Incorporating extrinsic goals into decision and cost-effectiveness analyses

Area of Science:

• Health Economics
• Medical Decision Making
• Patient-Centered Care

Background:

• The quality-adjusted life year (QALY) model primarily addresses ongoing health goals like pain reduction or mobility maintenance.
• Patient preferences sometimes conflict with the QALY model, suggesting the existence of goals not captured by it.
• Goals such as completing significant life events (e.g., project completion, child's graduation) are time-specific and difficult to quantify within the QALY framework.

Purpose of the Study:

• To examine methodologies for integrating extrinsic, time-specific patient goals into medical decision and cost-effectiveness analyses.
• To demonstrate the application of these methods using existing case studies.

Main Methods:

• Review and analysis of existing decision-making frameworks.
• Application of proposed methods to re-evaluate previously published analyses.
• Illustrative examples include management of unruptured intracranial arteriovenous malformations and preventive strategies for BRCA+ women.

Main Results:

• The study proposes and illustrates methods to incorporate extrinsic goals into analyses.
• Revisiting case studies demonstrates how these goals can influence outcomes and decisions.
• This approach offers a more comprehensive understanding of patient preferences in healthcare.

Conclusions:

• Standard models like QALYs may not fully capture all patient goals, particularly time-specific ones.
• Integrating extrinsic goals enhances the accuracy and patient-centeredness of medical decision and cost-effectiveness analyses.
• This expanded approach can lead to more aligned healthcare recommendations and resource allocation.