Health Technology Assessment (HTA)

Determination of utilities for the QLQ-C30

Georg Kemmler, Eva Gamper, Bernhard Holzner

Department for Psychiatry and Psychotherapy Innsbruck Medical University

Austria

Introduction

• Increasing importance of health economics and HTA in cancer research ( cost-utility analyses)

• Special “utility based“ QOL instruments are required for performing such analyses (like EQ-5D, SF-6D)

• Development of utility-based versions of the QLQ-C30 has been intiated, but so far restricted to English language versions (AUS, UK) ( next page)

• Versions for various European countries with national utility weights are required to make the QLQ-C30 a competitive utility instrument

Utilities for the EORTC QLQ-C30 The larger framework

• Study 1 (D Rowen, J Brazier et al.*): Utilities for the QLQ-C30 in multiple myeloma patients based on 8 of the 30 EORTC QLQ-C30 items (EORTC-8D, finished)

• Study 2 (M King et al.**): Utilities for the QLQ-C30 in a general population sample Stage 1: Determination of the number of domains (finished, 10 domains/items ) Stage 2: Determination of utilites by Discrete Choice Experiments (feasibility testing just started)

• Study 2a (EORTC QLG, in cooperation with M. King et al.):

Country-specific utilities for the QLQ-C30 (planning phase)

* Rowen D, Brazier JE, Young TA, Gaugrist S, Craig BM, King MT, Velikova G. Value Health 2011

** Consortium on Multi-Attribute Utility in Cancer MAUCa (M King, …, N Aaronson, G Velikova et al.)

Determination of Utilities for the QLQ-C30

Graphical illustration

EORTC QLQ-C30

PF EF SF RF CF

GQOL Pain

Fatigue Nausea Dyspnea

Appetite loss Sleep disturbances

Diarrhea Constipation

Financial Impact

Stage 1: Selection of key dimensions

for generating health states

(IRT - MAUCa)

EORTC utility score

x1 * PF + x2 * RF + x3 * SF + x4 * EF +

x5 * Pain + x6 * Fatigue + x7 * Nausea +

x8*Constipation/D + x9 * Appetite l. +

x10* Sleep d.

Stage 2: Determination

of utilities by DCE

EORTC xD PF RF SF EF

Pain Fatigue Nausea

Constipation/Diarrh Appetite loss Sleep disturb.

Depending on country (i.p. health care

system), population (cancer vs healthy)

Planned EORTC utility project*

Steps

1. Selection of EORTC QLQ-C30 dimensions/key items

2. Decision for utility elicitation method: TTO or DCE

3. Pilot study: Testing the feasibility of Discrete Choice Experiments

(DCE) for utility elicitation

4. Main study: Elicitation of utilities for the EORTC QLQ-C30

(for several European countries)

5. Statistical analyses: estimation of EORTC utility weights,

comparison between countries

*In close cooperation with Madeleine King and the MAUCa team

Testing the feasibility of Discrete Choice Experiments (DCE) for utility elicitation:

First results of the Austrian pilot study

• Small sample of healthy controls (N=47), patients planned

• Each participant had to complete 12 individual DCEs (comparisons “Life A“ vs. “Life B“)

• Two different designs tested: black and white vs color ( )

• Test acceptability and feasibility

• Test for an effect of the design/layout

What does a Discrete Choice Experiment (DCE) look like?

Example (simplified): Which of the two lives would you prefer?

In our case: Not 4 dimensions but 10! More complex task!

Situation A Situation B

You will live in this situation for ... years and

then die 5 years 2 years

Your physical condition or medical treatment

interferes with your social or family life Very much A little

You feel depressed Not at all A little

Pain interferes with your daily activities Not at all Quite a bit

You feel nauseated Very much Not at all

Which situation would you prefer?

Version 1: “black and white“ No colors for different categories

Version 2: “color“ green (not at all) – yellow (a little) - orange (quite a bit) - red (very much)

Results 1: Sample characteristics

Variable Category Population Sample (N=47)

Cancer Patients ongoing

Age (Mean ± SD) 36 ± 15 (18 – 95)

Gender Male 51%

Female 49%

Education Lower than A-levels 15%

A-levels (Matura) 22.5%

University 62.5%

Health status No chron. disease or cancer 90%

Cancer 0%

chron. diseases 10%

Results 2: Acceptability & Feasibility

Acceptability • All persons approached were willing to participate

• No complaints about annoying or intrusive questions

• However: possible selection bias (fairly high level of education!)

Feasibility • Every respondent was able to understand the task

• Clear explanations were essential (set of dimensions, severity levels)

• Problems were mentioned by a considerable proportion of persons (e.g. difficulties to imagine certain health states/ combinations)

Results 3: First statistical analyses

• In 7 of the 12 individual DCEs: clear preference for one to the two situations (>80% for one option, <20% for the other)

• In 5 of the 12 DCEs: opinions were more split

• Most influential dimensions: Nausea and Fatigue

• Color vs. black & white: Majority preferred color (73%), so far no significant differences between color and b & w

Limitations

• Utilities for individual health states can not yet be determined – too few cases, too few distinct DCEs

Summary: Aims of the planned EORTC QLG project

• General aim: Determination of country-specific utilities for the EORTC QLQ-C30

- many countries

- population sample and possibly cancer patients

• Phase I: Country-specific utilities for a few European countries (general population sample)

Many thanks for your attention!