title: Health utilities in gynecological oncology and mastology in Germany.
abstract: OBJECTIVE
  Cost increases in the healthcare system are leading to a need to distribute financial resources in accordance with the value of each service performed. Health-economic decision-making models can support these decisions. Due to the previous unavailability of health utilities in Germany (scored states of health as a basis for calculating quality-adjusted life-years, QALYs) for women undergoing treatment, international data are often used for such models. However, these may widely deviate from the values for a woman actually living in Germany. It is, therefore, necessary to collect and analyze health utilities in Germany.
  
  
  METHODS
  In a questionnaire survey, health utilities were collected, along with data for a healthy control group, for 580 female patients receiving treatment in the fields of mastology and gynecological oncology using a German version of the EuroQol questionnaire (EQ-5D) and a visual analogue scale (VAS). Data were also collected for the patients' medical history, tumor disease, and treatment.
  
  
  RESULTS
  Significant differences with regard to quality of life were measured in relation to the individual tumor entities and in comparison to the controls. Apart from the healthy control group, patients with breast or cervical carcinoma had the best quality of life. In patients with recurrent and metastatic disease, those with breast carcinoma experienced the greatest impairment of their quality of life. According to current treatment, the most important impairment of life quality occurred in patients under radiotherapy and after surgical treatment. There are significant differences from the health utilities recorded for other countries - for example, the state of health declines much more markedly in patients with metastatic disease among American women with breast carcinoma than among German women, in whom recurrent disease and a first diagnosis of metastasis were comparable. Overall, the VAS was able to distinguish more adequately than the EQ-5D questionnaire between the different situations and impairments resulting from diagnosis and therapy.
  
  
  CONCLUSIONS
  Health utilities are now, for the first time, available for further health-economics analyses in the field of gynecological oncology and mastology for women living in Germany. Important differences in these utilities from those of other countries are evident.
authors: Department of Gynecology and Obstetrics, Erlangen University Hospital, Universitätsstrasse 21-23, 91054 Erlangen, Germany. thomas.hildebrandt@uk-erlangen.de.
authors: Thomas
authors: T
authors: Hildebrandt
authors: Falk C
authors: FC
authors: Thiel
authors: Peter A
authors: PA
authors: Fasching
authors: Christiane
authors: C
authors: Graf
authors: Mayada R
authors: MR
authors: Bani
authors: Christian R
authors: CR
authors: Loehberg
authors: Michael G
authors: MG
authors: Schrauder
authors: Sebastian M
authors: SM
authors: Jud
authors: Carolin C
authors: CC
authors: Hack
authors: Matthias W
authors: MW
authors: Beckmann
authors: Michael P
authors: MP
authors: Lux
mesh_terms: D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005833:Genital Neoplasms, Female / Q000191:economics / Q000523:psychology / Q000628:therapy*; D005858:Germany; D006176:Gynecology / Q000191:economics / Q000706:statistics & numerical data*; D017048:Health Care Costs; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000191:economics / Q000706:statistics & numerical data*; D011788:Quality of Life
keywords: Quality-adjusted life years; breast carcinoma; cost-benefit analysis; gynecological malignancies; health economics; health utilities