Havrilesky Laura J, Broadwater Gloria, Davis Debra M, Nolte Kimberly C, Barnett J Cory, Myers Evan R, Kulasingam Shalini
Division of Gynecologic Oncology, Duke University Medical Center, Durham NC 27710, USA.
Gynecol Oncol. 2009 May;113(2):216-20. doi: 10.1016/j.ygyno.2008.12.026. Epub 2009 Feb 12.
(1) To define a set of health state descriptions related to screening, diagnosis, prognosis, and toxicities relevant to ovarian cancer; (2) To derive a set of quality of life-related utilities to be used for cost-effectiveness analyses.
A comprehensive list of health states was developed to represent the experiences of diagnostic testing for ovarian cancer, natural history of ovarian cancer (e.g., newly diagnosed early stage ovarian cancer, recurrent progressive ovarian cancer) and the most common chemotherapy-related toxicities (e.g. alopecia, peripheral neuropathy, pain, neutropenia, fatigue). Valuation of each health state was obtained through individual interviews of 13 ovarian cancer patients and 37 female members of the general public. Interviews employed visual analog score (VAS) and time trade off (TTO) methods of health state valuation.
Mean TTO-derived utilities were higher than VAS-derived utilities by 0.118 U (p<0.0001). Mean VAS-derived utilities for screening tests were 0.83 and 0.81 for true negative blood test and ultrasound; 0.79 and 0.78 for false negative blood test and ultrasound, respectively. Patients and volunteers generally agreed in their preference ranking of chemotherapy-associated states, with lowest rankings being given to febrile neutropenia, grades 3-4 fatigue, and grades 3-4 nausea/vomiting. For 55% of chemotherapy-associated health states, the average utility assigned was higher for patients than for volunteers.
This study establishes societal preferences for a number of health states related to screening, diagnosis and treatment of ovarian cancer that can be used for assessing the cost-effectiveness of different ovarian cancer screening and treatment regimens.
（1）定义一组与卵巢癌筛查、诊断、预后及毒性相关的健康状态描述；（2）得出一组用于成本效益分析的与生活质量相关的效用值。
制定了一份全面的健康状态清单，以代表卵巢癌诊断检测的经历、卵巢癌的自然病程（如新诊断的早期卵巢癌、复发性进展性卵巢癌）以及最常见的化疗相关毒性（如脱发、周围神经病变、疼痛、中性粒细胞减少、疲劳）。通过对13名卵巢癌患者和37名普通女性公众进行个体访谈，获得了每种健康状态的估值。访谈采用了视觉模拟评分（VAS）和健康状态估值的时间权衡（TTO）方法。
TTO得出的平均效用值比VAS得出的平均效用值高0.118个效用单位（p<0.0001）。筛查检测的VAS得出的平均效用值，真阴性血液检测和超声分别为0.83和0.81；假阴性血液检测和超声分别为0.79和0.78。患者和志愿者在化疗相关状态的偏好排序上总体一致，发热性中性粒细胞减少、3-4级疲劳以及3-4级恶心/呕吐的排序最低。对于55%的化疗相关健康状态，患者分配的平均效用值高于志愿者。
本研究确定了社会对一些与卵巢癌筛查、诊断和治疗相关的健康状态的偏好，这些偏好可用于评估不同卵巢癌筛查和治疗方案的成本效益。
