Cost-effectiveness analyses (CEAs) of interventions to prevent cervical cancer require estimates of the health-related quality of life (HRQoL) effects of screen tests and subsequent treatment. The results of such simulation analyses can be highly sensitive to the HRQoL weights employed. Accordingly, accurate assessment of HRQoL is essential for the generation of reliable CEA estimates. We reviewed the literature regarding HRQoL in cervical prevention and management in order to appraise the current evidence regarding this important input to CEA.
We searched the MEDLINE, Scopus and EconLit databases for studies that estimated HRQoL in cervical cancer prevention and management published January 1995-December 2015. The primary inclusion criterion was for studies that assess HRQoL using the EQ-5D instrument. Data were abstracted from eligible studies on setting, elicitation group, sample size, elicitation instruments, health state valuations, study design and follow-up. We assessed the quality and comparability of the studies with a particular focus on the HRQoL reported across states and groups
Fifteen papers met the inclusion criteria. Most used patient elicitation groups (n=11), 2 used the general public and 2 used a mix of both. Eight studies were cross-sectional and seven were longitudinal in design. Six studies used both the EQ-5D-3L and the EQ-VAS together with other measures of overall HRQoL or condition-specific instruments. Studies employing both the EQ-5D and specific measures of anxiety found that the EQ-5D tended to be insensitive for differences in anxiety scores detected by alternative instruments. Extensive heterogeneity was observed across study characteristics.
Our results reveal the challenges of sourcing reliable estimates of HRQoL for use in CEAs of cervical cancer prevention. The EQ-5D appears insufficiently sensitive for some health states. Research will be required to determine if the adoption of the more recent five-level EQ-5D-5L enhances sensitivity over the three-level EQ-5D-3L employed in the literature reviewed here. Another, more general problem is the paucity of HRQoL estimates for many health states and their change over time. There is scope for more detailed longitudinal analysis of the HRQoL burden of cervical cancer related healthcare interventions.