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EQ-5D Health Utility Scores: Data from a Comprehensive Canadian Cancer Centre

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Abstract

Background

To improve the precision of health economics analyses in oncology, reference datasets of health utility (HU) scores are needed from cancer survivors across different disease sites. These data are particularly sparse amongst Canadian survivors.

Methods

A survey was completed by 1759 ambulatory cancer survivors at the Princess Margaret Cancer Centre which contained demographic questions and the EuroQol-5D (EQ-5D) instrument. Clinical information was abstracted from electronic records and HU scores were calculated using Canadian health state valuations. Construct validity was assessed through correlation of HU and visual analog scale (VAS) scores (Spearman) and by comparing HU scores between performance status groups (effect size). The influence of socio-demographic clinical variables on HU was analyzed by non-parametric between-group comparisons and multiple linear regression.

Results

Mean EQ-5D HU scores were derived for 26 cancers. Among all survivors, the mean ± standard error of the mean EQ-5D utility score was 0.81 ± 0.004. Scores varied significantly by performance status (p < 0.0001) and correlated with VAS (Spearman r = 0.61). The cancer sites with the lowest mean HU scores were acute lymphoblastic leukemia (0.70 ± 0.03) and pancreatic cancer (0.76 ± 0.03); testicular cancer (0.89 ± 0.02) and chronic lymphocytic leukemia (0.90 ± 0.05) had the highest mean scores. A multiple regression model showed that scores were influenced by disease site (p < 0.001), education level (p < 0.001), partner status (p < 0.001), disease extent (p = 0.0029), and type of most recent treatment (p = 0.0061).

Conclusions

This work represents the first set of HU scores for numerous cancer sites derived using Canadian preference weights. The dataset demonstrated construct validity and HU scores varied by general socio-demographic and clinical parameters.

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References

  1. Canadian Cancer Society, Statistics Canada, Public Health Agency of Canada, Provincial/Territorial Cancer Registrie. Canadian cancer statistics 2015. Toronto: Canadian Cancer Society; 2015.

  2. de Oliveira C, Bremner KE, Pataky R, Gunraj N, Haq M, Chan K, et al. Trends in use and cost of initial cancer treatment in Ontario: a population-based descriptive study. CMAJ Open. 2013;1(4):E151–8.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Brauer CA, Rosen AB, Greenberg D, Neumann PJ. Trends in the measurement of health utilities in published cost-utility analyses. Value Health. 2006;9(4):213–8.

    Article  PubMed  Google Scholar 

  4. Whitehead SJ, Ali S. Health outcomes in economic evaluation: the QALY and utilities. Br Med Bull. 2010;96:5–21.

    Article  PubMed  Google Scholar 

  5. Tolley K. What are health utilities? What is…? Series. 2nd ed. 2009. http://www.whatisseries.co.uk/what-are-health-utilities/. Accessed 1 Aug 2016.

  6. Arnold D, Girling A, Stevens A, Lilford R. Comparison of direct and indirect methods of estimating health state utilities for resource allocation: review and empirical analysis. BMJ. 2009;339:b2688.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Canadian Agency for Drugs and Technologies in Health (CADTH). Guidelines for the economic evaluation of health technologies: Canada. 3rd ed. Ottawa: CADTH; 2006. pp. 1–75. https://www.cadth.ca/about-cadth/how-we-do-it/methods-and-guidelines/guidelines-for-the-economic-evaluation-of-health-technologies-canada. Accessed 1 Aug 2016.

  8. National Institute for Health and Care Excellence (NICE). Guide to the methods of technology appraisal 2013. London: NICE; 2013.

  9. Pickard AS, Wilke CT, Lin H-W, Lloyd A. Health utilities using the EQ-5D in studies of cancer. Pharmacoeconomics. 2007;25(5):366–84.

    Article  Google Scholar 

  10. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33:337–43.

    Article  CAS  PubMed  Google Scholar 

  11. Basch E, Abernethy AP, Mullins CD, Reeve BB, Lou Smith M, Coons SJ, et al. Recommendations for incorporating patient-reported outcomes into clinical comparative effectiveness research in adult oncology. J Clin Oncol. 2012;30(34):4249–55.

    Article  PubMed  Google Scholar 

  12. Barton GR, Sach TH, Jenkinson C, Avery AJ, Doherty M, Muir KR. Do estimates of cost-utility based on the EQ-5D differ from those based on the mapping of utility scores? Health Qual Life Outcomes. 2008;6:51.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Chan KKW, Willan AR, Gupta M, Pullenayegum E. Underestimation of uncertainties in health utilities derived from mapping algorithms involving health-related quality-of-life measures: statistical explanations and potential remedies. Med Decis Mak. 2014;34(7):863–72.

    Article  Google Scholar 

  14. Sullivan PW, Mulani PM, Fishman M, Sleep D. Quality of life findings from a multicenter, multinational, observational study of patients with metastatic hormone-refractory prostate cancer. Qual Life Res. 2007;16:571–5.

