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There is little information on patients' preferences for palliative therapy for malignant dysphagia.
In this study, physicians from the United States sought to quantitatively determine individual preferences for palliation using health state utilities.
The team measured health state utilities using 3 methods: time trade-off, visual analog scale, and the EQ-5D.
 | | Patients consistently rated their own utility better than the utility of standardized scenarios. | | American Journal of Gastroenterology |
The team asked patients with esophageal cancer to rate their own state of health, as well as of 3 standardized scenarios: local, regional, and metastatic disease.
They evaluated 50 patients with esophageal cancer.
The physicians found that using the time trade-off method, the utilities of patients' own health state were 0.80 for localized, 0.54 for regional, and 0.52 for metastatic cancer. There was no significant difference in mean utility scores for the 3 staging groups.
Visual analog scale and EQ-5D gave statistically similar values to time trade-off.
The team found that patients consistently rated their own utility better than the utility of standardized scenarios with similar stage and prognosis.
They also found that regardless of their staging, patients with high dysphagia scores rated their utility worse than patients with low dysphagia scores.
Dr Stephan Wildi and colleagues concluded, "These results confirm the perceived poor state of health of patients with esophageal cancer and are substantially lower than previous estimates in operated patients".
"Cost-effectiveness models must take into account significant differences between patients' assessment of their own state of health, and that of a "societal" perspective of others with a similar disease".
"All 3 methods provided similar estimates. Given the ease of use of visual analog scale and EQ-5D, these methods may be preferable to time trade-off".
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