Recombinant erythropoietin for chemotherapy-related anaemia - Economic value and health-related quality-of-life assessment using direct utility elicitation and discrete choice experiment methods
Recombinant erythropoietin for chemotherapy-related anaemia - Economic value and health-related quality-of-life assessment using direct utility elicitation and discrete choice experiment methods
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DOI：
10.2165/00019053-200725030-00005
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发表时间：
2007-01-01
影响因子：
4.4
通讯作者：
Sculpher, Mark
中科院分区：
文献类型：
--
作者：
Ossa, Diego F.;Briggs, Andrew;Sculpher, Mark
目的：采用直接效用启发法和离散选择实验(DCE)方法，从社会角度评价英国化疗相关性贫血患者的健康相关生活质量(HR-QOL)和促红细胞生成素治疗的经济价值。方法：采用时间权衡(TTO)法计算NO、轻、中、重度贫血患者的QALY值。健康状态描述是使用癌症治疗功能评估-贫血(FACT-AN)子量表和EQ-5D问卷制定的，并由临床专家和患者验证。此外，还实施了一项DCE，以引起对各种贫血治疗方案的偏好。DCE分析包括从文献回顾和咨询专家临床医生和癌症患者中确定的治疗的重要方面。DCE将成本作为一个属性包括在内，以便得出支付意愿价值(英镑，2004年值)。这两种方法被应用于110名外行人的同一横断面样本中。结果：非贫血状态的平均效用得分为0.86(标准差[SE]0.014)，轻度、中度和重度贫血状态的平均效用得分分别为0.78(SE 0.016)、0.61(SE 0.020)和0.48(SE 0.020)。DCE结果显示以下偏好是重要的预测因素：较高的疲劳感缓解程度、较短的给药持续时间、皮下/静脉给药与套管注射相比、全科医生与医院位置、较低的感染或过敏反应风险以及较低的患者每月费用。重组促红细胞生成素的属性水平高于输血；这反映在增加的福利价值为368磅(95%可信区间318,419)。结论：这一结果突出了一个社会观点，即化疗相关性贫血的严重程度将显著影响癌症患者的HR-QOL。DCE调查显示，公众更看重重组促红细胞生成素的治疗属性，并表明患者可能更倾向于使用重组促红细胞生成素治疗而不是输血。
Objective: To assess both the health-related quality of life (HR-QOL) and the economic value of erythropoietin treatment in chemotherapy-related anaemia using direct utility elicitation and discrete choice experiment (DCE) methods from a societal perspective in the UK.Methods: The time trade-off (TTO) method was employed to obtain utility values suitable for the calculation of QALYs for no, mild, moderate and severe anaemia. Health-state descriptions were developed using the Functional Assessment of Cancer Therapy - Anaemia (FACT-AN) subscale and the EQ-5D questionnaires, and were validated by clinical experts and patients. In addition, a DCE was implemented to elicit preferences for various anaemia treatment scenarios. The DCE analysis comprised important aspects of treatment identified from a literature review and by consultation with expert clinicians and cancer patients. The DCE included cost as an attribute in order to elicit willingness-to-pay (WTP) values ( pound, 2004 values). The two methods were applied in the same cross-sectional sample of 110 lay people. Face-to-face inter-views were conducted between February and March 2004.Results: The mean utility scores were 0.86 (standard error [SE] 0.014) for the no-anaemia state, and 0.78 (SE 0.016), 0.61 (SE 0.020) and 0.48 (SE 0.020) for the mild, moderate and severe anaemia states, respectively. The DCE results revealed the following preferences as significant predictors of choice: higher level of relief from fatigue, lower duration of administration, subcutaneous/intravenous administration versus cannula injection, GP versus hospital location, lower risk of infection or allergic reactions and lower cost per month to the patient. Attribute levels were valued higher for recombinant erythropoietin than for blood transfusion; this is reflected in an incremental welfare value of 368 pound (95% CI 318, 419).Conclusions: The results highlight a societal view that the severity of chemotherapy-related anaemia will significantly affect cancer patients' HR-QOL. The DCE survey shows that the public value favourably the attributes of treatment with recombinant erythropoietin, and indicates a likely patient preference for treatment with recombinant erythropoietin over blood transfusion.