensitive to the differences between the interventions , and a sensitivity analysis examined some of the relevant cost variations . At the 6-month follow-up ( i.e. , the " action " or initiation stage of lifestyle change ) , the RFE , BC , and BCI interventions produced a significant reduction in cardiovascular risk . Incremental analyses demonstrated RFE to be more cost-effective , but not as clinical ly effective as BC ; BC was more cost-effective than RFE when assessment costs were included , and BCI was judged to be the least cost-effective . At the 12-month follow-up ( i.e. , the " maintenance " stage of lifestyle of change ) , BC was the only program found to produce a significant reduction in CVD risk .  Individualized behavioral counseling was found to be a cost-effective strategy for the initiation and maintenance of CVD risk factor reduction Objectives A policy model is a model that can evaluate the effectiveness and cost-effectiveness of interventions and inform policy decisions . In this study , we introduce a cardiovascular disease ( CVD ) policy model which can be used to model remaining life expectancy including a measure of socioeconomic deprivation as an independent risk factor for CVD . Design A state transition model was developed using the Scottish Heart Health Extended Cohort ( SHHEC ) linked to Scottish morbidity and death records . Individuals start in a CVD-free state and can transit to three CVD event states plus a non-CVD death state . Individuals who have a non-fatal first event are then followed up until death . Taking a competing risk approach , the cause-specific hazards of a first event are modelled using parametric survival analysis . Survival following a first non-fatal event is also modelled parametrically . We assessed discrimination , validation and calibration of our model . Results Our model achieved a good level of discrimination in each component ( c-statistics for men (women)—non-fatal coronary heart disease ( CHD ) : 0.70 ( 0.74 ) , non-fatal cerebrovascular disease ( CBVD ) : 0.73 ( 0.76 ) , fatal CVD : 0.77 ( 0.80 ) , fatal non-CVD : 0.74 ( 0.72 ) , survival after non-fatal CHD : 0.68 ( 0.67 ) and survival after non-fatal CBVD : 0.65 ( 0.66 ) ) . In general , our model predictions were comparable with observed event rates for a Scottish r and omised statin trial population which has an overlapping follow-up period with SHHEC . After applying a calibration factor , our predictions of life expectancy closely match those published in recent national life tables . Conclusions Our model can be used to estimate the impact of primary prevention interventions on life expectancy and can assess the impact of interventions on inequalities Background Little is known about the relative cost-effectiveness of different secondary prevention cardiac rehabilitation ( CR ) program design s or how cost-effectiveness is influenced by patient clinical and demographic characteristics . The purpose of the study was ( i ) to evaluate the incremental cost-effectiveness of a st and ard 3-month CR program ( SCR ) versus a program distributed over 12 months ( distributed CR , DCR ) ; and ( ii ) to determine the effect of patient demographic characteristics ( cardiac risk , cardiac diagnosis , sex ) on incremental cost-effectiveness . Methods A two group cost-effectiveness analysis was conducted alongside a r and omized controlled trial . Patients with coronary artery disease ( mean age = 58 years , SD ± 10 ) were r and omized to either SCR ( n = 196 ) or DCR ( n = 196 ) and followed for 24 months . Program delivery costs , cardiac healthcare use , morbidity , mortality , and quality -adjusted life years were assessed . Cost-effectiveness was evaluated with incremental cost-utility analysis . Results In the pooled analysis , we found the probability of SCR being more cost-effective than DCR was 63–67 % . The sub analysis found SCR to be the more cost-effective intervention for patients at high risk , patients with previous coronary artery bypass graft and for male patients . The DCR program was more cost-effective for patients with lower risk of disease progression and for female patients . Conclusion Differences were noted in the cost-effectiveness of CR models based on cardiac risk level , reason for referral , and demographic characteristics . Our results suggest improved cost-effectiveness may be gained by triaging patients to different CR intervention models , however , further investigation is required Objective Community-based cardiovascular disease ( CVD ) risk factor screening programs have been used successfully in rural health improvement initiatives . However , little is known about what consumers like or dislike about them , which is a barrier to the design of future process improvements . The objective of this study was to examine the degree to which