Grant: CIHR Fellowship

Explicit rationing attempts to battle fiscal debt and increasing demand for healthcare were the focus of 2018 Ontario provincial elections. While rationing is one of the options to curb health care costs, it slowly disinherits us from the core principles of the Canada Health Act. An alternative solution is to base budget allocation decisions on "value" of healthcare interventions (cost vs. outcome). Quality-adjusted life-years (QALY) is the preferred metric for valuing health outcomes in terms of quality of life (QOL). Once cost per QALY is determined, service with the lowest cost per QALY is chosen. Traditionally, generic preference-based measures (PBM) have been used to calculate QALYs. However, they do not include concerns unique to breast cancer patients (body image, appearance, sexual) and hence lack sensitivity. The BREAST-Q is a widely used and validated breast cancer-specific QOL instrument, but it cannot be used to calculate QALYs. Hence, a descriptive classification system, the BREAST-Q Utility (BREAST-QU), was developed from BREAST-Q using patient interviews and input from an international team of experts. My postdoctoral research will advance this work by generating a scoring algorithm (i.e., preference weights for health states defined by BREAST-QU). A representative sample of the general population and women with breast cancer will be asked to participate in choice-based tasks (discrete choice experiment and best-worst scaling) to identify their preferences for various breast cancer health states. The responses will be analyzed using advanced statistical techniques, resulting in scoring algorithm for the BREAST-QU. The reliability, validity, and responsiveness of BREAST-QU will be assessed. The use of BREAST-QU in clinical practice, economic evaluation and policy-making will be promoted through publications, presentations, and professional networks; ultimately resulting in "biggest bang for the buck" in breast cancer and improved population health.