Use of Health State Utility Values in Cost-Utility Analyses of Selected Infectious Diseases in Aging Populations: A Systematic Review and Critical Appraisal

BACKGROUND: Health state utility values (HSUVs) are vital in cost-utility analyses (CUAs) that inform policymaking. However, suboptimal selection and application of HSUVs have been reported in areas such as cardiovascular disease and cancer. This study reviewed the methodological quality and appropriateness of HSUV in CUA use for interventions targeting infectious diseases in aging populations.

METHODS: A systematic search of the MEDLINE database was conducted to identify CUAs that evaluated interventions against six major infectious diseases from January 2000 to July 2025. Two reviewers independently screened the identified studies based on eligibility criteria. The two reviewers then assessed the included studies using a modified checklist that covered how HSUVs were selected, elicited, and applied. Findings are summarized by descriptive statistics across the entire period (January 2000 to July 2025) and three sub-periods (2000-2009, 2010-2019, and 2020 to July 2025).

RESULTS: Among the 146 included CUA studies, only 10 (7%) relied exclusively on original sources for HSUVs, while 78% used economic data, either alone or in combination with other secondary sources or assumptions. Most studies (78-91%) did not provide sufficient rationale or descriptions for the population or how HSUVs were elicited, and 42% failed to report all utility components. Complete comparability between the CUAs and reference data for the diagnosis, severity, and country was observed in only 51-60% of studies. Notably, fewer than half of CUAs reported HSUVs that were consistent with their cited sources, and 80% did not discuss the limitations associated with HSUV use. Most criteria showed limited improvements, and in some cases declines, between January 2000 and July 2025.

CONCLUSION: CUAs of infectious diseases in aging populations are frequently associated with suboptimal practices in how HSUVs are selected, elicited, and applied. These shortcomings highlight the need for cautious interpretation of CUA data and for greater methodological transparency. Improving the quality of economic evaluations will require systematic approaches to how HSUVs are selected and elicited, with increased investment in primary data collection and the creation of accessible utility databases.