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Stability of time trade-off utilities for health states associated with the treatment of prostate cancer

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Abstract

Background: Patients diagnosed with localized prostate cancer face several treatment options. Patient preferences for treatment side effects often dominate the decision making process. We proposed to learn more about the nature of patient preferences, or utilities, for these side effects. Methods: Two hundred and fifteen men were consecutively enrolled from three institutions for assessment after prostate needle biopsy. Baseline and 6 month follow-up assessments were done using the University of California, Los Angeles Prostate Cancer Index (UCLA PCI), and a laptop utility assessment application, U-Titer II. Patient utility was assessed for current pelvic functions as well as hypothetical pelvic dysfunctions. We calculated stability of utility scores and correlations between utility scores and UCLA PCI scores. Results: Utility scores for current pelvic functions exhibited a significant ‘ceiling effect.’ Utility scores for current pelvic functions and hypothetical impaired states were stable after 6 months in patients with negative biopsies. In patients who underwent treatment, utility for current sexual function decreased by 0.13 units (p < 0.00) and utility for current urinary function decreased by 0.09 units (p < 0.01). Utility for hypothetical stress urinary incontinence rose in men with a >25-point drop in UCLA PCI score. Conclusion: Utilities for some ‘current’ pelvic functions decreased in tandem with UCLA PCI scores in men who experienced >25-point changes in these scores. Utilities for some ‘hypothetical’ pelvic dysfunctions rose as men began to actually experience functional changes in those areas.

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References

  1. Martinez AA, Gonzalez JA, Chung AK, et al. A comparison of external beam radiation therapy versus radical prostatectomy for patients with low risk prostate carcinoma diagnosed, staged, and treated at a single institution. Cancer 2000; 88(2): 425-432.

    Google Scholar 

  2. Ramos CG, Carvalhal GF, Smith DS, Mager DE, Catalona WJ. Retrospective comparison of radical retropubic prostatectomy and 125iodine brachytherapy for localized prostate cancer. J Urol 1999; 161(4): 1212-1215.

    Google Scholar 

  3. Kaplan R. Utility Assessment for Estimating Quality-Adjusted Life Years. In: Sloan F (ed.), Valuing Health Care: Costs, Benefits, and Effectiveness of Pharmaceuticals and Other Medical Technologies. Boston: Cambridge University Press, 1990, pp. 31-60.

    Google Scholar 

  4. Stiggelbout AM, Kiebert GM, Kievit J, Leer JW, Stoter G, de Haes JC. Utility assessment in cancer patients: Adjustment of time tradeoff scores for the utility of life years and comparison with standard gamble scores. Med Decis Making 1994; 14(1): 82-90.

    Google Scholar 

  5. Rutten-van Molken MBC, van Doorslaer E, van der Linden S. Methodological issue of patient utility measurement. Med Care 1995; 33(9): 922-937.

    Google Scholar 

  6. Von Neumann J, Morgenstern O. The theory of games and economic behavior. Princeton, NJ: Princeton University Press, 1947.

    Google Scholar 

  7. Froberg DGKR. Methodology for measuring health-state preferences-II: Scaling Methods. J Clin Epidemiol 1989; 42(5): 459-471.

    Google Scholar 

  8. Torrance GW. Toward a utility theory foundation for health status index models. Health Serv Res 1976; 11(4): 349-369.

    Google Scholar 

  9. Torrance GW. Preferences for health states: A review of measurement methods. Mead Johnson Symp Perinat Dev Med 1982; 20: 37-45.

    Google Scholar 

  10. Torrance GW. Utility approach to measuring health-related quality of life. J Chronic Dis 1987; 40(6): 593-603.

    Google Scholar 

  11. Mohide EA, Torrance GW, Streiner DL, Pringle DM, Gilbert R. Measuring the wellbeing of family caregivers using the time trade-off technique. J Clin Epidemiol 1988; 41(5): 475-482.

    Google Scholar 

  12. Feeny DH, Torrance GW. Incorporating utility-based quality-of-life assessment measures in clinical trials. Two examples. Med Care 1989; 27(Suppl3): S190-S204.

    Google Scholar 

  13. Sonnnenberg FARM, Tsevat J, Wong JB, Barry M, Kent DL. Toward a peer review process for medical decision analysis models. Med Care 1994; 32(7): JS52-JS64, supplement.

    Google Scholar 

  14. Temple LK, Naimark D, McLeod RS. Decision analysis as an aid to determining the management of early low rectal cancer for the individual patient. J Clin Oncol 1999; 17(1): 312-318.

    Google Scholar 

  15. Fowler FJ Jr, Wennberg JE, Timothy RP, Barry MJ, Mulley AG Jr, Hanley D. Symptom status and quality of life following prostatectomy. JAMA 1988; 259(20): 3018-3022.

    Google Scholar 

  16. Revicki DA, Kaplan KR. Relationship between psychometric and utility-based approaches to the measurement of health-related quality of life. Quality of Life Research 1993; 2: 477-487.

    Google Scholar 

  17. Litwin MS, Hays RD, Fink A, Ganz PA, Leake B, Brook RH. The UCLA Prostate Cancer Index: Development, reliability, and validity of a health-related quality of life measure. Med Care 1998; 36(7): 1002-1012.

