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Preferences of Husbands and Wives for Outcomes of Prostate Cancer Screening and Treatment
SOCIOECONOMIC FACTORS, UROLOGICAL EPIDEMIOLOGY AND PRACTICE PATTERNS
outcomes. For those who are particularly interested in this topic this article provides an exhaustive appendix, summarizing the findings from the 198 studies reviewed. Peter C. Albertsen, M.D.
Preferences of Husbands and Wives for Outcomes of Prostate Cancer Screening and Treatment R. J. VOLK, S. B. CANTOR, A. R. CASS, S. J. SPANN, S. C. WELLER AND M. D. KRAHN, Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas J Gen Intern Med, 19: 339 –348, 2004 OBJECTIVE: To explore the preferences of male primary care patients and their spouses for the outcomes of prostate cancer screening and treatment, and quality of life with metastatic prostate cancer. DESIGN: Cross-sectional design. SETTING: Primary care clinics in Galveston County, Texas. PATIENTS: One hundred sixty-eight couples in which the husband was a primary care patient and a candidate for prostate cancer screening. MEASUREMENTS AND MAIN RESULTS: Preferences were measured as utilities for treatment outcomes and quality of life with metastatic disease by the time trade-off method for the husband and the wife individually and then conjointly for the couple. For each health state considered, husbands associated lower utilities for the health states than did their wives. Couples’ utilities fell between those of husbands and wives (all comparisons were significant at P ⬍.01). For partial and complete impotence and mild-to-moderate incontinence, the median utility value for the wives was 1.0, indicating that most wives did not associate disutility with their husbands having to experience these treatment complications. CONCLUSIONS: Male primary care patients who are candidates for prostate cancer screening evaluate the outcomes of prostate cancer treatment and life with advanced prostate cancer as being far worse than do their wives. Because the choice between quantity and quality of life is a highly individualistic one, both the patient and his partner should be involved in making decisions about prostate cancer screening. Editorial Comment: A utility is a quantitative measure of how a patient values a particular health state. Outcomes researchers frequently use these measures when modeling disease outcomes. In this study healthy patients were asked to imagine life with several potential outcomes associated with prostate cancer treatment, using time tradeoff techniques. The findings were remarkably similar to posttreatment results obtained from patients with prostate cancer. Utilities are usually scaled from 0 to 1, where 0 equals death and 1 equals optimal health. In this study mean utilities from the perspective of the couples interviewed were 0.91 for partial impotence and 0.84 for complete impotence. These same couples assigned a utility of 0.89 for mild to moderate incontinence and 0.79 for severe incontinence. In general, male preferences for these health states were lower than those of their spouses. Overall, the findings confirm earlier work directed at quantifying patient preferences for prostate cancer outcomes. Peter C. Albertsen, M.D.
Screening for Proteinuria in US Adults: A Cost-Effectiveness Analysis L. E. BOULWARE, B. G. JAAR, M. E. TARVER-CARR, F. L. BRANCATI AND N. R. POWE, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland JAMA, 290: 3101–3114, 2003 CONTEXT: Chronic kidney disease is a growing public health problem. Screening for early identification could improve health but could also lead to unnecessary harms and excess costs. OBJECTIVE: To assess the value of periodic, population-based dipstick screening for early detection of urine protein in adults with neither hypertension nor diabetes and in adults with hypertension. DESIGN, SETTING, AND POPULATION: Cost-effectiveness analysis using a Markov decision analytic model to compare a strategy of annual screening with no screening (usual care) for proteinuria at age 50 years followed by treatment with an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II-receptor blocker (ARB). MAIN OUTCOME MEASURE: Cost per quality-adjusted life-year (QALY). RESULTS: For persons with neither hypertension nor diabetes, the cost-effectiveness ratio for screening vs no screening (usual care) was unfavorable (282 818 dollars per QALY; incremental cost of 616 dollars and a gain of 0.0022 QALYs per person). However, screening such persons beginning at age 60 years yielded a more favorable ratio (53 372 dollars per QALY). For persons with hypertension, the ratio was highly favorable (18 621 dollars per QALY; incremental cost of 476 dollars and a gain of 0.03 QALYs per person). Cost-effectiveness was mediated by both chronic kidney disease progression and death prevention benefits of ACE inhibitor and ARB therapy. Influential parameters that might make screening for the general population more cost-effective include a greater incidence of proteinuria, age at screening (53 372 dollars per QALY for persons beginning screening
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outcomes. For those who are particularly interested in this topic this article provides an exhaustive appendix, summarizing the findings from the 198 studies reviewed. Peter C. Albertsen, M.D.
