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

Summary

We sought to determine pooled estimates of utility-based health-related quality-of-life (HRQOL) (utilities) for people with American Joint Cancer Committee stage I/II, III, IV melanoma for use in economic evaluations.

We performed a systematic review, meta-analysis, and meta-regression of utilities for melanoma patients. HRQOL scores reported with 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. Meta-regression examined the effects of baseline patient and study characteristics.

We identified 33 studies reporting 213 utilities. From meta-analyses, the mean utility for stage I/II melanoma was 0.970 (95%CI: 0.895-0.979); for stage III melanoma was 0.766 (95%CI: 0.699-0.833); for stage III/IV was 0.763 (95%CI: 0.755-0.771) and for stage IV melanoma was 0.764 (95%CI: 0.714-0.813). The difference in utility between stage III and stage IV was not statistically significant (p=0.521). For patients with stage I/II, the utility estimate at time of surgery was 0.772 (95%CI: 0.753-0.790), and from 3-12 months post-surgery, the utility estimate was 0.852 (95%CI: 0.844-0.860). Utility estimates for patients with stage IV melanoma were 0.653 (95%CI: 0.621-0.685) during the first 3 months of treatment and 0.831 (95%CI: 0.808-0.855) from 4-12 months on treatment. For patients with stage IV melanoma treated with chemotherapy, the utility estimate was 0.518 (95%CI: 0.513-0.523), while for those treated with targeted therapy, the utility estimate was 0.834 (95%CI: 0.822-0.846).

These 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.

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