Cross-Country Comparison of Cancer-Related Health Preferences Using the EORTC QLU C10D: Evidence Supporting Standardized Value Sets
Author(s)
Justin Yu, PharmD.
Post-doctoral Fellow, UIC, Chicago, IL, USA.
Post-doctoral Fellow, UIC, Chicago, IL, USA.
OBJECTIVES: Health technology assessment (HTA) guidelines recommend country-specific value sets for preference-based measures of health. However, producing these value sets is resource intensive. With increasing international harmonization of valuation protocols, this study assessed the feasibility of using a single or standardized value set across culturally similar countries using the EORTC QLU-C10D instrument.
METHODS: Two approaches were used. First, utility coefficient rankings at Level 4 severity across ten QLU-C10D dimensions were compared using published value sets from 13 countries. Second, an empirical analysis was conducted using cross-sectional data from 1,432 U.S. cancer patients who completed the QLQ-C30 and were rated on the ECOG Performance Status scale. Country-specific value sets were used to compute utilities, which were compared using ANOVA and Relative Efficiency (RE). Pearson correlation coefficients assessed the association between countries’ utility scores and ECOG levels.
RESULTS: The value sets from these countries revealed similar ranking of coefficients for the 10 dimensions. Among all countries, sleep, fatigue, and appetite had the smallest disutility (least impact on quality of life), while physical functioning, role functioning, and pain had the largest disutility. Mean utility scores declined with worsening ECOG status across all value sets. F-statistics and RE values were similar across countries, suggesting comparable discriminative performance. Pearson correlation coefficients between countries exceeded r>0.9, indicating strong correlation. Five groups of similar countries were identified based on disutility rankings and utility score patterns, including a core group of English-speaking countries and others with comparable cultural and health preferences.
CONCLUSIONS: Findings suggest that similarities of certain country-specific value sets support the feasibility of developing and applying a standardized value set across countries with comparable cultural and health preferences. This approach may reduce the burden of developing value sets for every country and enhance the efficiency of HTA processes. Further research should assess generalizability to other measures and countries.
METHODS: Two approaches were used. First, utility coefficient rankings at Level 4 severity across ten QLU-C10D dimensions were compared using published value sets from 13 countries. Second, an empirical analysis was conducted using cross-sectional data from 1,432 U.S. cancer patients who completed the QLQ-C30 and were rated on the ECOG Performance Status scale. Country-specific value sets were used to compute utilities, which were compared using ANOVA and Relative Efficiency (RE). Pearson correlation coefficients assessed the association between countries’ utility scores and ECOG levels.
RESULTS: The value sets from these countries revealed similar ranking of coefficients for the 10 dimensions. Among all countries, sleep, fatigue, and appetite had the smallest disutility (least impact on quality of life), while physical functioning, role functioning, and pain had the largest disutility. Mean utility scores declined with worsening ECOG status across all value sets. F-statistics and RE values were similar across countries, suggesting comparable discriminative performance. Pearson correlation coefficients between countries exceeded r>0.9, indicating strong correlation. Five groups of similar countries were identified based on disutility rankings and utility score patterns, including a core group of English-speaking countries and others with comparable cultural and health preferences.
CONCLUSIONS: Findings suggest that similarities of certain country-specific value sets support the feasibility of developing and applying a standardized value set across countries with comparable cultural and health preferences. This approach may reduce the burden of developing value sets for every country and enhance the efficiency of HTA processes. Further research should assess generalizability to other measures and countries.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
PCR54
Topic
Patient-Centered Research
Topic Subcategory
Health State Utilities
Disease
Oncology