Health State Utility Scores Research Articles

Health state utilities for non small cell lung cancer.

BackgroundExisting reports of utility values for metastatic non-small cell lung cancer (NSCLC) vary quite widely and are not all suitable for use in submissions in the UK. The aim of this study was to elicit UK societal based utility values for different stages of NSCLC and different grade III-IV toxicities commonly associated with chemotherapy treatments. Toxicities included neutropenia, febrile neutropenia, fatigue, diarrhoea, nausea and vomiting, rash and hair loss.MethodsExisting health state descriptions of metastatic breast cancer were revised to make them suitable as descriptions of metastatic NSCLC patients on second-line treatment. The existing health states were used in cognitive debrief interviews with oncologists (n = 5) and oncology specialist nurses (n = 5). Changes were made as suggested by the clinical experts. The resulting health states (n = 17) were piloted and used in a societal based valuation study (n = 100). Participants rated half of the total health states in a standard gamble interview to derive health state utility scores. Data were analysed using a mixed model analysis.ResultsEach health state described the symptom burden of disease and impact on different levels of functioning (physical, emotional, sexual, and social). The disutility related to each disease state and toxicity was estimated and were combined to give health state values. All disease states and toxicities were independent significant predictors of utility (p < 0.001). Stable disease with no toxicity (our base state) had a utility value of 0.653. Utility scores ranged from 0.673 (responding disease with no toxicity) to 0.473 for progressive disease.ConclusionThis study reflects the value that society place on the avoidance of disease progression and severe toxicities in NSCLC.

An assessment of the cost-utility of therapy for psoriasis

Recently a number of new therapies have been introduced to treat psoriasis, but concerns have been expressed about their high cost. The purpose of this study was to determine whether most psoriasis treatments lie within the accepted range of cost-utility. 32 patients with moderate to severe psoriasis were administered the Euro-Qol 5 Dimension (EQ-5D) survey to calculate their health state utility. Economic modeling was performed with a range of therapeutic costs applying the calculated utility score. Paired t-tests were used to calculate significance. At the conclusion of 2 weeks of therapy, the mean psoriasis area and severity index (PASI) improved 35% to 7.2 (p<0.001). The mean health state utility score on the EQ-5D improved 11.5% from 77.7 units before therapy to 86.7 units after therapy (p=0.007). A therapy that achieves at least a PASI 35 would be considered cost-effective by conventional standards if it does not exceed $33 600 in cost.

Validity and feasibility of the use of condition-specific outcome measures in economic evaluation.

Usually, generic questionnaires such as the EQ-5D or Health Utility Index (HUI) are used to obtain utility scores for computing QALYs. Sometimes, however, application of these instruments is not possible, or the responsiveness is doubted. An alternative strategy is to attribute utility scores to health states of a condition-specific outcomes measure (CSOM). We explored the validity and feasibility of this strategy. Our samples determined utility scores for the health states of the International Index of Erectile Function (IIEF) using time tradeoff (TTO). To reduce costs and time, the general population (n = 169) was interviewed in groups. We tested the validity of the group sessions in students. To test the extent of agreement between values obtained using the group and those obtained through individual administration, 63 students were interviewed individually and 54 in groups. The utility scores for the disease-specific health states showed good construct validity. Also, the criterion validity of the adapted TTO was confirmed. Disease-specific utility scores can be used in QALY analysis by converting them to a generic scale. Efforts should be undertaken to prevent response spreading. Administrating TTO in groups could reduce the time and costs of TTO administration and render the strategy of determining utilities for condition-specific health states more feasible.

Quantifying the harmful effect of psoriasis on health-related quality of life

Background: Psoriasis affects 7 million people in the United States, causing substantial cost, social stigma, and disability. Objective: The purpose of this study was to evaluate the health effects of skin disease by comparing psoriasis to other primary medical disorders using 3 different scales of health-related quality of life. Methods: A self-administered questionnaire consisting of 3 health-related quality of life measures was given sequentially to 35 eligible patients with psoriasis presenting to the Dermatology Branch of the National Cancer Institute (NCI) for an investigational therapeutic protocol. Results: All patients (100%) agreed to participate. The median Psoriasis Area and Severity Index (PASI) score was 13.0. Overall, 82.9% at least often felt the need to hide their psoriasis, and 74.3% claimed their self-confidence was at least often affected by their psoriasis. The median EQ-5D health state utility score was 13.0% less than healthy individuals (P < .001). On the SF-36, the mean general health score was 13.2% less (P = .005) and the median social functioning score 18.7% less (P = .005) than that of patients with no chronic conditions. Conclusion: Individuals with psoriasis are significantly affected in their health state utility, perception of general health, and social functioning when compared with individuals without chronic disease and those with certain primary medical conditions. (J Am Acad Dermatol 2002;47:512-8.)

The importance of lowering the costs of stem cell transplantation in developing countries.

