Differences in health state valuation for small, low-risk thyroid cancer between general population and cancer survivors: a cross-sectional analysis

PURPOSE: A low-risk cancer characterized by slow growth and excellent prognosis, papillary thyroid microcarcinoma (PTMC) is increasingly managed with less invasive alternatives to surgical resection, including active surveillance and radiofrequency ablation. To inform shared decision-making and comparative-effectiveness models, treatment preferences/quality of life quantified by health utilities must be derived for PTMC. However, there is ambiguity regarding the population from which these should be elicited. We aimed to compare health state utility estimates for PTMC as derived from general population volunteers (GenPop) and thyroid cancer survivors (TCSurv). METHODS: GenPop and TCSurv completed a time trade-off task for 10 PTMC health states described by clinical vignettes. Health utilities were compared between groups with univariate and multivariable linear regression, adjusting for age, sex, and income. Subgroup analysis was performed for health states with and without treatment complications. RESULTS: 70 GenPop and 72 TCSurv completed the surveys. GenPop reported lower utilities relative to TCSurv for all 10 health states, with an effect size of 0.044 attributed to participant group in the multivariable analysis (p = 0.01). This observation persisted in stratified analysis by treatment complication, with effect sizes 0.047 (p = 0.04) and 0.042 (p < 0.01) for uncomplicated and complicated groups, respectively. Health utilities were lower for complicated scenarios (effect size 0.067, p < 0.001) compared to uncomplicated scenarios. CONCLUSION: For 10 low-risk thyroid cancer health states, GenPop reported significantly lower health utilities than TCSurv. Health economists and healthcare delivery scientists should be aware of these differences when integrating health utilities into comparative-effectiveness research.