Quality of Life and Productivity Costs in Cancer Patients Receiving Proton Therapy: A Predictive and Descriptive Study
Author(s)
Diego A. Larrotta-Castillo, MD1, Margriet Sattler, MD2, Michiel Kroesen, MD2, Wouter Iserief, MSc(c)1, Carin Uyl-De Groot, PhD1, Mischa Hoogeman, PhD2, Hedwig M. Blommestein, PhD1.
1Erasmus School of Health Policy and Law, Rotterdam, Netherlands, 2HollandPTC, Delft, Netherlands.
1Erasmus School of Health Policy and Law, Rotterdam, Netherlands, 2HollandPTC, Delft, Netherlands.
OBJECTIVES: In The Netherlands, proton therapy (PT) is selectively used based on model-based indications, including head and neck (HNC) and breast cancer (BC), to minimize radiation-related toxicity. This study describes EQ5D-5L-derived health-related quality of life (HrQoL) and productivity costs measured via the iMTA Productivity Cost Questionnaire (iPCQ) in HNC and BC patients treated with PT as part of multimodality systemic treatment. A second objective is to develop a regression model to predict productivity costs from HrQoL data when productivity loss is not collected.
METHODS: Patient characteristics and outcomes from HrQoL and productivity questionnaires were collected at baseline, end-of-treatment, and at 6, 12, and 24 months post-PT. Results were summarized across timepoints using frequency tables. HrQoL was assessed via EQ5D-5L; productivity costs, including absenteeism and presenteeism, were measured in hours via the iPCQ. Missing HrQoL and productivity data were handled with multiple imputation. A generalized estimating equation (GEE) model accounted for intra-subject correlation and identified HrQoL domains associated with productivity loss.
RESULTS: A total of 224 patients completed EQ5D-5L questionnaires over a 2-year follow-up. HrQoL declined slightly at end of treatment but improved thereafter among reporting patients. Productivity cost data were available for 155 patients. Absenteeism was highest at baseline (mean = 107.2 ± 37.3 hours), decreasing by 2 years (75.3 ± 65.5); presenteeism decreased from 18.5 ± 12.8 to 15.3 ± 13.3 hours. The prediction model showed a significant negative association between higher scores in the EQ5D-5L self-care domain and the probability of attending work (β = -41.1, 95% CI: -44.3 to -38.0).
CONCLUSIONS: This study highlights dynamic changes in HrQoL and productivity costs among cancer patients treated with PT. Findings highlight the utility of patient-reported outcomes in estimating indirect costs and support their integration into health economic models informing value-based care and reimbursement strategies.
METHODS: Patient characteristics and outcomes from HrQoL and productivity questionnaires were collected at baseline, end-of-treatment, and at 6, 12, and 24 months post-PT. Results were summarized across timepoints using frequency tables. HrQoL was assessed via EQ5D-5L; productivity costs, including absenteeism and presenteeism, were measured in hours via the iPCQ. Missing HrQoL and productivity data were handled with multiple imputation. A generalized estimating equation (GEE) model accounted for intra-subject correlation and identified HrQoL domains associated with productivity loss.
RESULTS: A total of 224 patients completed EQ5D-5L questionnaires over a 2-year follow-up. HrQoL declined slightly at end of treatment but improved thereafter among reporting patients. Productivity cost data were available for 155 patients. Absenteeism was highest at baseline (mean = 107.2 ± 37.3 hours), decreasing by 2 years (75.3 ± 65.5); presenteeism decreased from 18.5 ± 12.8 to 15.3 ± 13.3 hours. The prediction model showed a significant negative association between higher scores in the EQ5D-5L self-care domain and the probability of attending work (β = -41.1, 95% CI: -44.3 to -38.0).
CONCLUSIONS: This study highlights dynamic changes in HrQoL and productivity costs among cancer patients treated with PT. Findings highlight the utility of patient-reported outcomes in estimating indirect costs and support their integration into health economic models informing value-based care and reimbursement strategies.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HTA276
Topic
Economic Evaluation, Health Technology Assessment, Methodological & Statistical Research
Disease
Oncology