scholarly journals Automated Tool for Health Utility Assessments: The Gambler II

2020 ◽  
Vol 5 (1) ◽  
pp. 238146832091430
Author(s):  
Adeboye A. Adejare ◽  
Mark H. Eckman
Keyword(s):  
Assessment Tool ◽  
Health Utility ◽  
Assessment Process ◽  
Health State ◽  
Health States ◽  
Convenience Sample ◽  
Utility Assessment ◽  
Clinical Encounters ◽  
System Usability Scale ◽  
Before And After

Background. The Gambler II is a web-based utility assessment tool supporting visual analogue scale (VAS), standard gamble (SG), and time trade-off (TTO) utility assessments. It contains novel features, including an easy to use project development authoring tool and use of multimedia clips for health state descriptions. Objectives. Evaluate the usability and understandability of the patient-facing side of The Gambler. Investigate the feasibility of using The Gambler and evaluate its impact on patient knowledge regarding the relevant health states. Materials and Methods. We used The Gambler to assess utilities on a convenience sample of 55 users for common long-term complications of type 2 diabetes mellitus: diabetic neuropathy, diabetic retinopathy, and diabetic foot infection requiring transmetatarsal amputation. Using VAS, SG, and TTO, we collected metadata, such as time spent on each assessment and the entire assessment process. We evaluated usability with an adaptation of the System Usability Scale survey and understandability. We evaluated impact on knowledge gained through knowledge assessments about these complications before and after use of The Gambler. Results. Overall satisfaction with The Gambler was high, 4.02 on a 5-point scale. Usability rated highly at 84.93 on a normalized scale between 0 and 100. Knowledge scores increased significantly following use of The Gambler from pretest mean of 68% to posttest mean of 76% ( P < 0.01). Average time using the software: ∼7½ minutes. Conclusions. The Gambler is an easy to use and understand computer-based tool for utility assessment. It is feasible to use within clinical encounters to support shared decision making, and it has unique features that make it a powerful tool for investigators interested in research on health utilities.

Feasibility of a Health Utility Assessment Platform in a Hemodialysis Outpatient Setting (Preprint)

2021 ◽  
Author(s):  
Adeboye A Adejare Jr ◽  
Heather J Duncan ◽  
Geoffrey R. Motz ◽  
Silvi Shah ◽  
Charuhas V. Thakar ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Assessment Tool ◽  
Health Utility ◽  
Assessment Process ◽  
Health State ◽  
Post Intervention ◽  
Health States ◽  
General Group ◽  
Utility Assessment ◽  
Clinic Setting

BACKGROUND Background: Patients with End-Stage Kidney Disease (ESKD) wait roughly 4 years for a kidney transplant. A potential way to reduce wait times is through the use of Hepatitis-C Viremic (HCV) kidneys. OBJECTIVE Objective: As preparation for developing a shared decision-making tool to assist ESKD patients with the decision whether to accept an HCV-viremic kidney transplant, we first wanted to assess the feasibility of using the Gambler II, a health utility assessment tool, in an ambulatory dialysis clinic setting. Secondary goals were to collect ESKD patients’ utilities and to explore whether use of race-matched vs race-mismatched exemplars impacted knowledge gained during the assessment process. METHODS Methods: We used the Gambler II to elicit utilities for ESKD-related health states: hemodialysis, kidney transplant with HCV-unexposed kidney, and transplantation with HCV-viremic kidney. We created race exemplar video clips describing these health states and randomly assigned patients into the race-matched or race-mismatched video arms. We obtained utilities for these 3 health states from each patient, and we evaluated knowledge about ESKD and HCV-associated health conditions with pre- and post-intervention knowledge assessments. RESULTS Results: 63 hemodialysis patients from 4 outpatient Dialysis Center Inc. sites completed the study. Mean adjusted standard gamble utilities for hemodialysis, transplant with HCV-unexposed kidney, and transplantation with HCV-viremic kidney were 82.5, 89, and 75.5 respectively. General group knowledge assessment scores improved by 10 points (p < 0.05) following utility assessment process. CONCLUSIONS Conclusion: Using The Gambler II to collect ESKD patients’ utilities in an ambulatory dialysis clinic setting proved feasible. In addition, educational information about health states provided as part of the utility assessment process tool improved patients’ knowledge and understanding about ESKD-related health states and implications of organ transplantation with HCV-viremic kidneys. Wide variation in patient health state utilities reinforces the importance of incorporating patients’ preferences into decisions regarding use of HCV-viremic kidneys for transplantation

scholarly journals Estimating an EQ-5D-3L Value Set for Romania Using Time Trade-Off

2021 ◽  
Vol 18 (14) ◽  
pp. 7415
Author(s):  
Marian Sorin Paveliu ◽  
Elena Olariu ◽  
Raluca Caplescu ◽  
Yemi Oluboyede ◽  
Ileana-Gabriela Niculescu-Aron ◽  
...  
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Assessment Process ◽  
Computer Assisted ◽  
Health State ◽  
Health States ◽  
Value Set ◽  
Health Technologies ◽  
Related Quality

