Evaluation of Health-related Quality of Life for Hypothesized Medical States Associated with Cervical Cancer


Background: When evaluating health-economics for cervical cancer prevention policies in Japan, it isimportant to use Japanese value settings. This study aimed to obtain preference-based measures (preferencemeasures) for hypothesized health states among healthy Japanese women, and to examine differences betweenthe EuroQol-5D (EQ-5D) and standard gamble (SG) instruments. Materials and
Methods: The investigation wasperformed among female students at a nursing university. We used written hypothetical scenarios describingthree grades of cervical intraepithelial neoplasia (CIN) and eight stages of cervical cancer, both at diagnosisand after medical intervention. Preference measures were evaluated using both EQ-5D and SG.
Results: Wereceived responses from 136 women. The mean number of respondents per stage was 24.6 (SD: 2.7). At diagnosis,average EQ-5D scores for CIN1, CIN2, CIN3, IA1, IA2, IB1, IB2, IIA, IIB, III, and IV stages were 0.84 (0.14),0.78 (0.12), 0.73 (0.10), 0.78 (0.12), 0.72 (0.12), 0.63 (0.13), 0.64 (0.12), 0.68 (0.08), 0.62 (0.13), 0.55 (0.21), and 0.18(0.24), respectively. Using one-way analysis of variance with the Tukey-Kramer method for multiple comparisons(each stage vs. CIN1), we found significant differences for IB1 and more advanced stages (p<0.05). After medicalintervention, corresponding EQ-5D scores were 0.84 (0.12), 0.81 (0.12), 0.84 (0.12), 0.80 (0.15), 0.78 (0.11), 0.64(0.15), 0.63 (0.15), 0.71 (0.15), 0.50 (0.17), 0.52 (0.17), 0.21 (0.28). The multiple comparisons identified significantdifferences for IB1 and more advanced stages, excepting IIA (p<0.05). SG evaluations were more variable andrelatively higher than EQ-5D evaluations.
Conclusions: We obtained preference measures for three grades ofCIN1-3 and eight stages of cervical cancer. In combination with appropriate sensitivity analyses, these preferencemeasures will provide a basis for an economic evaluation of cervical cancer prevention in Japan. We suggestthat EQ-5D is appropriate for cost-utility analysis of this topic.