HAL will be down for maintenance from Friday, June 10 at 4pm through Monday, June 13 at 9am. More information
Skip to Main content Skip to Navigation
Journal articles

Estimating health state utility from activities of daily living in the French National Hospital Discharge Database: a feasibility study with head and neck cancer

Abstract : Background : Health state utility (HSU) is a core component of QALYs and cost-effectiveness analysis, although HSU is rarely estimated among a representative sample of patients. We explored the feasibility of assessing HSU in head and neck cancer from the French National Hospital Discharge database. Methods: An exhaustive sample of 53,258 incident adult patients with a first diagnosis of head and neck cancer was identified in 2010–2012. We used a cross-sectional approach to define five health states over two periods: three "cancer stages at initial treatment" (early, locally advanced or metastatic stage); a "relapse state" and otherwise a "relapse-free state" in the follow-up of patients initially treated at early or locally advanced stage. In patients admitted in post-acute care, a two-parameter graded response model (Item Response Theory) was estimated from all 144,012 records of six Activities of Daily Living (ADLs) and the latent health state scale underlying ADLs was calibrated with the French EQ-5D-3 L social value set. Following linear interpolation between all assessments of the patient, daily estimates of utility in post-acute care were averaged by health state, patient and month of follow-up. Finally, HSU was estimated by health state and month of follow-up for the whole patient population after controlling for survivorship and selection in post-acute care. Results: Head and neck cancer was generally associated with poor HSU estimates in a real-life setting. As compared to “distant metastasis at initial treatment”, mean HSU was higher in other health states, although numerical differences were small (0.45 versus around 0.54). It was primarily explained by the negative effects on HSU of an older age (38.4% aged ≥70 years in “early stage at initial treatment”) and comorbidities (> 50% in other health states). HSU estimates significantly improved over time in the “relapse-free state” (from 8 to 12 months of follow-up). Conclusions: HSU estimates in head and neck cancer were primarily driven by age at diagnosis, comorbidities, and time to assessment of cancer survivors. This feasibility study highlights the potential of estimating HSU within and across severe conditions in a systematic way at the national level.
Complete list of metadata

Contributor : Elisabeth Lhuillier Connect in order to contact the contributor
Submitted on : Monday, August 26, 2019 - 2:28:51 PM
Last modification on : Wednesday, November 3, 2021 - 5:49:51 AM

Links full text




Michaël Schwarzinger, Stéphane Luchini, Sylvain Baillot, Mélina Bec, Lynda Benmahammed, et al.. Estimating health state utility from activities of daily living in the French National Hospital Discharge Database: a feasibility study with head and neck cancer. Health and Quality of Life Outcomes, BioMed Central, 2019, 17 (1), ⟨10.1186/s12955-019-1195-9⟩. ⟨hal-02270971⟩



Record views