Development and Prospective Evaluation of the Bladder Utility Symptom Scale (Utility): A Novel Tool to Measure Utilities and Quality of LIfe in Bladder Cancer Patients
Author(s)
Girish Kulkarni, MD PhD FRCSC1, Nathan Perlis, MD1, Douglas C. Cheung, MD1, Peter Black, MD2, Wassim Kassouf, MD3, Karen Bremner, BSc1, Katherine Lajkosz, MSc1, Joseph Chin, MD4, Robert K. Nam, MD5, William WL Wong, PhD6, George Tomlinson, PhD7;
1Princess Margaret Cancer Centre, Department of Surgery, Division of Urology, Toronto, ON, Canada, 2University of British Columbia, Department of Urologic Sciences, Vancouver, BC, Canada, 3McGill University Health Center, Department of Surgery, Montreal, QC, Canada, 4London Health Sciences Centre, London, ON, Canada, 5Sunnybrook Health Sciences Centre, Toronto, ON, Canada, 6University of Waterloo, School of Pharmacy, Waterloo, ON, Canada, 7University of Toronto, Toronto, ON, Canada
1Princess Margaret Cancer Centre, Department of Surgery, Division of Urology, Toronto, ON, Canada, 2University of British Columbia, Department of Urologic Sciences, Vancouver, BC, Canada, 3McGill University Health Center, Department of Surgery, Montreal, QC, Canada, 4London Health Sciences Centre, London, ON, Canada, 5Sunnybrook Health Sciences Centre, Toronto, ON, Canada, 6University of Waterloo, School of Pharmacy, Waterloo, ON, Canada, 7University of Toronto, Toronto, ON, Canada
OBJECTIVES: Bladder cancer (BCa) and its treatments significantly impact quality-of-life (QOL). To facilitate comparative-effectiveness research, a tool to measure QOL and utilities in these patients is required. The Bladder Utility Symptom Scale-Psychometric (BUSS-P) is a preference-based psychometric instrument that has undergone rigorous internal and external validation, and can be used across all phases of BCa. We created an algorithm to calculate utilities from the BUSS-P instrument and evaluated these in a prospective study.
METHODS: In time-tradeoff(TTO) interviews, 200 BCa patients and 200 community members provided utilities for scenarios derived from the BUSS-P. Patients were proportionally recruited from non-muscle-invasive(NMIBC), muscle-invasive(MIBC) and metastatic participants to represent all disease phases. Bayesian generalized linear multilevel models were used to estimate the impacts of the ten BUSS-P attributes. An algorithm was developed to calculate utilities from the BUSS-P responses (BUSS-Utility). We then prospectively evaluated the BUSS-U, and compared it against the EQ-5D-5L and EORTC-QLU-C10D.
RESULTS: Of 400 participants, 167 community members and 155 patients (70-NMIBC,53-MIBC,32-metastatic) completed the TTO exercises with adequate comprehension, providing 3,288 unique BUSS-P scenario valuations. The final BUSS-U derivation model had weighted correlation coefficients between predicted and observed utilities of 0.733 and 0.734 in community and patient groups, respectively. The BUSS-U was then completed by 406 BCa patients at three Canadian academic centres (Toronto, Vancouver, McGill), representing 17 unique health states. BUSS-U utilities discriminated health states, and followed EQ-5D-5L and EORTC-QLU-C10D scores.
CONCLUSIONS: The new BUSS-U is a BCa-specific utility instrument grounded in TTO methodology and applicable across the BCa care spectrum. Our study has created a standard reference set of BCa utilities for economic evaluations, decision-modeling, and policy work. Given the improved discrimination for health-related QOL when transitioning across clinically-significant health states, and the inclusion of BCa-specific health domains, we suggest using the BUSS to measure QOL and utilities in BCa patients for future research.
METHODS: In time-tradeoff(TTO) interviews, 200 BCa patients and 200 community members provided utilities for scenarios derived from the BUSS-P. Patients were proportionally recruited from non-muscle-invasive(NMIBC), muscle-invasive(MIBC) and metastatic participants to represent all disease phases. Bayesian generalized linear multilevel models were used to estimate the impacts of the ten BUSS-P attributes. An algorithm was developed to calculate utilities from the BUSS-P responses (BUSS-Utility). We then prospectively evaluated the BUSS-U, and compared it against the EQ-5D-5L and EORTC-QLU-C10D.
RESULTS: Of 400 participants, 167 community members and 155 patients (70-NMIBC,53-MIBC,32-metastatic) completed the TTO exercises with adequate comprehension, providing 3,288 unique BUSS-P scenario valuations. The final BUSS-U derivation model had weighted correlation coefficients between predicted and observed utilities of 0.733 and 0.734 in community and patient groups, respectively. The BUSS-U was then completed by 406 BCa patients at three Canadian academic centres (Toronto, Vancouver, McGill), representing 17 unique health states. BUSS-U utilities discriminated health states, and followed EQ-5D-5L and EORTC-QLU-C10D scores.
CONCLUSIONS: The new BUSS-U is a BCa-specific utility instrument grounded in TTO methodology and applicable across the BCa care spectrum. Our study has created a standard reference set of BCa utilities for economic evaluations, decision-modeling, and policy work. Given the improved discrimination for health-related QOL when transitioning across clinically-significant health states, and the inclusion of BCa-specific health domains, we suggest using the BUSS to measure QOL and utilities in BCa patients for future research.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
P12
Topic
Patient-Centered Research
Topic Subcategory
Health State Utilities, Instrument Development, Validation, & Translation, Patient-reported Outcomes & Quality of Life Outcomes
Disease
SDC: Oncology, SDC: Urinary/Kidney Disorders, STA: Surgery