OBJECTIVES : Cutaneous T-cell lymphoma (CTCL) is a rare group of lymphomas where malignant T-cell clones accumulate in the skin leading to disfiguring plaques and patches. The objective of this review was to identify appropriate utility values for CTCL that could be used in a cost-utility analysis of extracorporeal photopheresis (ECP) for the treatment of erythrodermic CTCL.

METHODS : A systematic review of the literature did not identify any relevant publications of utility values associated with CTCL. Psoriasis was identified as the most applicable disease to use as a proxy for quality of life, since patients with psoriasis suffer from pruritus, have physical disfigurement and erythroderma (all symptoms suffered by CTCL patients). Therefore, the literature search was expanded to identify utility values for patients with psoriasis. In addition, a clinician survey was conducted to further validate the use of psoriasis utility values as a proxy for erythrodermic CTCL.

RESULTS : The literature review identified nine relevant publications reporting psoriasis utility values. Of these, the study by Zug et al 1995 was considered the most appropriate publication to derive utility values for CTCL. The study elicited utilities based on psoriasis disease severity from 87 patients with psoriasis using the time trade-off instrument. These utility values were validated by the clinician survey, which showed that 86% of clinicians considered that the psoriasis utility values based on disease severity could be considered a reasonable proxy for treatment response in patients with skin manifestations of CTCL (i.e. CTCL complete response to treatment = Mild psoriasis (0.89); CTCL partial response to treatment = Moderate psoriasis (0.79); CTCL no response to treatment = Severe psoriasis (0.59)).

CONCLUSIONS : This review demonstrates that given the absence of specific utility values for CTCL, the application of psoriasis utility values can be considered a reasonable proxy for erythrodermic CTCL.