Estimating health state utility from activities of daily living in the French National Hospital Discharge Database: a feasibility study with head and neck cancer

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Activities of daily living; Cost-effectiveness analysis; EQ-5D-3L; Head and neck cancer; Health state utility; Item response theory; National hospital discharge database; QALYs.

Fig. 1

Survival according to health state in head and neck cancer

Fig. 2

Admission in post-acute care according to health state in head and neck cancer

Fig. 3

Characteristic curves of 6 Activities of Daily Living (ADL) recorded in post-acute care (n = 144,006). The trait on the horizontal axis is an arbitrarily scaled representation of the latent health state scale. As the value of the latent health state increases, the probability of a higher score on each ADL increases. The relative concentration of the curves reflects the relatively high discriminative ability of an ADL. On the contrary, the relative spread of the curves reflects the relatively low discriminative ability of an ADL

Fig. 4

Health state utility, by health state and month of follow-up of head and neck cancer patients in post-acute care

Fig. 5

Health state utility, by health state and month of follow-up of all head and neck cancer patients