Elicitation of health state utilities in metastatic renal cell carcinoma

Objective: The aim of the study was to obtain United Kingdom societal preferences for receiving newly developed treatments for metastatic renal cell carcinoma. Methods: Health states were developed based on a literature review and in-depth interviews with clinical experts. These states described the burden of both stable and progressive disease, and a variety of commonly encountered toxicities associated with first-line therapies (fatigue, diarrhoea, nausea/vomiting, mucositis, hand/foot syndrome, hypertension and anaemia). These states were further reviewed by additional clinicians and patients to ensure their validity. One hundred members of the general public rated the states using the time trade-off (TTO) methodology to determine health state utility. Results: Stable disease had a utility value of 0.795 whilst progressive disease demonstrated a significant decline with a value of 0.355. The range of toxicities showed a variable impact in line with their toxicity grading from fatigue grade I/II (0.751) to hand/foot syndrome grade III (0.469). Conclusions: This study highlights the burden associated with a number of common toxicities encountered with current first-line mRCC treatments. Practical constraints coupled with the societal nature of the valuation exercise limited the amount of direct involvement by patients. However, these utility values should better permit the consideration of toxicity profiles in establishing the cost-effectiveness of future treatments.