title: Impact of nausea/vomiting on quality of life as a visual analogue scale-derived utility score.
abstract: Pharmacoeconomic analysis is often based upon incremental cost per increase in survival (cost-effectiveness). Using this definition supportive care measures, which increase quality but not quantity of life, generate a zero denominator and cannot be directly compared with other components of health care cost. Cost-utility analysis, which measures incremental cost per increase in quality-adjusted life-years (QALY), where QALY = utility score x time at risk, addresses this problem, since successful supportive intervention increases the utility score and thus provides a finite denominator in QALY even when absolute survival is unchanged. However, utility scores for various supportive care modalities have not been well defined. As a pilot study to generate a first approximation of a utility score for nausea/vomiting, we used a rating scale technique and administered two visual analogue scale questions to 30 patients completing a cycle of chemotherapy. Patients rated their global quality of life during their previous cycle of chemotherapy with hypothetical absence or presence of nausea/vomiting as the only variable. The study population included 8 male and 22 female patients, with a median age of 56 years. The most common malignancies were breast cancer (8 patients), lung cancer (7 patients), and hematologic malignancies (7 patients). On a 100 mm visual analogue scale, the mean score for overall quality of life during chemotherapy was 79 mm without nausea/vomiting and 27 mm with nausea/vomiting (P < 0.001, paired t-test). The implied marked increase in utility with relief of nausea/vomiting suggests a significant impact on cost-utility analysis. Similar methodology could be used to estimate utility scores in other areas of supportive care.
authors.affiliation: Division of Hematology/Oncology, University of Vermont College of Medicine, Burlington, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Grunberg
authors.forename: N
authors.initials: N
authors.lastname: Boutin
authors.forename: A
authors.initials: A
authors.lastname: Ireland
authors.forename: S
authors.initials: S
authors.lastname: Miner
authors.forename: J
authors.initials: J
authors.lastname: Silveira
authors.forename: T
authors.initials: T
authors.lastname: Ashikaga
mesh_terms: D000328:Adult; D000368:Aged; D000932:Antiemetics / Q000191:economics* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced / Q000517:prevention & control*; D009369:Neoplasms / Q000188:drug therapy; D010147:Pain Measurement; D010865:Pilot Projects; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control*
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents