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A Review and Meta-Analysis of Prostate Cancer Utilities

Toronto General Research Institute University Health Network, kbremner{at}uhnresearch.ca

Christopher A. K. Y. Chong, MD

Department of Medicine, University of Toronto, Canada

George Tomlinson, PhD

Toronto General Research Institute University Health Network, Department of Medicine, University of Toronto, Canada, Department of Health Policy, Management, and Evaluation, University of Toronto, Canada, Department of Biostatistics, University of Toronto, Canada

Shabbir M. H. Alibhai, MD, MSc

Toronto General Research Institute University Health Network, Department of Medicine, University of Toronto, Canada, Department of Health Policy, Management, and Evaluation, University of Toronto, Canada

Murray D. Krahn, MD, MSc

Toronto General Research Institute University Health Network, Department of Medicine, University of Toronto, Canada, Department of Health Policy, Management, and Evaluation, University of Toronto, Canada, Department of Pharmacy, University of Toronto, Canada

Background. Health-related quality of life is a key issue in prostate cancer (PC) management. The authors summarized published utilities for common health-related quality of life outcomes of PC and determined how methodological factors affect them. Methods. In their systematic review, the authors identified 23 articles in English, providing 173 unique utilities for PC health states, each obtained from 2 to 422 respondents. Data were pooled using linear mixed-effects modeling with utilities clustered within the study, weighted by the number of respondents divided by the variance of each utility. Results. In the base model, the estimated utility of the reference case (scenario of a metastatic PC patient with severe sexual symptoms, rated by non-PC patients using time tradeoff) was 0.76. Disease stage, symptom type and severity, source of utility, and scaling method were associated with utility differences of 0.10 to 0.32 (P < 0.05). Utilities from PC patients rating their own health were 0.14 higher than those from the reference case, but utilities from PC patients rating scenarios were lowest. Time tradeoff yielded the highest utilities. Computer administration yielded lower utilities than personal interview (P = 0.02). Neither the scale's high anchor nor study purpose had significant effects on utilities. Conclusions. This study provides pooled utility estimates for common PC health states and describes how clinical and methodological factors can significantly affect these values. When possible, utility estimates for a modeling application should be derived similarly. Formal data synthesis methods might be useful to researchers integrating utility data from heterogeneous sources. Further exploration of these methods for this purpose is warranted.

Key Words: Key words: prostate cancer • utility assessment • preferences • quality of life • meta-analysis. (Med Decis Making 2007;27:288—298)

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