Evaluation of health-related quality of life for hypothesized medical states associated with cervical cancer.

Hideki Murasawa,Ichiro Arakawa,Ryo Konno,Ichiro Okubo

doi:10.7314/apjcp.2014.15.22.9679

Abstract

When evaluating health-economics for cervical cancer prevention policies in Japan, it is important to use Japanese value settings. This study aimed to obtain preference-based measures (preference measures) for hypothesized health states among healthy Japanese women, and to examine differences between the EuroQol-5D (EQ-5D) and standard gamble (SG) instruments. The investigation was performed among female students at a nursing university. We used written hypothetical scenarios describing three grades of cervical intraepithelial neoplasia (CIN) and eight stages of cervical cancer, both at diagnosis and after medical intervention. Preference measures were evaluated using both EQ-5D and SG. We received responses from 136 women. The mean number of respondents per stage was 24.6 (SD: 2.7). At diagnosis, average EQ-5D scores for CIN1, CIN2, CIN3, IA1, IA2, IB1, IB2, IIA, IIB, III, and IV stages were 0.84 (0.14), 0.78 (0.12), 0.73 (0.10), 0.78 (0.12), 0.72 (0.12), 0.63 (0.13), 0.64 (0.12), 0.68 (0.08), 0.62 (0.13), 0.55 (0.21), and 0.18 (0.24), respectively. Using one-way analysis of variance with the Tukey-Kramer method for multiple comparisons (each stage vs. CIN1), we found significant differences for IB1 and more advanced stages (p<0.05). After medical intervention, corresponding EQ-5D scores were 0.84 (0.12), 0.81 (0.12), 0.84 (0.12), 0.80 (0.15), 0.78 (0.11), 0.64 (0.15), 0.63 (0.15), 0.71 (0.15), 0.50 (0.17), 0.52 (0.17), 0.21 (0.28). The multiple comparisons identified significant differences for IB1 and more advanced stages, excepting IIA (p<0.05). SG evaluations were more variable and relatively higher than EQ-5D evaluations. We obtained preference measures for three grades of CIN1-3 and eight stages of cervical cancer. In combination with appropriate sensitivity analyses, these preference measures will provide a basis for an economic evaluation of cervical cancer prevention in Japan. We suggest that EQ-5D is appropriate for cost-utility analysis of this topic.

Highlights

Among women, cervical cancer is the third most common cancer in the world (Ferlay et al, 2012)
To obtain preference measures that would be useful for cost-utility analyses of cervical cancer prevention in Japan, we focused on healthy female students at a nursing university
There were 5, 1, 1, and 0 missing answers for at diagnosis (AD) evaluated by EQ-5D (EQ-5D AD), after medical intervention (AI) evaluated by EQ5D (EQ-5D AI), AD evaluated by standard gamble (SG) (SG AD), and AD evaluated by SG (SG AI), respectively

Summary

Introduction

Cervical cancer is the third most common cancer in the world (Ferlay et al, 2012). In Japan, cervical cancer is diagnosed in 21,000 women each year (Matsuda et al, 2007). Since the 1950’s, cytology-based screening for the cervical cancer prevention has been provided in Japan, contributing to downward trends in mortality rates (Konno, 2010). When evaluating health-economics for cervical cancer prevention policies in Japan, it is important to use Japanese value settings. Using one-way analysis of variance with the Tukey-Kramer method for multiple comparisons (each stage vs CIN1), we found significant differences for IB1 and more advanced stages (p

Objectives

Results

Conclusion