Health-related quality of life and costs in prostate cancer

Scientific evidence based on health economic evaluations is needed to enable decisions-makers to make informed decisions on resource allocations within health care systems. Usually the economic evaluations take place within health technology assessment (HTA). The use of health economic evaluations has increased during the last two decades and will hopefully contribute towards making the best possible use of limited health care resources. Prostate cancer (PC) is the most frequently diagnosed cancer in men accounting for 29% of all the cancers diagnosed in men in Finland. There are almost 50,000 men in Finland currently living with PC. The prevalence of PC is expected to rise with aging population and improved diagnostics and treatment options. This may also increase the burden from PC on the society and, consequently, resource optimization is warranted. Health-related quality of life (HRQoL) assessments in PC is an evolving field but, based on the literature, the use of preference-based single index measures to generate health state utilities or values valid for the estimation of quality adjusted life years (QALY) gained, is scarce. This is problematic, as health state utility estimates are an integral component of cost-utility analysis, which can be considered the gold standard method in health economics today. The general aim of this thesis was to study HRQoL and costs in different states of PC. HRQoL was assessed with one cancer-specific (EORTC QLQ-C30) and two generic (EQ-5D-3L and 15D) HRQoL instruments. Data (630 patients) were collected in the Helsinki and Uusimaa Hospital District in a cross-sectional setting. In addition, costs were also collected for these patients as incremental costs compared to age, gender and place of residence standardized peers. All evaluated HRQoL instruments provided valuable insight into patients’ overall HRQoL. HRQoL remained on a relatively high level until the disease progressed. Symptoms of fatigue and pain, and the background variables of financial difficulties and age, were the most important factors associated with poor HRQoL. Direct costs related to different states of PC are significant. However, productivity losses and costs of informal care also play a major role when estimating the total economic burden of PC. Excluding such a large share of costs from cost-effectiveness considerations might have a significant impact on the decision making pro¬cess of health economic evaluations or HTA. The single-index HRQoL instruments considered here (EQ-5D-3L and 15D) should not be considered interchangeable in health economic evaluations, especially in the case where HRQoL values are low or differ significantly from those of age-standardized peers.