Shiroiwa Takeru, Saito Shinya, Shimozuma Kojiro, Kodama Satoshi, Noto Shinichi, Fukuda Takashi
Department of Health and Welfare Service, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan.
Graduate School of Health Sciences, Okayama University, Okayama, Japan.
Appl Health Econ Health Policy. 2016 Jun;14(3):375-85. doi: 10.1007/s40258-016-0236-3.
Although quality-adjusted life-years (QALYs) may not completely reflect the value of a healthcare technology, it remains unclear how to adjust the cost per QALY threshold. First, the present study compares two survey methods of measuring people's preferences for a specific healthcare technology when each choice has the same efficiency. The second objective was to consider how this information regarding preferences could be used in decision making.
We conducted single-attribute (budget allocation) and multi-attribute (discrete-choice) experiments to survey public medical care preferences. Approximately 1000 respondents were sampled for each experiment. Six questions were prepared to address the attributes included in the study: (a) age; (b) objective of care; (c) disease severity; (d) prior medical care; (e) cause of disease; and (f) disease frequency. For the discrete-choice experiment (a) age, (b) objective of care, (c) disease severity, and (d) prior medical care were orthogonally combined. All assumed medical care had the same costs and incremental cost-effectiveness ratio (ICER; cost per life-year or QALY). We also calculated the preference-adjusted threshold (PAT) to reflect people's preferences in a threshold range.
The results of both experiments revealed similar preferences: intervention for younger patients was strongly preferred, followed by interventions for treatment and severe disease states being preferred, despite the same cost per life-year or QALY. The single-attribute experiment revealed that many people prefer an option in which resources are equally allocated between two interventions. Marginal PATs were calculated for age, objective of care, disease severity, and prior medical care.
The single- and multi-attribute experiments revealed similar preferences. PAT can reflect people's preferences within the decision-maker's threshold range in a numerical manner.
尽管质量调整生命年（QALYs）可能无法完全反映医疗技术的价值，但如何调整每QALY阈值的成本仍不明确。首先，本研究比较了两种测量人们对特定医疗技术偏好的调查方法，每种选择具有相同的效率。第二个目的是考虑如何将这种关于偏好的信息用于决策。
我们进行了单属性（预算分配）和多属性（离散选择）实验，以调查公众的医疗偏好。每个实验抽取了约1000名受访者。准备了六个问题来涉及研究中包含的属性：（a）年龄；（b）护理目标；（c）疾病严重程度；（d）既往医疗护理；（e）病因；（f）疾病频率。对于离散选择实验，（a）年龄、（b）护理目标、（c）疾病严重程度和（d）既往医疗护理进行了正交组合。所有假设的医疗护理具有相同的成本和增量成本效益比（ICER；每生命年或QALY的成本）。我们还计算了偏好调整阈值（PAT），以反映阈值范围内人们的偏好。
两个实验的结果都显示出相似的偏好：尽管每生命年或QALY的成本相同，但强烈倾向于对年轻患者进行干预，其次是对治疗和严重疾病状态的干预。单属性实验表明，许多人更喜欢在两种干预措施之间平均分配资源的选项。计算了年龄、护理目标、疾病严重程度和既往医疗护理的边际PAT。
单属性和多属性实验显示出相似的偏好。PAT可以以数字方式反映决策者阈值范围内人们的偏好。