health risks and participant characteristics predicted screening satisfaction . Design This study utilized a cross-sectional survey design . Setting Data was collected as part of the broader Heart of New Ulm Project , which is a community-based CVD prevention demonstration project based in rural Minnesota . Participants There were 126 r and omly invited individuals from the CVD risk factor screenings , with 118 individuals who agreed to participate and had complete data available for analyses . Methods A multivariate logistic regression analysis was used to examine the association between demographics , lifestyle , and biometric risk factors and screening satisfaction . Results Twenty percent of respondents indicated some level of dissatisfaction with the screening process . Satisfied participants were more likely to be female ( OR=4.15 ) , not have an optimal lifestyle ( OR=3.47 ) , and have an intention to improve their lifestyle habits ( OR=3.26 ) . Age , education , and CVD risk level were not significant predictors in the final model . Conclusion Satisfaction was high in this screening program , with healthy males being least satisfied with their experience . This has implication s for the design of future intervention efforts , as they may require specific programmatic features and more specialized , targeted marketing strategies to attract a broad spectrum of participants likely to benefit Background Learning and coping education strategies ( LC ) was implemented to enhance patient attendance in the cardiac rehabilitation programme . This study assessed the cost-utility of LC compared to st and ard education ( st and ard ) as part of a rehabilitation programme for patients with ischemic heart disease and heart failure . Methods The study was conducted alongside a r and omised controlled trial with 825 patients who were allocated to LC or st and ard rehabilitation and followed for 5 months . The LC approach was identical to the st and ard approach in terms of physical training and education , but with the addition of individual interviews and weekly team evaluations by professionals . A societal cost perspective including the cost of intervention , health care , informal time and productivity loss was applied . Cost was based on a micro-costing approach for the intervention and national administrative registries for other cost categories . Quality adjusted life years ( QALY ) were based on SF-6D measurements at baseline , after intervention and follow-up using British preference weights . Multiple imputation was used to h and le non-response on the SF-6D . Conventional cost effectiveness methodology was employed to estimate the net benefit of the LC and to illustrate cost effectiveness acceptability curves . The statistical analysis was based on means and bootstrapped st and ard errors . Results An additional cost of DKK 6,043 ( 95 % CI −5,697 ; 17,783 ) and a QALY gain of 0.005 ( 95 % CI −0.001 ; 0.012 ) was estimated for LC . However , better utility scores in both arms were due to higher utility while receiving the intervention than better health after the intervention . The probability that LC would be cost-effective did not exceed 29 % for any threshold values of willingness to pay per QALY . The alternative scenario analysis was restricted to a health care perspective and showed that the probability of cost-effectiveness increased to 62 % over the threshold values . Discussion The LC was unlikely to be cost-effective within 5 months of follow-up from a societal perspective , but longer-term follow-up should be evaluated before a definite conclusion is drawn . Conclusion Future research should assess the LC strategies ' long-term efficacy and cost-utility . Trial registration Background .Utility methods that are responsive to changes in desirable outcomes are needed for cost-effectiveness ( CE ) analyses and to help in decisions about re source allocation . Objectives .Evaluated is the responsiveness of different methods that assign utility weights to subsets of SF-36 items to average improvements in health result ing from quality improvement ( QI ) interventions for depression . Design .A group level , r and omized , control trial in 46 primary care clinics in six managed care organizations . Clinics were r and omized to one of two QI interventions or usual care . Subjects . One thous and one hundred thirty-six patients with current depressive symptoms and either 12-month , lifetime , or no depressive disorder identified through screening 27,332 consecutive patients . Measures .Utility weighted SF-12 or SF-36 measures , probable depression , and physical and mental health-related quality of life scores . Results .Several utility-weighted measures showed increases in utility values for patients in one of the interventions , relative to usual care , that paralleled the