OBJECTIVES: To identify health state utility values for patients with R/R CLL or SLL who received second-line or later or mixed/multiple-line treatments.
METHODS: A systematic literature review searched electronic databases and grey literature from 01/2011‒09/2021 according to a prespecified protocol to identify publications reporting health utility values (1=perfect health; 0=death) for second-line or later or mixed/multiple-line treatments for patients with CLL or SLL. Double screening with discrepancy reconciliation was performed at all study selection levels. Included studies were assessed for compliance with the National Institute for Health and Care Excellence reference case, which specifies the most appropriate methods for estimating clinical/cost-effectiveness. Variation within and across health states was evaluated.
RESULTS: Of 512 publications screened, 28 met the predefined inclusion criteria (3 randomized controlled trials, 1 observational study, 2 vignette studies, 5 published models, and 17 health technology assessment reports). Twenty-four publications focused on second-line treatment, and 4 considered mixed/multiple-line (first- and second-line) treatments. Twenty-four studies included patients with CLL, and 4 included patients with CLL and SLL. Utility value variations were reported within and across health states with estimate ranges of 0.428‒0.91 for progression-free health states and 0.214‒0.6 for progressed disease. Despite the range of reported values, 3 recent health technology assessments in patients with R/R CLL accepted estimates of 0.748 for the progression-free health state and 0.60 for the progressed health state.
CONCLUSIONS: This systematic literature review identified several utility estimates for second-line or mixed/multiple-line treatments for patients with R/R CLL and SLL. Overall, utility value variation was found within health states, which may result in substantial uncertainty in quality-adjusted life-year estimates. No studies were identified in patients receiving third-line or later treatment despite the unmet need in this population.
