Differences in the selection of health state utility values by sponsorship in published cost-effectiveness analyses

BACKGROUND: Health state utility values (HSUVs) are among the most influential attributes of cost-effectiveness analyses (CEAs). Our objective was to evaluate whether industry-funded studies select systematically different HSUVs compared to studies without industry funding. METHODS: Among ten diseases with high disease burden in the United States, we further identified 31 progressive health states. We then searched the Tufts Medical Center’s CEA Registry to identify studies that included HSUVs and were submitted to the registry between 2002 and 2019. Two reviewers mapped the free-text descriptions of health states onto the 31 pre-defined health states. We analyzed the effect of industry funding on the point estimates of these HSUVs with a beta regression. We also analyzed the difference between related health states within studies by funding source with a linear regression. RESULTS: After identifying 26,222 HSUVs from 4,198 CEAs, we matched 2,573 HSUVs to the 31 pre-defined health states. We observed large variations within each health state: 12 out of 31 health states included a range of HSUVs greater than 0.5. The point estimate model showed 1 statistically significant difference out of 31 comparisons between studies with any industry funding and those without. The utility difference model found 3 significant difference out of 39 comparisons between CEAs with any industry funding and those without. LIMITATIONS: Inclusion of unpublished CEAs may have affected our conclusions about the effect of industry funding on selection of HSUVs. We also relied on free-text descriptions of health states available in the CEA Registry and did not include adjustment for multiple comparisons. CONCLUSION: Limited evidence exists that industry-funded studies select different HSUVs compared to non-industry-funded studies for the health states we considered.