    Google Scholar 

  18. Litwin MS, Hays RD, Fink A, et al. Quality-of-life outcomes in men treated for localized prostate cancer. JAMA 1995; 273(2): 129-135.

    Google Scholar 

  19. Krongrad A, Perczek RE, Burke MA, Granville LJ, Lai H, Lai S. Reliability of Spanish translations of select urological quality of life instruments. J Urol 1997; 158(2): 493-496.

    Google Scholar 

  20. Greenfield S, Apolone G, McNeil BJ, Cleary PD. The importance of co-existent disease in the occurrence of postoperative complications and one-year recovery in patients undergoing total hip replacement. Comorbidity and outcomes after hip replacement. Med Care 1993; 31(2): 141-154.

    Google Scholar 

  21. Albertsen PC, Nease RF Jr, Potosky AL. Assessment of patient preferences among men with prostate cancer. J Urol 1998; 159(1): 158-163.

    Google Scholar 

  22. Nease RF Jr, Kneeland T, O'Connor GT, et al. Variation in patient utilities for outcomes of the management of chronic stable angina. Implications for clinical practice guidelines. Ischemic Heart Disease Patient Outcomes Research Team. JAMA 1995; 273(15): 1185-1190.

    Google Scholar 

  23. Zug KA, Littenberg B, Baughman RD, et al. Assessing the preferences of patients with psoriasis. A quantitative, utility approach. Arch Dermatol 1995; 131(5): 561-568.

    Google Scholar 

  24. Alexander NE, Ross J, Sumner W, Nease RF Jr, Littenberg B. The effect of an educational intervention on the perceived risk of breast cancer. J Gen Intern Med 1996; 11(2): 92-97.

    Google Scholar 

  25. Nease RF Jr, Owens DK. A method for estimating the costeffectiveness of incorporating patient preferences into practice guidelines. Med Decis Making 1994; 14(4): 382-392.

    Google Scholar 

  26. Handler RM, Hynes LM, Nease RF Jr. Effect of locus of control and consideration of future consequences on time tradeoff utilities for current health. Qual Life Res 1997; 6(1): 54-60.

    Google Scholar 

  27. Gage BF, Cardinalli AB, Albers GW, Owens DK. Costeffectiveness of warfarin and aspirin for prophylaxis of stroke in patients with nonvalvular atrial fibrillation [see comments]. JAMA 1995; 274(23): 1839-1845.

    Google Scholar 

  28. O'Leary JF, Fairclough DL, Jankowski MK, Weeks JC. Comparison of time-tradeoff utilities and rating scale values of cancer patients and their relatives: Evidence for a possible plateau relationship. Med Decis Making 1995; 15(2): 132-137.

    Google Scholar 

  29. Fowler FJ Jr, Cleary PD, Massagli MP, Weissman J, Epstein A. The role of reluctance to give up life in the measurement of the values of health states. [Comment In: Med Decis Making 1995 Jul-Sep; 15(3): 286-287]. Med Decis Making 1995; 15(3): 195-200.

    Google Scholar 

  30. Llewellyn-Thomas HA SH, Thiel EC. Do patients' evaluation of a health state change when they actually enter that state? Med Care 1993; 31: 1002-1006.

    Google Scholar 

  31. Sprangers MA. Response-shift bias: A challenge to the assessment of patients' quality of life in cancer clinical trials. Cancer Treat Rev 1996; 22(Suppl)A: 55-62.

    Google Scholar 

  32. Tsevat J, Goldman L, Soukup JR, et al. Stability of timetradeoff utilities in survivors of myocardial infarction. Med Decis Making 1993; 13(2): 161-165.

    Google Scholar 

  33. O'Connor AM, Boyd NF, Warde P, Stolbach L, Till JE. Eliciting preferences for alternative drug therapies in oncology: Influence of treatment outcome description, elicitation technique and treatment experience on preferences. J Chronic Dis 1987; 40(8): 811-818.

    Google Scholar 

  34. Katz JN, Phillips CB, Fossel AH, Liang MH. Stability and responsiveness of utility measures. Med Care 1994; 32(2): 183-188.

    Google Scholar 

  35. Bombardier C, Ware J, Russell IJ, Larson M, Chalmers A, Read JL. Auranofin therapy and quality of life in patients with rheumatoid arthritis. Results of a multicenter trial. Am J Med 1986; 81(4): 565-578.

    Google Scholar 

  36. Kestle JLM, Depauw S, Kelleher L. A time trade-off method for measuring quality of life in stage 2 breast cancer patients. Clinical Res 1989; 37: 316A (abstract).

    Google Scholar 

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Authors and Affiliations

  1. Departments of Urology, Health Services and Biostatistics, Schools of Medicine and Public Health, University of California, Los Angeles, USA

    Christopher S. Saigal, Jeffrey Gornbein, Kristen Reid & Mark S. Litwin

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  1. Christopher S. Saigal
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  2. Jeffrey Gornbein
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  3. Kristen Reid
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  4. Mark S. Litwin
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Correspondence to Mark S. Litwin.

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Saigal, C.S., Gornbein, J., Reid, K. et al. Stability of time trade-off utilities for health states associated with the treatment of prostate cancer. Qual Life Res 11, 405–414 (2002). https://doi.org/10.1023/A:1015609126536

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