Article2003

Patient and Community Preferences for Outcomes in Prostate Cancer

Murray Dale Krahn · Paul Ritvo · Jane Irvine · GEORGE A. TOMLINSON · Karen E. Bremner · Andrea Bezjak +2 more

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Health Systems, Economic Evaluations, Quality of Life Prostate Cancer Diagnosis and Treatment Economic and Environmental Valuation

Abstract

BACKGROUND: Preferences, or utilities, for health outcomes are central in prostate cancer decision-making. Utilities can be elicited directly from patients using standard techniques, or indirectly, using questionnaires that incorporate preference weights from community members. OBJECTIVES: To evaluate directly elicited and indirectly elicited (questionnaire-derived, community-weighted) utilities for prostate cancer outcomes and the effects of sexual, urinary, and bowel dysfunction on them. MATERIALS AND METHODS: Utilities for the current health of 141 prostate cancer patients, recruited from ambulatory clinics, were elicited directly with the Patient Oriented Prostate Utility Scale, rating scale (PORPUS-U(RS)) and standard gamble (PORPUS-U(SG)) subscales. Patients completed the Health Utilities Index (HUI) and Quality of Well Being Scale (QWB), utility instruments incorporating community preferences, and the UCLA Prostate Cancer Index. RESULTS: Patients' treatments included radical prostatectomy (18%), radiation (60%), and hormonal (42%). Mean utility scores for current health were 0.65 (QWB), 0.79 (PORPUS-U(RS)), 0.80 (HUI), 0.86 (PORPUS-U(SG)). Utility decrements for dysfunction were small (0.08-0.14 [sexual], 0.06 to 0.13 [urinary], and 0.01 to 0.13 [bowel]), and even smaller when adjusted for concomitant changes in other quality of life (QOL) domains. CONCLUSIONS: Patients' directly elicited utilities for their own health were higher than community-derived utilities obtained from HUI and QWB administration to the same patients. HUI scores of these patients were similar to those of age-matched Canadian men. Sexual, urinary, and bowel problems were common but had less impact on overall QOL than reported in previous utility studies. These results weaken the argument that prostate cancer screening and treatment should be limited because of severe and debilitative side effects.

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References

2019Theory of games and economic behavior 2007The Expected Utility Model: Its Variants, Purposes, Evidence and Limitations 2002Multiattribute and Single-Attribute Utility Functions for the Health Utilities Index Mark 3 System 1987Utility approach to measuring health-related quality of life 1995Multi-Attribute Health Status Classification Systems 1993The Beaver Dam Health Outcomes study 1989Methodology for measuring health-state preferences—II: Scaling methods 1995Multi-Attribute Preference Functions

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2007Measuring Preferences for Cost-Utility Analysis 2005Comparison of EQ-5D, HUI, and SF-36-derived societal health state values among Spine Patient Outcomes Research Trial (SPORT) participants 2007A Review and Meta-Analysis of Prostate Cancer Utilities 2003Comparing directly measured standard gamble scores to HUI2 and HUI3 utility scores: group- and individual-level comparisons 2013Cost effectiveness of proton therapy compared with photon therapy in the management of pediatric medulloblastoma

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