Health state utilities for metastatic breast cancer

Abstract

The aim of the study was to obtain United Kingdom-based societal preferences for distinct stages of metastatic breast cancer (MBC) and six common toxicities. Health states were developed based on literature review, iterative cycles of interviews and a focus group with clinical experts. They described the burden of progressive, responding and stable disease on treatment; and also febrile neutropenia, stomatitis; diarrhoea/vomiting; fatigue; hand-foot syndrome (grade 3/4 toxicities) and hair loss. One hundred members of the general public rated them using standard gamble to determine health state utility. Data were analysed with a mixed model analysis. The study sample was a good match to the general public of England and Wales by demographics and current quality of life. Stable disease on treatment had a utility value of 0.72, with a corresponding gain of þ 0.07 following a treatment response and a decline by 0.27 for disease progression. Toxicities lead to declines in utility between 0.10 (diarrhoea/vomiting) and 0.15 (febrile neutropenia). This study underlines the value that society place on the avoidance of disease progression and severe side effects in MBC. This may be the largest preference study in breast cancer designed to survey a representative general public sample.

A Markov model to evaluate cost-effectiveness of antiangiogenesis therapy using bevacizumab in advanced cervical cancer

“…Additionally, costeffectiveness of bevacizumab in metastatic breast cancer has been evaluated [10][11][12]21], with marginal cost effectiveness of $232,720.72 reported by Refaat et al [10]. Although not approved in age-related macular degeneration, bevacizumab is considered an acceptable alternative to ranibizumab based on a randomized trial [26].…”

“…The dominant theme to emerge from cost-effectiveness studies is that with the exception of the non-lethal condition of age-related macular degeneration for which very small dosages of drug are required, bevacizumab will not be cost-effective in the management of solid tumor malignancies due to the current high cost of the drug, relatively limited impact on duration of survival, and healthcare expenditures required to manage anti-VEGF-specific toxicology [10][11][12]15,16,18,20,[31][32][33].…”

“…For example, Montero et al used a baseline health utility of 0.715 for patients with metastatic breast cancer, then adjusted from that for various changes in health state, building upon Lloyd et al [11,12].…”

Pharmacoeconomic analysis of lapatinib treatment in metastatic breast cancer with HER2+ overexpression

“…Kulikov et al (2015), based on a global model, which formed the basis of further analysis of effectiveness [3]. In this study we developed an adapted model using the Kaplan-Meier method for calculation of effectiveness criteria over three years [29,31,32,34]. The criteria of effectiveness / utility were determined as a result.…”

Cost-Effectiveness Analysis of Bevacizumab in Combined Chemotherapy for Human epidermal growth factor receptor 2-negative Metastatic Breast Cancer in Japan

“…Because no utility score, which was applicable to this study, in Japanese women with MBC was found, utilities for health states were obtained from literatures 20) . Health state utility values from United Kingdom general public for health states related to stable, responding and progressive MBC were reported using the mixed model based on standard gamble in 2006.…”