Table 5 Summary of findings for outcome valuation (KQ2)
Number of included studies; sample size | Disutility (95% CI) 0 (no decrease in HRQoL) to 1 (HRQoL equal to death) | GRADEꝉ | What does the evidence say? |
|---|---|---|---|
Disutility from hip fracture | |||
16 studies; n = 7409 | EQ-5D, at time of fracture (< 3 months) 0.53 (0.44 to 0.62) | ⊕ ⊕ ⊕ ⊝ Moderatea | The disutility of a hip fracture is probably 0.53 immediately after injury |
27 studies; n = 9399 | EQ-5D, 12-month post-fracture 0.16 (0.12 to 0.20) | ⊕ ⊕ ⊕ ⊕ High | The disutility of a hip fracture is 0.16 at 12 months after injury |
Disutility from non-hip* fracture | |||
4 studies; n = 1792 | EQ-5D, at time of fracture (< 3 months) 0.57 (0.43 to 0.71) | ⊕ ⊕ ⊝ ⊝ Lowab | The disutility of a non-hip fracture may be 0.57 immediately after injury |
4 studies; n = 1792 | EQ-5D, 12-month post-fracture 0.19 (0.10 to 0.28) | ⊕ ⊕ ⊕ ⊝ Moderateb | The disutility of a non-hip fracture is probably 0.19 at 12 months after injury |
Disutility from any injurious fall | |||
0 study | No evidence | Not applicable | The disutility of an injurious fall is uncertain |
Disutility from a fall (within last 12 months) | |||
6 studies; n = 4653 | EQ-5D 0.09 (− 0.04 to 0.22) | ⊕ ⊕ ⊝ ⊝ LowA | The disutility after a fall may be 0.09 |
Disutility from functional impairment (impairment in at least one ADL**) | |||
1 study; n = 123 | HUI Mark II 0.12 (0.05 to 0.19) | ⊕ ⊕ ⊝ ⊝ Lowcd | The disutility from impairment in one or more ADLs may be 0.12 |
Disutility of LTC admission (compared to full health) | |||
1 study; n = 194 | TTO Median (IQR): 1 (1, 1) “80% of participants said they would rather be dead" | ⊕ ⊕ ⊝ ⊝ Lowcd | The disutility from a long-term care admission (compared to full health) may be 1 |
Relative importance across health states | |||
EQ-5D unless otherwise specified Disutility, LTC admission: 1 (TTO) Disutility, non-hip fracture (< 3 mos): 0.57 Disutility, non-hip fracture (12 mos): 0.19 Disutility, hip fracture (< 3 mos): 0.53 Disutility, hip fracture (12 mos): 0.16 Disutility, ADL impairment: 0.12 (HUI Mark II) Disutility, fall: 0.09 Disutility, injurious fall: unknown Also see below rows for findings from other preference-based studies, used for comparison | ⊕ ⊕ ⊝ ⊝ Lowe,f | LTC admission may be more important than all other outcomes | |
⊕ ⊕ ⊕ ⊝ Moderatea | Fracture (hip or non-hip) is probably more important than falls and functional impairment | ||
⊕ ⊕ ⊝ ⊝ Lowe,f | Functional impairment may be somewhat more important than a fall | ||
Findings of relative importance between health states | |||
50% decrease in fracture risk:50% decrease in fall risk: ratio, SMD of coefficients: 2.43 (Milette 2013, Franco 2015; DCE) 50% improvement in daily functioning:50% decrease in fall risk: ratio, SMD of coefficients: 2.11 (Franco 2015; DCE) Ability to manage domestic activities:HRQoL: ratio, relative importance score: 1.58 (Hilingsman 2020; CA) Ability to manage domestic activities:fall frequency: ratio, relative importance score: 1.20 (Hilingsman 2020; CA) LTC admission:falls risk: ratio, relative importance score: 1.18 (Robinson 2015; CA) 50% decrease in fracture risk:50% improvement in daily functioning (Milette 2013, Franco 2015; DCE): ratio, SMD of coefficients: 1.14 | |||
Data from other utility instruments, disutilities | |||
Hip fracture; disutility at time closest to injury Average of HUI Mark II, SF-6D, SG, & FT 1 study; n = 80 0.25 (0.20 to 0.30) Hip fracture; disutility at time closest to 12 mos TTO 2 studies; n = 471 0.57 (0.32 to 0.82) Average of HUI Mark II, SF-6D, SG, & FT 1 study; n = 80 0.12 (0.07 to 0.17) Falls: disutility any time after event TTO 1 study; n = 203 0.33 (0.26 to 0.40) | |||