Centre for Mental Health Research, School of Health Sciences, University of London, London and East London NHS Foundation Trust, London, United Kingdom.
Centre for Health Services Research, School of Health Sciences, University of London, London, United Kingdom.
PLoS One. 2018 Oct 23;13(10):e0205223. doi: 10.1371/journal.pone.0205223. eCollection 2018.
Utility scores are integral to health economics decision-making. Typically, utility scores have not been scored or developed with mental health service users. The aims of this study were to i) collaborate with service users to develop descriptions of five mental health states (psychosis, depression, eating disorder, medication side effects and self-harm); ii) explore feasibility and acceptability of using scenario-based health states in an e-survey; iii) evaluate which utility measures (standard gamble (SG), time trade off (TTO) and rating scale (RS)) are preferred; and iv) determine how different participant groups discriminate between the health scenarios and rank them.
This was a co-produced mixed methods cross-sectional online survey. Utility scores were generated using the SG, TTO and RS methods; difficulty of the completing each method, markers of acceptability and participants' preference were also assessed.
A total of 119 participants (58%) fully completed the survey. For any given health state, SG consistently generated higher utility scores compared to RS and for some health states higher also than TTO (i.e. SG produces inflated utility scores relative to RS and TTO). Results suggest that different utility measures produce different evaluations of described health states. The TTO was preferred by all participant groups over the SG. The three participant groups scored four (of five) health scenarios comparably. Psychosis scored as the worst health state to live with while medication side-effects were viewed more positively than other scenarios (depression, eating disorders, self-harm) by all participant groups. However, there was a difference in how the depression scenario was scored, with service users giving depression a lower utility score compared to other groups.
Mental health state scenarios used to generate utility scores can be co-produced and are well received by a broad range of participants. Utility valuations using SG, TTO and RS were feasible for use with service users, carers, healthcare professionals and members of the general public. Future studies of utility scores in psychiatry should aim to include mental health service users as both co-investigators and respondents.
效用评分是健康经济学决策的重要组成部分。通常情况下，效用评分并未针对心理健康服务使用者进行评分或制定。本研究的目的是：i）与服务使用者合作，描述五种心理健康状况（精神病、抑郁、饮食障碍、药物副作用和自伤）；ii）探讨在电子调查中使用基于情景的健康状况的可行性和可接受性；iii）评估哪些效用衡量标准（标准博弈（SG）、时间权衡（TTO）和评分量表（RS））更受欢迎；iv）确定不同参与者群体如何区分健康情景并对其进行排名。
这是一项合作产生的混合方法横断面在线调查。使用 SG、TTO 和 RS 方法生成效用评分；还评估了每种方法的完成难度、可接受性标志和参与者的偏好。
共有 119 名参与者（58%）完整完成了调查。对于任何给定的健康状况，SG 始终比 RS 产生更高的效用评分，对于某些健康状况，SG 也比 TTO 高（即 SG 相对于 RS 和 TTO 产生了夸大的效用评分）。结果表明，不同的效用衡量标准对描述的健康状况产生不同的评估。所有参与者群体都更喜欢 TTO 而不是 SG。三个参与者群体对四个（五个）健康情景进行了可比评分。精神病是最糟糕的生存状态，而药物副作用比其他情景（抑郁、饮食障碍、自伤）被所有参与者群体更积极地看待。然而，抑郁情景的评分方式存在差异，服务使用者给予抑郁的效用评分低于其他群体。
用于生成效用评分的心理健康状况情景可以共同制定，并受到广泛参与者的欢迎。SG、TTO 和 RS 用于效用评估对服务使用者、照顾者、医疗保健专业人员和一般公众都是可行的。未来精神病学中的效用评分研究应旨在将心理健康服务使用者作为共同调查员和受访者纳入。
