A meta-analysis of health state valuations for people with diabetes: explaining the variation across methods and implications for economic evaluation



To review published studies on the effect of diabetes and its complications on utility scores to establish whether there is systematic variation across studies and to examine the implications for the estimation of quality-adjusted life years (QALYs).


A systematic review was performed using studies reporting QALY measures elicited from people with diabetes including those with a history of complications. Meta-analysis was used to obtain the average utility, and meta-regression was employed to examine the impact of study characteristics and elicitation methods on these values. The effect of different utility scores on QALYs was examined using diabetes simulation models.


In the meta-analysis based on 45 studies reporting 66 values, the average utility score was 0.76 (95% CI 0.75–0.77). A meta-regression showed significant variation due to age, method of elicitation and the proportion of males. The average utility score for individual complications ranged from 0.48 (95% CI 0.25, 0.71) for chronic renal disease to 0.75 (95% CI 0.73, 0.78) for myocardial infarction, and these differences produced meaningful changes in simulated QALYs. There was significant heterogeneity between studies.


We provide summary utility scores for diabetes and its major complications that could help inform economic evaluation and policy analysis.

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This report is independent research commissioned by the National Institute for Health Research. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. We are grateful to Edmund Fitzgerald and Melanie Wyld for assistance with the literature review. In regard to other funding, AJH received support from an Australian National Health and Medical Research Council (NHMRC) Project Grant 512463; PMC was funded from an Australian NHMRC Career Development Award (571122). AH was funded from the NHMRC Screening a Test Evaluation Program Grant (633003).

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Correspondence to Tom W. C. Lung.

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Lung, T.W.C., Hayes, A.J., Hayen, A. et al. A meta-analysis of health state valuations for people with diabetes: explaining the variation across methods and implications for economic evaluation. Qual Life Res 20, 1669–1678 (2011). https://doi.org/10.1007/s11136-011-9902-y

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  • Meta-analysis
  • Health-related quality of life
  • Diabetes
  • Diabetes-related complications
  • Simulation modelling
  • QALYs