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Introduction: Loneliness is a public health concern affecting mental and physical health. The EU-H2020 project RECETAS evaluates loneliness-alleviating interventions. We will combine short-term RECETAS trial data [1] with long-term data in a decision-analytic model (DAM) to evaluate the long-term benefit-harm balance and cost effectiveness of loneliness-alleviating interventions. One important aspect for our evaluation is health-related quality of life (QoL). To implement QoL in our DAM, health-state utility values (HSUVs) are needed. We aimed to derive loneliness-related HSUVs following international guidelines [2], [3], [4].

Methods: We elicited HSUVs for “lonely” from the RECETAS trials in Spain and Finland with the EQ-5D-5L. Additionally, we performed systematic searches in PubMed supplemented by hand searches to identify systematic reviews and meta-analyses including HSUVs for the following loneliness-related diseases defined by the WHO [5]: Anxiety/depression, cardiovascular diseases (CVD), dementia, and diabetes type 2 (T2DM). We included studies in English on HSUVs elicited with the EQ-5D. Studies were screened for eligibility and either a pooled or a single study estimate was chosen. HSUVs for a specific loneliness-related disease were adjusted with an eligible reference population. The resulting factor will be used in our DAM as a relative utility (multiplier) to weight the HSUVs of loneliness-related diseases. Additionally, uncertainty measures were extracted or estimated (+/-20%) for probabilistic sensitivity analyses and appropriate distributions were chosen.

Results: The HSUV for “lonely” derived from the RECETAS trials were 0.71 (beta-distribution, standard deviation (SD)=0.20) in Spain and 0.57 (SD=0.23) in Finland. Overall, we identified 113 systematic reviews/meta-analyses (14 anxiety/depression, 64 CVD, 17 dementia, 18 T2DM).

For dementia in Spain, we pooled three studies applying a random effects meta-analysis and adjusted the HSUVs to dementia severity. In Finland, dementia-related HSUVs from one study were adjusted by dementia severity. Dividing dementia-specific HSUVs by the corresponding population norm, yielded the following multipliers: Spain 0.66 (beta-distributions: dementia: mean=0.54, 95% confidence interval (CI):0.48-0.59; population norm: mean=0.81, SD=0.25) and Finland 0.78 (lognormal-distribution, +/-20%).

For CVD, we identified published relative utilities. Pooling these multipliers (lognormal-distributions) for the three most incident CVD types, resulted in 0.81 (95%CI:0.80-0.83) for Spain and 0.82 (95%CI:0.81-0.83) for Finland.

For T2DM, no study in Spain or Finland was identified. Therefore, we used HSUV for T2DM patients without complications (beta-distribution: mean=0.79, SD=0.27) based on the United Kingdom (UK) Prospective Diabetes Study and adjusted it for complications. Correcting the HSUVs with a corresponding UK population norm (beta-distribution: mean=0.80, SD=0.16) resulted in a relative utility of 0.93.

For anxiety/depression, we selected a study reporting a negative effect (beta-distribution: mean=0.167, 95%CI:0.15-0.18, population norm from same study: 0.9) for emotional disorders in Spain and a study in Finland reporting HSUVs for anxiety/depressive disorders (beta-distributions: mean=0.71, SD=0.29; population norm: mean=0.87, SD=0.21). The corresponding utility multipliers are 0.81 for Spain and 0.82 for Finland.

Conclusion: Overall, we found sufficient evidence on loneliness-related HSUVs to populate our RECETAS DAMs with HSUVs to estimate quality-adjusted life years for decision making for clinical guidelines and reimbursement informed by DAM on the benefit, harm and cost effectiveness, despite the challenging huge variety of reported HSUVs and settings.

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 945095.

The authors declare that a positive ethics committee vote has been obtained.

Literatur

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[5] World Health Organization. Social isolation and loneliness among older people: advocacy brief. Geneva: WHO; 2021.