Stiggelbout Anne M, de Vogel-Voogt Elsbeth
Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
Value Health. 2008 Jan-Feb;11(1):76-87. doi: 10.1111/j.1524-4733.2007.00216.x.
Health state utilities play an important role in decision analysis and cost-utility analysis. The question whose utilities to use at various levels of health-care decision-making has been subject of considerable debate. The observation that patients often value their own health, but also other health states, higher than members of the general public raises the question what underlies such differences? Is it an artifact of the valuation methods? Is it adaptation versus poor anticipated adaptation? This article describes a framework for the understanding and study of potential mechanisms that play a role in health state valuation. It aims at connecting research from within different fields so that cross-fertilization of ideas may occur.
The framework is based on stimulus response models from social judgment theory. For each phase, from stimulus, through information interpretation and integration, to judgment, and, finally, to response, we provide evidence of factors and processes that may lead to different utilities in patients and healthy subjects.
Examples of factors and processes described are the lack of scope of scenarios in the stimulus phase, and appraisal processes and framing effects in the information interpretation phase. Factors that play a role in the judgment phase are, for example, heuristics and biases, adaptation, and comparison processes. Some mechanisms related to the response phase are end aversion bias, probability distortion, and noncompensatory decision-making.
The framework serves to explain many of the differences in valuations between respondent groups. We discuss some of the findings as they relate to the field of response shift research. We propose issues for discussion in the field, and suggestions for improvement of the process of utility assessment.
健康状态效用值在决策分析和成本效用分析中发挥着重要作用。在不同层次的医疗保健决策中使用谁的效用值这一问题一直是大量辩论的主题。患者通常比普通公众更看重自身健康状态以及其他健康状态，这一观察结果引发了一个问题，即这种差异的根源是什么？是评估方法的人为因素？是适应与预期适应不良？本文描述了一个用于理解和研究在健康状态评估中起作用的潜在机制的框架。其目的是将不同领域的研究联系起来，以便可能产生思想的交叉融合。
该框架基于社会判断理论中的刺激反应模型。对于从刺激到信息解读与整合、再到判断，最后到反应的每个阶段，我们都提供了可能导致患者和健康受试者产生不同效用值的因素和过程的证据。
所描述的因素和过程的例子包括刺激阶段情景范围的不足，以及信息解读阶段的评估过程和框架效应。在判断阶段起作用的因素例如启发法和偏差、适应以及比较过程。与反应阶段相关的一些机制是终点厌恶偏差、概率扭曲和非补偿性决策。
该框架有助于解释应答组之间评估中的许多差异。我们讨论了一些与反应转移研究领域相关的发现。我们提出了该领域有待讨论的问题，以及改进效用评估过程的建议。
