UTILITY-ASSESSMENT IN CANCER-PATIENTS - ADJUSTMENT OR TIME TRADEOFF SCORES FAR THE UTILITY OF LIFE YEARS AND COMPARISON WITH STANDARD GAMBLE SCORES

The standard gamble (SG) and the time tradeoff (TTO), two frequently u sed methods of utility assessment, have often been found to lead to di fferent utilities for the same health state. The authors investigated whether adjustment of TTO scores for the utility of life years (risk a ttitude) eliminated this difference. In addition, the association betw een risk attitude and sociodemographic and medical variables was studi ed. In 30 disease-free testicular cancer patients, SG and TTO were use d to assess the utilities of four health profiles relevant to testicul ar cancer. Utility of life years was estimated from certainty equivale nts (CEs). SG scores were significantly higher than unadjusted TTO sco res for all profiles. As the majority of patients (85%) were risk-aver se, CE-adjusted TTO scores were higher than unadjusted scores, and wer e not significantly different from those obtained from the SG for thre e of the four profiles. However, adjusted scores were still slightly b ut consistently lower than SG scores. Possible explanations for this d iscrepancy are discussed. An association was found between risk aversi on and medical treatment: patients who had received chemotherapy for t heir cancers were more risk-averse than were patients who had been in a surveillance protocol only. As risk aversion can have an impact on t reatment decisions, it is important to assess the risk posture of the patient to whom the decision pertains.