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Responsiveness of disease-specific and generic utility instruments in prostate cancer patients

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Abstract

Background

Preferences (utilities) for health outcomes have an important role in decisions about prostate cancer screening and treatment. The responsiveness of utility instruments has not been evaluated.

Subjects

Prostate cancer outpatients from the Princess Margaret Hospital, Toronto (n = 248) were allocated into three cohorts: N — newly diagnosed and treated; M — metastatic disease; O — all others.

Measures

We measured quality of life at 3 points within 12 months using 3 disease-specific utility instruments (Patient Oriented Prostate Utility Scales), 3 generic utility instruments (Health Utilities Index, EQ-5D, Quality of Well-Being Scale), and 3 profile scales (PORPUS-P profile, Prostate Cancer Index, QLQ-C-30). Responsiveness was assessed using measures of internal responsiveness (standardized effect size, standardized response mean) and external responsiveness (receiver operator curve analysis, mixed model regression).

Results

Cohort N patients showed post-treatment declines followed by improvement in global health and functional status. Disease specific instruments detected moderate (0.4–1.3) decrements followed by small increments (0.1–0.4) in standardized effect size and standardized response mean. Most instruments detected change using external responsiveness measures (all cohorts).

Conclusions

Disease-specific utility instruments appeared to be more responsive than generic instruments. Use of generic instruments should be supplemented with a responsive disease-specific instrument, particularly for applications in early prostate cancer.

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Abbreviations

AUROC:

area under the receiver operator curve

EQ-5D:

EuroQol 5 dimension quality of life instrument

HRQL:

health related quality of life

HUI:

Health Utilities Index

PCI:

Prostate Cancer Index

PORPUS:

Patient Oriented Prostate Utility Scales

PORPUSI :

health index version of PORPUS

PORPUSP :

health profile version of PORPUS

PORPUSRS :

direct utility elicitation version of the PORPUS, using rating scale scaling

PORPUSSG :

direct utility elicitation version of the PORPUS, using standard gamble scaling

QLQ-C30:

European Organisation for the Research and Treatment of Cancer quality of life questionnaire, core module

QWB:

Quality of Well Being Scale

RS:

rating scale

SES:

standardized effect size

SG:

standard gamble

SRM:

standardized response mean

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Acknowledgements

Support was provided by the Canadian Institutes for Health Research (CIHR), (Grant #006169), Zeneca Canada Inc., an Investigator Award from the Canadian Institutes for Health Research (Dr.␣Krahn), the F. Norman Hughes Chair in Pharmacoeconomics (Dr. Krahn) and the Mary Trimmer Chair in Geriatric Medicine Research (Dr. Naglie).

Author information

Authors and Affiliations

  1. Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Murray Krahn, Karen E. Bremner, George Tomlinson & Gary Naglie

  2. Faculty of Pharmacy, University of Toronto, Toronto, Canada

    Murray Krahn

  3. Department of Psychology, University of Toronto, Toronto, Canada

    Paul Ritvo & Jane Irvine

  4. Department of Public Health Sciences, University of Toronto, Toronto, Canada

    George Tomlinson

  5. Departments of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada

    George Tomlinson & Gary Naglie

  6. Ontario Cancer Institute, Toronto, Ontario, Canada

    Paul Ritvo

  7. York University, Toronto, Canada

    Jane Irvine

  8. Department ofMedicine, University of Toronto, The Toronto General Hospital, EN14-207, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada

    Murray Krahn

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  1. Murray Krahn
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  2. Karen E. Bremner
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  4. Paul Ritvo
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  5. Jane Irvine
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  6. Gary Naglie
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Correspondence to Murray Krahn.

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Krahn, M., Bremner, K.E., Tomlinson, G. et al. Responsiveness of disease-specific and generic utility instruments in prostate cancer patients. Qual Life Res 16, 509–522 (2007). https://doi.org/10.1007/s11136-006-9132-x

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