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168 Appendix 10 TABLE 51 Mean (SD) TTO scores for two versions of questionnaire The first version (personal version) of TTO asked each of 31 patients to imagine that their current health was described by health state A (or B or C). For the TTO exercise they were asked to choose between this particular health state for 10 years and a treatment that would restore full and perfect health, but would offer less than 10 years’ survival. In the second version (impersonal) of TTO, 28 patients were asked to imagine that they had two friends, one whose current health was described by state A (or B or C). For the TTO exercise they were asked to choose between this particular health state for 10 years and a treatment that would restore full and perfect health, but would offer less than 10 years’ survival. Several changes were made in the instrument during its development, thus limiting the subsequent findings. Twenty-four patients in the personal TTO were presented the health state descriptions without frequency information about the mood, sexual, bladder and bowel dysfunction. The remaining seven patients, as the patients involved in the impersonal TTO, were given the final health state descriptions. The mean scores of the personal and impersonal version of TTO are shown in Table 51. The results show that patients responding to the impersonal version of TTO were more likely to trade off length of life for improved QoL compared with the same health states described in the personal version. Author: Chapman et al. (1999) 75 Title: A multi-attribute model of prostate cancer patients’ preferences for health states Multi-attribute utility theory was used to develop a model to measure patients’ preferences with prostate cancer medical treatment. Fifty-seven patients were recruited, 26 with localised and 26 with metastatic prostate cancer, to evaluate alternative prostate cancer health states. Personal version (31 patients) Impersonal version (28 patients) Health state A 0.78 (0.30) 0.78 (0.29) Health state B 0.72 (0.35) 0.51 (0.30) Health state C 0.35 (0.35) 0.20 (0.26) Current health 0.83 (0.25) 0.71 (0.32) The health states were described in terms of five health attributes affected by prostate cancer: pain, mood, sexual function, bladder and bowel function and fatigue and energy. Each attribute had three levels that were used to form three clinical health state descriptions: A = high, B = moderate and C = low. A fourth personalised health state description (P) was used to match the patient’s current health. Each attribute was weighted by their relative importance, and pain received the highest attribute weight (29% of the overall value of QoL) the other attributes received different weights among localised and metastatic prostate cancer patients. In order to measure patients’ preferences, Chapman and colleagues used a TTO approach in order to elicit valuations for the three health states (A, B and C) and for the patient’s current health state (P). The TTO for the patients’ own health state (P) was standardised by comparing it with TTO judgements for states A and C: P stand = P – C/A – C Several changes were made in the instrument during its development; thus 22 patients were presented the TTO questions in a personal choice format and the remaining 35 patients were given an impersonal TTO description that described a hypothetical health state that would be experienced by a friend. The mean TTO scores are shown in Table 52. The scores for states A, B, C and P were calculated by taking the number of years in perfect health equivalent to 10 years in each health state and dividing by 10. The 57 patients, on average, estimated their present heath state utility as a value of 0.79. In conclusion, despite several changes in the instrument measure, the patients assessed their current health between the high and low states.