improved health effects for depression and emotional well being . However , QALY gains were small . Directly elicited utility values showed a paradoxical result of lower utility during the first year of the study for intervention patients relative to controls . Conclusions .The results raise concerns about the use of direct single-item utility measures or utility measures derived from generic health status measures in effectiveness studies for depression . Choice of measure may lead to different conclusions about the benefit and CE of treatment . Utility measures that capture the mental health and non-health outcomes associated with treatment for depression are needed AIM Informing a person of their individual risk of developing a disease in the future may be sufficient to provide the person with the impetus to adopt risk reducing behaviours . The aim of this study was to determine if a personalised 10-year cardiovascular disease ( CVD ) risk estimate can increase  physical activity  and other risk reduction behaviours in adults at high risk of CVD . METHODS Pilot 2 × 2 factorial r and omised controlled trial conducted in Oxfordshire , UK including 194 adults at increased CVD risk ( 10-year CVD risk ≥ 20 % ) recruited from four general practice s. Main outcome measure at one month was physical activity measured by accelerometer . RESULTS Median ( IQR ) age was 62.3 ( 54.9 , 66.1 ) years , 67 % were men and 19 % had known diabetes . Mean ( SD ) total accelerometer counts per day was 297 × 10(-3 ) ( 110 × 10(-3 ) ) and activity of moderate or greater intensity was undertaken for 53 ( 22 ) minutes per day . In the 185 ( 95 % ) participants attending follow-up an increase in physical activity was not seen . There was a non-significant 0.5 % ( p = 0.56 ) greater increase in accelerometer counts in those receiving personalised CVD risk estimates . No significant within or between group changes were seen at one month in estimated 10-year CVD risk . A net 7 % decrease in mean LDL cholesterol ( p = 0.004 ) was seen in the intervention group despite similar increases in new prescriptions for lipid lowering therapies . CONCLUSION In adults at increased risk of CVD provision of personalised 10-year CVD risk estimates did not appear to increase physical activity or estimated CVD risk over a one-month period Objective To evaluate the performance of ASSIGN against the Framingham equations for predicting 10 year risk of cardiovascular disease in a UK cohort of patients from general practice and to make the evaluation comparable to an independent evaluation of QRISK on the same cohort . Design Prospect i ve open cohort study . Setting 288 practice s from Engl and and Wales contributing to The Health Improvement Network ( THIN ) data base . Participants Patients registered with 288 UK practice s for some period between January 1995 and March 2006 . The number of records available was 1 787 169 . Main outcome measures First diagnosis of myocardial infa rct ion , coronary heart disease , stroke and transient ischaemic attacks recorded . Methods We implemented the And erson Framingham Coronary Heart Disease and Stroke models , ASSIGN , and a more recent Framingham Cox proportional-hazards model and analysed their calibration and discrimination . Results Calibration showed that all models tested over-estimated risk particularly for men . ASSIGN showed better discrimination with higher AUROC ( 0.756/0.792 for men/women ) , D statistic ( 1.35/1.58 for men/women ) , and R2 ( 30.47%/37.39 % for men/women ) . The performance of ASSIGN was comparable to that of QRISK on the same cohort . Models agreed on 93–97 % of categorical ( high/lower ) risk assessment s and when they disagreed , ASSIGN was often closer to the estimated Kaplan-Meier incidence . ASSIGN also provided a steeper gradient of deprivation and discriminated between those with and without recorded family history of CVD . The estimated incidence was twice/three times as high for women/men with a recorded family history of CVD . Conclusions For systematic CVD risk assessment all models could usefully be applied , but ASSIGN improved on the gradient of deprivation and accounted for recorded family history whereas the Framingham equations did not . However , all models display relatively low specificity and sensitivity . An additional conclusion is that the recording of family history of CVD in primary care data bases needs to improve given its importance in risk assessment Introduction : Cancer clinical trials frequently incorporate quality of life ( QoL ) measures but rarely patient utility . Utility information is required for cost utility evaluations of novel cancer therapies . We assessed the feasibility of converting QoL data into utility scores using the European Organization for Research and Treatment of Cancer Quality of Life-Core  30 question naire ( EORTC QLQ-C30 ) and the EQ-5D in patients with non-small cell lung cancer ( NSCLC ) . Methods : Out patients with all different disease states of NSCLC attending a major Canadian cancer center completed the QLQ-C30 and EQ5D on a single visit . Results of the QLQ-C30 summary scores were mapped to predict EQ-5D utility scores using linear regression . Backward variable elimination using the Akaike Information Criterion was used to reduce the full model that included all QLQ-C30 summary scores to examine which QLQ-C30 dimensions best predict a patient 's utility score . To test the predictive power of the model , 10-fold cross-validation was used . Results : A total of 172 patients participated in the study . Median age of the sample was 66 years ( range , 32–85 years ) ; 46.5 % were men . The cross-validation estimate of mean utility score was 0.76 ( SD : 0.20 ) , which was the same as the actual mean utility score . Of the 15 QLQ-C30 dimensions , 4 functional dimensions ( physical , role , emotional , and social ) and the pain symptom dimension were predictive of patient utility scores . Conclusions : Our study demonstrates the feasibility of deriving utility scores from prospect i ve QoL data . Validation of the QLQ-C30 predictors found in this study could further the ability to estimate cost utility of therapies for economic evaluations PURPOSE Cardiovascular disease ( CVD ) is the most common nonmalignant cause of death in Hodgkin lymphoma ( HL ) survivors , especially after mediastinal irradiation . The role of screening for CVD in HL survivors is unclear , but confrontation with risks of CVD may have a negative influence on health-related quality of life ( HRQL ) . As part of a phase 2 screening study using computed tomography angiography ( CTA ) among HL survivors , an HRQL analysis was done to evaluate the emotional and practical burden and perceived benefits of screening and the effect of CVD-specific counseling on patient satisfaction . METHODS AND MATERIAL S Patients who participated in the screening study also took part in the HRQL study . The impact of undergoing screening was evaluated with a 9-item question naire , and impact on HRQL with the European Organization for Research and Treatment of Cancer ( EORTC ) Quality of Life Core Question naire C30 , version 3.0 . The effect of counseling of CVD on perceived provision of information was evaluated with EORTC INFO-25 . All question naires were completed at baseline and after screening . RESULTS Baseline question naires were received from 48 participants , and 43 completed question naires after screening .  Mean age was 47 years , and mean time since diagnosis was 21 years . Of the total , 93 % of subjects were content with participating , and 80 % did not find the emphasis placed on late effects burdensome , although screening did have a small impact on social functioning and global quality of life . Perceived information on disease , medical tests , and treatment increased significantly after screening ( P<.01 ) . Differences were clinical ly relevant . There were no differences in perceived information between patients with and without screen-detected CVD . CONCLUSIONS Screening was evaluated favorably , whether CTA showed abnormalities or not . Extensive counseling result ed in substantially increased provision of information and improved information satisfaction . Screening by means of CTA and subsequent cardiac intervention was highly valued , and the benefits were felt to outweigh the emotional and practical burden Purpose . The aim of this study was to analyze quality -of-life data from the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) to estimate the impact of diabetes-related complications on utility-based measures of quality of life . Methods . The EuroQol EQ-5D instrument was administered in 1996 to 3667 UKPDS patients with type 2 diabetes .  Tobit and censored least absolute deviations ( CLAD ) regression analysis based on data from the 3192 respondents was used to estimate the impact of major complications on ( 1 ) the visual analog scale ( VAS ) and ( 2 ) the EQ-5D utilities derived from population -based time trade-off values . Results . Using the tobit model , the effect on tariff values was as follows : myocardial infa rct ion = -0.055 ( 95 % confidence interval [ CI ] = -0.067 , -0.042 ) , blindness in 1 eye = -0.074 ( 95 % CI = -0.124 , -0.052 ) , ischemic heart disease = -0.090 ( 95 % CI = -0.126 , -0.054 ) , heart failure = -0.108 ( 95 % CI = -0.169 , -0.048 ) , stroke = -0.164 ( 95 % CI = -0.222 , -0.105 ) , and amputation = -0.280 ( 95 % CI = -0.389 , -0.170 ) . The impact on the VAS scores was smaller , but the ranking was identical . Estimates of these effects , based on the nonparametric CLAD estimator , are also reported and compared . Conclusion . These results demonstrate