The effectiveness and efficiency of health care systems can be assessed by economic evaluation, comparing the costs and outcomes of alternative interventions. Direct costs include accommodation, nursing, physicians' fees, diagnostic tests and treatment. Indirect costs derive from the loss of a persons ability to use life in a productive way e.g. employment. In cost-effectiveness analyses, cost is the numerator and effectiveness (related to health outcomes) is the denominator. The unit of measurement of effectiveness is usually years of life saved. Cost utility analyses require a preference-based measurement of health-related quality of life (HRQL) to allow the calculation of utility scores for health states and so the adjustment of effectiveness for quality. Typically, this allows the calculation of quality-adjusted life years (QALYs). A review of published reports, to be presented in detail, yields the following summation. The greater cost of stem cell harvest from peripheral blood is more than offset by the reduced costs associated with a shorter hospital stay. Transplants early in first remission cost less than those undertaken at later points in disease evolution/treatment experience. Changing the primary locus of care from inpatient to outpatient may result in notable cost savings but can produce cost-shifting (from inpatient to outpatient). Nevertheless, in selected patient, the use of non-myeloablative transplants may offer a cost-effective option, especially in the developing country context.

The minor oral surgery outcome scale: A multi-attribute patient-derived outcome measure

Purpose: The purpose of this study was to produce a clinically useful, patient-derived, minor oral surgery outcome scale. Patients and Methods: Seventy-seven consecutive patients scheduled for minor oral surgery were interviewed using semistructured interview techniques to identify those areas of life (domains) that patients believed will be affected by minor oral surgery. These interviews were analyzed by a multidisciplinary panel and a scale based on 5 domains, each with 4 outcome statements was constructed. The domains and outcome statements were weighted in terms of importance by a further consecutive sample of 100 patients using resource allocation and visual analog tasks. An additive mathematical formula was applied to the mean weights for each domain and outcome states to produce the final weighted scale. Results: Five domains were identified from the interviews and weighted according to their order of importance (0 to 100 scale; 0 = least important). These were general health and well-being (24.6); impact on home/social life (20.8); health and comfort of the mouth, teeth, and gums (20.0); appearance (18.8); and impact on job/studies (15.8). Conclusion: A clinically applicable, multi-attribute outcome scale has been produced that takes into account all determinants of health outcome as perceived by the patient in the context of minor oral surgery. It is completed by selecting a weighted statement from each domain, the sum of which constitutes the patient's health state utility score. The scale has potentially extensive application to both clinical care and research. © 2000 American Association of Oral and Maxillofacial Surgeons

Economic methods for measuring the quality of life associated with HIV infection.

Quality of life is measured as utilities for cost-effectiveness analyses. To test the adequacy of three common utility elicitation methods for individuals with Human Immunodeficiency Virus (HIV) disease. HIV-positive participants (n = 75) rated three standardized health states (symptomatic HIV infection, minor AIDS defining illness, and major AIDS defining illness) with two utility elicitation methods (Standard Gamble [SG], and Time Trade-off [TTO]) and one value method (Visual Analog [VA]). Participants also rated their own health with one utility method (Health Utilities Index [HUI]) and one conventional quality of life method (Medical Outcomes Study--HIV Health Survey [MOS-HIV]). For all states, SG and TTO scores ranged from near 0.00 (equivalent to death) to 1.00 (best possible quality of life). Mean scores for symptomatic HIV were similar with the SG (0.80) and TTO (0.81) but higher than with the VA (0.70). Similar results were observed for minor AIDS defining illnesses (0.65, 0.65, 0.46 respectively) and major AIDS defining illnesses (0.42, 0.44, 0.25 respectively). Discrepant SG and TTO scores were observed in many individuals and were not explained by demographic characteristics. As expected, HUI scores of an individual's own health were related to the disease state. Four of ten MOS-HIV subscales (overall health, physical functioning, role functioning, and pain) were also related to disease state. HUI scores were correlated with the MOS-HIV score for overall health and for all MOS-HIV subscales except health transition. Mean utility scores for HIV-related health states elicited by the Standard Gamble and Time Trade-off were similar but a large degree of individual variation persists. Economic methods provide imprecise estimates of the quality of life associated with HIV infection.

Patient-assigned health state utilities for depression-related outcomes: differences by depression severity and antidepressant medications

Background: Major depressive disorder is a prevalent psychiatric disorder in primary care associated with impaired patient functioning and well-being. We compared patient utilities for hypothetical depression-related and current health states and to examine differences in utilities by patient demographic and clinical characteristics. Methods: Seventy patients with DSM-III-R major depressive disorder or dysthymia who completed at least 8 weeks of antidepressant treatment were recruited from primary care practices. Patients assessments included the Hamilton Depression Rating Scale (HDRS), SF-36 Health Survey, and standard gamble interviews to obtain utilities for 11 hypothetical depression-related states, varying depression severity and antidepressant treatment, and the patient's current health state. Results: The mean utility for severe depression was 0.30 and 25% of patients rated this state as worse than or equivalent to death. Utilities varied from 0.55 to 0.63 for moderate depression, 0.64 to 0.73 for mild depression, and 0.72 to 0.83 for antidepressant maintenance therapy. Statistically significant differences were observed in mean utilities by level of disease severity and by tricyclic antidepressants compared with the newer antidepressants (i.e., fluoxetine, nefazodone). There were no significant differences in utilities for hypothetical states by demographic variables. Mean patient-assigned utilities for current health varied by depression severity and presence of medication side effects. Conclusions: Health state utility scores can be provided by patients with depression and the utility scores provided by patients for hypothetical states demonstrate differences by disease severity and antidepressant treatment. Limitations: The sample size was small which may limit generalizability and statistical power for detecting important differences. The study findings are limited to patients who have successfully completed 8 weeks of antidepressant treatment. Clinical Relevance: Understanding patient preferences for depression outcomes is important for economic evaluations of new antidepressants and for understanding patient behavior and adherence to antidepressant treatment regimens.