Utilities for prostate cancer health states in men aged 60 and older.
OBJECTIVE
We sought to measure utilities for prostate cancer health states in older men.


METHODS
A total of 162 men aged 60 years or older (52% of whom had been diagnosed with prostate cancer) provided standard gamble utilities for 19 health states associated with prostate cancer or its treatment using an interactive, computer-based utility assessment program. Demographics and experience with specific health states were examined as predictors of ratings using ordinary least squares regression analysis.


RESULTS
Mean utilities ranged from 0.67 to 0.84 for living with symptom-free cancer under conservative management ("watchful waiting") and from 0.71 to 0.89 for symptoms occurring with treatment (prostatectomy, radiation, and hormone ablation). For long-term treatment complications, bowel problems (0.71) were rated as significantly worse than impotence (0.89), urinary difficulty (0.88), or urinary incontinence (0.83). Combinations of these conditions were rated as significantly worse than individual component states. Men who had experienced impotence or urinary incontinence rated these states as slightly better than men who had not experienced the specific problems.


CONCLUSIONS
Both "watchful waiting" and treatment complications from prostate cancer treatments can have large impacts on quality of life. Mean ratings are important for use in policy-making and cost-effectiveness analyses. Variation in ratings across patients suggests that mean scores do not reflect individual preferences and that shared decision-making may be best for clinical decisions.
Stewart
Susan T
ST
Harvard Interfaculty Program for Health Systems Improvement and the National Bureau of Economic Research, Cambridge, Massachusetts, USA.
Lenert
Leslie
L
Bhatnagar
Vibha
V
Kaplan
Robert M
RM
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000523:psychology; D003661:Decision Support Techniques; D007172:Erectile Dysfunction / Q000523:psychology; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011471:Prostatic Neoplasms / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D012725:Sexual Behavior / Q000523:psychology; D018434:Sickness Impact Profile; D014549:Urinary Incontinence / Q000523:psychology