the magnitude of the impact of 6 complications on utility-based measures of quality of life , which can be used to estimate the outcome of interventions that reduce these diabetes-related complications OBJECTIVE To compare in patients with fibromyalgia ( FM ) utilities derived by rating scale and st and ard gamble methods ; to gain insight into construct validity by relating utility values to other outcome measures ; to assess the sensitivity to change of utilities . METHODS A total of 73 patients with FM were r and omized into one of 3 groups : low impact fitness training , biofeedback , or controls . At baseline and after 6 mo the Maastricht Utility Measurement Question naire was applied . By means of both the rating scale and st and ard gamble method patients were asked to value their own health status . Construct validity of patient utility measurements was evaluated by Spearman correlation and multiple regression of baseline values with pain , stiffness , patient 's global assessment , Sickness Impact Profile ( SIP ) , modified Health Assessment Question naire and Arthritis Impact Measurement Scale ( AIMS ) . Sensitivity to change was assessed against changes in these outcomes . RESULTS Rating scale utilities correlated significantly ( p < 0.05 ) with patient 's global assessment ( rs = 0.53 ) , pain ( rs = -0.47 ) , SIP ( rs = -0.43 ) , and with 9 of 11 dimensions of the AIMS ( rs ranging from 0.23 to 0.62 ) . St and ard gamble utilities correlated significantly with mobility , pain , and arthritis impact of the AIMS scale ( rs from 0.22 to 0.36 ) and with pain by visual analog scale ( rs = -0.24 ) and patient 's global assessment ( rs = 0.32 ) . Multiple regression analysis showed that patient 's global assessment explained 41 % ( rating scale ) and 10 % ( st and ard gamble ) of total variance in baseline utilities . Also , 16 % of the variance in change in rating scale utility values was explained by changes in patient 's global assessment . In contrast , variance of changes in st and ard gamble utility values was not explained significantly by changes in other disease outcomes . CONCLUSION Rating scale utilities correlated more strongly with disease outcome measures than st and ard gamble utilities . Also , construct validity for the rating scale was better than for the st and ard gamble . In FM , utility measurement is sensitive to the method chosen to elicit patient priorities Objectives To investigate the long-term cost-effectiveness ( measured as the ratio of incremental NHS cost to incremental quality -adjusted life years ) of a telehealth intervention for patients with raised cardiovascular disease ( CVD ) risk . Design A cohort simulation model developed as part of the economic evaluation conducted alongside the Healthlines r and omised controlled trial . Setting Patients recruited through primary care , and intervention delivered via telehealth service .  Participants Participants with a 10-year CVD risk ≥20 % , as measured by the QRISK2 algorithm , and with at least 1 modifiable risk factor , individually r and omised from 42 general practice s in Engl and . Intervention A telehealth service delivered over a 12-month period . The intervention involved a series of responsive , theory-led encounters between patients and trained health information advisors who provided access to information re sources and supported medication adherence and coordination of care . Primary and secondary outcome measures Cost-effectiveness measured by net monetary benefit over the simulated lifetime of trial participants from a UK National Health Service perspective . Results The probability that the intervention was cost-effective depended on the duration of the effect of the intervention . The intervention was cost-effective with high probability if effects persisted over the lifetime of intervention recipients . The probability of cost-effectiveness was lower for shorter duration s of effect . Conclusions The intervention was likely to be cost-effective under a lifetime perspective . Trial registration number IS RCT N27508731 ; Results Objectives Investigate the association between socioeconomic deprivation and completeness of cardiovascular disease ( CVD ) risk factor recording in primary care , uptake of screening in people with incomplete risk factor recording and with actual CVD risk within the screened subgroup . Design Cross-sectional study . Setting Nine UK general practice s. Participants 7987 people aged 50–74 years with no CVD diagnosis . Methods CVD risk was estimated using the Framingham equation from data extracted from primary care electronic health records . Where there was insufficient information to calculate risk , patients were invited to attend a screening assessment . Analysis Proportion of patients for whom clinical data were sufficiently complete to enable