Quality-of-life valuations of advanced breast cancer by New Zealand women
Quality-of-life valuations of advanced breast cancer by New Zealand women
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DOI：
10.2165/00019053-200624030-00007
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发表时间：
2006-01-01
影响因子：
4.4
通讯作者：
Cubitt, A
中科院分区：
文献类型：
--
作者：
Milne, RJ;Heaton-Brown, KH;Cubitt, A
目的：获得新西兰妇女对代表晚期（转移性）乳腺癌的四种健康状态的健康相关生活质量（HR-QOL）评估（或“效用”），适合用于成本效用分析，并比较四种评估方法。方法：与九位肿瘤学专业人士协商，编写了代表晚期乳腺癌的四种健康状态（激素治疗、化疗、放疗和高钙血症）的书面病例描述。时间权衡（TTO）和视觉模拟量表（VAS）估值是通过对 50 名年龄在 25-69 岁的女性样本进行访谈获得的，这些女性是从新西兰公众中随机选择的，并通过非正式网络进行。还从受访者处获得了 EQ-5D 健康状况分类系统中四个健康州的表示，随后使用新西兰和英国 EQ-5D 社会费率进行了评估。结果：四种评估方法对四个州的平均评估进行了相同的排序：激素治疗 > 化疗 >= 放疗 > 高钙血症。除 TTO 之外的所有方法都区分化疗和放疗。按照分别采用新西兰和英国关税的 VAS 和 TTO 方法以及 EQ-5D 的顺序，估值 [平均值 (95% CI)] 为： 激素治疗 0.54 (0.48, 0.59)； 0.65（0.57，0.73）； 0.54（0.51，0.58）； 0.60（0.54，0.65）；化疗0.46（0.41，0.51）； 0.49（0.40，0.57）； 0.48（0.43，0.53）； 0.51（0.43，0.59）；放射治疗严重骨痛0.35（0.30，0.40）； 0.45（0.37，0.54）； 0.31（0.27，0.35）； 0.25（0.18，0.33）；中度至重度高钙血症 0.13 (0.09, 0.17)； -0.17（-0.29，-0.05）； -0.05（-0.07，-0.03）； -0.52（-0.56，-0.48）。四种估值方法对化疗给出了相似的结果，但对于其他三个州，TTO 估值与通过 VAS 方法以及新西兰和英国 EQ-5D 关税获得的估值不同。尽管从英国 EQ-5D 关税中获得的高钙血症估值与其他三种方法相比非常低，并且 VAS 估值为正而非负，但这四种方法在所有四种健康状态之间均存在显着的成对相关性。 结论：我们的研究表明，新西兰公众中的女性能够使用直接方法（VAS 或 TTO）或 EQ-5D 健康状态分类系统一致地评估和评价晚期乳腺癌的病例描述。使用四种方法得出的一些估值在数量上有所不同，特别是对于高钙血症。由于我们的样本量不大（50），而且结果不能代表新西兰女性人口，因此这项研究只是一项试点研究。
Objectives: To obtain health-related quality-of-life (HR-QOL) valuations (or 'utilities') from New Zealand women for four health states representative of advanced (metastatic) breast cancer, suitable for use in cost-utility analysis, and to compare four valuation methodologies.Methods: Written case descriptions of four health states representative of advanced breast cancer (hormonal therapy, chemotherapy, radiotherapy and hypercalcaemia) were developed in consultation with nine oncology professionals. Time trade-off (TTO) and visual analogue scale (VAS) valuations were obtained via interviews from a sample of 50 women, aged 25-69 years, randomly selected from the New Zealand general public and through informal networks. Representations of the four health states on the EQ-5D health state classification system were also obtained from the respondents and later valued using New Zealand and UK EQ-5D social tariffs.Results: The four valuation methods ranked the four states' mean valuations identically: hormonal therapy > chemotherapy >= radiotherapy > hypercalcaernia. All methods except the TTO distinguished between chemotherapy and radiotherapy. In order of the VAS and TTO methods and the EQ-5D with NZ and UK tariffs, respectively, the valuations [mean (95% CI)] were: hormonal therapy 0.54 (0.48, 0.59); 0.65 (0.57, 0.73); 0.54 (0.51, 0.58); 0.60 (0.54, 0.65); chemotherapy 0.46 (0.41, 0.51); 0.49 (0.40, 0.57); 0.48 (0.43, 0.53); 0.51 (0.43, 0.59); radiotherapy for severe bone pain 0.35 (0.30, 0.40); 0.45 (0.37, 0.54); 0.31 (0.27, 0.35); 0.25 (0.18, 0.33); and moderate to severe hypercalcaernia 0.13 (0.09, 0.17); -0.17 (-0.29, -0.05); -0.05 (-0.07, -0.03); -0.52 (-0.56, -0.48). The four valuation methods gave similar results for chemotherapy, but for the three other states the TTO valuations differed from those obtained from the VAS method and the NZ and UK EQ-5D tariffs. There were significant pairwise correlations between the four methods across all four health states, although the valuation for hypercalcaemia obtained from the UK EQ-5D tariff was very low compared with the three other methods, and the VAS valuation was positive rather than negative.Conclusion: Our study suggests that women in the New Zealand general public are able to consistently evaluate and value case descriptions of advanced breast cancer using either direct methods (VAS or TTO) or the EQ-5D health state classification system. Some of the valuations elicited using the four methods differ quantitatively, especially for hypercalcaemia. As our sample size was modest (50) and it turned out to be unrepresentative of the New Zealand female population, this study serves as a pilot study.