Health state utilities for skeletal-related events secondary to bone metastases.
BACKGROUND
Patients with bone metastases often experience skeletal-related events (SREs). Although cost-utility models are used to examine treatments for metastatic cancer, limited information is available on utilities of SREs. The purpose of this study was to estimate the disutility of four SREs: spinal cord compression, pathological fracture, radiation to bone, and surgery performed to stabilize a bone.


METHODS
General population participants from the UK and Canada completed time trade-off (TTO) interviews to assess the utility of health states drafted based on literature review, clinician interviews, and patient interviews. Respondents first rated a health state describing cancer with bone metastases. Then, the SREs were added to this health state.


RESULTS
Interviews were completed with 187 participants (50.8 % male, 80.2 % white). Cancer with bone metastases without an SRE had a mean utility of 0.47 (SD = 0.43) on a standard utility scale (1 = full health, 0 = death). Of the SREs, spinal cord compression was associated with the greatest disutility (i.e., the utility decrease): -0.32 with paralysis and -0.22 without paralysis. Surgery had a disutility of -0.07. Leg, arm, and rib fractures had disutilities of -0.06, -0.04, and -0.03. Two weeks of daily radiation treatment had a disutility of -0.06, while two radiation appointments had the smallest impact on utility (-0.02).


CONCLUSIONS
All SREs were associated with statistically significant utility decreases, suggesting a perceived impact on quality of life beyond the impact of cancer with bone metastases. The resulting disutilities may be used in cost-utility models examining treatments to prevent SREs secondary to bone metastases.
Outcomes Research, United BioSource Corporation, 7101 Wisconsin Avenue, Suite 600, Bethesda, MD, 20814, USA, louis.matza@unitedbiosource.com.
Louis S
LS
Matza
Karen
K
Chung
Kate
K
Van Brunt
John E
JE
Brazier
Ada
A
Braun
Brooke
B
Currie
Andrew
A
Palsgrove
Evan
E
Davies
Jean-Jacques
JJ
Body
D000328:Adult; D001847:Bone Diseases / Q000191:economics / Q000209:etiology* / Q000523:psychology*; D001859:Bone Neoplasms / Q000150:complications* / Q000378:metabolism*; D002170:Canada; D002755:Choice Behavior; D003362:Cost-Benefit Analysis; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D006113:United Kingdom