Elicitation of health state utilities in metastatic renal cell carcinoma

Abstract

Objective:

The aim of the study was to obtain United Kingdom societal preferences for receiving newly developed treatments for metastatic renal cell carcinoma.

Methods:

Health states were developed based on a literature review and in-depth interviews with clinical experts. These states described the burden of both stable and progressive disease, and a variety of commonly encountered toxicities associated with first-line therapies (fatigue, diarrhoea, nausea/vomiting, mucositis, hand/foot syndrome, hypertension and anaemia). These states were further reviewed by additional clinicians and patients to ensure their validity. One hundred members of the general public rated the states using the time trade-off (TTO) methodology to determine health state utility.

Results:

Stable disease had a utility value of 0.795 whilst progressive disease demonstrated a significant decline with a value of 0.355. The range of toxicities showed a variable impact in line with their toxicity grading from fatigue grade I/II (0.751) to hand/foot syndrome grade III (0.469).

Conclusions:

This study highlights the burden associated with a number of common toxicities encountered with current first-line mRCC treatments. Practical constraints coupled with the societal nature of the valuation exercise limited the amount of direct involvement by patients. However, these utility values should better permit the consideration of toxicity profiles in establishing the cost-effectiveness of future treatments.

Key words::

• Adverse effects
• Economic evaluation
• Health-related quality of life
• Renal cancer
• Utility

Transparency

Declaration of funding

This study was funded by GlaxoSmithKline.

Declaration of financial/other relationships

P.S. and A.L. have disclosed that they are employees of Oxford Outcomes Ltd who were paid for designing and conducting the study. D.C. has disclosed that he is a consultant and grant recipient of GlaxoSmithKline. T.K.C. has disclosed that he is a consultant and has taken part in advisory boards for GlaxoSmithKline. M.P.N. has disclosed that she is an employee and shareholder of GlaxoSmithKline. P.N. has disclosed that he is the recipient of an honorarium from GlaxoSmithKline.

Some peer reviewers receive honoraria from CMRO for their review work. The peer reviewers of this paper have disclosed that they have no relevant financial relationships.

Acknowledgment

The authors acknowledge the contributions made by Assoc Prof Martin Stockler, University of Sydney, New South Wales, Australia; Dr Amit Bahl and Julia Hardwick, St Mary’s Hospital, Bristol, UK; and Dr Philip Savage and Rachel Sharkey, Charing Cross Hospital, London, UK for providing their clinical expertise. Honoraria for those contributions were provided by GlaxoSmithKline.

The study was designed and conducted by Oxford Outcomes Ltd with sponsorship from GlaxoSmithKline.