Skip to main content

Advertisement

SpringerLink
Log in

Health State Utility Values for Ileostomies and Colostomies: a Systematic Review and Meta-Analysis

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Ileostomies and colostomies may affect the quality of life of patients after colorectal surgery; however, the impact has been difficult to quantify using questionnaire-based measures. Utilities reflect patient preferences for health states and provide an alternate method of quality of life assessment. We aimed to systematically review the literature on utilities for ileostomy and colostomy health states.

Methods

We searched MEDLINE, EMBASE, and EBM Reviews (to August 16, 2017) to identify studies reporting utilities for colostomies or ileostomies using direct or indirect, preference-based elicitation tools. We categorized utilities based on elicitation group (patients with stoma, patients without stoma, healthcare providers, general population) and tool. We pooled utilities using random effects models to determine mean utilities for each elicitation group and tool.

Results

We identified ten studies reporting colostomy utilities and three studies reporting ileostomy utilities. Utilities were most commonly obtained using direct elicitation measures administered to individuals with an understanding of the health state. Patients with stomas and providers gave high utility ratings for the colostomy state (range 0.88–0.92 and 0.86–0.92, respectively, using direct elicitation tools). Ileostomy utilities obtained from patients following surgery and from providers also demonstrated high values placed on the ileostomy health state (range 0.88–1.0).

Conclusions

Following stoma surgery, values placed on quality of life are similar to those obtained from patients with conditions such as asthma and allergies or individuals of similar age without chronic conditions. This confirms the findings of questionnaire-based studies, which report minimal long-term decrements to overall quality of life among stomates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. O'leary, D., et al., Quality of life after low anterior resection with total mesorectal excision and temporary loop ileostomy for rectal carcinoma. British Journal of Surgery, 2001. 88(9): p. 1216–1220.

    Article  PubMed  CAS  Google Scholar 

  2. Sprangers, M., et al., Quality of life in colorectal cancer. Diseases of the colon & rectum, 1995. 38(4): p. 361–369.

    Article  CAS  Google Scholar 

  3. Grant, M.M., Quality of Life in Colorectal Cancer. Developments in Supportive Cancer Care, 1999. 3(1): p. 4–9.

    Google Scholar 

  4. Dabirian, A., et al., Quality of life in ostomy patients: a qualitative study. Patient preference and adherence, 2011. 5: p. 1.

    Google Scholar 

  5. Bekkers, M., et al., Survival and psychosocial adjustment to stoma surgery and nonstoma bowel resection: a 4-year follow-up. Journal of psychosomatic research, 1997. 42(3): p. 235–244.

    Article  PubMed  CAS  Google Scholar 

  6. Bossema, E.R., et al., The relation between illness cognitions and quality of life in people with and without a stoma following rectal cancer treatment. Psycho-Oncology, 2011. 20 (4): p. 428–434.

  7. Cornish, J.A., et al., A meta-analysis of quality of life for abdominoperineal excision of rectum versus anterior resection for rectal cancer. Annals of surgical oncology, 2007. 14(7): p. 2056–2068.

    Article  PubMed  Google Scholar 

  8. Orsini, R., et al., Quality of life of older rectal cancer patients is not impaired by a permanent stoma. European Journal of Surgical Oncology (EJSO), 2013. 39(2): p. 164–170.

    Article  CAS  Google Scholar 

  9. Ross, L., et al., Quality of life of Danish colorectal cancer patients with and without a stoma. Supportive Care in Cancer, 2007. 15(5): p. 505–513.

    Article  PubMed  Google Scholar 

  10. Torrance, G.W., Utility approach to measuring health-related quality of life. Journal of chronic diseases, 1987. 40(6): p. 593–600.

    Article  PubMed  CAS  Google Scholar 

  11. Torrance, G.W., Measurement of health state utilities for economic appraisal: a review. Journal of health economics, 1986. 5(1): p. 1–30.

    Article  PubMed  CAS  Google Scholar 

  12. Von Neumann, J. and O. Morgenstern, Theory of games and economic behavior. 2007: Princeton university press.

  13. Hozo, S.P., B. Djulbegovic, and I. Hozo, Estimating the mean and variance from the median, range, and the size of a sample. BMC medical research methodology, 2005. 5(1): p. 13.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wan, X., et al., Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC medical research methodology, 2014. 14(1): p. 135.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Pickard, A.S., M.P. Neary, and D. Cella, Estimation of minimally important differences in EQ-5D utility and VAS scores in cancer. Health and quality of life outcomes, 2007. 5(1): p. 70.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Walters, S.J. and J.E. Brazier, Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Quality of life research, 2005. 14(6): p. 1523–1532.