    Article  PubMed  Google Scholar 

  15. Teckle P, McTaggart-Cowan H, Van der Hoek K, Chia S, Melosky B, Gelmon K, et al. Mapping the FACT-G cancer-specific quality of life instrument to the EQ-5D and SF-6D. Health Qual Life Outcomes. 2013;11:203.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Conner-Spady BL, Cumming C, Nabholtz J-M, Jacobs P, Stewart D. A longitudinal prospective study of health-related quality of life in breast cancer patients following high-dose chemotherapy with autologous blood stem cell transplantation. Bone Marrow Transpl. 2005;36(3):251–9.

    Article  CAS  Google Scholar 

  17. Krahn M, Bremner KE, Tomlinson G, Ritvo P, Irvine J, Naglie G. Responsiveness of disease-specific and generic utility instruments in prostate cancer patients. Qual Life Res. 2007;16:509–22.

    Article  PubMed  Google Scholar 

  18. Jang RW, Isogai PK, Mittmann N, Bradbury PA, Shepherd FA, Feld R, et al. Derivation of utility values from European Organization for Research and Treatment of Cancer Quality of Life-Core 30 questionnaire values in lung cancer. J Thorac Oncol. 2010;5(12):1953–7.

    Article  PubMed  Google Scholar 

  19. Sørensen JB, Klee M, Palshof T, Hansen HH. Performance status assessment in cancer patients. An inter-observer variability study. Br J Cancer. 1993;67(4):773–5.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bansback N, Tsuchiya A, Brazier J, Anis A. Canadian valuation of EQ-5D health states: preliminary value set and considerations for future valuation studies. PLoS One. 2012;7(2):e31115.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Dolan P. Modeling valuations for EuroQol health states. Med Care. 1997;35(11):1095–108.

    Article  CAS  PubMed  Google Scholar 

  22. Shaw JW, Johnson JA, Coons SJ. US valuation of the EQ-5D health states: development and testing of the D1 valuation model. Med Care. 2005;43(3):203–20.

    Article  PubMed  Google Scholar 

  23. Farkkila N, Torvinen S, Roine RP, Sintonen H, Hanninen J, Taari K, et al. Health-related quality of life among breast, prostate, and colorectal cancer patients with end-stage disease. Qual Life Res. 2014;23:1387–94.

    Article  PubMed  Google Scholar 

  24. Grutters JPC, Joore MA, Wiegman EM, Langendijk JA, de Ruysscher D, Hochstenbag M, et al. Health-related quality of life in patients surviving non-small cell lung cancer. Thorax. 2010;65(10):903–7.

    Article  PubMed  Google Scholar 

  25. Chouaid C, Agulnik J, Goker E, Herder GJM, Lester JF, Vansteenkiste J, et al. Health-related quality of life and utility in patients with advanced non–small-cell lung cancer: a prospective cross-sectional patient survey in a real-world setting. J Thorac Oncol. 2013;8(8):997–1003.

    Article  PubMed  Google Scholar 

  26. Torvinen S, Farkkila N, Sintonen H, Saarto T, Roine RP, Taari K. Health-related quality of life in prostate cancer. Acta Oncol. 2013;52:1094–101.

    Article  PubMed  Google Scholar 

  27. Proskorovsky I, Lewis P, Williams CD, Jordan K, Kyriakou C, Ishak J, et al. Mapping EORTC QLQ-C30 and QLQ-MY20 to EQ-5D in patients with multiple myeloma. Health Qual Life Outcomes. 2014;12(1):35.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Reichardt P, Leahy M, Garcia Del Muro X, Ferrari S, Martin J, Gelderblom H, et al. Quality of life and utility in patients with metastatic soft tissue and bone sarcoma: the sarcoma treatment and burden of illness in North America and Europe (SABINE) study. Sarcoma. 2012;2012:740279.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Tramontano AC, Schrag DL, Malin JK, Miller MC, Weeks JC, Swan JS, et al. Catalog and comparison of societal preferences (utilities) for lung cancer health states: results from the Cancer Care Outcomes Research and Surveillance (CanCORS) study. Med Decis Mak. 2015;35(3):371–87. doi:10.1177/0272989X15570364.

    Article  Google Scholar 

  30. Sullivan PW, Ghushchyan V. Preference-Based EQ-5D index scores for chronic conditions in the United States. Med Decis Making. 2006;26(4):410–20.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Sullivan PW, Slejko JF, Sculpher MJ, Ghushchyan V. Catalogue of EQ-5D scores for the United Kingdom. Med Decis Making. 2011;31(6):800–4.

    Article  PubMed  Google Scholar 

  32. Cheville AL, Almoza M, Courmier JN, Basford JR. A prospective cohort study defining utilities using time trade-offs and the Euroqol-5D to assess the impact of cancer-related lymphedema. Cancer. 2010;116:3722–31.

