title: Population preference values for treatment outcomes in chronic lymphocytic leukaemia: a cross-sectional utility study.
abstract: BACKGROUND
  Given that treatments for chronic lymphocytic leukaemia (CLL) are palliative rather than curative, evaluating the patient-perceived impacts of therapy is critical. To date, no utility (preference) studies from the general public or patient perspective have been conducted in CLL. The objective of this study was to measure preferences for health states associated with CLL treatment.
  
  
  METHODS
  This was a cross-sectional study of 89 members of the general population in the UK (England and Scotland). Using standard gamble, each participant valued four health states describing response status, six describing treatment-related toxicities based on Common Toxicity Criteria, and two describing line of treatment. The health states incorporated standardized descriptions of treatment response (symptoms have "improved," "stabilized," or "gotten worse"), swollen glands, impact on daily activities, fatigue, appetite, and night sweats. Utility estimates ranged from 0.0, reflecting dead, to 1.0, reflecting full health.
  
  
  RESULTS
  Complete response (CR) was the most preferred health state (mean utility, 0.91), followed by partial response (PR), 0.84; no change (NC), 0.78; and progressive disease (PD), 0.68. Among the toxicity states, grade I/II nausea and nausea/vomiting had the smallest utility decrements (both were -0.05), and grade III/IV pneumonia had the greatest decrement (-0.20). The utility decrements obtained for toxicity states can be subtracted from utilities for CR, PR, NC, and PD, as appropriate. The utilities for second- and third-line treatments, which are attempted when symptoms worsen, were 0.71 and 0.65, respectively. No significant differences in utilities were observed by age, sex, or knowledge/experience with leukaemia.
  
  
  CONCLUSIONS
  This study reports UK population utilities for a universal set of CLL health states that incorporate intended treatment response and unintended toxicities. These utilities can be applied in future cost-effectiveness analyses of CLL treatment.
authors.affiliation: Oxford Outcomes, Bethesda, MD, USA. kathy.beusterien@oxfordoutcomes.com
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Beusterien
authors.forename: John
authors.initials: J
authors.lastname: Davies
authors.forename: Michael
authors.initials: M
authors.lastname: Leach
authors.forename: David
authors.initials: D
authors.lastname: Meiklejohn
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Grinspan
authors.forename: Alison
authors.initials: A
authors.lastname: O'Toole
authors.forename: Steve
authors.initials: S
authors.lastname: Bramham-Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*; D008297:Male; D011788:Quality of Life; D018434:Sickness Impact Profile; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents