Sensitivity of Preference-Based Quality-of-Life Measures for Economic Evaluations in Early-Stage Melanoma

Abstract

IMPORTANCE The diagnosis of a life-threatening disease like melanoma can affect all aspects of a person's life, including health-related quality of life (HRQOL) and psychological aspects of melanoma such as fear of cancer recurrence (FCR). Economic evaluations of psychological interventions require preference-based (utility) instruments that are sensitive to changes in well-being and HRQOL; however, very few studies have evaluated the sensitivity of these instruments when used for people with melanoma. OBJECTIVE To compare utility scores from the multiple-attribute instrument Assessment of Quality of Life-8-Dimension Scale (AQoL-8D) with the mapped utility scores of the Functional Assessment of Cancer Therapy-Melanoma (FACT-M) and to investigate the sensitivity of both instruments in identifying the influence of FCR on HRQOL. DESIGN, SETTING, AND PARTICIPANTS This assessment of data from a randomized clinical trial of a psychoeducational intervention to reduce FCR, conducted at 3 high-risk melanoma clinics in Australia, evaluated 164 patients with early-stage melanoma and a high risk of developing a second primary melanoma. MAIN OUTCOMES AND MEASURES The FACT-M and AQoL-8D were used to assess HRQOL and FCR among the study participants. Concurrent validity was assessed by comparing the total and subdomain scores of the 2 instruments, and the strength of associations was assessed using Pearson correlation coefficient. Convergent validity was assessed by comparing participants' HRQOL, demographic, and clinical characteristics using the χ 2 test and F statistic. Both the FACT-M and AQoL-8D utilities were regressed on FCR Inventory (FCRI) severity scores to estimate the effect of elevated FCR on HRQOL. RESULTS A total of 164 participants completed the baseline questionnaires, but only 163 met all inclusion criteria and underwent the full analysis: 72 were women; 91 were men; and mean (SD) age was 58.2 (12.1) years. Both the AQoL-8D and FACT-M instruments showed good concurrent validity and could differentiate between relevant subgroups including level of FCRI severity. The AQoL-8D and FACT-M utilities were strongly correlated (r 2 = 0.57). Respondents had a mean (SD) AQoL-8D utility of 0.77 (0.2), and a mean (SD) FACT-M utility score of 0.76 (0.07). High levels of FCRI severity were associated with a decrease in utility of 0.12 (95% CI, −0.19 to −0.05) as measured by AQoL-8D, and a decrease of 0.03 (95% CI, −0.05 to −0.01) as measured by the FACT-M. CONCLUSIONS AND RELEVANCE For economic evaluations of psychological interventions in melanoma, the AQoL-8D and FACT-M are valid measures of utility; however, the AQoL-8D demonstrates greater sensitivity to FCRI severity. Our results suggest a significant association between FCR and HRQOL.

Long-Term Survival, Quality of Life, and Psychosocial Outcomes in Advanced Melanoma Patients Treated with Immune Checkpoint Inhibitors

“…In a systematic review of 7 studies (4246 patients; 6 cross-sectional [36–44], and 1 prospective study [45]), it was found that determinants of lower HRQOL (either psychological, physical, or global) were marital status, age, sex, poor social support, melanoma severity at diagnosis, and comorbidities (Table 3) [46]. Dieng et al found that HRQOL, measured with the Functional Assessment of Cancer Therapy (FACT-M), was correlated with fear of recurrence of disease in patients with metastatic melanoma (Table 3) [47]. A more comprehensive understanding of HRQOL can improve patient centered care in melanoma patients.…”

The Cost of Neurodevelopmental Disability: Scoping Review of Economic Evaluation Methods

“… 10 Another study found that the Assessment of Quality of Life 8 Dimension Scale (AQoL-8D) to be more sensitive measure than others within context of economic evaluation of psychological interventions in melanoma. 51 Despite numerous challenges associated with collecting quality of life information in young and medically complex populations in a way that is suitable for inclusion in economic modelling, there remains extensive opportunity for improvement in these estimates.…”

Health-related quality of life using the FACT-M questionnaire in patients with malignant melanoma: A systematic review

“…Finally, 20 full-text articles were screened and assessed for eligibility. Makady et al [30] was excluded for being a feasibility study using social media for measuring HRQOL, Swartz et al [31] was excluded for not using the established FACT-M questionnaire, and Davies et al [32] and Dieng et al [33] was excluded for not reporting any structured FACT-M data. See Fig.…”