TABLE 52 Mean (SD) TTO scores (N = 57) Health state description TTO score State A 0.84 (0.19) State B 0.66 (0.29) State C 0.23 (0.25) Personalised description (P) 0.79 (0.23) Standardised P 0.92 (0.74) Authors: Krahn et al. (2003) 76 Title: Patient and community preferences for outcomes in prostate cancer A total of 141 prostate cancer patients were recruited to evaluate preferences for outcomes for two main health states (non-metastatic and metastatic disease) using RS and SG methods. The aim was to assess the impact of sexual, urinary and bowel dysfunction on and highlight the differences between valuations based on community and patient preferences. In order to assess the differences between the separate sources of preferences, patients’ utilities were elicited from a disease-specific QoL measure, PORPUS. Community preferences were assessed based on the patient descriptions provided based on their responses to two separate generic QoL questionnaires, HUI and QWB. PORPUS is an instrument composed of 10 psychometric attributes: pain and disturbing body sensations, energy, support from family and friends, communications with doctor, emotional well-being, urinary frequency and urgency, leaking urine and poor bladder control, sexual function, sexual interest and drive and bowel problems. The HUI has eight attributes: vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain. The QWB has three attributes: mobility, physical activity and social activity. The HUI and TABLE 53 Mean QoL scores © Queen’s Printer and Controller of HMSO 2007. All rights reserved. Health Technology Assessment 2007; Vol. 11: No. 2 QWB have two components, a health state classification system and a system of utility weights. Hence patients were used to classify their current health state in the context of the descriptive system and weights were subsequently applied based on community values. The mean QoL scores elicited from community and patients are presented in Table 53. In summary, the mean utilities elicited using SG were higher than RS utilities. The valuations based on the disease-specific measure (PORPUS) were closer to the generic measure assessed using SG (HUI) than that based on an RS approach (QWB). Finally, patients appeared to value their current health state higher than the valuations based on community preferences. Author: Sandblom et al. (2004) 77 Title: A population-based study of pain and quality of life during the year before death in men with prostate cancer A total of 1442 patients with prostate cancer received a questionnaire to evaluate the pain and health QoL with prostate cancer; 1237 patients (635 with palliative treatment, 383 with watchful waiting and 219 with treatment with curative intent) responded to the questionnaire. The questionnaire was a combination of EuroQol, two parts of the Brief Pain Inventory (BPI) form and eight specially designed questions. The EuroQol is a generic (non-disease-specific) instrument, comprising five health dimensions (and three levels of severity): mobility, self-care, usual activities, pain and anxiety/depression (derived to EQ-5D). A value score, based on societal valuations, is attached to the different combinations of these dimensions. In addition, a SG utilities RS utilities Patients N PORPUS SG HUI PORPUS RS QWB All patients 141 0.86 0.80 0.79 0.65 Non-metastatic cancer patients 110 0.86 0.80 0.80 0.66 Metastatic cancer patients 31 0.85 0.81 0.75 0.62 RS, rating scale; SG, standard gamble. 169
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A systematic review and economic mo
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xvi Executive summary of study desi
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xviii Executive summary prednisone/
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Description of underlying health pr
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● Patients with severe fluid rete
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Search strategy As stated in Chapte
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consensus and, if necessary, a thir
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TABLE 1 Summary of included RCTs St
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TABLE 2 Treatment comparisons relat
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tumour response was reported for on
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decrease in PSA level (51 and 39% c
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Survival (%) 100 80 60 40 20 0 0 co
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TABLE 9 Grade 3 or 4 adverse events
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these, 69 patients had measurable t
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Effectiveness of mitoxantrone plus
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over to receive additional mitoxant
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Progression-free survival It is not
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compared with corticosteroids. The
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statistically significant improveme
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Summary of studies included in the
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TABLE 19 Percentage of costs by res
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TABLE 21 Summary of submission by S
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TABLE 24 Other in-trial costs a bod
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TABLE 27 Cost-effectiveness results
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Introduction The review of cost-eff
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cancer QoL estimation. Studies whic
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Localised Metastatic mHRPC Bennet (
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were assigned to the total follow-u
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was set to be 1.5 years based on th
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76 Discussion (CCI-NOV22) and least
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78 Discussion subsequent chemothera
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Rodolphe Perard received funding fr
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84 References Compendium; 2004. URL
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86 References (D) in patients (pts)
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88 References 100. Aventis Pharma.
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90 References low-dose prednisone i
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92 References 180. Kozloff M, Robin
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94 References locally advanced pros
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96 References 251. Scholz MC, Guess
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Clinical effectiveness Searching fo
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1. Prostatic Intraepithelial Neopla
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19. donataxel 20. doxetal 21. doxmi
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6. Mitozantrone.ti,ab. 7. Mitoxantr
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Texot or Trazoteva or Trixotene or
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1. (docetaxel OR asodecel OR doxeta
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10. (index of wellbeing or quality
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Appendix 2 Excluded studies Study d
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Study details Reason for exclusion
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