Project Grant K08CA293167

PREFERENCE-BASED TREATMENT VALUATION IN LOW-RISK THYROID CANCER - SUMMARY/ABSTRACT: THIS CAREER DEVELOPMENT AWARD (K08) ESTABLISHES HEALTH STATE UTILITIES ACROSS SEVERAL ESTABLISHED AND EVOLVING THERAPIES FOR LOW-RISK, SUB-CENTIMETER THYROID CANCER (PAPILLARY THYROID MICROCARCINOMA, PTMC). WHILE SURVIVAL FOR PTMC IS FAVORABLE, ITS TREATMENT CAN INCUR SUBSTANTIAL MORBIDITY AND SOCIETAL COSTS. ACCEPTABLE TREATMENTS INCLUDE ACTIVE SURVEILLANCE, PARTIAL OR TOTAL THYROIDECTOMY, AND RADIOFREQUENCY ABLATION. DUE TO THE DISEASE'S EXCELLENT PROGNOSIS, IT IS UNLIKELY THAT THESE TREATMENTS WOULD YIELD MEANINGFUL DIFFERENCES IN SURVIVAL, HOWEVER POST-TREATMENT EXPERIENCES ARE DIFFERENT. THUS, TREATMENT VALUE IS LARGELY DRIVEN BY PATIENTS' PERCEPTIONS AND PREFERENCES REGARDING THE TREATMENT EXPERIENCE. THIS VALUE MAY BE ESTIMATED THROUGH STATED-PREFERENCE INSTRUMENTS THAT DEFINE THE UTILITY OF PRE-DEFINED HEALTH STATES. THUS FAR, THERE IS LITTLE DATA ON HEALTH STATE UTILITIES IN PTMC, AND IT IS UNCLEAR WHETHER PATIENTS, CLINICIANS, OR THE GENERAL POPULATION ARE THE MOST SUITABLE PARTICIPANTS FOR STUDIES THAT ESTIMATE UTILITY. THE CANDIDATE WILL ADDRESS THESE KNOWLEDGE GAPS BY ESTIMATING THE UTILITIES OF A SERIES OF PTMC CLINICAL VIGNETTES USING A TIME TRADE-OFF PREFERENCE-BASED INSTRUMENT. THESE UTILITIES WILL THEN BE INCORPORATED INTO A MARKOV COST-EFFECTIVENESS MODEL COMPARING SURGICAL AND NON-SURGICAL OPTIONS. SPECIFICALLY, THE CANDIDATE WILL TEST THE FOLLOWING HYPOTHESES: 1) AVERAGE UTILITY FOR THE ACTIVE SURVEILLANCE HEALTH STATE IS NON- INFERIOR TO THAT OF PARTIAL THYROIDECTOMY, 2) TREATMENT COMPLICATIONS SIGNIFICANTLY REDUCE UTILITY, 3) GENERAL POPULATION RESPONDENTS SIGNIFICANTLY UNDERESTIMATE THYROID CANCER UTILITIES RELATIVE TO EXPERIENCED PATIENTS AND HEALTHCARE WORKERS, AND 4) ACTIVE SURVEILLANCE IS MORE COST-EFFECTIVE FOR THE MANAGEMENT OF PTMC THAN SURGERY OR RADIOFREQUENCY ABLATION. THE LONG-TERM OBJECTIVE OF THIS RESEARCH IS TO ESTABLISH PREFERENCE-BASED HEALTH STATE UTILITIES THAT CAN BE USED IN HEALTH ECONOMICS RESEARCH TO OPTIMIZE RESOURCE ALLOCATION IN THYROID CANCER. FOLLOWING A CLINICAL FELLOWSHIP IN SURGICAL ONCOLOGY, THE CANDIDATE WAS APPOINTED ASSISTANT PROFESSOR OF SURGERY AT THE UNIVERSITY OF MARYLAND BALTIMORE. HE HAS SINCE PARTNERED WITH SCIENTIFIC MENTOR C. DANIEL MULLINS, PHD, TO ENGAGE WITH PATIENT AND PHYSICIAN STAKEHOLDERS IN HEALTH SERVICES RESEARCH. THIS K08 IS DESIGNED TO TRANSITION TO RESEARCH INDEPENDENCE THROUGH GRADUATE LEVEL TRAINING IN SURVEY DESIGN, PATIENT-CENTERED OUTCOMES, BIOSTATISTICS, AND HEALTH POLICY. ADDITIONAL PROFESSIONAL COURSES WILL ADDRESS RESEARCH CAREER DEVELOPMENT AND HEALTH TECHNOLOGY ASSESSMENT. THE APPLICATION DRAWS UPON RESOURCES THROUGH THE SCHOOL OF MEDICINE'S DEPARTMENT OF SURGERY AND THE SCHOOL OF PHARMACY. WITH THE ADVANCED TRAINING AFFORDED BY THE K08, THE CANDIDATE WILL BE POSITIONED TO SUBMIT A COMPETITIVE R01 APPLICATION.