Evidence‐Based Medicine in Otolaryngology Part 9: Valuing Health Outcomes

Abstract

Decisions about resource allocation are increasingly based on value trade-offs between health outcomes and cost. This process relies on comprehensive and standardized definitions of health status that accurately measure the physical, mental, and social well-being of patients across disease states. These metrics, assessed through clinical trials, observational studies, and health surveys, can facilitate the integration of patient preferences into clinical practice. This ninth installment in the Evidence-Based Medicine in Otolaryngology Series is a practical overview of health outcome valuation, as well as the integration of both quality and quantity of life into standardized metrics for health research, program planning, and resource allocation. Tools for measuring preference-based health states, measures of effectiveness, and the application of metrics in economic evaluations are discussed.

Quality of life and health-related utility after head&neck cancer surgery

“…Some studies, such as in [9], investigated face and construct validity of direct utility elicitation methods. Liao et al [10], comparing utility values in Taiwan and Sweden, confirm the need of understanding population differences and the same claim is reported in [11]: “Future health state valuations would ideally be based on representative value sets to reflect the different populations within and beyond the currently evaluated countries.” Again, no study targeted Swiss population, and no study reported UCs for the health states after mini-invasive surgery.…”

“…Despite patients, of course, are more aware about their health state and how it affects their life, the general population is probably more suitable for analyses that will be used by healthcare policy makers to take decisions that will affect the population as a whole. One motivation for relying in general community values instead of patients’ ones is that patients may develop adapting behaviors to live with a certain heath state, thus overestimating the true state utility [11].…”

Evidence‐Based Medicine in Otolaryngology Part 10: Cost‐Effectiveness Analyses in Otolaryngology

“…100 A published review of the Tufts CEA registry from 1976 to 2011 revealed that only 2.0% of the CUAs evaluated otolaryngology interventions. 34,39 The study demonstrated a higher proportion of published CUAs in otology (31.1%) than in endocrine surgery (19.6%), sleep medicine/surgery (18.0%), head and neck surgery (13.0%), pediatric otolaryngology (8.2%), allergy (6.6%), and rhinology (3.3%). 100 There were no CUAs related to facial plastics uncovered in their search.…”

“…36,37,40 QALYs represent the summary measure of a health intervention in terms of time spent in a series of these quality-weighted health states. 38,39,41 Given the multidimensional health outcomes evaluated in surgical interventions, QALYs are commonly used to integrate measures of survival and quality of life. 1,35,40 In the previous example, a patient who takes the chemotherapeutic agent for nasopharyngeal carcinoma may have chronic renal failure as a complication of therapy, which reduces his or her quality of life from 1 to 0.6.…”

Quality of life and health-related utility after trans-oral surgery for head and neck cancers

“…However, their aim was to investigate face and construct validity of different elicitation methods, and no specific post-surgery states were addressed. Finally, Liao et al [ 17 ] compared utility values ascertained from Taiwan and Sweden, and suggested the need for understanding population differences, which is corroborated by Caulley et al [ 18 ]. As a matter of fact, UCs are subjective measures, and may vary among different populations, depending on cultural, geographical, and economical factors [ 19 , 20 ].…”