Estimating Health State Utility Values for Comorbidities

A comorbidity is defined as the presence of at least one additional health condition co-occurring with a primary health condition. Decision analytic models in healthcare depict the typical clinical pathway of patients in general clinical practice and frequently include health states defined to represent comorbidities such as sequelae or adverse events. Health state utility values (HSUVs) are often not available for these and analysts generally estimate them. This article provides a summary of the methodological literature on estimating methods frequently used together with worked examples. The three main methods used (minimum, multiplicative and additive) can produce a wide range in the values estimated. In general, the minimum method overestimates observed HSUVs and the magnitude of error tends to increase as the observed values decrease. Conversely, the additive and multiplicative methods generally underestimate observed values and the magnitude of the errors is generally greater for the additive method. HSUVs estimated using the multiplicative method tend to decrease for lower HSUVs and the largest errors are in observed HSUVs >0.6. Differences in estimated values can produce substantial differences in the resulting incremental cost effectiveness ratio. Based on the current evidence, the multiplicative method is advocated but additional research is required to determine appropriate methods when estimating values for additional comorbidities.