Objective: To provide health-related quality of life (HRQoL) data to support health technology assessment (HTA) and reimbursement decisions in Romania, by developing a country-specific value set for the EQ-5D-3L questionnaire. Methods: We used the cTTO method to elicit health state values using a computer-assisted personal interviewing approach. Interviews were standardized following the most recent version of the EQ-VT protocol developed by the EuroQoL Foundation. Thirty EQ-5D-3L health states were randomly assigned to respondents in blocks of three. Econometric modeling was used to estimate values for all 243 states described by the EQ-5D-3L. Results: Data from 1556 non-institutionalized adults aged 18 years and older, selected from a national representative sample, were used to build the value set. All tested models were logically consistent; the final model chosen to generate the value set was an interval regression model. The predicted EQ-5D-3L values ranged from 0.969 to 0.399, and the relative importance of EQ-5D-3L dimensions was in the following order: mobility, pain/discomfort, self-care, anxiety/depression, and usual activities. Conclusions: These results can support reimbursement decisions and allow regional cross-country comparisons between health technologies. This study lays a stepping stone in the development of a health technology assessment process more driven by locally relevant data in Romania.

Health Utility Measurement

2011 ◽  
pp. 787-813 ◽  
Author(s):  
Donna Rowen ◽  
John Brazier
Keyword(s):  
Economic Evaluation ◽  
Health Utility ◽  
Health State ◽  
Health States ◽  
Health State Description ◽  
Utility Measurement ◽  
Current State ◽  
Increasing Demand ◽  
Demand For Health

Measuring and valuing health is a major component of economic evaluation, meaning that health utility measurement has been growing in popularity in recent years due to the increasing demand for health state values in economic models and evaluations. The main issues in health utility measurement are how to describe health states, how to value the health state description and whose values should be used. This article briefly outlines these main issues and then focuses on recent methodological developments in health utility measurement. It assesses the current state of health utility measurement and discusses the question of assessment of a health state to be used in economic evaluation. The discussion whether experience utility should be used rather than conventional preference-based utility raises important issues about perspective and the role of various factors.

scholarly journals Age dependency of EQ-5D-Youth health states valuations on a visual analogue scale

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Jim G. A. Retra ◽  
Brigitte A. B. Essers ◽  
Manuela A. Joore ◽  
Silvia M. A. A. Evers ◽  
Carmen D. Dirksen
Keyword(s):  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Future Research ◽  
Health State ◽  
Older Children ◽  
Health States ◽  
Convenience Sample ◽  
Severe Health State ◽  
Health Domains ◽  
Regular Classes

Abstract Background Examine whether the use of different ages has an impact on the valuation of EQ-5D-Y health states for a hypothetical child or adolescent. Methods A survey was administered during regular classes among a convenience sample of university students in the Netherlands. Respondents first valued 6 EQ-5D-Y health states (2 mild, 2 moderate, 2 severe) describing a hypothetical child/adolescent of a certain age on a visual analogue scale (VAS). After 1 h respondents valued the same six health states again but this time the age of the child was different. Age differed between 4, 10 and 16 year old. Results Number of respondents was 311. No significant differences in valuation of the six health states were found between the age of 10 and 16. One moderate health state was valued significantly better for a 4-year old compared to a 10 and a 16 year old. The same applied for one severe health state that was valued higher for a 4-year old compared to a 16-year old. Conclusion Our study shows that, except for one moderate and one severe health state, other EQ-5D-Y health states were not valued significantly different when description of age differed. It is possible that problems in specific health domains are considered more severe for older children/adolescents compared to younger children who might still be dependent on their caregivers. Future research should examine whether our findings are also present in a broader set of EQ-5D-Y health states, with a choice-based method like TTO or DCE, and a more heterogeneous sample.

Population-Based Health Utility Assessment of Migraine Headache Symptoms before and after Surgical Intervention

2020 ◽  
Vol 145 (1) ◽  
pp. 210-217
Author(s):  
Radbeh Torabi ◽  
Lynn Bourn ◽  
Jacob Veith ◽  
Ian Wisecarver ◽  
Kenneth Briley ◽  
...  
Keyword(s):  
Migraine Headache ◽  
Surgical Intervention ◽  
Health Utility ◽  
Population Based ◽  
Utility Assessment ◽  
Before And After

scholarly journals Setting Dead at Zero: Applying Scale Properties to the QALY Model

2018 ◽  
Vol 38 (6) ◽  
pp. 627-634 ◽  
Author(s):  
Bram Roudijk ◽  
A. Rogier T. Donders ◽  
Peep F.M. Stalmeier
Keyword(s):  
Decision Making ◽  
Research Question ◽  
Health Utility ◽  
Discrete Choice Experiments ◽  
Health State ◽  
Ratio Scale ◽  
Health States ◽  
A Value ◽  
Scale Properties ◽  
Utility Scale

