NHMRC Clinical Trials Centre, University of Sydney, 92-94 Parramatta Road, Camperdown 2050, Australia.
St Vincent's Department of Radiotherapy, St Vincent's Hospital, Darlinghurst 2010, Australia.
Br J Dermatol. 2018 Feb;178(2):384-393. doi: 10.1111/bjd.16098. Epub 2018 Jan 17.
Health-related quality of life (HRQOL) in melanoma is affected by cancer stage. Previous studies have reported limited data on utility-based HRQOL.
To determine pooled estimates of utility-based HRQOL (utilities) for people with American Joint Cancer Committee stage I/II, III or IV melanoma for use in economic evaluations.
We performed a systematic review, meta-analysis and metaregression of utilities for patients with melanoma. HRQOL scores reported with the QLQ-C30, SF-36, SF-12, FACT-G and FACT-M instruments were converted to utilities using published mapping algorithms. Meta-analysis was used to calculate mean utilities. Metaregression was used to examine the effects of baseline patient and study characteristics.
We identified 33 studies reporting 213 utilities. From meta-analyses, the mean utility for stage I/II melanoma was 0·97 [95% confidence interval (CI) 0·90-0·98]; for stage III melanoma it was 0·77 (95% CI 0·70-0·83); for stage III/IV 0·76 (95% CI 0·76-0·77); and for stage IV melanoma 0·76 (95% CI 0·71-0·81). The difference in utility between stage III and stage IV was not statistically significant (P = 0·52). For patients with stage I/II, the utility estimate at the time of surgery was 0·77 (95% CI 0·75-0·79), and at 3-12 months postsurgery it was 0·85 (95% CI 0·84-0·86). Utility estimates for patients with stage IV melanoma were 0·65 (95% CI 0·62-0·69) during the first 3 months of treatment and 0·83 (95% CI 0·81-0·86) at 4-12 months on treatment. For patients with stage IV melanoma treated with chemotherapy, the utility estimate was 0·52 (95% CI 0·51-0·52), while for those treated with targeted therapy it was 0·83 (95% CI 0·82-0·85).
These robust, evidence-based estimates of health state utility can be used in economic evaluations of new treatments for patients with early-stage or advanced-stage melanoma.
健康相关生活质量（HRQOL）在黑色素瘤中受癌症分期影响。以往研究对基于效用的 HRQOL 数据的报告有限。
确定用于经济评估的美国癌症联合委员会（AJCC）分期 I/II、III 或 IV 期黑色素瘤患者基于效用的 HRQOL（效用）的汇总估计值。
我们进行了一项系统评价、基于效用的 HRQOL 荟萃分析和元回归研究，纳入了黑色素瘤患者的研究。使用已发表的映射算法，将使用 QLQ-C30、SF-36、SF-12、FACT-G 和 FACT-M 量表报告的 HRQOL 评分转换为效用。使用荟萃分析计算平均效用。使用元回归分析检查基线患者和研究特征的影响。
我们确定了 33 项报告 213 个效用的研究。荟萃分析结果显示，I/II 期黑色素瘤的平均效用为 0.97（95%置信区间 0.90-0.98）；III 期黑色素瘤为 0.77（95%置信区间 0.70-0.83）；III/IV 期黑色素瘤为 0.76（95%置信区间 0.76-0.77）；IV 期黑色素瘤为 0.76（95%置信区间 0.71-0.81）。III 期和 IV 期黑色素瘤之间的效用差异无统计学意义（P=0.52）。对于 I/II 期患者，手术时的效用估计值为 0.77（95%置信区间 0.75-0.79），术后 3-12 个月时为 0.85（95%置信区间 0.84-0.86）。IV 期黑色素瘤患者在治疗的前 3 个月的效用估计值为 0.65（95%置信区间 0.62-0.69），在治疗的 4-12 个月时为 0.83（95%置信区间 0.81-0.86）。接受化疗的 IV 期黑色素瘤患者的效用估计值为 0.52（95%置信区间 0.51-0.52），而接受靶向治疗的患者为 0.83（95%置信区间 0.82-0.85）。
这些基于证据的健康状态效用的可靠估计值可用于评估新疗法治疗早期或晚期黑色素瘤患者的经济效果。
