Wang Kaiying, Barr Chris, Norman Richard, George Stacey, Whitehead Craig, Ratcliffe Julie
College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia.
College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia.
Appl Health Econ Health Policy. 2021 Jan;19(1):111-121. doi: 10.1007/s40258-020-00588-3.
Population ageing is a phenomenon taking place in almost every global region. Current estimates indicate that 10-20% of older people in developed countries have mild cognitive impairment (MCI), with these percentages predicted to rise markedly by 2050.
Our objective was to apply eye-tracking technology to investigate the information processes adopted by older people with and without MCI in determining preferences for health states in the five-level EuroQol-5 Dimensions (EQ-5D-5L) instrument.
Older people (aged ≥ 65 years; including both patients and family carers) attending outpatient memory clinics in Southern Adelaide between July 2017 and June 2018, competent to read and converse in English and with a Mini-Mental State Examination (MMSE) cognition score of ≥ 19 were invited to participate. In total, 52 people met the inclusion criteria, of whom 20 (38%) provided informed consent and fully participated. Participants were categorised into two subgroups (each n = 10) for comparison based upon established MMSE cognition thresholds (19-23, lower MMSE indicative of MCI; ≥ 24, higher MMSE indicative of good cognition). A discrete-choice experiment (DCE) comprising a series of pairwise choices between alternative EQ-5D-5L health states of varying survival duration with differential levels of task complexity (approximated by the degree of attribute level overlap in each choice), was administered as a face-to-face interview with the participant wearing an eye-tracking device.
Attribute non-attendance (ANA) was higher for the lower MMSE subgroup than for the higher MMSE subgroup, although these differences were generally not statistically significant. ANA remained relatively low and consistent for participants with good cognition regardless of task complexity. In contrast, ANA increased notably in participants exhibiting MCI, increasing from 10% on average per participant in the lower MMSE subgroup with five attribute level overlap to 23% on average per participant in the lower MMSE subgroup with zero attribute level overlap.
This exploratory study provided important insights into the information processes adopted by older people with varying levels of cognitive functioning when choosing between alternative EQ-5D-5L health states of varying survival duration and specifically the relationships between cognitive capacity, task complexity and the extent of ANA. Recent advances in econometric modelling of health state valuation data have demonstrated the added value of capturing ANA information as this can be accounted for in the DCE data analysis, thereby improving the precision of model estimates. Eye-tracking technology can usefully inform the design, conduct and econometric modelling of DCEs, driving the inclusion of this rapidly growing population traditionally excluded from preference-elicitation studies of this nature.
人口老龄化是几乎在全球每个地区都在发生的一种现象。目前的估计表明，发达国家10% - 20%的老年人患有轻度认知障碍（MCI），预计到2050年这些比例将显著上升。
我们的目的是应用眼动追踪技术，研究患有和未患有MCI的老年人在确定五级欧洲五维健康量表（EQ - 5D - 5L）工具中健康状态偏好时所采用的信息处理过程。
邀请2017年7月至2018年6月期间在阿德莱德南部门诊记忆诊所就诊的老年人（年龄≥65岁；包括患者和家庭护理人员）参与研究，这些老年人能够用英语阅读和交流，且简易精神状态检查表（MMSE）认知得分≥19分。共有52人符合纳入标准，其中20人（38%）提供了知情同意并完全参与了研究。根据既定的MMSE认知阈值（19 - 23，较低的MMSE表明存在MCI；≥24，较高的MMSE表明认知良好）将参与者分为两个亚组（每组n = 1）进行比较。进行了一项离散选择实验（DCE），该实验包括在具有不同生存持续时间和不同任务复杂程度水平（通过每个选择中属性水平重叠程度近似表示）的替代EQ - 5D - L健康状态之间进行一系列成对选择，以面对面访谈的形式进行，参与者佩戴眼动追踪设备。
较低MMSE亚组的属性未关注（ANA）高于较高MMSE亚组，尽管这些差异通常无统计学意义。对于认知良好的参与者，无论任务复杂程度如何，ANA保持相对较低且一致。相比之下，表现出MCI的参与者中ANA显著增加，从属性水平重叠为五时较低MMSE亚组中每位参与者平均10%增加到属性水平重叠为零时较低MMSE亚组中每位参与者平均23%。
这项探索性研究为不同认知功能水平的老年人在选择具有不同生存持续时间的替代EQ - 5D - 5L健康状态时所采用的信息处理过程，特别是认知能力、任务复杂程度和ANA程度之间的关系提供了重要见解。健康状态估值数据的计量经济学建模的最新进展表明，捕捉ANA信息具有附加价值，因为这可以在DCE数据分析中得到考虑，从而提高模型估计的精度。眼动追踪技术可以有效地为DCE的设计、实施和计量经济学建模提供信息，促使将这一迅速增长的人群纳入传统上被排除在这类偏好诱导研究之外的研究中。
