Measuring the Impact of Common Prostate Cancer Survivorship Conditions With Health Utilities.

[OBJECTIVE] To assess the effect of disease exposure on the perceived impact of common prostate cancer (CaP) survivorship conditions and their surgical treatments. MATERIALS AND METHODS: Two cohorts-disease-exposed (DE) patients treated for CaP and disease naïve (DN) recruited from Qualtrics-were given standardized clinical scenarios on stress urinary incontinence (SUI) and erectile dysfunction (ED) and asked to assess disease impact using four health state utility (HSU) instruments which were averaged and reported in Quality-Adjusted-Life-Years (QALY; range 0.0 [death] to 1.0 [perfect health]). We then assessed the impact that inflatable penile prosthesis (IPP) and artificial urinary sphincter (AUS) had on health. QALYs were compared by condition and cohort.

[RESULTS] Cohorts included 196 DN and 42 DE participants. The DE cohort rated all conditions to have significantly less impact on health than the DN cohort (+0.14 QALY for ED and +0.11 QALY for SUI). Both cohorts rated SUI (QALY 0.60, 0.71) to have more impact than ED (QALY 0.65, 0.79; P<.001). ED treatment with IPP did not statistically impact the overall mean QALY in either group (+0.02, +0.02; P = .38). SUI treatment with AUS improved QALY in both (+0.04, +0.07; P<.001). Subanalysis revealed significant group heterogeneity in the impact of IPP and AUS, with 20%-25% of the cohorts reporting a QALY improvement of >17% (clinically significant).

[CONCLUSION] We demonstrate how HSUs can provide a measure of disease impact in both DN and DE cohorts, allowing for an objective, standard comparison between cohorts and between conditions, including the ability to assess the perceived impact of surgical interventions. Evidence for disease adaptation in the DE cohort and heterogeneity of perceived impact of surgical interventions was demonstrated.