Indiana University School of Medicine, Dept. of Public Health & Obstetrics and Gynecology, Indianapolis, IN 46202, USA.
Gynecol Oncol. 2013 Feb;128(2):175-80. doi: 10.1016/j.ygyno.2012.10.024. Epub 2012 Oct 30.
Cost-effectiveness/cost-utility analyses are increasingly needed to inform decisions about care. Algorithms have been developed using the Functional Assessment of Cancer Therapy (FACT) quality of life instrument to estimate utility weights for cost analyses. This study was designed to compare these algorithms in the setting of ovarian cancer.
GOG-0152 was a 550-patient randomized phase III trial of interval cytoreduction, and GOG-0172 was a 415-patient randomized phase III trial comparing intravenous versus intraperitoneal therapy among women with advanced ovarian cancer. QOL data were collected via the FACT at four time points in each study. Two published mapping algorithms (Cheung and Dobrez) and a linear transformation method were applied to these data. The agreement between measures was assessed by the concordance correlation coefficient (r(CCC)), and paired t-tests were used to compare means.
While agreement between the estimation algorithms was good (ranged from 0.72 to 0.81), there were statistically significant (p<0.001) and clinically meaningful differences between the scores: mean scores were higher with Dobrez than with Cheung or the linear transformation method. Scores were also statistically significantly different (p<0.001) between studies.
In the absence of prospectively collected utility data, the use of mapping algorithms is feasible, however, the optimal algorithm is not clear. There were significant differences between studies, which highlight the need for validation of these algorithms in specific settings. If cost analyses incorporate mapping algorithms to obtain utility estimates, investigators should take the variability into account.
成本效益/成本效用分析越来越需要为医疗决策提供信息。已经开发了使用功能性评估癌症治疗（FACT）生活质量工具的算法来估计成本分析的效用权重。本研究旨在比较卵巢癌环境中的这些算法。
GOG-0152 是一项 550 例患者随机的 III 期间隔减瘤试验，GOG-0172 是一项 415 例患者随机的 III 期试验，比较了晚期卵巢癌患者静脉内与腹腔内治疗。在每个研究的四个时间点通过 FACT 收集 QOL 数据。两种已发表的映射算法（Cheung 和 Dobrez）和线性变换方法应用于这些数据。通过一致性相关系数（r（CCC））评估措施之间的一致性，并使用配对 t 检验比较平均值。
虽然估计算法之间的一致性很好（范围从 0.72 到 0.81），但评分之间存在统计学显著（p<0.001）和临床有意义的差异：Dobrez 评分高于 Cheung 或线性变换方法。评分在研究之间也存在统计学显著差异（p<0.001）。
在没有前瞻性收集效用数据的情况下，使用映射算法是可行的，但是，最佳算法尚不清楚。研究之间存在显著差异，这突出了在特定环境中验证这些算法的必要性。如果成本分析采用映射算法来获得效用估计，研究人员应考虑到变异性。
