Elicitation and modelling of imprecise utility of health states

Jakubczyk, Michał; Golicki, Dominik

doi:10.1007/s11238-019-09707-6

Cited by 4 publications

(3 citation statements)

References 35 publications

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“…The mixed-method convergent approach that we followed in this secondary analysis provided a deeper understanding of individual preferences on thromboprophylaxis in pregnancy. While value elicitation exercises (scoring health states) are well accepted(48, 49), they can, in some instances, be imprecise for people's lack of trade-off experience (50). Furthermore, some authors (32) argue that health states valuations are likely to be a function of both the severity of the health state and the context of the choice; for example, responses to standard gamble questions are likely to be in uenced by attitudes toward risk.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Values and preferences towards the use of prophylactic low-molecular-weight heparin during pregnancy: A convergent mixed-methods secondary analysis of data from the Decision Analysis in SHared decision making for Thromboprophylaxis during Pregnancy (DASH-TOP) study

León‑García,

Humphries,

Xie

et al. 2024

Preprint

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Background: Venous thromboembolism (VTE) in pregnancy is a major cause of maternal morbidity and mortality, and the use of preventive low-molecular-weight heparin (LMWH) can be challenging. Clinical guidelines recommend eliciting pregnant individuals’ preferences towards the use of daily injections of LMWH and discussing the best option through a shared decision-making (SDM) approach. Our aim was to identify individuals’ preferences concerning each of the main clinical outcomes, and categorize attributes influencing the use of LMWH during pregnancy. Methods: Design: Convergent mixed-methods. Participants: Pregnant women or those planning a pregnancy with VTE recurrence risk. Intervention: A SDM intervention about thromboprophylaxis with LMWH in pregnancy. Analysis: Quantitatively, we report preference scores assigned to each of the health states. Qualitatively, we categorized preference attributes using Burke’s pentad of motives framework: scene, agent, agency, act, and purpose. We use mixed-method convergent analysis to report findings using side-by-side comparison of concordance/discordance. Results: The least valued health state was to experience a pulmonary embolism (PE), followed by major obstetrical bleeding (MOB), deep vein thrombosis (DVT), and using daily injections of LMWH (valued as closest to a ‘healthy pregnancy’). Women's previous experiences, access to care (scene) and shared decision-making (agent) affected preferences. LMWH's benefits were noted, but substantial drawbacks described (agency). The main goal was avoiding the risk of VTE (purpose). Side-by-side comparisons revealed concordance between motives and DVT and PE health states. Discordance appeared between using daily injections of LMWH and agent- and agency motives and between MOB and the agency motive. Conclusions: Mixed-methods provide a nuanced understanding of women's LMWH preferences, by quantifying health states preferences and exploring attributes qualitatively. Incorporating both methods may improve patient-centered care around preference-sensitive decisions in thromboprophylaxis during pregnancy.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Values and preferences towards the use of prophylactic low-molecular-weight heparin during pregnancy: A convergent mixed-methods secondary analysis of data from the Decision Analysis in SHared decision making for Thromboprophylaxis during Pregnancy (DASH-TOP) study

León‑García,

Humphries,

Xie

et al. 2024

Preprint

View full text Add to dashboard Cite

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“…The health state valuation literature since MVH 8 and Dolan 1 to Viney et al 9,11 has operationalized perceived implausible states in terms of two-way contrasting combinations (also see Jakubczyk and Golicki, 12 Lim et al, 27 or Bagust 28 ). However, there are 3 things to note.…”

Section: Why Use General Population Data Sets For Stage 1?mentioning

confidence: 99%

“…However, as the authors state, the exercise examined only the efficiency of designs and not the measurement error attributable to the difficulty of imagining these states. In a separate study, Jakubczyk and Golicki 12 applied an experimental TTO design to examine the amount of imprecision around health preferences from a Polish student sample. The authors found that values of states with two-way contrasting combinations have higher imprecision and that imprecision is mostly driven by UA and AD.…”

mentioning

confidence: 99%

Implausible States: Prevalence of EQ-5D-5L States in the General Population and Its Effect on Health State Valuation

et al. 2020

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The EQ-5D is made up of health state dimensions and levels, in which some combinations seem less “plausible” than others. If “implausible” states are used in health state valuation exercises, then respondents may have difficulty imagining them, causing measurement error. There is currently no standard solution: some valuation studies exclude such states, whereas others leave them in. This study aims to address 2 gaps in the literature: 1) to propose an evidence-based set of the least prevalent two-way combinations of EQ-5D-5L dimension levels and 2) to quantify the impact of removing perceived implausible states from valuation designs. For the first aim, we use data from 2 waves of the English General Practitioner Patient Survey ( n = 1,639,453). For the second aim, we remodel a secondary data set of a Discrete Choice Experiment (DCE) with duration that valued EQ-5D-5L and compare across models that drop observations involving different health states: 1) implausible states as defined in the literature, 2) the least prevalent states identified in stage 1, and 3) randomly select states, alongside 4) a model that does not drop any observations. The results indicate that two-way combinations previously thought to be implausible actually exist among the general population; there are other combinations that are rarer, and removing implausible states from an experimental design of a DCE with duration leads to value sets with potentially different characteristics depending on the criterion of implausible states. We advise against the routine removal of implausible states from health state valuation studies.

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How sure are you? — the properties of self-reported conviction in the elicitation of health preferences with discrete choice experiments

Jakubczyk,

Lewandowski

2023

Theory Decis

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Discrete choice experiments (DCE) are often used to elicit preferences, for instance, in health preference research. However, DCEs only provide binary responses, whilst real-life choices are made with varying degrees of conviction. We aimed to verify whether eliciting self-reported convictions on a 0–100 scale adds meaningful information to the binary choice. Eighty three respondents stated their preferences for health states using DCE and the time trade-off method (TTO). In TTO, utility ranges were also elicited to account for preference imprecision. We verified the properties of the conviction across three areas: (1) response to various choice task modifications (e.g. dominance, increase in complexity, distance from the status quo) and association with rationality violations (e.g. intransitivity); (2) association with test–retest results; (3) relation to the utility difference and imprecision estimated in TTO. Regarding (1), conviction increased in choice tasks with lower complexity, larger relative attractiveness, and lower distance to the status quo. Regarding (2), choices made with above-median conviction were sustained in 90% of the cases, compared to 68% for below-median conviction. Regarding (3), the conviction increases with utility difference and it decreases with utility imprecision; overconfidence seems to prevail: non-zero conviction is reported even for identical utilities. Self-reported conviction in DCE is associated in an intuitive way with the observed choices. It may, therefore, be useful in explaining or predicting behaviour or bridging the gap between the results of various elicitation tasks.

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Elicitation and modelling of imprecise utility of health states

Cited by 4 publications

References 35 publications

Values and preferences towards the use of prophylactic low-molecular-weight heparin during pregnancy: A convergent mixed-methods secondary analysis of data from the Decision Analysis in SHared decision making for Thromboprophylaxis during Pregnancy (DASH-TOP) study

Values and preferences towards the use of prophylactic low-molecular-weight heparin during pregnancy: A convergent mixed-methods secondary analysis of data from the Decision Analysis in SHared decision making for Thromboprophylaxis during Pregnancy (DASH-TOP) study

Implausible States: Prevalence of EQ-5D-5L States in the General Population and Its Effect on Health State Valuation

How sure are you? — the properties of self-reported conviction in the elicitation of health preferences with discrete choice experiments

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