Estimating health state utility from activities of daily living in the French National Hospital Discharge Database: a feasibility study with head and neck cancer
Abstract Background Health state utility (HSU) is a core component of QALYs and cost-effectiveness analysis, although HSU is rarely estimated among a representative sample of patients. We explored the feasibility of assessing HSU in head and neck cancer from the French National Hospital Discharge da...
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doaj-06d087d57ac14b79831572d25f801f212020-11-25T03:32:37ZengBMCHealth and Quality of Life Outcomes1477-75252019-07-0117111210.1186/s12955-019-1195-9Estimating health state utility from activities of daily living in the French National Hospital Discharge Database: a feasibility study with head and neck cancerMichaël Schwarzinger0Stéphane Luchini1for the EPICORL Study GroupTranslational Health Economics Network (THEN)Aix-Marseille University (Aix-Marseille School of Economics), Centre National de la Recherche Scientifique and EHESS MarseilleAbstract Background Health state utility (HSU) is a core component of QALYs and cost-effectiveness analysis, although HSU is rarely estimated among a representative sample of patients. We explored the feasibility of assessing HSU in head and neck cancer from the French National Hospital Discharge database. Methods An exhaustive sample of 53,258 incident adult patients with a first diagnosis of head and neck cancer was identified in 2010–2012. We used a cross-sectional approach to define five health states over two periods: three "cancer stages at initial treatment" (early, locally advanced or metastatic stage); a "relapse state" and otherwise a "relapse-free state" in the follow-up of patients initially treated at early or locally advanced stage. In patients admitted in post-acute care, a two-parameter graded response model (Item Response Theory) was estimated from all 144,012 records of six Activities of Daily Living (ADLs) and the latent health state scale underlying ADLs was calibrated with the French EQ-5D-3 L social value set. Following linear interpolation between all assessments of the patient, daily estimates of utility in post-acute care were averaged by health state, patient and month of follow-up. Finally, HSU was estimated by health state and month of follow-up for the whole patient population after controlling for survivorship and selection in post-acute care. Results Head and neck cancer was generally associated with poor HSU estimates in a real-life setting. As compared to “distant metastasis at initial treatment”, mean HSU was higher in other health states, although numerical differences were small (0.45 versus around 0.54). It was primarily explained by the negative effects on HSU of an older age (38.4% aged ≥70 years in “early stage at initial treatment”) and comorbidities (> 50% in other health states). HSU estimates significantly improved over time in the “relapse-free state” (from 8 to 12 months of follow-up). Conclusions HSU estimates in head and neck cancer were primarily driven by age at diagnosis, comorbidities, and time to assessment of cancer survivors. This feasibility study highlights the potential of estimating HSU within and across severe conditions in a systematic way at the national level.http://link.springer.com/article/10.1186/s12955-019-1195-9Head and neck cancerHealth state utilityEQ-5D-3LQALYsCost-effectiveness analysisActivities of daily living |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Michaël Schwarzinger Stéphane Luchini for the EPICORL Study Group |
spellingShingle |
Michaël Schwarzinger Stéphane Luchini for the EPICORL Study Group Estimating health state utility from activities of daily living in the French National Hospital Discharge Database: a feasibility study with head and neck cancer Health and Quality of Life Outcomes Head and neck cancer Health state utility EQ-5D-3L QALYs Cost-effectiveness analysis Activities of daily living |
author_facet |
Michaël Schwarzinger Stéphane Luchini for the EPICORL Study Group |
author_sort |
Michaël Schwarzinger |
title |
Estimating health state utility from activities of daily living in the French National Hospital Discharge Database: a feasibility study with head and neck cancer |
title_short |
Estimating health state utility from activities of daily living in the French National Hospital Discharge Database: a feasibility study with head and neck cancer |
title_full |
Estimating health state utility from activities of daily living in the French National Hospital Discharge Database: a feasibility study with head and neck cancer |
title_fullStr |
Estimating health state utility from activities of daily living in the French National Hospital Discharge Database: a feasibility study with head and neck cancer |
title_full_unstemmed |
Estimating health state utility from activities of daily living in the French National Hospital Discharge Database: a feasibility study with head and neck cancer |
title_sort |
estimating health state utility from activities of daily living in the french national hospital discharge database: a feasibility study with head and neck cancer |
publisher |
BMC |
series |
Health and Quality of Life Outcomes |
issn |
1477-7525 |
publishDate |
2019-07-01 |
description |
Abstract Background Health state utility (HSU) is a core component of QALYs and cost-effectiveness analysis, although HSU is rarely estimated among a representative sample of patients. We explored the feasibility of assessing HSU in head and neck cancer from the French National Hospital Discharge database. Methods An exhaustive sample of 53,258 incident adult patients with a first diagnosis of head and neck cancer was identified in 2010–2012. We used a cross-sectional approach to define five health states over two periods: three "cancer stages at initial treatment" (early, locally advanced or metastatic stage); a "relapse state" and otherwise a "relapse-free state" in the follow-up of patients initially treated at early or locally advanced stage. In patients admitted in post-acute care, a two-parameter graded response model (Item Response Theory) was estimated from all 144,012 records of six Activities of Daily Living (ADLs) and the latent health state scale underlying ADLs was calibrated with the French EQ-5D-3 L social value set. Following linear interpolation between all assessments of the patient, daily estimates of utility in post-acute care were averaged by health state, patient and month of follow-up. Finally, HSU was estimated by health state and month of follow-up for the whole patient population after controlling for survivorship and selection in post-acute care. Results Head and neck cancer was generally associated with poor HSU estimates in a real-life setting. As compared to “distant metastasis at initial treatment”, mean HSU was higher in other health states, although numerical differences were small (0.45 versus around 0.54). It was primarily explained by the negative effects on HSU of an older age (38.4% aged ≥70 years in “early stage at initial treatment”) and comorbidities (> 50% in other health states). HSU estimates significantly improved over time in the “relapse-free state” (from 8 to 12 months of follow-up). Conclusions HSU estimates in head and neck cancer were primarily driven by age at diagnosis, comorbidities, and time to assessment of cancer survivors. This feasibility study highlights the potential of estimating HSU within and across severe conditions in a systematic way at the national level. |
topic |
Head and neck cancer Health state utility EQ-5D-3L QALYs Cost-effectiveness analysis Activities of daily living |
url |
http://link.springer.com/article/10.1186/s12955-019-1195-9 |
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