Healthstate Utilities for Hormone Receptor-Positive (HR+) Human Epidermal Growth Factor-Receptor 2 Negative (HER2-) Breast Cancer
Author(s)
Alison Davie, BSc, MSc1, Anna Emde, MD, PhD1, Nicholas Durno, MSc2, Debdeep Chattopadhyay, PhD3, Adele Barlassina, MSc3, Debra Hill, N/A4, Helen Innes, MBChB, MRCP, MD5, Peter S. Hall, MB ChB, MRCP, PhD6.
1Eli Lilly & Co. Ltd., Bracknell, United Kingdom, 2OPEN Health, London, United Kingdom, 3OPEN Health, Rotterdam, Netherlands, 4Independent Patient Expert, N/A, United Kingdom, 5The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom, 6Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom.
1Eli Lilly & Co. Ltd., Bracknell, United Kingdom, 2OPEN Health, London, United Kingdom, 3OPEN Health, Rotterdam, Netherlands, 4Independent Patient Expert, N/A, United Kingdom, 5The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom, 6Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom.
OBJECTIVES: Trial-based health-related quality-of-life data for HR+/HER2- breast cancer (BC) are limited to short-term follow-up (~30 days post-disease progression/recurrence), leading to reliance on alternative sources for determining long-term health-state utilities in economic evaluations. Aligned with NICE hierarchical preferences, we estimated HR+/HER2- BC health-state utilities using United Kingdom (UK) general population participants.
METHODS: This was a three-phase non-interventional UK observational study. In Phase 1, BC vignettes (descriptions of key health states) were developed based on literature and advisory group input (two healthcare professionals, one patient expert). Phase 2 involved interviews of ten patients at various BC disease states (recruited by a general practitioner) and advisory group validation. In Phase 3, 200 general population adult females were surveyed online to elicit EQ-5D scores based on the vignettes; these were converted to utilities using the NICE-recommended EQ-5D-5L to EQ-5D-3L mapping model. Data were summarised descriptively.
RESULTS: Invasive disease-free survival (IDFS) off-treatment/remission had the highest mean (standard deviation) utility value (0.70 [0.24]), followed by IDFS on treatment (0.46 [0.29]), locally advanced (0.33 [0.29]), locally advanced (non-curable)/metastatic stable (0.18 [0.32]) and progressive metastatic disease (0.01 [0.32]). Mean (SD) rating of participants’ own health was 0.80 (0.25).
CONCLUSIONS: This study provides new UK health utility estimates for HR+/HER2- BC disease states aligned with NICE guidance for use in economic evaluations, given the limitations associated with previous datasets. While a logical decrease in estimated health-state utility was observed with increasing disease severity, general population-estimated values were much lower than those collected through clinical trials and alternative health-state utility elicitation studies. These data are valuable in the absence of patient-reported data. However, they highlight the challenges associated with the vignette-based approach and obtaining disease-specific values from the general population, who may under-estimate patient adaptation and resilience to BC symptoms and their effects, leading to low utility scores.
METHODS: This was a three-phase non-interventional UK observational study. In Phase 1, BC vignettes (descriptions of key health states) were developed based on literature and advisory group input (two healthcare professionals, one patient expert). Phase 2 involved interviews of ten patients at various BC disease states (recruited by a general practitioner) and advisory group validation. In Phase 3, 200 general population adult females were surveyed online to elicit EQ-5D scores based on the vignettes; these were converted to utilities using the NICE-recommended EQ-5D-5L to EQ-5D-3L mapping model. Data were summarised descriptively.
RESULTS: Invasive disease-free survival (IDFS) off-treatment/remission had the highest mean (standard deviation) utility value (0.70 [0.24]), followed by IDFS on treatment (0.46 [0.29]), locally advanced (0.33 [0.29]), locally advanced (non-curable)/metastatic stable (0.18 [0.32]) and progressive metastatic disease (0.01 [0.32]). Mean (SD) rating of participants’ own health was 0.80 (0.25).
CONCLUSIONS: This study provides new UK health utility estimates for HR+/HER2- BC disease states aligned with NICE guidance for use in economic evaluations, given the limitations associated with previous datasets. While a logical decrease in estimated health-state utility was observed with increasing disease severity, general population-estimated values were much lower than those collected through clinical trials and alternative health-state utility elicitation studies. These data are valuable in the absence of patient-reported data. However, they highlight the challenges associated with the vignette-based approach and obtaining disease-specific values from the general population, who may under-estimate patient adaptation and resilience to BC symptoms and their effects, leading to low utility scores.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HTA177
Topic
Economic Evaluation, Health Technology Assessment
Topic Subcategory
Value Frameworks & Dossier Format
Disease
Oncology