    Article  PubMed  Google Scholar 

  17. Boyd, N.F., et al., Whose utilities for decision analysis? Medical Decision Making, 1990. 10(1): p. 58–67.

    Article  PubMed  CAS  Google Scholar 

  18. Bossema, E., et al., Patients’ preferences for low rectal cancer surgery. European Journal of Surgical Oncology (EJSO), 2008. 34(1): p. 42–48.

    Article  CAS  Google Scholar 

  19. Brasel, K.J., D.C. Borgstrom, and J.A. Weigelt, Management of penetrating colon trauma: a cost-utility analysis. Surgery, 1999. 125(5): p. 471–479.

    Article  PubMed  CAS  Google Scholar 

  20. Dominitz, J.A. and D. Provenzale, Patient preferences and quality of life associated with colorectal cancer screening. American Journal of Gastroenterology, 1997. 92(12).

  21. Hamashima, C., Long-term quality of life of postoperative rectal cancer patients. Journal of gastroenterology and hepatology, 2002. 17(5): p. 571–576.

    Article  PubMed  Google Scholar 

  22. Kuruvilla, K., T. Osler, and N.H. Hyman, A comparison of the quality of life of ulcerative colitis patients after IPAA vs ileostomy. Diseases of the Colon & Rectum, 2012. 55(11): p. 1131–1137.

    Article  Google Scholar 

  23. Einstein, M.H., et al., Quality of life in cervical cancer survivors: patient and provider perspectives on common complications of cervical cancer and treatment. Gynecologic oncology, 2012. 125(1): p. 163–167.

    Article  PubMed  Google Scholar 

  24. Masya, L.M., et al., Preferences for outcomes of treatment for rectal cancer: patient and clinician utilities and their application in an interactive computer-based decision aid. Diseases of the Colon & Rectum, 2009. 52(12): p. 1994–2002.

    Article  Google Scholar 

  25. McLeod, R.S., et al., Quality of life of patients with ulcerative colitis preoperatively and postoperatively. Gastroenterology, 1991. 101(5): p. 1307–1313.

    Article  PubMed  CAS  Google Scholar 

  26. Smith, D.M., et al., Misremembering colostomies? Former patients give lower utility ratings than do current patients. Health Psychology, 2006. 25(6): p. 688.

    Article  PubMed  Google Scholar 

  27. Hoch, J., et al., A health-related quality-of-life study comparing Vitala continence control device versus traditional pouch system only in patients with end colostomy. European journal of gastroenterology & hepatology, 2013. 25(6): p. 739–747.

    Article  Google Scholar 

  28. Damschroder, L.J., B.J. Zikmund-Fisher, and P.A. Ubel, Considering adaptation in preference elicitations. Health Psychology, 2008. 27(3): p. 394.

    Article  PubMed  Google Scholar 

  29. Byrne, et al., Patient and clinician preferences for surgical and medical treatment options in ulcerative colitis. Colorectal Disease, 2014. 16(4): 285–292.

    Article  PubMed  CAS  Google Scholar 

  30. Harrison, et al., Patient and physician preferences for surgical and adjuvant treatment options for rectal cancer. Archives of Surgery, 2008. 143(4): p. 389–394.

    Article  PubMed  Google Scholar 

  31. Solomon, et al., What do patients want? Patient preferences and surrogate decision making in the treatment of colorectal cancer. Diseases of the Colon & Rectum, 2003. 46(10): p. 1351–1357.

    Article  Google Scholar 

  32. Coca, et al., The Impact of Specialty Practice Nursing Care on Health-Related Quality of Life in Persons With Ostomies. Journal of Wound Ostomy and Continence Nursing, 2015. 42(3): p. 257–263.

    Article  Google Scholar 

  33. Hornbrook, et al., Complications Among Colorectal Cancer Survivors SF-6D Preference-Weighted Quality of Life Scores. Medical Care, 2011. 49(3): p. 321–326.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Lim, et al., Psychometric Properties of the Chinese Version of the Acceptance of Chronic Health Conditions (Stoma) Scale for Patients With Stoma. Cancer Nursing, 2017. 28: p. 28.

    Google Scholar 

  35. Neil, et al., A Cost-Utility Model of Care for Peristomal Skin Complications. Journal of Wound Ostomy and Continence Nursing, 2016. 43(1): p. 62–68.

    Article  Google Scholar 

  36. Ness, R.M., et al., Utility valuations for outcome states of colorectal cancer. The American journal of gastroenterology, 1999. 94(6): p. 1650–1657.

