Eliciting Preferences for Clinical Follow-Up in Patients with Head and Neck Cancer Using Best-Worst Scaling.

OBJECTIVES: There are no commonly accepted standards for monitoring patients treated for head and neck cancer. The aim of this study was to assess patients' preferences for different aspects of follow-up. METHODS: A best-worst survey was conducted in a sample of head and neck cancer patients in clinical follow-up at the National Cancer Institute (Milan, Italy). Conditional logit regression with choice as the dependent variable was run to analyse the data. A covariate-adjusted analysis was performed in order to identify socio-demographic and clinical factors related to the selection of best-worst items. The participants were asked to report any difficulties encountered during the survey. RESULTS: A total of 143 patients, predominantly male (74%) and with a mean age of 58 years were enrolled in the survey. The strongest positive preference was expressed for a hospital-based program of physical examinations with frequency decreasing over time. Conversely, the lowest valued item was not performing any positron emission tomography (PET) scan during follow-up. Patients with high educational levels were more likely to value attending a primary care-based program and undergoing intensive radiological investigations. Other patient-specific variables significantly associated with the choice of items were employment and living status, time already spent in follow-up and number of treatments received. CONCLUSIONS: Overall, patients were more likely to choose an intensive follow-up scheme broadly consistent with the program currently administered by the hospital. There is little evidence of preference heterogeneity that might justify customized programs based on demographics. The best-worst scaling task appeared feasible for most participants

Valuing Follow-up Programs In Head and Neck Cancer

This thesis deals with the topic of head and neck cancer (HNC) follow-up from a health economics perspective. Despite recent advances in treating primary HNC, the long-term prognosis of these patients is still poor due to a high risk of cancer recurrence. Until now, there is no agreement about the best way of monitoring patients after the end of therapies. Moreover, patients’ preferences for alternative surveillance schemes are unknown. A multicentre randomized controlled trial comparing two follow-up strategies of different intensity is currently ongoing in Italy. This thesis aims at filling some of the literature “gaps” around HNC surveillance, using Italy as a case study. The first chapter introduces the topic. The second chapter is a systematic literature review and critical appraisal of economic evaluation studies of post-treatment follow-up programs in any cancer type. The third chapter is a systematic literature review and quality appraisal of studies reporting original health state utility values in HNC, with a focus on articles addressing the post-treatment phase. The fourth chapter maps the EuroQol 5-Dimension 5-Level (EQ-5D-5L) utility values from two cancer-specific measures developed by the European Organization for Research and Treatment of Cancer (EORTC) by using a variety of regression techniques (linear, Tobit, mixture models) and several EQ-5D-5L country tariff sets; the developed functions are useful to inform future economic evaluations in HNC. The fifth chapter presents an exploratory model-based economic evaluation of the two follow-up strategies under investigation in the trial, where an intensive program of radiological assessments is compared to a symptom-driven surveillance; the cost analysis is conducted from a regional healthcare system perspective in Italy. Lastly, the sixth chapter presents a discrete choice experiment using best-worst scaling to elicit patients’ preferences during follow-up at the National Cancer Institute (Milan, Italy)