Preferences of Husbands and Wives for Outcomes of Prostate Cancer Screening and Treatment R. J. VOLK, S. B. CANTOR, A. R. CASS, S. J. SPANN, S. C. WELLER AND M. D. KRAHN, Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas J Gen Intern Med, 19: 339 –348, 2004 OBJECTIVE: To explore the preferences of male primary care patients and their spouses for the outcomes of prostate cancer screening and treatment, and quality of life with metastatic prostate cancer. DESIGN: Cross-sectional design. SETTING: Primary care clinics in Galveston County, Texas. PATIENTS: One hundred sixty-eight couples in which the husband was a primary care patient and a candidate for prostate cancer screening. MEASUREMENTS AND MAIN RESULTS: Preferences were measured as utilities for treatment outcomes and quality of life with metastatic disease by the time trade-off method for the husband and the wife individually and then conjointly for the couple. For each health state considered, husbands associated lower utilities for the health states than did their wives. Couples’ utilities fell between those of husbands and wives (all comparisons were significant at P ⬍.01). For partial and complete impotence and mild-to-moderate incontinence, the median utility value for the wives was 1.0, indicating that most wives did not associate disutility with their husbands having to experience these treatment complications. CONCLUSIONS: Male primary care patients who are candidates for prostate cancer screening evaluate the outcomes of prostate cancer treatment and life with advanced prostate cancer as being far worse than do their wives. Because the choice between quantity and quality of life is a highly individualistic one, both the patient and his partner should be involved in making decisions about prostate cancer screening. Editorial Comment: A utility is a quantitative measure of how a patient values a particular health state. Outcomes researchers frequently use these measures when modeling disease outcomes. In this study healthy patients were asked to imagine life with several potential outcomes associated with prostate cancer treatment, using time tradeoff techniques. The findings were remarkably similar to posttreatment results obtained from patients with prostate cancer. Utilities are usually scaled from 0 to 1, where 0 equals death and 1 equals optimal health. In this study mean utilities from the perspective of the couples interviewed were 0.91 for partial impotence and 0.84 for complete impotence. These same couples assigned a utility of 0.89 for mild to moderate incontinence and 0.79 for severe incontinence. In general, male preferences for these health states were lower than those of their spouses. Overall, the findings confirm earlier work directed at quantifying patient preferences for prostate cancer outcomes. Peter C. Albertsen, M.D.
Screening for Proteinuria in US Adults: A Cost-Effectiveness Analysis L. E. BOULWARE, B. G. JAAR, M. E. TARVER-CARR, F. L. BRANCATI AND N. R. POWE, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland JAMA, 290: 3101–3114, 2003 CONTEXT: Chronic kidney disease is a growing public health problem. Screening for early identification could improve health but could also lead to unnecessary harms and excess costs. OBJECTIVE: To assess the value of periodic, population-based dipstick screening for early detection of urine protein in adults with neither hypertension nor diabetes and in adults with hypertension. DESIGN, SETTING, AND POPULATION: Cost-effectiveness analysis using a Markov decision analytic model to compare a strategy of annual screening with no screening (usual care) for proteinuria at age 50 years followed by treatment with an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II-receptor blocker (ARB). MAIN OUTCOME MEASURE: Cost per quality-adjusted life-year (QALY). RESULTS: For persons with neither hypertension nor diabetes, the cost-effectiveness ratio for screening vs no screening (usual care) was unfavorable (282 818 dollars per QALY; incremental cost of 616 dollars and a gain of 0.0022 QALYs per person). However, screening such persons beginning at age 60 years yielded a more favorable ratio (53 372 dollars per QALY). For persons with hypertension, the ratio was highly favorable (18 621 dollars per QALY; incremental cost of 476 dollars and a gain of 0.03 QALYs per person). Cost-effectiveness was mediated by both chronic kidney disease progression and death prevention benefits of ACE inhibitor and ARB therapy. Influential parameters that might make screening for the general population more cost-effective include a greater incidence of proteinuria, age at screening (53 372 dollars per QALY for persons beginning screening
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