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Comparing treatment valuations between and within subjects in clinical trials: does it make a difference?
E Birnie1, W M Monincx, H A Zondervan
1Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, The Netherlands.
Journal of Clinical Epidemiology
|February 29, 2000
Summary
Patient valuations of healthcare strategies can be biased, especially within randomized clinical trials. This study shows that both in-hospital and domiciliary monitoring were preferred by patients assigned to them, indicating inherent valuation biases.
Area of Science:
- Health Services Research
- Clinical Trial Methodology
- Patient-Reported Outcomes
Background:
- Patient valuations of healthcare interventions are crucial but can be influenced by biases.
- Randomized clinical trials (RCTs) may introduce specific biases when eliciting these valuations.
Purpose of the Study:
- To investigate biases in patient valuations of in-hospital versus domiciliary monitoring within an RCT.
- To compare between-subject and within-subject valuation differences.
Main Methods:
- Women in an RCT assigned valuations (0-10 visual analogue scale) to their allocated strategy and the alternative.
- Valuations were analyzed as between-subject differences (by allocated group) and within-subject differences (by all participants).
Main Results:
- Women valued their allocated strategy higher: in-hospital monitoring (P=0.02) and domiciliary monitoring (P=0.10).
- Average within-subject differences varied significantly by allocated strategy (P<0.01).
- Valuation differences exhibited substantial inter- and intra-group variability, influenced by patient preference and treatment experience.
Conclusions:
- Neither between-subject nor within-subject valuation differences are free from bias in this RCT setting.
- Biases in patient valuation are likely unavoidable in similar study designs.
- Comparing different valuation methods provides valuable insights into potential biases.