Health Technology Assessment (HTA)

Transcription

1 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

2 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

3 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.)

4 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 xd PF RF SF EF Pain Fatigue Nausea Constipation/Diarrh Appetite loss Sleep disturb. Stage 2: Determination of utilities by DCE 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. Depending on country (i.p. health care system), population (cancer vs healthy)

5 Steps Planned EORTC utility project* 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

6 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

7 What does a Discrete Choice Experiment (DCE) look like? Example (simplified): Which of the two lives would you prefer? You will live in this situation for... years and then die Situation A Situation B 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? In our case: Not 4 dimensions but 10! More complex task!

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

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

10 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%

11 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)

12 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

13 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)

14 Many thanks for your attention!