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Whose utilities for decision analysis?

N F Boyd1, H J Sutherland, K Z Heasman

  • 1Department of Medicine, Ontario Cancer Institute, Toronto, Canada.

Medical Decision Making : an International Journal of the Society for Medical Decision Making
|January 1, 1990
PubMed
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Patient and physician utilities for colostomy (an outcome of rectal cancer treatment) varied significantly. Those with colostomies and physicians valued this health state more highly than patients without colostomies, impacting treatment decisions.

Area of Science:

  • Health Economics
  • Decision Analysis
  • Oncology

Background:

  • Health state utilities are crucial for clinical decision-making and cost-effectiveness analyses.
  • Understanding variations in utility values is essential for accurate health policy and patient-centered care.
  • Colostomy is a common health state resulting from rectal cancer treatment, significantly impacting patients' quality of life.

Purpose of the Study:

  • To investigate the sources of variation in utilities assigned to the health state of colostomy.
  • To compare utility values for colostomy across different groups, including patients, physicians, and healthy individuals.
  • To assess the impact of these utility variations on clinical decision-making regarding rectal cancer treatment.

Main Methods:

  • A common clinical problem, rectal cancer, was used as a case study.

Related Experiment Videos

  • Utilities for colostomy were elicited from five groups: patients with colostomies, patients treated with radiotherapy (no colostomy), and healthy subjects, using standard gamble, category rating, and treatment choice questionnaires.
  • The clinical significance was evaluated using a simplified decision problem comparing surgery (with colostomy) versus radiotherapy (without colostomy).

    • Main Results:

    • Substantial differences in utilities assigned to colostomy were observed across the studied groups.
    • Patients with colostomies and physicians assigned significantly higher utilities to colostomy compared to patients without colostomies.
    • These utility differences significantly influenced the expected clinical value of treatment alternatives (surgery vs. radiotherapy).

    Conclusions:

    • Patient and physician utilities for health states, such as colostomy, exhibit significant variation.
    • These variations have a substantial impact on clinical decision-making, highlighting the importance of patient-specific values.
    • Further research is needed to understand the factors influencing health state utility assignments in diverse populations.