Original Study Real-World EQ5D Health Utility Scores for Patients With Metastatic Lung Cancer by Molecular Alteration and Response to Therapy Catherine Labbé, 1,2 Yvonne Leung, 2 João Gabriel Silva Lemes, 3 Erin Stewart, 2 Catherine Brown, 2 Andrea Perez Cosio, 2 Mark Doherty, 2 Grainne M. O’Kane, 2 Devalben Patel, 2 Nicholas Cheng, 2 Mindy Liang, 2 Gursharan Gill, 2 Alexandra Rett, 2 Hiten Naik, 2 Lawson Eng, 2 Nicole Mittmann, 4 Natasha B. Leighl, 2 Penelope A. Bradbury, 2 Frances A. Shepherd, 2 Wei Xu, 2 Geoffrey Liu, 2 Doris Howell 2 Abstract There is limited data outside of clinical trials on health utility scores in patients with metastatic lung cancer. This longitudinal cohort study evaluated EQ5D-3L-derived health utility scores in 475 outpatients. Mean scores were higher in patients carrying driver mutations stable on targeted treatments than in patients without alterations stable on chemotherapy. Such differences should be considered in economic analyses of upcoming treatments. Introduction: Economic analyses of upcoming treatments for lung cancer benefit from real-world health utility scores (HUSs) in an era of targeted therapy. Methods: A longitudinal cohort study at Princess Margaret Cancer Centre evaluated 1571 EQ5D-3L-derived HUSs in 475 outpatients with metastatic lung cancer across various disease states. Patients with epidermal growth factor receptor (EGFR) (n ¼ 183) and anaplastic lymphoma kinase (ALK ) (n ¼ 38) driver alterations were enriched through targeted enrolment; patients with wild-type nonesmall-cell lung cancer (WT NSCLC) (n ¼ 224) and small-cell lung cancer (SCLC) (n ¼ 30) were sampled randomly. Results: For patients stable on most appropriate treatment, the mean HUSs were 0.81 and 0.82 in patients receiving EGFR and ALK tyrosine kinase in- hibitors (TKIs) respectively (with similar HUSs across agents), which were higher than patients with WT NSCLC (0.78; P ¼ .04) and SCLC receiving chemotherapy (0.72; P ¼ .06). In mutation-specific comparisons, disease stability on appropriate therapy resulted in significantly higher mean HUSs (P < .002-.02) than when disease was progressing (mean HUS: EGFR, 0.70; ALK, 0.69; WT NSCLC, 0.66; SCLC, 0.52). When evaluating treatment-related toxicities, significant inverse relationships were observed between HUS and the severity of fatigue and decreased appetite in the EGFR group. There was also a significant inverse relationship between the total number of clinically significant symptoms and HUS, both in patients who were EGFR-mutated and patients with WT NSCLC. Conclusions: In a North American setting, HUSs generated from patients with metastatic lung cancer are higher in treated, stable patients carrying driver mutations. This is partially explainable by treatment toxicity and patient symptom differences. Such differences in scores should be considered in economic analyses. Clinical Lung Cancer, Vol. 18, No. 4, 388-95 ª 2016 Elsevier Inc. All rights reserved. Keywords: ALK, EGFR, HUS, NSCLC, SCLC D.H. and G.L. contributed equally to this work. 1 Respirology and Thoracic Surgery Department, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada 2 Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada 3 Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network (Scholar of the CNPq-Brazil), Toronto, ON, Canada 4 Health Outcomes and PharmacoEconomics (HOPE) Research Centre, Sunnybrook Research Institute, Toronto, ON, Canada Submitted: Jul 14, 2016; Revised: Dec 20, 2016; Accepted: Dec 20, 2016; Epub: Dec 28, 2016 Address for correspondence: Geoffrey Liu, MSc, MD, 610 University Ave, Toronto, Ontario M5G2M9, Canada E-mail contact: Geoffrey.Liu@uhn.on.ca 388 - Clinical Lung Cancer July 2017 1525-7304/$ - see frontmatter ª 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.cllc.2016.12.015