Health Technology Assessment (HTA)

Transcription

1 Health Technology Assessment (HTA) Utilities for the QLQ-C30 an Update Plenary Session 11 th Sept., 2015, Krakow Georg Kemmler, Eva Gamper, Virginie Nerich, Bernhard Holzner Department of Psychiatry and Psychotherapy Innsbruck Medical University Austria

2 Overview Introduction: The EORTC utility project German utility weights for the QLU-C10D: an update French utility weights for the QLU-C10D: first results Other issues: cancer patients, test-retest Outlook: What comes next?

3 Introduction: The EORTC Utility Project Aim: Development of a utility measure for the QLQ-C30 (QLU - C10D) Cooperation of MAUCa Consortium (Madeleine King et al.) and EORTC HTA Group (Georg, Eva et al.) EORTC grant: Development of utility weights for five European countries Georg Kemmler, Eva Gamper, Virginie Nerich, Bernhard et al. First two EU countries:

4 German utility weights for the QLQ-C30: an update

5 German utility weights for the QLQ-C30 Methods Recruitment & data assessment by specialized company via an online panel Data assessment: discrete choice experiments ( next page) Pilot study: N=200 General population sample of N=1000 Statistical analysis by conditional logistic regression

6 Data assessment Data are assessed by discrete choice experiments (DCE) The individual choice sets look like this: depressed

7 Results (n=1000) Socio-demographics Variable Categories % or Mean ± SD Age (Years) 46.5 ± 14.6 (18-82) 70 years + 3.6% Gender Male 61% Female 39% General Population 15% (70-82 y.) 49% 51% Education Compulsory school/ apprenticeship 24% Intermediate school educ. 24% A-levels 22% University/Technical college 28% 16-17% / 10% higher/lower than in the general population

8 Utility weights for the German QLU-C10D To recall For optimal health state: u = 1 For death: u = 0 For every other health state u = 1 - decrement for lacking mobility - decrement for lacking role functioning - decrement for lacking social functioning decrement for diarrhea/obstipation

9 Utility weights for the German QLU-C10D Dimensons with largest impact on utilities (decrement for level very much ) 1) Long/short walk (-0.28) 2) Pain (-0.20) 3) Daily activities (-0.14) 4) Social/family life (-0.13) 5) Nausea (-0.105)

10 Unexpected findings 1) Utility decrements for depressed are very small. 2) Small decrements also for fatigue, sleep dis., lack of appetite 3) Utility decrements for a little and quite a bit are often quite similar Problems 1) and 3) may have to do with the German translation of the QLQ-C30!

11 Summary of Findings Determination of utilities for the QLQ-C30 by DCE in the German population feasible Majority of findings make sense Some unexpected findings! Utility decrements of item depressed rather low levels a little vs. quite a bit very similar decrements Comparison with utility weights of other countries required Perhaps revision of German translation of QLQ-C30 (!?)

12 French utility weights for the QLU-C10D First findings - Translation and scientific collaboration: Virginie Nerich (Besançon and Innsbruck) - Recruitment, data assessment: as in German study - Quota sampling: respresentative w.r.t. age and gender - N=1000 just finished

13 Utility weights for the French version Dimensons with largest impact on utilities (decrement for level very much ) 1) Long/short walk (-0.32) 2) Pain (-0.20) 3) Daily activities (-0.151) 4) Depression (-0.147) 5) Obstipation/diarrh. (-0.146) 5) Nausea (-0.142)

14 Summary of Findings (France) Findings generally similar as for German survey Separation of response categories 2 and 3 (a little, quite a bit) better than in German survey Utility decrements for depressed not as small as in German survey Decrements for fatigue, sleep disorder and lacking appetite rather small (like in German survey) This may be different in cancer patients/survivors

15 Other Issues: Cancer patients, test-retest Elicitation of utilities in cancer patients cognitive debriefing Interviews by Eva Gamper N = 10 cancer patients interviewed so far Overall positive feed-back: important issue, generally feasible Criticism: some implausible health states (e.g., very much sleep disturbances, but no fatigue) Test-retest for German version (n=300) Overall agreement (retest valuation = first valuation): 80.2% Kappa = 0.60

16 What comes next? Further analyses Germany, France Other EU countries: Italy/Spain, Poland, Austria Cancer patients/survivors... *** Poster ISOQOL (German utility weights preliminary results) Methodological papers: Sequence effect (Richard Norman, MK et al.), Test-retest (Eva et al.) Review paper on the use of utilities in CUAs (Virginie et al.) Papers on Australian (MK et al.), German (GK et al.) and French (VN et al.) utility weights...