Estimating health state utility from activities of daily living in the French National Hospital Discharge Database: a feasibility study with head and neck cancer - Archive ouverte HAL Access content directly
Journal Articles Health and Quality of Life Outcomes Year : 2019

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

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Michaël Schwarzinger
  • Function : Author
Stéphane Luchini
Sylvain Baillot
  • Function : Author
Mélina Bec
  • Function : Author
  • PersonId : 898555
Lynda Benmahammed
  • Function : Author
Caroline Even
  • Function : Author
Lionnel Geoffrois
  • Function : Author
Florence Huguet
  • Function : Author
Béatrice Le Vu
  • Function : Author
Laurie Lévy-Bachelot
  • Function : Author
Yoann Pointreau
  • Function : Author
Camille Robert
  • Function : Author
Luis Sagaon-Teyssier
Antoine Schernberg
  • Function : Author
Stéphane Temam
  • Function : Author

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.

Dates and versions

hal-02270971 , version 1 (26-08-2019)

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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, 2019, 17 (1), ⟨10.1186/s12955-019-1195-9⟩. ⟨hal-02270971⟩
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