Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA.
Health Qual Life Outcomes. 2011 Jan 20;9:6. doi: 10.1186/1477-7525-9-6.
Health state descriptions used to describe hypothetical scenarios in community-perspective utility surveys commonly omit detail on the time of onset of a condition, despite our knowledge that among patients who have a condition, experience affects the value assigned to that condition. The debate regarding whose values to use in cost utility analysis is based in part on this observed difference between values depending on the perspective from which they are measured. This research explores the effect on community preferences for hypothetical health states of including the time of onset of a health condition in the health state description, to investigate whether this information induces community respondents to provide values closer to those of patients with experience with a condition. The goal of the research is to bridge the gap between patient and community preferences.
A survey of community-perspective preferences for hypothetical health states was conducted among a convenience sample of healthy adults recruited from a hospital consortium's research volunteer pool. Standard gambles for three hypothetical health states of varying severity were compared across three frames describing time of onset: six months prior onset, current onset, and no onset specified in the description. Results were compared within health state across times of onset, controlling for respondent characteristics known to affect utility scores. Sub-analyses were conducted to confirm results on values meeting inclusion criteria indicating a minimum level of understanding and compliance with the valuation task.
Standard gamble scores from 368 completed surveys were not significantly different across times of onset described in the health state descriptions regardless of health condition severity and controlling for respondent characteristics. Similar results were found in the subset of 292 responses that excluded illogical and invariant responses.
The inclusion of information on the time of onset of a health condition in community-perspective utility survey health state descriptions may not be salient to or may not induce expression of preferences related to disease onset among respondents. Further research is required to understand community preferences regarding condition onset, and how such information might be integrated into health state descriptions to optimize the validity of utility data. Improved understanding of how the design and presentation of health state descriptions affect responses will be useful to eliciting valid preferences for incorporation into decision making.
在社区视角效用调查中，用于描述假设情景的健康状况描述通常忽略了疾病发作时间的细节，尽管我们知道，对于患有某种疾病的患者，其经历会影响对该疾病状况的赋值。在成本效用分析中使用谁的价值的争论部分基于从不同视角衡量价值时观察到的这种差异。这项研究探讨了在健康状况描述中包含疾病发作时间对社区对假设健康状况偏好的影响，以调查该信息是否会促使社区受访者提供更接近有疾病经历的患者的价值。研究的目标是缩小患者和社区偏好之间的差距。
在从医院联盟的研究志愿者库中招募的健康成年人的便利样本中，进行了一项针对假设健康状况的社区视角偏好的调查。对三种严重程度不同的假设健康状况的标准赌博进行了比较，这些健康状况在描述发作时间的三个框架中进行了描述：发作前六个月、当前发作和描述中未指定发作。在控制已知影响效用得分的受访者特征的情况下，根据健康状况在发作时间上进行比较。进行了亚分析以确认满足表明对估值任务有最低程度理解和遵守的纳入标准的价值。
无论健康状况的严重程度如何，在控制受访者特征的情况下，在健康状况描述中描述的发作时间不同的情况下，来自 368 份完整调查的标准赌博得分没有显著差异。在排除不合理和不变响应的 292 个响应的子集中也发现了类似的结果。
在社区视角效用调查健康状况描述中包含有关健康状况发作时间的信息可能对受访者来说并不突出，也不会诱导与疾病发作相关的偏好表达。需要进一步研究以了解社区对疾病发作的偏好，以及如何将此类信息纳入健康状况描述以优化效用数据的有效性。更好地了解健康状况描述的设计和呈现方式如何影响响应，对于得出可纳入决策的有效偏好将非常有用。
