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This study examines the effects of use of an automated computer protocol to correct a common error in utility elicitations--namely, scoring of a health state with a greater impairment as being more desirable than one with lesser impairment. The authors studied the protocol in a sample of 563 members of the Internet-using public. Results revealed that errors were common (17% of ratings) but were typically successfully repaired (individuals who made only 1 or 2 errors had a 75% chance of repairing them). The values of individuals who repaired errors were similar to those without apparent error. In contrast, individuals who refused to repair errors had lower scores for the best health state in the series and higher ones for the worst health state. Results suggest that the repair procedures were successful and that inclusion of utility scores from individuals who fail to repair illogically ordered ratings may bias estimates of mean utilities.

iMPACT3 (Internet Multimedia Preference Assessment Instrument Construction Tool, version 3) is a software development environment that helps researchers build Internet-capable multimedia utility elicitation software programs. The program is a free, openly accessible Web site (http.// preferences.ucsd.edu/impact3/asp). To develop a utility elicitation software program using iMPACT3, a researcher selects modular protocol components from a library and custom tailors the components to the details of his or her research protocol. iMPACT3 builds a Web site implementing the protocol and downloads it to the researcher's computer. In a study of 75 HIV-infected patients, an iMPACT3-generated protocol showed substantial evidence of construct validity and good internal consistency (logic error rates of 4% to 10% and procedural invariance error rates of 10% to 28%, depending on the elicitation method) but only fair 3- to 6-week test-retest reliability (intraclass correlation coefficient= 0.42 to 0.55). Further work may be needed on specific utility assessment procedures, but this study's results confirm iMPACT3's feasibility in facilitating the collection of health state utility data.

BACKGROUND: There is increasing concern about the potential effects of the lipodystrophy syndrome on the health and quality of life of HIV‐infected patients. OBJECTIVE: Understand patients' perception of the significance of the lipodystrophy syndrome's quality‐of‐life effects. DESIGN: Cross‐sectional study of volunteer HIV‐infected patients. SETTING: An urban, university‐affiliated HIV clinic in San Diego, California. Patients: 75 well‐educated, predominantly male, HIV‐infected patients. MEASUREMENTS: Patients' beliefs about the importance of appearance upon quality of life and preferences for hypothetical states performed using the standard gamble and time trade‐off methods. RESULTS: Almost all patients (95%) indicated that appearance was important to their quality of life, and 89% agreed that they would be “really bothered” if their HIV diagnosis were revealed by their appearance. Patients were willing, on average, to give up 2 years (s.d. 2.8), out of a 10‐year life‐expectancy, to live in good health rather than live with the syndrome, over and above what they would give up to be free of symptoms from HIV infection. Patients would take an additional 13% (s.d. 20%) risk of death to be cured of HIV infection when complicated by the syndrome (median increase in risk, 9%), above the risk they would accept to be cured of uncomplicated HIV infection. The amount that the patients would trade off was associated with beliefs about the importance of their appearance to quality of life (p = 0.0045) and worry that their appearance would expose their diagnosis by (p = 0.032). CONCLUSIONS: The physical effects of the lipodystrophy syndrome are important enough to cause many patients to consider accepting considerable risks of death or trading off substantial life‐expectancy to avoid the syndrome. Physicians may need to tailor HIV care to this aspect of patients' preferences.