Whose Utilities for Decision Analysis?

Abstract

The goal of this study was to examine sources of variation in the utilities assigned to health states. The authors selected a common clinical problem, carcinoma of the rectum, and examined the utilities assigned to colostomy, a common outcome of treatment for that disease. After preparing and validating a description of colostomy and its effects on patients' lives, utilities for the state were obtained from five groups of individuals. These comprised two groups of patients who received treatment for rectal cancer, a group of physicians and surgeons specializing in the treatment of this disease, and two groups of healthy subjects, none of whom were health professionals. Of the patients who had been treated for rectal cancer, one group had been treated surgically with the formation of colostomies and the other had been treated with radiotherapy and none had a colostomy. Utilities for colostomy were elicited using the standard gamble, category rating, and a treatment choice questionnaire. The groups differed substantially in the utilities assigned to colostomy. In general, patients with colostomies and physicians assigned significantly higher utilities than did patients who did not themselves have a colostomy. The clinical significance of these differences was examined in a simplified clinical decision problem that compared surgery (with colostomy) and radiotherapy (without colostomy) as primary treatment. The expected clinical value of these treatment alternatives was substantially influenced by the differences observed in utilities for colostomy. These results emphasize the importance of patient utilities in clinical decision making and the need to gain greater understanding of the factors that influence the utilities that patients assign to health states.

Health Professionals’ Assessment of Health-Related Quality of Life Values for Oral Clefting by Age Using a Visual Analogue Scale Method

“…Different types of evaluators have been used in research, including patients, parents (or relatives), community sample members, and health professionals. Arguments for and against the appropriateness of using different types of evaluators are found in the literature, without any clear consensus (e.g., Boyd et al, 1990;Gold et al, 1996;Dolan, 1999). The optimal choice of specific evaluator groups (e.g., patients versus community members) may be dependent on the purpose of the particular cost-effectiveness analysis conducted, particularly whether it is to guide overall allocation of health care resources or is focused on treating a specific condition in a cost-effective manner (see Gold et al, 1996).…”

On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review

“…When patient populations are asked about an increase in QALYs, their WTP is on average lower than the general population’s. A possible reason for this is the fact that the expected utility of a disease by the general population is lower than the actual utility of having that disease [59,60]. …”

Beliefs and practices of patients with advanced cancer: implications for communication

“…However, studies also show that patients are prepared to accept a lower level of benefit from treatment than healthy surrogates (Sackett and Torrance, 1978;Boyd et al, 1990;Llewellyn-Thomas et al, 1991;Coates and Simes, 1992;Llewellyn-Thomas et al, 1992). These results suggest that illness-related behaviour is more than the sum of communicated information.…”