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Preference-Based Health-Related Quality of Life Outcomes Associated with Preterm Birth: A Systematic Review and Meta-analysis

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Abstract

Objectives

Assessments of health-related quality of life outcomes associated with preterm birth provide valuable complementary data to the objective biomedical assessments that have traditionally been reported. The objective of this study was to perform a systematic review and meta-analysis of health utility values associated with preterm birth generated using preference-based approaches to health-related quality of life measurement.

Methods

Systematic searches of MEDLINE, Web of Science, EconLit, EMBASE, CINAHL, PsycINFO, the Cochrane Library and SCOPUS were performed, covering the literature from inception of the search engines to 26 June 2018. Studies reporting health utility values estimated using either direct or indirect utility elicitation methods and published in the English language were included. Central descriptive statistics and measures of variability surrounding health utility values for each study and control group, and differences between comparator groups, are reported for each included article. The effect of preterm birth on health utility values was estimated using a hierarchical linear model in a linear mixed-effects meta-regression.

Results

Of 2139 unique articles retrieved, 20 articles met the inclusion criteria. All but one study used the Health Utilities Index (HUI) Mark 2 (HUI2) or Mark 3 (HUI3) measures as their primary health utility assessment method. All studies reporting health utility values for individuals born preterm or at low birthweight and a control group of individuals born at full term or normal birthweight reported lower utility values in the study groups, regardless of age at assessment, respondent type or valuation method. The meta-regression revealed that preterm birth was associated with a mean utility decrement of 0.066 (95% confidence interval [CI] 0.035–0.098; p < 0.001) after controlling for valuation method, respondent type, administration mode, year of publication, geographical region of study, study setting and age at assessment.

Conclusion

Evidence identified by this review can act as data inputs into future economic evaluations of preventive or treatment interventions for preterm birth. Future research should focus particularly on estimating health utility values during the various stages of adulthood, and incorporating the effects of preterm birth on the preference-based health-related quality of life outcomes of parents and other family members.

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Data Availability Statement

The data generated or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank Samantha Johnson for her assistance with the development and piloting of the literature search strategies. We would also like to thank colleagues at the University of Warwick for comments on earlier drafts of the paper.

Funding

SP receives support as an NIHR (National Institute for Health Research) Senior Investigator (NF-SI-0616-10103). SP also receives funding from the European Union’s 2020 research and innovation programme, Research on European Children and Adults born Preterm (RECAP), under grant agreement number 733280. The views contained within this paper are those of the authors and not necessarily of the funders.

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Authors and Affiliations

  1. Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK

    Stavros Petrou, Natnaree Krabuanrat & Kamran Khan

  2. Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK

    Stavros Petrou

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Contributions

SP designed the study, extracted and reviewed the evidence from all contributing studies, wrote the article and acts as guarantor. NK and KK performed the literature searches and screened all titles and abstracts and full-text articles. NK also extracted data from all full-text articles. All authors read and approved the final version of the article. SP is the guarantor of the overall content.

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Correspondence to Stavros Petrou.

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SP, NK and KK have no conflicts of interest.

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Petrou, S., Krabuanrat, N. & Khan, K. Preference-Based Health-Related Quality of Life Outcomes Associated with Preterm Birth: A Systematic Review and Meta-analysis. PharmacoEconomics 38, 357–373 (2020). https://doi.org/10.1007/s40273-019-00865-7

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