Including the quality‐of‐life effects in the evaluation of prostate cancer screening: expert opinions revisited?

Abstract

OBJECTIVE To apply the general empirical framework for estimating utilities in cost‐utility analysis (CUA) of population‐based prostate cancer screening, including an assessment of empirical health status with a classifying measure (e.g. the EQ‐5D) and linking these descriptions to utility estimates using the standard preference‐based algorithm, combining them with the appropriate duration into quality‐adjusted life years, and sensitivity analysis. MATERIALS AND METHODS Empirical studies to describe and value the health status effects of prostate cancer screening have been ongoing within the Rotterdam centre of the European Randomised Study on Screening for Prostate Cancer since 1995. The results of these studies, including the screening, the primary treatment phase and advanced disease, will be used in estimating utilities for cost‐utility analysis. RESULTS Estimation of cost‐utility of population‐based prostate cancer screening with the results of the three empirical health status studies yielded partly counterintuitive results, underestimating the unfavourable health status effects that are inevitably associated with prostate cancer screening. This may be caused by other than health effects of the screening itself (‘process effects’) and adaptive changes in perception of their situation in patients after curative primary treatment (‘response shift’), among other elements. CONCLUSION These results prompted us to reconsider the suitability of the general framework of CUA for screening programmes. Possible directions for solutions are indicated.

Responsiveness of disease-specific and generic utility instruments in prostate cancer patients

“…The EQ5-D is the shortest, perhaps least cognitively demanding, and appears to be at least as responsive as the other community weighted instruments. The EQ-5D is currently being used to assess outcomes in the European Randomised Study on Screening for Prostate Cancer [26,52]. The HUI instruments are somewhat more challenging to complete, but generate utility scores that are similar to patientsÕ utilities for their own health (e.g.…”

“…The measurement properties of indirect, generic utility instruments have received little attention in prostate cancer [26]. It is noteworthy that three key dimensions in prostate cancer, sexual, urinary, and bowel problems, are poorly represented in the QWB [27], and not represented at all in the HUI [16] or EQ-5D [28].…”

To be screened or not to be screened? Modeling the consequences of PSA screening for the individual

“…Just as with insurance against fire, where the costs are much higher than the expected benefits, people may deem the adverse effects to be acceptable in exchange for the benefits received, while this might not be the case according to expected utility theory. Also, while it is already difficult to assess the loss in quality of life for individuals who are diagnosed and treated for prostate cancer (Essink-Bot et al , 2003), it is probably even more difficult to assess the anticipated loss in quality of life for individuals who are not even screened yet. Therefore, it might be difficult to use the utility break-even points.…”

Quality-adjusted life years in cancer: pros, cons, and alternatives

“…In the UK, a proposal highlighting the future role of the National Institute for Health and Clinical Excellence would amend its current use of cost per QALY ratios to make recommendations to the National Health Service on reimbursement decisions. Other European journals have also begun to address aspects of the QALY debate (Essink-Bot et al 2003;McKenzie & van der Pol 2009;Vemer & Rutten-van Molken 2011;Dranitsaris et al 2012). In Germany, the Institute for Quality and Efficiency in Health Care's technology assessment approach rejected universal use of the cost per QALY model, citing ethical and methodological concerns related to judgments about the benefits of treating different diseases that arise as part of QALY construction [Institute for Quality and Efficiency in Health Care (IQWIG) 2009].…”