Utility Assessment in Cancer Patients: Adjustment of Time Tradeoff Scores for the Utility of Life Years and Comparison with Standard Gamble Scores

The standard gamble (SG) and the time tradeoff (TTO), two frequently used methods of utility assessment, have often been found to lead to different utilities for the same health state. The authors investigated whether adjustment of TTO scores for the utility of life years (risk attitude) eliminated...

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Bibliographic Details
Published in:Medical decision making 1994, Vol.14 (1), p.82-90
Main Authors: Stiggelbout, A.M., Kiebert, G.M., Kievit, J., Leer, J.W.H., Stoter, G., De Haes, J.C.J.M.
Format: Article
Language:English
Subjects:
Adult
Chemotherapy, Adjuvant
Combined Modality Therapy
Decision Support Techniques
Humans
Male
Middle Aged
Neoplasms - mortality
Neoplasms - therapy
Neoplasms, Germ Cell and Embryonal - mortality
Neoplasms, Germ Cell and Embryonal - therapy
Orchiectomy
Prognosis
Quality of Life
Risk
Survival Analysis
Testicular Neoplasms - mortality
Testicular Neoplasms - therapy
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Summary:The standard gamble (SG) and the time tradeoff (TTO), two frequently used methods of utility assessment, have often been found to lead to different utilities for the same health state. The authors investigated whether adjustment of TTO scores for the utility of life years (risk attitude) eliminated this difference. In addition, the association between risk attitude and sociodemographic and medical variables was studied. In 30 disease-free testicular cancer patients, SG and TTO were used to assess the utilities of four health profiles relevant to testicular cancer. Utility of life years was estimated from certainty equivalents (CEs). SG scores were significantly higher than unadjusted TTO scores for all profiles. As the majority of patients (85%) were risk-averse, CE-adjusted TTO scores were higher than unadjusted scores, and were not significantly different from those obtained from the SG for three of the four profiles. However, adjusted scores were still slightly but consistently lower than SG scores. Possible explanations for this discrepancy are discussed. An association was found between risk aversion and medical treatment: patients who had received chemotherapy for their cancers were more risk-averse than were patients who had been in a surveillance protocol only. As risk aversion can have an impact on treatment decisions, it is important to assess the risk posture of the patient to whom the decision pertains. Key words: utility assessment; QALY; risk aversion; oncology; treatment preferences. (Med Decis Making 1994;14:82-90)
ISSN:0272-989X
1552-681X
DOI:10.1177/0272989X9401400110