한빛사논문
Chang Wook Jeonga,b,*, Janet E. Cowana, Jeanette M. Broeringa, Renske M.T. ten Hamc,d, Leslie S. Wilsonc, Peter R. Carrolla, Matthew R. Cooperberga,e
a Helen Diller Family Comprehensive Cancer Center, Department of Urology, University of California, San Francisco, CA, USA
b Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
c Health Policy and Economics, Department of Clinical Pharmacy, University of California, San Francisco, CA, USA
d Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
e Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
*Corresponding author : Chang Wook Jeong
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.
Keywords : Prostate cancer; Utility; Quality of life; Cohort study; Cancer survivors
논문정보
관련 링크
연구자 키워드
관련분야 연구자보기
소속기관 논문보기
관련분야 논문보기
해당논문 저자보기