ELICITATION OF HEALTH STATE UTILITIES ASSOCIATED PROGRESSION FROM BCG-UNRESPONSIVE NON-MUSCLE INVASIVE BLADDER CANCER (NMIBC) HEALTH STATES

This study was conducted to elicit utility values for the treatment of NMIBC, with the aim to understand preferences for different stages of bladder cancer for use in a cost-effectiveness model. Phase I developed and tested NMIBC health states, involving interviews with three clinicians, a patient advisor, and 30 members of the general population (as a pilot stage of the time trade-off [TTO] exercise). Interview findings were used to finalise the health states. Phase II involved utility elicitation; vignette-based TTO utility interviews conducted in-person with a sample of participants from the general population in London, United Kingdom (UK). Four chronic and one path hypothetical health states described different NMIBC scenarios. Participants were asked to rank each of the four chronic health states, followed by the TTO valuation exercise for all health states. Descriptions differed in terms of NMIBC symptoms’ severity, impacts, and mode and frequency of administration. Mean age of participants (n=202) was 46; 46% were female. Mean (standard deviation [SD]) EQ-5D-5L Visual Analogue Scale (VAS) and index scores were 83.2 (12.3) and 0.89 (0.18), respectively, indicating a healthy sample. Mean utilities were 0.781 for “No high-grade recurrence”, 0.586 for “High-grade recurrence”, 0.572 for “>1-year post cystectomy”, and 0.283 for “MIBC with metastatic disease”. The path health state of “First year post cystectomy” had a mean utility of 0.288. Pairwise comparisons found statistically significant differences between utilities (p < 0.001), except the comparison between high-grade recurrence and >1-year post cystectomy (p = 0.524). There were significant differences in health state utility scores by age and employment status. These results demonstrate that the general public highly value delaying radical cystectomy as a treatment alternative for bladder cancer. The health state with bladder-sparing therapy elicited a distinctly higher value compared to the other health states.