Docetaxel with prednisone or prednisolone for the treatment of ...

TABLE 56 Descriptive statistics for TTO utilities by subjects’ perspectives
The first phase involved a detailed education
period with descriptions of prostate cancer.
Metastatic (advanced) prostate cancer was
described in two health states corresponding to
hormonally responsive prostate cancer and
hormonally refractory prostate cancer:
● The hormonally responsive prostate cancer
state was a cancer that has spread to other parts
of the body. The purpose of the treatment is to
slow the growth of prostate cancer cells by
stopping the production of testosterone.
● The hormonally refractory prostate cancer state
was a cancer that has spread throughout the
body. Hormone treatment is no longer effective.
The purpose of the treatment is to slow the
spread of disease and control symptoms, in
particular pain.
The descriptions included treatment
complications involving sexual function, urinary
and rectal tracts and a summary of their possible
treatment. A utility assessment was undertaken to
measure the impact of each complication on the
HRQoL of metastatic prostate cancer.
In the second phase, a scaling technique was
involved where the subject ranked each health
state on a continuum from 0 (death) to 100
(perfect health).
Finally, in the third phase, the TTO method
determined the point of indifference between a
period in an outcome state and a shorter period
in perfect health. (NB: the maximum period of
time in the health state was based on the
husband’s life expectancy, as determined by US
life tables.)
The metastatic prostate cancer preferences were
measured as utilities. The results for the two
metastatic prostate cancer health states, ranging
from 0.0 (death) to 1.0 (perfect or full health), are
presented in Table 56.
For each health state, husbands reported lower
utilities than did their wives. The largest absolute
Health Technology Assessment 2007; Vol. 11: No. 2
Hormonally responsive prostate cancer HRPC
Subject Mean Median 25th percentile 75th percentile Mean Median 25th percentile 75th percentile
Husbands 0.72 0.79 0.55 0.96 0.55 0.50 0.33 0.78
Wives 0.86 0.94 0.82 1.00 0.66 0.68 0.43 0.92
Couples 0.83 0.90 0.73 1.00 0.62 0.65 0.41 0.89
© Queen’s Printer and Controller of HMSO 2007. All rights reserved.
differences in median utilities between husbands
and wives were observed for HRPC. There was a
low correlation between husbands and wives’ TTO
utilities.
This study demonstrates that male primary care
patients who are candidates for prostate cancer
screening have preferences for the outcomes
of prostate cancer treatment and QoL with
advanced prostate cancer that differ from the
preferences of their wives. In conclusion, most
husbands would be willing to trade some
longevity to avoid the metastatic prostate cancer
scenarios.
Authors: Stewart et al. (2005) 79
Title: Utilities for prostate cancer
health states in men aged 60 and
older
A total of 162 men aged 60 years and older
(including 52% with prostate cancer) were
recruited to provide valuations for 19 health
states associated with prostate cancer or its
treatment using approaches based on SG. Similar
ratings were also obtained using TTO and VAS
approaches, although the data for these were not
reported in the paper.
The 162 subjects randomly rated nine of the 19
health states. These 19 health states were then
combined and used to assess four main health
states. These health states comprised three
‘asymptomatic’ states with a different probability
of tumour spread, plus a terminal ‘symptomatic’
health state.
In order to measure SG utilities, respondents were
asked to imagine that they were in one of the four
health states presented, and that there was a
treatment that could cure them but with an
associated risk of mortality. A ping-pong method
was then used to help the respondent to choose
the maximum risk of death he would accept as a
consequence of treatment. The utility for the
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