    Article  PubMed  CAS  Google Scholar 

  37. Shiroiwa, et al., Health utility scores of colorectal cancer based on societal preference in Japan. Quality of Life Research, 2009. 18(8): p. 1095–1103.

    Article  PubMed  Google Scholar 

  38. Van Den Brink, M., et al., Cost-utility analysis of preoperative radiotherapy in patients with rectal cancer undergoing total mesorectal excision: a study of the Dutch Colorectal Cancer Group. Journal of clinical oncology, 2004. 22(2): p. 244–253.

    Article  Google Scholar 

  39. Wilson, et al., Measurement of health-related quality of life in the early follow-up of colon and rectal cancer. Diseases of the Colon & Rectum, 2006. 49(11): p. 1692–1702.

    Article  Google Scholar 

  40. Bewtra, et al., Patient Preferences for Surgical Versus Medical Therapy for Ulcerative Colitis. Inflammatory Bowel Diseases, 2014. 20(1): p. 103–114.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Mittmann, N., et al., Utility scores for chronic conditions in a community-dwelling population. Pharmacoeconomics, 1999. 15(4): p. 369–376.

    Article  PubMed  CAS  Google Scholar 

  42. Awad, R., et al., Life quality and psychological morbidity with an ileostomy. British journal of surgery, 1993. 80(2): p. 252–253.

    Article  PubMed  CAS  Google Scholar 

  43. Tolley, K., What are health utilities. Hayward Medical Communications, London, 2009.

    Google Scholar 

  44. Williams, N., et al., De-functioning stomas: a prospective controlled trial comparing loop ileostomy with loop transverse colostomy. British journal of surgery, 1986. 73(7): p. 566–570.

    Article  PubMed  CAS  Google Scholar 

  45. Silva, M.A., G. Ratnayake, and K.I. Deen, Quality of life of stoma patients: temporary ileostomy versus colostomy. World journal of surgery, 2003. 27(4): p. 421–424.

    Article  PubMed  Google Scholar 

  46. Tilney, H.S., et al., Comparison of outcomes following ileostomy versus colostomy for defunctioning colorectal anastomoses. World journal of surgery, 2007. 31(5): p. 1143–1152.

    Article  Google Scholar 

  47. Gooszen, A., et al., Temporary decompression after colorectal surgery: randomized comparison of loop ileostomy and loop colostomy. British journal of surgery, 1998. 85(1): p. 76–79.

    Article  PubMed  CAS  Google Scholar 

  48. Excellence, N.I.f.H.a.C., The guidelines manual. 2012, London: National Institute for Health and Clinical Excellence.

  49. Drugs, C.A.f. and T.i. Health, Guidelines for the economic evaluation of health technologies: Canada. 4th ed., in Guidelines for the economic evaluation of health technologies: Canada. 2017, CADTH: Ottawa.

  50. EUnetHTA, Methods for Health Economic Evaluations – A Guideline Based on Current Practices in Europe. Vol. 2014. 2014, Copenhagen: EUnetHTA.

Download references

Acknowledgements

The authors acknowledge Joshua K. Ramjist, Devon P. Richardson, Lebei Pi, and Calvin F. Johnston for their assistance with study selection and Ms. Bridget Morant (senior information specialist) for help with constructing the literature search strategy.

Author information

Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Fahima Dossa, Jonathan Josse, Sergio A. Acuna & Nancy N. Baxter

  2. Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Fahima Dossa, Sergio A. Acuna & Nancy N. Baxter

  3. Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

    Fahima Dossa, Sergio A. Acuna & Nancy N. Baxter

  4. Department of Surgery, St. Michael’s Hospital, Toronto, ON, Canada

    Fahima Dossa, Sergio A. Acuna & Nancy N. Baxter

  5. Division of General Surgery, St. Michael’s Hospital, 040-16 Cardinal Carter Wing, 30 Bond Street, Toronto, ON, M5B 1W8, Canada

    Nancy N. Baxter

Authors
  1. Fahima Dossa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jonathan Josse
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sergio A. Acuna
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nancy N. Baxter
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

FD, SAA, and NNB designed the study. FD and JJ participated in screening and data extraction. FD conducted statistical analyses and drafted the manuscript. All authors revised the report and approved the final version of the manuscript prior to submission.

Corresponding author

Correspondence to Nancy N. Baxter.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Electronic supplementary material

ESM 1

(DOCX 29 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dossa, F., Josse, J., Acuna, S.A. et al. Health State Utility Values for Ileostomies and Colostomies: a Systematic Review and Meta-Analysis. J Gastrointest Surg 22, 894–905 (2018). https://doi.org/10.1007/s11605-018-3671-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-018-3671-7

Keywords

Search

Navigation