Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Inflamm Bowel Dis. 2011 Jun;17(6):1328-32. doi: 10.1002/ibd.21515. Epub 2010 Nov 16.
In cost-effectiveness analysis, discount rates are used in calculating the value of future costs and benefits. However, standard discount rates may not accurately describe the decision-making of patients with ulcerative colitis (UC). These patients often choose the long-term risks of immunosuppressive therapy over the short-term risks of colectomy, demonstrating very high discount rates for future health. In this study we aimed to measure the discount rate in UC patients and identify variables associated with the discount rate.
We surveyed patients with UC and patients who were postcolectomy for UC to measure their valuations of UC and colectomy health states. We used Standard Gamble (SG) and Time-Trade-Off (TTO) methods to assess current and future health state valuations and calculated the discount rate.
Participants included 150 subjects with UC and 150 subjects who were postcolectomy for UC. Adjusted discount rates varied widely (0%-100%), with an overall median rate of 55.0% (interquartile range [IQR] 20.6-100), which was significantly higher than the standard rate of 5%. Within the normal range of discount rates, patients' expected discount rate increased by 0.80% for each additional year of age, and female patients had discount rates that averaged ≈ 8% less than their age-matched counterparts and approached statistical significance.
The accepted discount rate of 5% grossly underestimates UC patients' preference for long-term over short-term risk. This might explain UC patients' frequent choice of the long-term risks of immunosuppressive medical therapy over the short-term risks of colectomy.
在成本效益分析中，贴现率用于计算未来成本和收益的价值。然而，标准贴现率可能无法准确描述溃疡性结肠炎（UC）患者的决策。这些患者通常选择免疫抑制治疗的长期风险而不是结肠切除术的短期风险，表现出对未来健康的非常高的贴现率。在这项研究中，我们旨在测量 UC 患者的贴现率并确定与贴现率相关的变量。
我们调查了 UC 患者和因 UC 而行结肠切除术的患者，以衡量他们对 UC 和结肠切除术健康状况的估值。我们使用标准博弈（SG）和时间权衡（TTO）方法来评估当前和未来健康状况的估值，并计算贴现率。
参与者包括 150 名 UC 患者和 150 名因 UC 而行结肠切除术的患者。调整后的贴现率差异很大（0%-100%），总体中位数为 55.0%（四分位距 [IQR] 20.6-100），显著高于标准率 5%。在正常贴现率范围内，患者的预期贴现率每增加 1 岁增加 0.80%，女性患者的贴现率平均比同龄患者低 ≈ 8%，接近统计学意义。
5%的公认贴现率严重低估了 UC 患者对长期风险的偏好超过短期风险。这可能解释了 UC 患者为何经常选择免疫抑制药物治疗的长期风险，而不是结肠切除术的短期风险。
