A systematic review and meta‐analysis of utility estimates in melanoma. (17th January 2018)

• Record Type: Journal Article
• Authors: Tran, A.D.; Fogarty, G.; Nowak, A.K.; Espinoza, D.; Rowbotham, N.; Stockler, M.R.; Morton, R.L.
• Is Part Of: British journal of dermatology. Volume 178:Number 2(2018)
• Page Start: 384
• Page End: 393
• Publication Date: 2018-01-17
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.16098
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: Background: Health‐related quality of life (HRQOL) in melanoma is affected by cancer stage. Previous studies have reported limited data on utility‐based HRQOL. Objectives: To determine pooled estimates of utility‐based HRQOL (utilities) for people with American Joint Cancer Committee stage I/II, III or IV melanoma for use in economic evaluations. Methods: We performed a systematic review, meta‐analysis and metaregression of utilities for patients with melanoma. HRQOL scores reported with the QLQ‐C30, SF‐36, SF‐12, FACT‐G and FACT‐M instruments were converted to utilities using published mapping algorithms. Meta‐analysis was used to calculate mean utilities. Metaregression was used to examine the effects of baseline patient and study characteristics. Results: We identified 33 studies reporting 213 utilities. From meta‐analyses, the mean utility for stage I/II melanoma was 0·97 [95% confidence interval (CI) 0·90–0·98]; for stage III melanoma it was 0·77 (95% CI 0·70–0·83); for stage III/IV 0·76 (95% CI 0·76–0·77); and for stage IV melanoma 0·76 (95% CI 0·71–0·81). The difference in utility between stage III and stage IV was not statistically significant ( P = 0·52). For patients with stage I/II, the utility estimate at the time of surgery was 0·77 (95% CI 0·75–0·79), and at 3–12 months postsurgery it was 0·85 (95% CI 0·84–0·86). Utility estimates for patients with stage IV melanoma were 0·65 (95% CI 0·62–0·69) during the first 3 months of treatment and 0·83 (95% CI 0·81–0·86) at 4–12 months on treatment. For patients with stage IV melanoma treated with chemotherapy, the utility estimate was 0·52 (95% CI 0·51–0·52), while for those treated with targeted therapy it was 0·83 (95% CI 0·82–0·85). Conclusions: These robust, evidence‐based estimates of health state utility can be used in economic evaluations of new treatments for patients with early‐stage or advanced‐stage melanoma. Abstract : What's already known about this topic? Health‐related quality of life (HRQOL) in melanoma is affected by cancer stage: it is higher at stages 0, I and II and lower at stage III/IV. HRQOL is lower at the time of surgery or initiating treatment but higher after completing treatment. HRQOL studies contained limited data on utility‐based HRQOL. Previous reviews focused on interferon and chemotherapy treatments but not targeted therapies. What does this study add? This large review, meta‐analysis and metaregression of contemporary melanoma treatments has found utility‐based quality‐of‐life for stage I/II melanoma to be 0·97, for stage III 0·77, for stage III/IV 0·76 and for stage IV alone 0·76. Among people with stage I/II melanoma, higher utility was observed for men and those older than 55 years. Utility was lowest in the first 3 months following surgery for stage I/II melanoma, or during initial treatment with chemotherapies for stage IV melanoma.