Abstract
Background: Valid health utility values are essential for comparative effectiveness analyses. However, subjective utilities in long-term survivors of prostate cancer (PCa) with various oncological and functional outcomes have not been well described. Objective: To quantify utilities in long-term survivors of PCa using the standard gamble method, generally regarded as the approach best grounded in economic theory. Design, setting, and participants: We performed a cross-sectional study nested within a prospective cohort—Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE). Overall, 1884 (59.7%) of 3155 active participants across all disease states returned the questionnaire. Intervention: Various primary treatments for PCa. Outcome measurements and statistical analysis: Utility values for PCa health, sexual function, urinary function, bowel function, and overall health were measured, based on patients’ conditions at the time of the survey. Bias correction methods were employed. Results and limitations: After exclusion of incomplete or disqualified data, 1740 (92.3% of responding) patients were included in the final analysis. The mean age was 73.1 ± 8.2 yr at a median of 9 yr (interquartile range: 6–11) since diagnosis. Mean utilities for PCa health and overall health were 0.934 ± 0.120 and 0.960 ± 0.100, respectively. After bias correction by probability weighting function, utilities were 0.866 ± 0.154 and 0.897 ± 0.142, and by mixed model correction, 0.845 ± 0.186 and 0.884 ± 0.176, respectively. Measured utilities were similarly high for specific functional outcomes, even with bias corrections. Survivorship bias and skewed proportion of disease status due to natural history of PCa were potential limitations. Conclusions: Standard gamble-based utilities in long-term survivors of PCa were much higher than those determined previously. The results indicate substantial human resilience: most PCa patients adapt to their health status over time even if they experience incomplete functional recovery and would not take risk in pursuit of better quality of life. Patient summary: We elicited health utilities (measures of quality of life) among long-term survivors of prostate cancer using the most robust method. These were much higher than previously reported values that were based on theoretical scenarios or indirect methods. Long-term survivors of prostate cancer may adapt well to their health conditions over time even if they experience disease-specific or functional problems.
Original language | English |
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Pages (from-to) | 743-751 |
Journal | European Urology |
Volume | 76 |
Issue number | 6 |
DOIs | |
Publication status | Published - Dec 2019 |
Funding
These results provide the most reliable reference utility values to date for a wide range of health states among long-term survivors of PCa. SG utilities were much higher than those of previous studies that were based on theoretical scenarios or indirect methods. We do not imply that differential impacts of various PCa treatments on HRQoL are not meaningful or important, but rather that long-term survivors of PCa may adapt well to their health conditions over time even if they continue to experience disease-specific or functional problems. Surviving PCa patients would not take the risk of death in pursuit of better HRQoL compared with what previous studies have suggested, and this remarkable human resilience—as reflected in the new utility values provided here–should be considered in future comparative effectiveness research. Author contributions : Chang Wook Jeong and Matthew R. Cooperberg had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Cooperberg, Broering, ten Ham, Wilson, Carroll, Jeong. Acquisition of data: Broering, Cowan, Cooperberg, Carroll. Analysis and interpretation of data : Jeong, Cooperberg. Drafting of the manuscript : Jeong. Critical revision of the manuscript for important intellectual content : All authors. Statistical analysis : Jeong. Obtaining funding: Carroll, Cooperberg, Jeong. Administrative, technical, or material support : Carroll. Supervision: Carroll, Cooperberg. Other: None. Financial disclosures: Chang Wook Jeong certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None. Funding/Support and role of the sponsor: CaPSURE was funded until 2007 by TAP Pharmaceutical Products Inc. It is currently funded by U.S. Department of Defense grant W81XWH-13-2-0074 and the University of California, San Francisco , Department of Urology resources. This study was also partly supported by a grant from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea ( HA17C0039 ). None of the sponsors had any access to the data, or any influence on or access to the analysis plan, results, or manuscript. Acknowledgments: Dr. Michael W. Kattan (Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA) generously provided the standard gamble questionnaire that was used in the study, as well as guidance on its use. Appendix A
Keywords
- Cancer survivors
- Cohort study
- Prostate cancer
- Quality of life
- Utility