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Quality-of-Life Valuations of Advanced Breast Cancer by New Zealand Women

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Abstract

Objectives

To obtain health-related quality-of-life (HR-QOL) valuations (or ‘utilities’) from New Zealand women for four health states representative of advanced (metastatic) breast cancer, suitable for use in cost-utility analysis, and to compare four valuation methodologies.

Methods

Written case descriptions of four health states representative of advanced breast cancer (hormonal therapy, chemotherapy, radiotherapy and hypercalcaemia) were developed in consultation with nine oncology professionals. Time trade-off (TTO) and visual analogue scale (VAS) valuations were obtained via interviews from a sample of 50 women, aged 25–69 years, randomly selected from the New Zealand general public and through informal networks. Representations of the four health states on the EQ-5D health state classification system were also obtained from the respondents and later valued using New Zealand and UK EQ-5D social tariffs.

Results

The four valuation methods ranked the four states’ mean valuations identically: hormonal therapy > chemotherapy ≥ radiotherapy > hypercalcaemia. All methods except the TTO distinguished between chemotherapy and radiotherapy. In order of the VAS and TTO methods and the EQ-5D with NZ and UK tariffs, respectively, the valuations [mean (95% CI)] were: hormonal therapy 0.54 (0.48, 0.59); 0.65 (0.57, 0.73); 0.54 (0.51, 0.58); 0.60 (0.54, 0.65); chemotherapy 0.46 (0.41, 0.51); 0.49 (0.40, 0.57); 0.48 (0.43, 0.53); 0.51 (0.43, 0.59); radiotherapy for severe bone pain 0.35 (0.30, 0.40); 0.45 (0.37, 0.54); 0.31 (0.27, 0.35); 0.25 (0.18, 0.33); and moderate to severe hypercalcaemia 0.13 (0.09, 0.17); −0.17 (−0.29, −0.05); −0.05 (−0.07, −0.03); −0.52 (−0.56, −0.48). The four valuation methods gave similar results for chemotherapy, but for the three other states the TTO valuations differed from those obtained from the VAS method and the NZ and UK EQ-5D tariffs. There were significant pairwise correlations between the four methods across all four health states, although the valuation for hypercalcaemia obtained from the UK EQ-5D tariff was very low compared with the three other methods, and the VAS valuation was positive rather than negative.

Conclusion

Our study suggests that women in the New Zealand general public are able to consistently evaluate and value case descriptions of advanced breast cancer using either direct methods (VAS or TTO) or the EQ-5D health state classification system. Some of the valuations elicited using the four methods differ quantitatively, especially for hypercalcaemia. As our sample size was modest (50) and it turned out to be unrepresentative of the New Zealand female population, this study serves as a pilot study.

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Acknowledgements

We are grateful to the following individuals for helping us to develop the four case studies: Andrew Simpson, Garry Forgeson, Christopher Wynne and Jeremy Long (oncologists); Faye Kenny, Gillian Lay, Gillian Maxwell and Gill Gibbs (oncology nurses); and Judy Forsyth (oncology clinical psychologist).

Kathy Heaton-Brown and Leah Ebbers conducted the interviews. Wande Remme (EuroQol Group, Rotterdam) authorised use of the EQ-5D questionnaire and provided the New Zealand version. Alistair Stewart and Greg Gamble kindly advised on the statistical analyses. R.J. Milne and D. Thomas designed the study; R.J. Milne, D. Thomas and K. Heaton-Brown designed the interview methodology; R.J. Milne analysed the data; R.J. Milne and P. Hansen revised the manuscript; R.J. Milne, K. Heaton-Brown, V. Harvey and A. Cubitt developed the case studies.

This study was funded by Novartis NZ Ltd, which took no part in the study design, analysis or interpretation of the findings and placed no restriction on copyright or publication. V. Harvey has received honoraria from Novartis NZ Ltd.

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Authors and Affiliations

  1. School of Population Health, University of Auckland, Auckland, New Zealand

    Richard J. Milne, David Thomas & Vernon Harvey

  2. Health Outcomes Associates Ltd, PO Box 60315, Titirangi, Auckland, New Zealand

    Richard J. Milne & Kathy H. Heaton-Brown

  3. Department of Economics, University of Otago, Dunedin, New Zealand

    Paul Hansen

  4. Oncology Service, Auckland District Health Board, Auckland, New Zealand

    Vernon Harvey & Alison Cubitt

Authors
  1. Richard J. Milne
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  2. Kathy H. Heaton-Brown
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Correspondence to Richard J. Milne.

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Milne, R.J., Heaton-Brown, K.H., Hansen, P. et al. Quality-of-Life Valuations of Advanced Breast Cancer by New Zealand Women. Pharmacoeconomics 24, 281–292 (2006). https://doi.org/10.2165/00019053-200624030-00007

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