OBJECTIVES: Current cost-effectiveness models of heat and moisture exchangers (HMEs) for laryngectomized patients, do not consider the potential changes in health-related quality of life (HRQoL) due to reduced cough and sputum symptoms and impact. The aim of this study is to investigate whether the Cough and Sputum Assessment Questionnaire (CASA-Q) can be used to identify health states that distinguish in HRQoL, or utility, for cost-effectiveness models.

METHODS: Patient-level data from a clinical study was used to determine whether the CASA-Q can inform health states that distinguish in HRQoL. The EuroQol-5-dimensions (EQ-5D) and CASA-Q were administered in 40 patients with three different measurement moments (i.e., 120 measurement moments). The cut-off scores were informed by literature. Correlations between the CASA-Q domains and EQ-5D were calculated to assess the level of convergence. One-way ANOVA was used to assess the magnitude of differences in the utility scores across the health states.

RESULTS: The correlation between the EQ-5D and CASA-Q indicate a moderate level of convergence for the cough impact (r=0.32; p=0.0005), sputum symptoms (r=0.46; p<0.0001), and sputum impact (r=0.59; p<0.0001) domains. The correlation between the cough symptoms domain is weak (r=0.20; p=0.03). Based on the sputum impact domain, three health states with their cut-offs were distinguished: no to mild sputum impact (SPUI=>94), moderate sputum impact (64<=SPUI<94), and severe sputum impact (SPUI<64). The utilities of these health states were 0.9183, 0.8009, and 0.6228, respectively. There was a statistically significant difference in utilities between health states as demonstrated by one-way ANOVA (F(1,118)=36.3, p<0.0001).

CONCLUSIONS: The sputum impact domain of the CASA-Q may be suitable to differentiate health states for cost-effectiveness models and capture improvements in HRQoL in laryngectomized patients. These health states may provide a more sensitive choice and complement the current available models.