Johnson F Reed, Sheehan John J, Ozdemir Semra, Wallace Matthew, Yang Jui-Chen
Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
Pharmacoeconomics. 2025 Jan;43(1):45-52. doi: 10.1007/s40273-024-01437-0. Epub 2024 Oct 4.
This study was designed to test hypotheses regarding the path dependence of health-outcome values in the form of linear additivity of health-state utilities and diminishing marginal utility of health outcomes.
We employed a discrete-choice experiment to quantify patient treatment preferences for major depressive disorder. In a series of choice questions, participants evaluated seven symptom-improvement sequences and out-of-pocket costs over 6-week durations. Money-equivalent values were derived from a deductive latent-class mixed-logit analysis.
The discrete-choice experiment was completed by 751 respondents with self-reported major depressive disorder recruited from an online commercial panel. The class-membership probability was 0.83 for latent-class preferences consistent with supporting relative importance weights for all symptom-improvement sequences in the study design. First, we found strong support for diminishing marginal utility in symptom-improvement sequences. The money-equivalent value of an initial week of normal mood was $147 (95% confidence interval: $128, $166) and a second week of normal mood was $70 ($49, $91). Furthermore, for short treatment durations where conventional discounting was not a factor, equivalent changes in health status were valued more highly for an earlier onset of effect: holding subsequent symptom patterns constant, $338 (211, 454) versus $70 (49, 91) for improvements starting in week 2 versus week 3 and $147 ($128, $166) versus $29 (-$4, $64) for improvements starting in week 3 versus week 4.
Our findings imply that conventional quality-adjusted life-year calculations in which health values are assumed to be path independent can understate the value of health improvements that appear earlier in a sequence.
本研究旨在检验关于健康结果值的路径依赖性的假设，这些假设以健康状态效用的线性可加性和健康结果的边际效用递减的形式呈现。
我们采用离散选择实验来量化患者对重度抑郁症治疗的偏好。在一系列选择问题中，参与者评估了7种症状改善序列以及6周期间的自付费用。货币等价价值来自于演绎性潜在类别混合逻辑分析。
751名从在线商业面板招募的自我报告患有重度抑郁症的受访者完成了离散选择实验。对于与研究设计中所有症状改善序列的相对重要性权重支持一致的潜在类别偏好，类别归属概率为0.83。首先，我们发现对症状改善序列中的边际效用递减有强有力的支持。正常情绪第一周的货币等价价值为147美元（95%置信区间：128美元，166美元），第二周为70美元（49美元，91美元）。此外，对于常规贴现不是一个因素的短治疗期，健康状况的等效变化在效果更早出现时被赋予更高的价值：在后续症状模式不变的情况下，从第2周开始改善的价值为338美元（211美元，454美元），而从第3周开始改善的价值为70美元（49美元，91美元）；从第3周开始改善的价值为147美元（128美元，166美元），而从第4周开始改善的价值为29美元（-4美元，64美元）。
我们的研究结果表明，在假设健康价值与路径无关的传统质量调整生命年计算中，可能会低估序列中较早出现的健康改善的价值。
