Vignette-Based Utilities: Usefulness, Limitations, and Methodological Recommendations

Matza, Louis S.; Stewart, Katie D.; Lloyd, Andrew; Rowen, Donna; Brazier, John

doi:10.1016/j.jval.2020.12.017

Cited by 63 publications

(39 citation statements)

References 79 publications

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“…There are some limitations to this study, mostly related to the use of vignettes. Vignettes are widely used in health services research, and have been shown to reliably represent patients’ clinical experiences, behaviors, and perspectives [ 49 ]. An assumption of the study design was that participants were able to imagine themselves in an exchange with their own PCP similar to the one described in the vignettes.…”

Section: Discussionmentioning

confidence: 99%

Does de-implementation of low-value care impact the patient-clinician relationship? A mixed methods study

Rockwell

Michaels

Epling

2022

BMC Health Serv Res

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Background The importance of reducing low-value care (LVC) is increasingly recognized, but the impact of de-implementation on the patient-clinician relationship is not well understood. This mixed-methods study explored the impact of LVC de-implementation on the patient-clinician relationship. Methods Adult primary care patients from a large Virginia health system volunteered to participate in a survey (n = 232) or interview (n = 24). Participants completed the Patient-Doctor Relationship Questionnaire (PDRQ-9) after reading a vignette about a clinician declining to provide a low-value service: antibiotics for acute sinusitis (LVC-antibiotics); screening EKG (LVC-EKG); screening vitamin D test (LVC-vitamin D); or an alternate vignette about a high-value service, and imagining that their own primary care clinician had acted in the same manner. A different sample of participants was asked to imagine that their own primary care clinician did not order LVC-antibiotics or LVC-EKG and then respond to semi-structured interview questions. Outcomes data included participant demographics, PDRQ-9 scores (higher score = greater relationship integrity), and content analysis of transcribed interviews. Differences in PDRQ-9 scores were analyzed using one-way ANOVA. Data were integrated for analysis and interpretation. Results Although participants generally agreed with the vignette narrative (not providing LVC), many demonstrated difficulty comprehending the broad concept of LVC and potential harms. The topic triggered memories of negative experiences with healthcare (typically poor-quality care, not necessarily LVC). The most common recommendation for reducing LVC was for patients to take greater responsibility for their own health. Most participants believed that their relationship with their clinician would not be negatively impacted by denial of LVC because they trusted their clinician’s guidance. Participants emphasized that trusted clinicians are those who listen to them, spend time with them, and offer understandable advice. Some felt that not providing LVC would actually increase their trust in their clinician. Similar PDRQ-9 scores were observed for LVC-antibiotics (38.9), LVC-EKG (37.5), and the alternate vignette (36.4), but LVC-vitamin D was associated with a significantly lower score (31.2) (p < 0.05). Conclusions In this vignette-based study, we observed minimal impact of LVC de-implementation on the patient-clinician relationship, although service-specific differences surfaced. Further situation-based research is needed to confirm study findings.

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Section: Discussionmentioning

confidence: 99%

Does de-implementation of low-value care impact the patient-clinician relationship? A mixed methods study

Rockwell

Michaels

Epling

2022

BMC Health Serv Res

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“…Nevertheless, it should also be stressed that these symptoms of AADC deficiency were derived from extensive content validation involving parents and caregivers of, as well as physicians treating AADC deficiency patients. 16 The use of vignettes may have also contributed to this; however, given the rarity of AADC deficiency and the nature of the patients affected (predominantly very young children), this is the only methodology available 27 to generate health state utilities in this population.…”

Section: Discussionmentioning

confidence: 99%

A Discrete Choice Experiment to Derive Health Utilities for Aromatic L-Amino Acid Decarboxylase (AADC) Deficiency in France

AB¹,

Hanbury²,

Whitty³

et al. 2022

PROM

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Purpose Cost-effectiveness evaluations of interventions require health utility data. However, in medical conditions, such as aromatic L-amino acid decarboxylase (AADC) deficiency, this presents problems due to the rarity of the disease. The study aim therefore was to employ a discrete choice experiment (DCE) to generate health utilities for AADC deficiency. Methods A previous literature review, clinician and parent interviews had identified six key AADC deficiency attributes: mobility, muscle weakness, oculogyric crises (OCG), feeding ability, cognitive impairment and screaming. A representative sample of the French general population was recruited. Participants rated 5 health state vignettes describing AADC deficiency using time-trade-off (TTO) and standard gamble (SG). Additionally, participants rated the worst health state using the Health Utility Index version 3 (HUI3). Subsequently, participants completed DCE 11 choice sets. Indirect DCE part-worth utilities were converted to health utilities using the anchors from the TTO, SG and HUI3. Results The DCE was completed online by 1001 participants (50.9% female; mean age 45.7 years). Most participants (596, 59.5%) provided consistent responses to the repeated choice task. Five models were evaluated, and one preference reversal (“head control”/“sitting unaided”) was identified in all models. The rescaled utilities ranged from 0.3891 to 0.5577 (difference of 0.17 utilities) for TTO anchors corresponding to the worst (633233) and best (111111) health states. Health utilities ranged from 0.5534 to 0.7093 for the SG anchors. The disutility associated with a transition from “no problems walking” to “bedridden” was −0.0533, whereas disutility of moving from “constant screaming” relative to “no screaming” was −0.0248. The disutility associated with daily OCG was −0.0167. Disutilities for the other attributes were small although there were exceptions. Conclusion A DCE was used to derive health utilities for AADC deficiency. These health utilities will subsequently be used in an economic model evaluating an AADC deficiency intervention.

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“…The draft methods guide states "If there is evidence that generic measures are unsuitable for the condition or intervention, refer to the hierarchy of preferred sources for health-related quality of life." [34] The hierarchy also includes general information on the design and conduct of vignette studies which is applicable to young children [35,36].…”

Section: Discussionmentioning

confidence: 99%

The Challenges of Measuring and Valuing Quality of Life in Preschool Children: A Retrospective Review of NICE Appraisals

2021

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Health technology assessment agencies evaluate interventions across the lifespan. However, there is no consensus about best-practice methods to measure health-related quality of life (HRQoL) in preschool children (<5 years) and data are often scarce. We reviewed methods used to capture the HRQoL of preschool children in past National Institute for Health and Care Excellence (NICE) appraisals to establish whether there is a need for better methods in this area and if so, to identify priority research areas. We identified past NICE appraisals that included preschool children, examining the methods used to generate utility values and whether committees believed these captured HRQoL adequately. Of the 12 appraisals, most used generic HRQoL measures designed for adults. Measures were usually completed by adult patients or clinical experts. Committees frequently commented on limitations in the HRQoL data. While acknowledging that data collection may be challenging, committees would value evidence based on HRQoL data from parents or guardians collected as part of a clinical trial. We identified several research priorities including the psychometric properties of existing measures; the feasibility and validity of valuation studies; and mapping. Progress in these areas will help ensure that the aspects of HRQoL which matter to children and their families are captured in NICE evaluations.

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Vignette-Based Utilities: Usefulness, Limitations, and Methodological Recommendations

Cited by 63 publications

References 79 publications

Does de-implementation of low-value care impact the patient-clinician relationship? A mixed methods study

Does de-implementation of low-value care impact the patient-clinician relationship? A mixed methods study

A Discrete Choice Experiment to Derive Health Utilities for Aromatic L-Amino Acid Decarboxylase (AADC) Deficiency in France

The Challenges of Measuring and Valuing Quality of Life in Preschool Children: A Retrospective Review of NICE Appraisals

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