Health-related quality of life and survival outcomes in prostate cancer

The aim of health care is to maximize health, and in practice, health must be produced in the context of scarce resources. In order to make wise resource allocations, health economic analyses are needed, often in the context of Health Technology Assessment (HTA). Health economic analyses concentrate on assessing the economic value of interventions, whereas full HTA also considers other aspects of decision-making. In recent years, the concept of value-based health care (VBHC) has emerged on the side of traditional health economic analyses. They both try to answer questions concerning the value of interventions in health care - i.e., the relationship of outcomes and investments needed. The objective in VBHC is also to find such actions that can improve the cost-effectiveness of health care dynamically over time. Health-related quality of life (HRQoL) is a patient-reported outcome measure which, in combination with survival data, can produce quality-adjusted life years (QALYs) gained needed as the outcome measure in cost-utility analyses (CUA). This thesis generates real-world data for the use of health economic analyses and compares outcomes of conventional treatment strategies in PC. According to the systematic literature review in this study, preference-based HRQoL data in PC patients are still scarce. HRQoL of PC patients was measured in different stages of the disease (Local, Locally Advanced and Metastatic) and in patients undergoing different treatments with two HRQoL instruments, namely the generic 15D and disease-specific EORTC QLQ-C30. HRQoL data were obtained from 1050 and clinical background data from 1024 patients. The mean age of the patients at baseline was 66.5 years, and most of the patients were in an early stage of the disease as only 59 (6%) of the patients were metastatic at the time of the diagnosis. Even though the mean 15D score of Local and Locally advanced patients did not differ from that of the age-standardized male population, there was a statistically significant difference on the dimensions of depression and distress among all patient groups, which indicates that there are psychological side effects from the awareness of cancer diagnosis. Out of the five functioning scales in the EORTC QLQ-C30 instrument, patients in the Local and Locally advanced groups scored the lowest in emotional function, which can indicate anxiety, worrying, irritation, and/or depression due to the awareness of the diagnosis. The four major treatment strategies during the first year after diagnosis were active surveillance (n=226), radiation (n=280), radical surgery (n=299) and hormonal treatment (n=62). The mean follow-up time in the survival analysis was 77.7 months, and at the end of the follow-up, 84.4% of patients were alive. Median overall survival was 53.8 months (95% CI 44.5 – 63.2 months) in the hormonal group, and median survival for the other groups was not reached. Prostate cancer was a rare cause of death, especially in the active surveillance and surgery groups. The hormonal treatment group had the lowest HRQoL and survival among the studied treatment groups, and consequently, also experienced the least number of QALYs during the two-year follow-up. Outcomes of the three other treatment groups were similar in terms of HRQoL and overall survival, and thus also regarding the number of QALYs experienced.