Section of Geriatrics & Palliative Medicine, University of Chicago, Chicago, IL 60637, USA.
Med Care. 2011 Jan;49(1):59-66. doi: 10.1097/MLR.0b013e3181f37bf2.
Variations in health state utilities can impact cost-effectiveness analyses. One potential source of error is when joint health state (JS) utilities are rated higher than the embedded single state (SS) utilities. Knowing when and in whom this occurs can improve cost-effectiveness analyses.
Men (n = 323) were surveyed at the time of prostate biopsy. Time tradeoff SS and JS utilities for prevalent prostate cancer (PCa) health states were collected. JS utilities assessed included those most prevalent for PCa. "Inconsistency" was defined in the following 3 ways: (1) any size rank order violation; (2) total number of violations; and (3) differences greater than 1 standard deviation (SD). Regression analysis assessed independent patient characteristics associated with inconsistent responses.
Aggregate JS utilities were consistent. At the individual level, 36% to 41% of responses violated rank order and 12% to 14% were larger than 1 SD. In all, 69% of respondents had at least 1 JS inconsistency, and 24% had >1 SD inconsistencies. Being married and feeling anxious were independently correlated with giving all types of inconsistent ratings, and lower education correlated with making >SD errors. SS utilities, and not JS utilities, were significantly lower for the inconsistent group. "Correcting" JS inconsistencies decreased aggregate utilities 1 to 9 units.
Inconsistent JS utilities for PCa are prevalent in men at biopsy. Being married, more anxious, and having less education are correlated with inconsistencies. It is the SS utilities, rather than the JS utilities, that differ between consistent and inconsistent raters. Better understanding of the source of these inconsistencies is needed.
健康状态效用的变化可能会影响成本效益分析。一个潜在的误差来源是当联合健康状态（JS）效用被评定高于嵌入的单一状态（SS）效用时。了解何时以及在谁身上发生这种情况可以改善成本效益分析。
在前列腺活检时对男性（n=323）进行了调查。收集了现患前列腺癌（PCa）健康状态的时间权衡 SS 和 JS 效用。评估的 JS 效用包括最常见的 PCa 效用。“不一致”定义为以下 3 种方式：（1）任何大小的秩次违反；（2）违反总数；（3）差异大于 1 个标准差（SD）。回归分析评估了与不一致反应相关的独立患者特征。
总体 JS 效用是一致的。在个体水平上，36%至 41%的反应违反了秩次，12%至 14%的反应大于 1 SD。总的来说，69%的受访者至少有 1 种 JS 不一致，24%的受访者有>1 SD 的不一致。已婚和焦虑是与所有类型的不一致评分相关的独立因素，而较低的教育水平与>SD 错误相关。不一致组的 SS 效用显著低于 JS 效用。“纠正”JS 不一致将总体效用降低了 1 到 9 个单位。
在接受前列腺活检的男性中，PCa 的 JS 不一致性很常见。已婚、更焦虑和受教育程度较低与不一致性相关。是 SS 效用而不是 JS 效用在一致和不一致的评分者之间存在差异。需要更好地了解这些不一致的来源。