Introduction. Scaling severe states can be a difficult task. First, the method of measurement affects whether a health state is considered better or worse than dead. Second, in discrete choice experiments, different models to anchor health states on 0 (dead) and 1 (perfect health) produce varying amounts of health states worse than dead. Research Question. Within the context of the quality-adjusted life year (QALY) model, this article provides insight into the value assigned to dead and its consequences for decision making. Our research questions are 1) what are the arguments set forth to assign dead the number 0 on the health–utility scale? And 2) what are the effects of the position of dead on the health–utility scale on decision making? Methods. A literature review was conducted to explore the arguments set forth to assign dead a value of 0 in the QALY model. In addition, scale properties and transformations were considered. Results. The review uncovered several practical and theoretical considerations for setting dead at 0. In the QALY model, indifference between 2 health episodes is not preserved under changes of the origin of the duration scale. Ratio scale properties are needed for the duration scale to preserve indifferences. In combination with preferences and zero conditions for duration and health, it follows that dead should have a value of 0. Conclusions. The health–utility and duration scales have ratio scale properties, and dead should be assigned the number 0. Furthermore, the position of dead should be carefully established, because it determines how life-saving and life-improving values are weighed in cost–utility analysis.

scholarly journals Sagittal craniosynostosis: a utility outcomes study

2017 ◽  
Vol 20 (2) ◽  
pp. 113-118 ◽  
Author(s):  
Victoria Kuta ◽  
P. Daniel McNeely ◽  
Simon Walling ◽  
Michael Bezuhly
Keyword(s):  
Online Survey ◽  
Assessment Tools ◽  
Health State Utility ◽  
Health State ◽  
Or Education ◽  
Health States ◽  
Utility Assessment ◽  
Objective Health ◽  
Sagittal Craniosynostosis ◽  
Utility Scores

OBJECTIVESagittal craniosynostosis results in a characteristic scaphocephalic head shape that is typically corrected surgically during a child’s 1st year of life. The authors’ objective was to determine the potential impact of being born with sagittal craniosynostosis by using validated health state utility assessment measures.METHODSAn online utility assessment was designed to generate health utility scores for scaphocephaly, monocular blindness, and binocular blindness using standardized utility assessment tools, namely the visual analog scale (VAS) and the standard gamble (SG) and time trade-off (TTO) tests. Utility scores were compared between health states using the Wilcoxon and Kruskal-Wallis tests. Univariate regression was performed using age, sex, income, and education as independent predictors of utility scores.RESULTSOver a 2-month enrollment period, 122 participants completed the online survey. One hundred eighteen participants were eligible for analysis. Participants rated scaphocephaly due to sagittal craniosynostosis with significantly higher (p < 0.001) median utility scores (VAS 0.85, IQR 0.76–0.95; SG 0.92, IQR 0.84–0.98; TTO 0.91, IQR 0.84–0.95) than both monocular blindness (VAS 0.60, IQR 0.50–0.70; SG 0.84, IQR 0.68–0.94; TTO 0.84, IQR 0.67–0.91) and binocular blindness (VAS 0.25, IQR 0.20–0.40; SG 0.51, IQR 0.18–0.79; TTO 0.55, IQR 0.36–0.76). No differences were noted in utility scores based on participant age, sex, income, or education.CONCLUSIONSUsing objective health state utility scores, authors of the current study demonstrated that the preoperatively perceived burden of scaphocephaly in a child’s 1st year of life is less than that of monocular blindness. These relatively high utility scores for scaphocephaly suggest that the burden of disease as perceived by the general population is low and should inform surgeons’ discussions when offering morbid corrective surgery, particularly when driven by aesthetic concerns.

scholarly journals Incorporating Patients’ Values and Preferences Into Decision Making About Transplantation of HCV-Naïve Recipients With Kidneys From HCV-Viremic Donors: A Feasibility Study

2021 ◽  
Vol 6 (2) ◽  
pp. 238146832110565
Author(s):  
Mark H. Eckman ◽  
Adeboye A. Adejare ◽  
Heather Duncan ◽  
E. Steve Woodle ◽  
Charuhas V. Thakar ◽  
...  
Keyword(s):  
Decision Making ◽  
Hemodialysis Patients ◽  
Patient Specific ◽  
Health State ◽  
Net Benefit ◽  
Health States ◽  
Convenience Sample ◽  
Mean Values ◽  
Life Years ◽  
Dialysis Vintage

Introduction. While use of (hepatitis C virus) HCV-viremic kidneys may result in net benefit for the average end-stage kidney disease (ESKD) patient awaiting transplantation, patients may have different values for ESKD-related health states. Thus, the best decision for any individual may be different depending on the balance of these factors. Our objective was to explore the feasibility of sampling health utilities from hemodialysis patients in order to perform patient-specific decision analyses considering various transplantation strategies. Study Design. We assessed utilities on a convenience sample of hemodialysis patients for health states including hemodialysis, and transplantation with either an HCV-uninfected kidney or an HCV-viremic kidney. We performed patient-specific decision analyses using each patient’s age, race, gender, dialysis vintage, and utilities. We used a Markov state transition model considering strategies of continuing hemodialysis, transplantation with an HCV-unexposed kidney, and transplantation with an HCV-viremic kidney and HCV treatment. We interviewed 63 ESKD patients from four dialysis centers (Dialysis Clinic Inc., DCI) in the Cincinnati metropolitan area. Results. