Eliciting and Exploiting Utility Coefficients in an Integrated Environment for Shared Decision-Making

Abstract

Background In shared decision-making, a key step is quantifying the patient's preferences in relation to all the possible outcomes of the compared clinical options. According to utility theory, this can be done by eliciting utility coefficients (UCs) from the patient. The obtained UCs are then used in decision models (e.g., decision trees). The elicitation process involves the choice of one or more elicitation methods, which is not easy for decision-makers who are unfamiliar with the theoretical framework. Moreover, to our knowledge there are no tools that integrate functionalities for UC elicitation with functionalities to run decision models that include the elicited values. Objectives The first aim of this work is to provide decision support to the clinicians for the selection of the elicitation method. The second aim is to bridge the gap between UC elicitation and the exploitation of those UCs in shared decision-making. Methods Based on evidence from the utility theory literature, we developed a set of production rules that recommend the optimal elicitation method(s) according to the patient's profile and health state. We then complemented this decision support tool with a functionality for quantifying and running decision trees defined through the commercial software TreeAge. Results The result is an integrated framework for shared decision-making. Given the primary aim of this work, we focus for result evaluation on the elicitation tool. It was tested on 51 volunteers, who expressed UCs for four purposely selected health states. The insights on the collected UCs validated the rules included in the decision support system. The usability of the tool was assessed through the System Usability Scale, obtaining positive results. Conclusion We developed an integrated environment to facilitate shared decision-making in the clinical practice. The next step is the validation of the entire framework and its use besides shared decision-making. As a matter of fact, it may also be exploited to target cost-utility analysis to a specific patient population.

Cost Utility of Bronchial Thermoplasty for Severe Asthma: Implications for Future Cost-Effectiveness Analyses Based on Phenotypic Heterogeneity

“…Beyond relevance to policy, coverage, and reimbursement, cost-utility models offer relevance to the patient and provider during clinical decision-making to initiate conversations relative to the trade-offs of therapy and long-term clinical and cost outcomes. 39 These models can also be used to educate patients about the importance of adherence to asthma medication, given that model outcomes are often based on clinical trial data and that higher levels of adherence are noted in trials than in the general population. 40 Further, while cost-utility or cost-effectiveness models are often conducted through the lens of the payor or healthcare system, more work can be done to build them from the perspective of the patient, which is currently difficult owing to the lack of transparency regarding private insurance costs in the US payer context.…”

Quality of life and health-related utility after head&neck cancer surgery

“…Using a computer-based tool helps the interviewers to pursue this objective. We used UceWeb, a system that we developed in the last years [1,21,22] and that has been already validated in other medical contexts [23,24]. The distinguishing features of UceWeb are:…”

Quality of life and health-related utility after trans-oral surgery for head and neck cancers

“…In order to obtain consistent values from all the individuals, it is important that everybody is interviewed following the same procedure. We used a computer based tool, UceWeb, a system developed by our group [ 4 , 22 , 23 ] and that has been previously validated in other medical contexts [ 24 , 25 ]. The main features of UceWeb are:…”