Standard Gamble to Derive Utility Health States for Limbal Stem Cell Deficiency

Adam Smith, Jenny Retzler, Matthew Taylor

Research output: Contribution to journalArticle


Purpose: To generate UK health-related quality of life (HRQoL) data for adult patients with moderate to severe Limbal Stem Cell Deficiency (LSCD), unilateral or bilateral, due to physical or chemical ocular burns to help inform economic evaluations of treatments.

Patients and methods: EQ-5D-3L with vision bolt-on scores were prospectively measured for one of five clinical scenarios of LSCD described in vignettes in a demographically representative population of 520 UK adults. These were converted to health state utilities using three different UK value sets. A standard gamble (SG) was then undertaken using 12 SG scenarios to examine the component drivers of health utility for the treatment of LSCD.

Results: For the EQ-5D-3L scenarios, the mean disutility for LSCD with poor visual acuity, pain and disfigurement in both eyes compared to one eye was -0.084 (range -0.156 to -0.045 across the value sets). The mean disutility of bilateral LSCD with pain, disfigurement and poor visual acuity compared to unilateral LSCD with only poor visual acuity in one eye was -0.104 (range -0.151 to -0.078). Similarly, where one eye was affected, pain and disfigurement in combination were associated with a greater mean disutility than improvements in visual acuity alone: -0.011 (range -0.04 to 0.005). Mean SG utilities were within a narrow range (0.682 to 0.765). Where one eye was affected the main driver was disfigurement: mean utility was 0.731 (0.709 to 0.753) compared to 0.682 (0.659 to 0.704) when disfigurement was removed compared to vision restored to normal. For bilateral LSCD, mean utilities were 0.693 (0.672 to 0.715) for normal vision and 0.75 (0.73 to 0.771) when disfigurement and pain were removed.

Conclusions: Improvements in pain and disfigurement appeared to be the main factor driving differences in health utilities associated with symptom profiles in LSCD, with improvements in visual acuity having lesser impact.
Original languageEnglish
Pages (from-to)535-546
Number of pages12
JournalClinicoEconomics and Outcomes Research
Publication statusPublished - 15 Sep 2020
Externally publishedYes

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