Influence of Perspective on Preferences for Prostate Cancer Outcomes
Gries, Katharine Suzanne
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Background The utility value is a necessary component of the cost-utility analysis (CUA). They can be obtained from various perspectives and using different methods. The relationship between elicitation methods and perspectives is unknown in prostate cancer. Objective To quantify the difference in utility values comparing three different perspectives and disease-specific health states with a generic preference measure. Then to understand the sensitivity of the disease-specific utility value derived from three perspectives in a CUA model. Methods Disease-specific health states were developed with attributes that varied across five health domains: sexual function, urinary function, bowel function, pain, and emotional well-being. Men with prostate cancer, men at risk for prostate cancer, and a sample from the general population were recruited to value the health states using standard gamble (SG) methodology and to complete the Health Utilities Index (HUI). Disease-specific utility values were modeled in a prostate cancer CUA to assess the sensitivity of the parameter estimate. Results 136 participants (n= 43 prostate cancer; n=40 at risk, n=49 general population) completed the study visit. Mean disease-specific utility values ranged from 0.46 to 0.85 for men with prostate cancer, 0.37 to 0.75 for men at risk, and 0.32 to 0.81 for the general population group. Mean HUI3 current health ratings: men with prostate cancer HUI3: 0.75 (SD=0.260), men at risk HUI3: 0.77 (SD=0.238), general population HUI3: 0.84 (SD=0.178). There were small differences in utility values comparing between perspectives and between the SG and HUI methods. While the incremental cost-effectiveness ratios were high and would not be considered cost-effective, using the perspective of the general population was more cost effective compared to the patient perspective. Conclusion The utility values for men with prostate cancer support the hypothesis that patients experiencing the disease state (patient perspective) assign higher utility values to disease-specific health states. Utility values were higher when obtained by the generic, preference based measure compared to the disease-specific method. The CUA was sensitive to the change in utility value when holding all other parameters constant.
- Pharmaceutics