Utilities play a key role in the evaluation of treatments that, in addition to cost and survival, have quality of life implications (Gold 96). However, considerable dissatisfaction exists regarding the quality of utility instruments available (Froberg-III, 89, Gold 96), and how utility scores are used in cost-effectiveness analyses (CEA; Neumann 1997 MDM, Fryback). The extent to which utility assessment, and method for incorporating utilities in to the cost-effectiveness (CE) models, actually affects the CE model results in a significant and meaningful way is largely unstudied. In the proposed study, we will use a model for ovarian cancer screening to address these issues.
Our specific aims are: (1) Compare six utility questionnaires: (2) Determine the impact of frame of reference on current health and hypothetical health state utilities; and (3) Determine the sensitivity of cost- effectiveness models to assessment method, sample characteristics, including experience with the disease, age, race/ethnicity and gender, and to techniques for incorporating the utility scores in to the cost-effectiveness model. We will conduct simulations to determine both the range of screening parameters for which any screen for ovarian cancer might be considered cost-effective, and to fit our ovarian cancer screening model to screening for other cancer diagnoses, to determine whether cost-effectiveness models for screening for other cancer diagnoses are also sensitive to choice of utility score. We will specifically administer six different utility questionnaires for current health and multiple hypothetical health states in ovarian cancer and primary care patients, and in women enrolled in the Northwestern Ovarian Cancer Early Detection Program (n=1800). A sampling strategy will be used where each patient responds to four of the six utility questionnaires for three health states to minimize respondent burden. This methodological study will focus on the improvement of cost- effectiveness methods through both the better measurement and use of utilities in CFAs, providing information that is generalizable across all cancers and chronic illnesses, and will also provide the framework for future studies of the CE of ovarian cancer screening.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA089503-04
Application #
6657998
Study Section
Special Emphasis Panel (ZRG1-SNEM-4 (01))
Program Officer
Reeve, Bryce
Project Start
2001-08-20
Project End
2005-07-31
Budget Start
2003-08-01
Budget End
2005-07-31
Support Year
4
Fiscal Year
2003
Total Cost
$324,195
Indirect Cost
Name
Northshore University Healthsystem
Department
Type
DUNS #
069490621
City
Evanston
State
IL
Country
United States
Zip Code
60201
Hope, Joanie Mayer; Wang, Feng-Qiang; Whyte, Jill S et al. (2009) LPA receptor 2 mediates LPA-induced endometrial cancer invasion. Gynecol Oncol 112:215-23
Devine, Kathleen M; Smicun, Yoel; Hope, Joanie Mayer et al. (2008) S1P induced changes in epithelial ovarian cancer proteolysis, invasion, and attachment are mediated by Gi and Rac. Gynecol Oncol 110:237-45
Smicun, Yoel; Gil, Orlando; Devine, Kate et al. (2007) S1P and LPA have an attachment-dependent regulatory effect on invasion of epithelial ovarian cancer cells. Gynecol Oncol 107:298-309
Do, Thuy-Vy; Symowicz, Jay C; Berman, David M et al. (2007) Lysophosphatidic acid down-regulates stress fibers and up-regulates pro-matrix metalloproteinase-2 activation in ovarian cancer cells. Mol Cancer Res 5:121-31
Smicun, Yoel; Reierstad, Scott; Wang, Feng-Qiang et al. (2006) S1P regulation of ovarian carcinoma invasiveness. Gynecol Oncol 103:952-9
Wang, Feng-Qiang; Smicun, Yoel; Calluzzo, Nicholas et al. (2006) Inhibition of matrilysin expression by antisense or RNA interference decreases lysophosphatidic acid-induced epithelial ovarian cancer invasion. Mol Cancer Res 4:831-41
Wang, Fengqiang; Reierstad, Scott; Fishman, David A (2006) Matrilysin over-expression in MCF-7 cells enhances cellular invasiveness and pro-gelatinase activation. Cancer Lett 236:292-301
Wang, Feng-qiang; So, John; Reierstad, Scott et al. (2006) Vascular endothelial growth factor-regulated ovarian cancer invasion and migration involves expression and activation of matrix metalloproteinases. Int J Cancer 118:879-88
Wang, Feng-Qiang; So, John; Reierstad, Scott et al. (2005) Matrilysin (MMP-7) promotes invasion of ovarian cancer cells by activation of progelatinase. Int J Cancer 114:19-31
So, John; Wang, Feng-qiang; Navari, Jason et al. (2005) LPA-induced epithelial ovarian cancer (EOC) in vitro invasion and migration are mediated by VEGF receptor-2 (VEGF-R2). Gynecol Oncol 97:870-8

Showing the most recent 10 out of 15 publications