Rowen Donna, Brazier John, Keetharuth Anju, Tsuchiya Aki, Mukuria Clara
Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
Department of Economics, University of Sheffield, Sheffield, UK.
Appl Health Econ Health Policy. 2016 Feb;14(1):89-104. doi: 10.1007/s40258-015-0197-y.
Proposals for value-based assessment, made by the National Institute of Health and Care Excellence (NICE) in the UK, recommended that burden of illness (BOI) should be used to weight QALY gain. This paper explores some of the methodological issues in eliciting societal preferences for BOI.
This study explores the impact of mode of administration and framing in a survey for eliciting societal preferences for BOI.
A pairwise comparison survey with six arms was conducted online and via face-to-face interviews, involving two different wordings of questions and the inclusion/exclusion of pictures. Respondents were asked which of two patient groups they thought a publically funded health service should treat, where the groups varied by life expectancy without treatment, health-related quality of life (HRQOL) without treatment, survival gain from treatment, and HRQOL gain from treatment. Responses across different modes of administration, wording and use of pictures were compared using chi-squared tests and probit regression analysis controlling for respondent socio-demographic characteristics.
The sample contained 371 respondents: 69 were interviewed and 302 completed the questionnaire online. There were some differences in socio-demographic characteristics across the online and interview samples. Online respondents were less likely to choose the group with higher BOI and more likely to treat those with a higher QALY gain, but there were no statistically significant differences by wording or the inclusion of pictures for the majority of questions. Regression analysis confirmed these results. Respondents chose to treat the group with larger treatment gain, but there was little support for treating the group with higher BOI. Respondents also preferred to treat the group with treatment gains in life expectancy rather than HRQOL.
Mode of administration did impact on responses, whereas question wording and pictures did not impact on responses, even after controlling for the socio-demographic characteristics of respondents in the regression analysis.
英国国家卫生与临床优化研究所（NICE）提出的基于价值的评估建议，建议使用疾病负担（BOI）来权衡质量调整生命年（QALY）的增益。本文探讨了在获取社会对疾病负担的偏好时的一些方法学问题。
本研究探讨了在一项获取社会对疾病负担偏好的调查中，管理方式和框架的影响。
通过在线和面对面访谈进行了一项有六个分支的成对比较调查，涉及两种不同的问题措辞以及图片的包含/排除。受访者被问及他们认为公共资助的医疗服务应该治疗哪两个患者组，其中这两个组在未接受治疗时的预期寿命、未接受治疗时的健康相关生活质量（HRQOL）、治疗带来的生存增益以及治疗带来的HRQOL增益方面有所不同。使用卡方检验和控制受访者社会人口统计学特征的概率回归分析，比较了不同管理方式、措辞和图片使用情况下的回答。
样本包含371名受访者：69人接受了访谈，302人在线完成了问卷。在线和访谈样本的社会人口统计学特征存在一些差异。在线受访者选择疾病负担较高组的可能性较小，而选择QALY增益较高组进行治疗的可能性较大，但对于大多数问题，措辞或图片的包含与否没有统计学上的显著差异。回归分析证实了这些结果。受访者选择治疗增益较大的组，但几乎没有支持治疗疾病负担较高组的情况。受访者也更倾向于治疗预期寿命有增益的组，而不是HRQOL有增益的组。
管理方式确实对回答有影响，而问题措辞和图片即使在回归分析中控制了受访者的社会人口统计学特征后，也不会对回答产生影响。
