Swan J Shannon, Lennes Inga T, Stump Natalie N, Temel Jennifer S, Wang David, Keller Lisa, Donelan Karen
Massachusetts General Hospital Institute for Technology Assessment (JSS, NNS, KD), Boston, Massachusetts.
Harvard Medical School (JSS, ITL, JST, KD), Boston, Massachusetts.
MDM Policy Pract. 2018 Oct 15;3(2):2381468318801565. doi: 10.1177/2381468318801565. eCollection 2018 Jul-Dec.
A preference-based quality-of-life index for non-small cell lung cancer was developed with a subset of Functional Assessment of Cancer Therapy (FACT)-General (G) and FACT-Lung (L) items, based on clinician input and the literature. A total of 236 non-small cell lung carcinoma patients contributed their preferences, randomly allocated among three survey groups to decrease burden. The FACT-L Utility Index (FACT-LUI) was constructed with two methods: 1) multiattribute utility theory (MAUT), where a visual analog scale (VAS)-based index was transformed to standard gamble (SG); and 2) an unweighted index, where items were summed, normalized to a 0 to 1.0 scale, and the result transformed to a scale length equivalent to the VAS or SG MAUT-based model on a Dead to Full Health scale. Agreement between patients' direct utility and the indexes for current health was assessed. The agreement of the unweighted index with direct SG was superior to the MAUT-based index (intraclass correlation for absolute agreement: 0.60 v. 0.35; mean difference: 0.03 v. 0.19; and mean absolute difference 0.09 v. 0.21, respectively). Mountain plots showed substantial differences, with the unweighted index demonstrating a median bias of 0.02 versus the MAUT model at 0.2. There was a significant difference ( = 0.0002) between early (I-II) and late stage (III-IV) patients, the mean difference for both indexes being greater than distribution-based estimates of minimal important difference. The population was limited to non-small cell lung cancer patients. However, most quality-of-life literature consulted and the FACT instruments do not differentiate between lung cancer cell types. Minorities were also limited in this sample. The FACT-LUI shows early evidence of validity for informing economic analysis of lung cancer treatments.
基于临床医生的意见和文献，利用癌症治疗功能评估量表（FACT）通用版（G）和肺癌版（L）的部分条目，开发了一种针对非小细胞肺癌的基于偏好的生活质量指数。共有236例非小细胞肺癌患者参与了偏好评估，他们被随机分配到三个调查小组以减轻负担。FACT-L效用指数（FACT-LUI）通过两种方法构建：1）多属性效用理论（MAUT），即将基于视觉模拟量表（VAS）的指数转换为标准博弈（SG）；2）非加权指数，即将各条目得分相加，标准化为0至1.0的量表，并将结果转换为与基于VAS或SG MAUT模型在从死亡到完全健康量表上等效的量表长度。评估了患者直接效用与当前健康指数之间的一致性。非加权指数与直接SG的一致性优于基于MAUT的指数（绝对一致性的组内相关性：0.60对0.35；平均差异：0.03对0.19；平均绝对差异分别为0.09对0.21）。山形图显示出显著差异，非加权指数的中位数偏差为0.02，而MAUT模型为0.2。早期（I-II期）和晚期（III-IV期）患者之间存在显著差异（P = 0.0002），两种指数的平均差异均大于基于分布的最小重要差异估计值。研究人群仅限于非小细胞肺癌患者。然而，所查阅的大多数生活质量文献以及FACT工具并未区分肺癌细胞类型。该样本中的少数族裔也有限。FACT-LUI显示出早期有效性证据，可为肺癌治疗的经济分析提供参考。