CVD risk to be calculated ; proportion of patients invited to screening who attended ; proportion of patients who attended screening whose 10-year risk of a cardiovascular event was high ( > 20 % ) . For each outcome , a set of logistic regression models were run . Crude and adjusted ORs were estimated for person-level deprivation , age , gender and smoking status . We included practice -level deprivation as a continuous variable and practice as a r and om effect to account for clustering . Results People who had lower  Indices of Multiple Deprivation ( IMD ) scores ( less deprived ) had significantly worse routine CVD risk factor recording ( adjusted OR 0.97 ( 0.95 to 1.00 ) per IMD decile ; p=0.042 ) . Screening attendance was poorer in those with more deprivation ( adjusted OR 0.89 ( 0.86 to 0.91 ) per IMD decile ; p<0.001 ) . Among those who attended screening , the most deprived were more likely to have CVD risk > 20 % ( OR 1.09 ( 1.03 to 1.15 ) per IMD decile ; p=0.004 ) . Conclusions Our data suggest that those who had the most to gain from screening were least likely to attend , potentially exacerbating existing health inequalities . Future research should focus on tailoring the delivery of CVD screening to ensure engagement of socioeconomically deprived groups BACKGROUND Depression imposes a substantial burden on society . In view of the economic burden of depression , studies evaluating depression treatment increasingly incorporate a cost-utility analysis . Outcomes of these analyses are used by decision makers to prioritize healthcare . Although generic preference-based instruments have been recommended for measuring utility , depression research often uses a disease-specific method , based on depression-free days ( DFD ) , to measure utilities . AIMS OF THE STUDY The objective of this study was to compare utility measurement techniques in the context of a r and omized controlled trial . In particular , we studied the agreement between QALYs measured with the  EuroQol ( EQ-5D ) , the Short Form 6D ( SF-6D ) , and the DFD method , using the EQ-5D as the reference method . We also studied whether the use of different techniques leads to different conclusions for decision makers . METHODS Data were derived from the Depression in Elderly with Long-Term Afflictions ( DELTA ) study . This r and omized controlled trial was design ed to study the effectiveness and cost-effectiveness of a minimal psychological intervention for chronically ill patients with co-occurring minor or mild to moderate major depression . The  EQ-5D , SF-6D and Beck Depression Inventory  ( to estimate DFDs ) were assessed at baseline , and at three , six and twelve months after baseline . RESULTS Poor agreement was found between the EQ-5D and DFD ( Kendall 's Tau : 0.33 ; ICC : 0.21 ( 95 % CI:-0.07 - 0.45 ) ) and moderate agreement between the EQ-5D and SF-6D ( Kendall 's Tau : 0.60 ; ICC : 0.47 ( 95 % CI : 0.36 - 0.57 ) ) . The incremental cost-utility ratio led to similar conclusions for decision makers across techniques . DISCUSSION In conclusion , utilities from the disease-specific DFD method should not be compared directly with utilities derived from the EQ-5D . Although a disease-specific method might yield similar cost-utility ratios as generic instruments , generic instruments remain the preferred option for prioritizing healthcare . Limitations of this study include the presence of minor depression and chronic illnesses in our study population . IMPLICATION S Generic instruments remain preferred for cost-utility analyses , especially when results are used to prioritize healthcare . If the DFD method is a way forward , further research is required to vali date utility weights assigned to the DFDs
In this sub-set , it was found that method ological differences contributed to variation in utility values .
Direct methods often yielded higher scores than did indirect methods .
Within direct methods , there were no clear trends in head-to-head studies ( st and ard gamble [ SG ] vs time trade-off ) ; but general population respondents often provided lower scores than did patients with the disease when evaluating the same health states with SG methods .
When comparing indirect methods , the EQ-5D typically yielded higher values than the SF-6D , but also showed more sensitivity to differences in health states .
When selecting CVD utility values for an economic model , consideration of the utility elicitation method is important , as this review demonstrates that methodology of choice impacts utility values in CVD
AIMS Utility values inform estimates of the cost-effectiveness of treatment for cardiovascular disease ( CVD ) , but values can vary depending on the method used .
The aim of this systematic literature review ( SLR ) was to explore how methods of elicitation impact utility values for CVD .