Conservative versus aggressive follow up of mildly abnormal Pap smears: testing for process utility

Economic evaluation generally limits outcome measurement to the valuation of health outcomes produced by interventions without considering the impact of processes on utility. We test for process utility by comparing utility measurements for alternative approaches to managing abnormal Pap smears in the context of a fixed outcome. The impact of health care interventions on individual well-being was not confined to health outcomes. Aggressive and conservative follow-up approaches were associated with statistically significant differences in utilities. We also found that relative preferences among different processes may depend on the particular circumstances or pathologies being considered.