A structured review of health utility measures and elicitation in advanced/metastatic breast cancer

Abstract

BackgroundHealth utilities are increasingly incorporated in health economic evaluations. Different elicitation methods, direct and indirect, have been established in the past. This study examined the evidence on health utility elicitation previously reported in advanced/metastatic breast cancer and aimed to link these results to requirements of reimbursement bodies.MethodsSearches were conducted using a detailed search strategy across several electronic databases (MEDLINE, EMBASE, Cochrane Library, and EconLit databases), online sources (Cost-effectiveness Analysis Registry and the Health Economics Research Center), and web sites of health technology assessment (HTA) bodies. Publications were selected based on the search strategy and the overall study objectives.ResultsA total of 768 publications were identified in the searches, and 26 publications, comprising 18 journal articles and eight submissions to HTA bodies, were included in the evidence review. Most journal articles derived utilities from the European Quality of Life Five-Dimensions questionnaire (EQ-5D). Other utility measures, such as the direct methods standard gamble (SG), time trade-off (TTO), and visual analog scale (VAS), were less frequently used. Several studies described mapping algorithms to generate utilities from disease-specific health-related quality of life (HRQOL) instruments such as European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – Core 30 (EORTC QLQ-C30), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – Breast Cancer 23 (EORTC QLQ-BR23), Functional Assessment of Cancer Therapy – General questionnaire (FACT-G), and Utility-Based Questionnaire-Cancer (UBQ-C); most used EQ-5D as the reference. Sociodemographic factors that affect health utilities, such as age, sex, income, and education, as well as disease progression, choice of utility elicitation method, and country settings, were identified within the journal articles. Most submissions to HTA bodies obtained utility values from the literature rather than exploring the HRQOL data obtained during clinical development. This was critiqued by the National Institute for Health and Clinical Excellence (NICE). Furthermore, the impact of age on utilities was highlighted by NICE and it was suggested that an age match of the study population should be attempted.ConclusionHealth utilities are recorded across the globe to varying extents and using differing elicitation methods. Manufacturers seeking reimbursement need to be aware of the country-specific requirements for elicitation of health utilities.

Quality of life in a real-world cohort of advanced breast cancer patients: a study of the SONABRE Registry

“…Thus, due to the large variation in methods used to assess QoL in breast cancer patients, [8,[14][15][16] there is a need for a more standardized approach. Therefore, the European guideline on the treatment of ABC urges the development of specific tools to evaluate QoL in ABC patients with attention to solid methodology [55].…”

“…Despite the increased awareness of evaluation of QoL in addition to clinical outcomes, QoL and health-utility are underreported and not uniformly addressed in most breast cancer studies [8,[14][15][16][17]. Gaining insights into the QoL and the factors influencing this outcome is especially important for advanced stages of breast cancer, as the goal for these patients does comprise not only prolonging life, but also optimizing the QoL, considering treatments given in this disease stage are of palliative intend.…”

Estimation of health state utilities in breast cancer

“…As previous breast cancer utility studies8,9 have used different methodologies, scenarios, and subject groups, direct comparisons are not possible. In this study, SG utility scores were higher than VAS values, corroborating previous research reports 22,26.…”

“…According to the study of Peasgood et al9 reviewing 49 articles, SG was the most frequently used with 59.9%, followed by VAS (22.2%), TTO (11.1%), and EQ-5D (34.5%) in the estimation of utility of metastatic breast cancer health states, and VAS was the most frequently used with 34.5%, followed by SG (28%), EQ-5D (16.9%), and TTO (15.3%) in the estimation of utility of early breast cancer health states. Health utilities in breast cancer states have been shown to vary significantly depending on valuation method, study population, health states, and location 8,9. Policy decision makers need to be aware of country-specific utility weight when evaluating health care interventions.…”

A systematic literature review of health state utility values in head and neck cancer

“…These tools are formed of a generic HRQoL questionnaire and an accompanying formula or set of weights (or “tariffs”) elicited from a sample of the general population for converting responses into HSUVs; thus, the utility measure can be considered as a preference-based evaluation of a given health state described by the dimensions of the tool [ 11 , 12 ]. The National Institute for Health and Care Excellence (NICE) and the European Network for Health Technology Assessment (EUnetHTA) recommend the EuroQol 5-dimension questionnaire (EQ-5D) ( https://euroqol.org ) [ 13 , 14 ]. Accordingly, the TTO with a 10-year time horizon is the most frequently used approach among the direct techniques, because of greater comparability with the method used to develop the EQ-5D scoring algorithm [ 15 ].…”