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. 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. 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). 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.

中文翻译：

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通过法国国家医院出院数据库中的日常生活活动估算健康状态效用：头颈癌的可行性研究

尽管很少在有代表性的患者样本中估计HSU，但健康状态效用（HSU）是QALY和成本效益分析的核心组成部分。我们从法国国家医院出院数据库探讨了评估头颈癌HSU的可行性。在2010-2012年期间，确定了53258名首次诊断为头颈癌的成年患者的详尽样本。我们采用横断面方法在两个时期内定义了五个健康状态：三个“初始治疗阶段的癌症阶段”（早期，局部晚期或转移阶段）；在早期或局部晚期阶段最初接受治疗的患者的随访中，“复发状态”为“复发状态”，否则为“无复发状态”。在接受急性后护理的患者中，从六个日常活动（ADL）的全部144,012条记录中，估计出一个两参数分级的响应模型（项目响应理论），并使用法国EQ-5D-3 L社会价值集对潜在的健康状态量表进行了校准。在对患者的所有评估之间进行线性插值后，按健康状况，患者和​​随访月份将对急性后护理效用的每日估计值平均。最后，在控制急性后护理中的存活率和选择后，通过健康状况和整个患者群体的随访月份来评估HSU。在现实生活中，头颈癌通常与HSU估计差有关。与“初始治疗时的远处转移”相比，其他健康状态的平均HSU更高，尽管数值差异很小（0.45比0左右）。54）。主要原因是年龄较大（“初次治疗早期”≥70岁的38.4％年龄≥70岁）和合并症（其他健康状态> 50％）对HSU的负面影响。HSU估计，在“无复发状态”（随访8到12个月）中，随着时间的推移，显着改善。HSU对头颈癌的估计主要取决于诊断时的年龄，合并症和评估癌症幸存者的时间。这项可行性研究强调了在国家层面以系统的方式估算严峻条件之内和之间的HSU的潜力。HSU估计，在“无复发状态”（随访8到12个月）中，随着时间的推移，显着改善。HSU对头颈癌的估计主要取决于诊断时的年龄，合并症和评估癌症幸存者的时间。这项可行性研究强调了在国家层面以系统的方式估算严峻条件之内和之间的HSU的潜力。HSU估计，在“无复发状态”（随访8到12个月）中，随着时间的推移，显着改善。HSU对头颈癌的估计主要取决于诊断时的年龄，合并症和评估癌症幸存者的时间。这项可行性研究强调了在国家层面以系统的方式估算严峻条件之内和之间的HSU的潜力。