Purpose: The use of decision analysis to examine the cost-effectiveness of alternative surveillance strategies following polypectomy requires that the health outcome states for patients with colorectal cancer (CRC) be identified and that the quality of life (or utility) that patients undergoing surveillance place on each of the outcome states be measured. Therefore, we sought to identify these states and develop an instrument to measure their associated utilities. Methods: We conducted formal discussions with oncologic clinicians and convened six focus groups composed of patients with cancer (Ca) of the colon or rectum to identify the following distinct outcome states of CRC: A) Stage I rectal or stage I/II colon Ca treated with resection only, B) stage III colon Ca treated with resection and chemotherapy (chemo) without side-effects, C) same as state B with significant side-effects, D) stage II/III rectal Ca treated with resection/chemo/ radiation, E) stage II/III rectal Ca treated with resection/ostomy/chemo/radiation, F) Stage IV metastatic or unresectable disease without an ostomy, and G) same as state F with an ostomy. We then created representative descriptions of each state and developed a utilities assessment instrument which employed the standard gamble. We used this instrument to measure utilities among 32 otherwise healthy patients between 45 and 64 years of age who had previously undergone a colonoscopy with the removal of at least one adenomatous polyp. Results: The mean utility score (scaled from 0-1) for each of the identified health outcome states of CRC was found to be significantly different than the patient's self-health state. These states can be separated into at least four different categories based on comparison of mean utility scores. Category of Health Measured State(s) mean(s)±SE p-value(s) 1 "patient's self-health" 0.85±.03 2 A 0.72±.04 0.021* B 0.74±0.5 0.015* 3 C 0.55±.09 0.071** D 0.59±.05 0.021** E 0.46±.05 0.001** 4 F 0.18±.07 0.008*** G 0.21±.06 0.002*** *comparison to "patient's self-health"; **comparison to B; ***comparison to E Conclusions: We identified distinct health outcome states of CRC, developed an instrument to measure their associated utilities, and determined mean utilities for each state. This instrument and these measures can be used in decision analysis to examine the cost-effectiveness of strategies for the prevention of CRC.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging