A systematic review and meta-analysis of utility estimates in melanoma

BackgroundHealth-related quality of life (HRQOL) in melanoma is affected by cancer stage. Previous studies have reported limited data on utility-based HRQOL. ObjectivesTo 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. MethodsWe 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. ResultsWe identified 33 studies reporting 213 utilities. From meta-analyses, the mean utility for stage I/II melanoma was 097 [95% confidence interval (CI) 090-098]; for stage III melanoma it was 077 (95% CI 070-083); for stage III/IV 076 (95% CI 076-077); and for stage IV melanoma 076 (95% CI 071-081). The difference in utility between stage III and stage IV was not statistically significant (P=052). For patients with stage I/II, the utility estimate at the time of surgery was 077 (95% CI 075-079), and at 3-12months postsurgery it was 085 (95% CI 084-086). Utility estimates for patients with stage IV melanoma were 065 (95% CI 062-069) during the first 3months of treatment and 083 (95% CI 081-086) at 4-12months on treatment. For patients with stage IV melanoma treated with chemotherapy, the utility estimate was 052 (95% CI 051-052), while for those treated with targeted therapy it was 083 (95% CI 082-085). ConclusionsThese 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. 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 097, for stage III 077, for stage III/IV 076 and for stage IV alone 076. Among people with stage I/II melanoma, higher utility was observed for men and those older than 55years. Utility was lowest in the first 3months following surgery for stage I/II melanoma, or during initial treatment with chemotherapies for stage IV melanoma.