A technique for approximating transition rates from published survival analyses

© 2019 The Author(s). Background: Quality-adjusted-life-years (QALYs) are used to concurrently quantify morbidity and mortality within a single parameter. For this reason, QALYs can facilitate the discussion of risks and benefits during patient counseling regarding treatment options. QALYs are often calculated using partitioned-survival modelling. Alternatively, QALYs can be calculated using more flexible and informative state-transition models populated with transition rates estimated using multistate modelling (MSM) techniques. Unfortunately the latter approach is considered not possible when only progression-free survival (PFS) and overall survival (OS) analyses are reported. Methods: We have developed a method that can be used to estimate approximate transition rates from published PFS and OS analyses (we will refer to transition rates estimated using full multistate methods as true transition rates). Results: The approximation method is more accurate for estimating the transition rates out of health than the transition rate out of illness. The method tends to under-estimate true transition rates as censoring increases. Conclusions: In this article we present the basis for and use of the transition rate approximation method. We then apply the method to a case study and evaluate the method in a simulation study

A General Population Utility Valuation Study For Metastatic Epidural Spinal Cord Compression Health States.

STUDY DESIGN: General population utility valuation study OBJECTIVES.: This study obtained utility valuations from a Canadian general population perspective for 31 unique Metastatic Epidural Spinal Cord Compression (MESCC) health states and determined the relative importance of MESCC-related consequences on quality-of-life. SUMMARY OF BACKGROUND DATA: Few prospective studies on the treatment of MESCC have collected quality-adjusted-life-year weights (termed utilities ). Utilities are an important summative measure which distills health outcomes to a single number that can assist healthcare providers, patients, and policy makers in decision making. METHODS: We recruited a sample of 1138 adult Canadians using a market research company. Quota sampling was used to ensure that the participants were representative of the Canadian population in terms of age, gender, and province of residence. Using the validated MESCC module for the Self-administered Online Assessment of Preferences (SOAP) tool, participants were asked to rate 6 of the 31 MESCC health states, each of which presented varying severities of 5 MESCC-related dysfunctions (dependent; non-ambulatory; incontinent; pain; other symptoms). RESULTS: Participants equally valued all MESCC-related dysfunctions which followed a pattern of diminishing marginal disutility (each additional consequence resulted in a smaller incremental decrease in utility than the previous). These results demonstrate that the general population values physical function equal to other facets of quality-of-life. CONCLUSIONS: We provide a comprehensive set of ex ante utility estimates for MESCC health states that can be used to help inform decision making. This is the first study reporting direct utility valuation for a spinal disorder. Our methodology offers a feasible solution for obtaining quality-of-life data without collecting generic health status questionnaire responses from patients. LEVEL OF EVIDENCE: 4