    Article  PubMed  Google Scholar 

  33. Askew RL, Swartz RJ, Xing Y, Cantor SB, Ross MI, Gershenwald JE, et al. Mapping FACT-melanoma quality-of-life scores to EQ-5D health utility weights. Value Health. 2011;14(6):900–6.

    Article  PubMed  Google Scholar 

  34. Whynes DK. Correspondence between EQ-5D health state classifications and EQ VAS scores. Health Qual Life Outcomes. 2008;6:94.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Oremus M, Tarride J-E, Clayton N, Raina P. Health utility scores in Alzheimer’s disease: differences based on calculation with American and Canadian preference weights. Value Health. 2014;17(1):77–83.

    Article  PubMed  Google Scholar 

  36. Mittmann N, Trakas K, Risebrough N, Liu BA. Utility scores for chronic conditions in a community-dwelling population. Pharmacoeconomics. 1999;15(4):369–76.

    Article  CAS  PubMed  Google Scholar 

  37. Sullivan PW, Lawrence WF, Ghushchyan V. A national catalog of scores preference-based in the United States for chronic conditions. Med Care. 2005;43(7):736–49.

    Article  PubMed  Google Scholar 

  38. Pickard AS, Wilke CT, Lin H-W, Lloyd A. Health utilities using the EQ-5D in studies of cancer. Pharmacoeconomics. 2007;25(5):365–84.

    Article  PubMed  Google Scholar 

  39. Wildi SM, Cox MH, Clark LL, Turner R, Hawes RH, Hoffman BJ, et al. Assessment of health state utilities and quality of life in patients with malignant esophageal dysphagia. Am J Gastroenterol. 2004;99(6):1044–9.

    Article  PubMed  Google Scholar 

  40. Hildebrandt T, Thiel FC, Fasching PA, Graf C, Bani MR, Loehberg CR, et al. Health utilities in gynecological oncology and mastology in Germany. Anticancer Res. 2014;34(2):829–35.

    PubMed  Google Scholar 

  41. Müller-Nordhorn J, Roll S, Böhmig M, Nocon M, Reich A, Braun C, et al. Health-related quality of life in patients with pancreatic cancer. Digestion. 2006;74(2):118–25.

    Article  PubMed  Google Scholar 

  42. Marcellusi A, Capone A, Favato G, Mennini FS, Baio G, Haeussler K, et al. Health utilities lost and risk factors associated with HPV-induced diseases in men and women: the HPV Italian Collaborative Study Group. Clin Ther. 2015;37(1):156–67. e4.

  43. Dudgeon D, King S, Howell D, Green E, Gilbert J, Hughes E, et al. Cancer Care Ontario’s experience with implementation of routine physical and psychological symptom distress screening. Psychooncology. 2012;21(4):357–64.

    Article  PubMed  Google Scholar 

  44. Färkkilä N, Sintonen H, Saarto T, Järvinen H, Hänninen J, Taari K, et al. Health-related quality of life in colorectal cancer. Colorectal Dis. 2013;15(5):e215–22.

    Article  PubMed  Google Scholar 

  45. Pickard AS, Neary MP, Cella D. Estimation of minimally important differences in EQ-5D utility and VAS scores in cancer. Health Qual Life Outcomes 2007;5:70.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Crott R, Versteegh M, Uyl-De-Groot C. An assessment of the external validity of mapping QLQ-C30 to EQ-5D preferences. Qual Life Res. 2013;22(5):1045–54.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to acknowledge the following individuals for contributing to data collection: Brandon Tse, Elizabeth Hall, Emily Tam, Judy Chen, Michael Borean, Tiffany Tse, Vivian Tam, Yuchen Li, and Kishan Shani.

Author Contributions

HN, GL, NM, and DH designed the study. HN, GL, MCB, AV, and DH planned and coordinated data collection. HN, MI, VP, HS, TW, HH, LE, MM, HT, and VH performed the majority of data collection. HN, GL, WX, SJS, and NM planned, designed, and assisted with data analyses. HN, JS, and XQ conducted the data analyses. HN, GL, and NM wrote the paper. All authors reviewed and approved of the final manuscript.

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Correspondence to Geoffrey Liu.

Ethics declarations

This study was funded by the Ontario Patient Reported Outcomes of Symptoms and Toxicity (ON-PROST), Cancer Care Ontario, the Alan B. Brown Chair, Lusi Wong Fund, and The Comprehensive Research Experience for Medical Students (University of Toronto). The authors HN, DH, JS, XQ, MCB, AV, MI, VP, HS, TW, HH, LE, MM, HT, VH, WX, SJS, NM, and GL have no conflicts of interest to declare.

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Naik, H., Howell, D., Su, S. et al. EQ-5D Health Utility Scores: Data from a Comprehensive Canadian Cancer Centre. Patient 10, 105–115 (2017). https://doi.org/10.1007/s40271-016-0190-z

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