Health State Utility Values in Early-Stage Non-small Cell Lung Cancer: A Systematic Literature Review

Abstract

Background: Non-small cell lung cancer (NSCLC) is the predominant histological subtype of lung cancer and is the leading cause of cancer-related deaths globally. Quality of life is an important consideration for patients and current treatments can adversely affect health-related quality of life (HRQoL).

Objective: The objectives of this systematic literature review (SLR) were to identify and provide a comprehensive catalogue of published health state utility values (HSUVs) in patients with early-stage NSCLC and to understand the factors impacting on HSUVs in this indication.

Methods: Electronic searches of Embase, MEDLINE and Evidence-Based Medicine Reviews were conducted via the Ovid platform in March 2021 and June 2022 and were supplemented by grey literature searches of conference proceedings, reference lists, health technology assessment bodies, and other relevant sources. Eligibility criteria were based on patients with early-stage (stage I-III) resectable NSCLC receiving treatment in the adjuvant or neoadjuvant setting. No restriction was placed on interventions or comparators, geography, or publication date. English language publications or non-English language publications with an English abstract were of primary interest. A validated checklist was applied to conduct quality assessment of the full publications.

Results: Twenty-nine publications (27 full publications and two conference abstracts) met all eligibility criteria and reported 217 HSUVs and seven disutilities associated with patients with early NSCLC. The data showed that increasing disease stage is associated with decreasing HRQoL. It was also indicated that utility values vary by treatment approach; however, the choice of treatment may be influenced by the patients' disease stage at presentation. Few studies aligned with the requirements of health technology assessment (HTA) bodies, indicating a need for future studies to conform to these preferences, making them suitable for use in economic evaluations.

Conclusions: This SLR found that disease stage and treatment approach were two of several factors that can impact patient-reported HRQoL. Additional studies are warranted to confirm these findings and to investigate emerging therapies for early NSCLC. In collecting a catalogue of HSUV data, this SLR has begun to identify the challenges associated with identifying reliable utility value estimates suitable for use in economic evaluations of early NSCLC.

Fig. 1

PRISMA flow diagram. EBM evidence-based medicine, HRQoL health-related quality of life, HSUV health state utility value, PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses, SLR systematic literature review, ti/ab title and abstract

Fig. 2

Utilities by disease stage. The three estimates for ‘Stage IA–IIIB’ are derived from the study by Andreas et al (2018) [23]. All patients underwent complete surgical resection. Of these patients, some remained disease free (0.72), but others relapsed and progressed to locoregional recurrence (0.62) or distant metastasis/terminal disease (0.67), forming the three distinct data points. 15D 15 Dimensions, AQoL Assessment of Quality of Life, EQ-5D European Quality of Life-5 dimensions, EQ-5D-3L European Quality of Life -5 dimensions 3 levels, EQ-5D-5L European Quality of Life -5 dimensions 5 levels, FACT-U Functional Assessment of Cancer Therapy—lung utility index, MAUT Multi-Attribute Utility Theory, NR not reported, SF-6D Short Form-6 dimensions, SG standard gamble, VAS visual analogue scale

Fig. 3

HSUVs by intervention. † For studies that did not report follow-up times in weeks, these were converted up to 1 year of follow-up. ‡ A single study by Jang et al (2009) [41] provided the 6-year data for chemotherapy treatment. No baseline value is provided for this treatment as the three groups represented are post-treatment but different stages of toxicity: TWiST state (0.75); toxicity state (0.68) and relapse state (0.60). CGA comprehensive geriatric assessment, HSUVs health state utility values, NR not reported, SBRT stereotactic body radiation therapy, VATS video-assisted thoracoscopic surgery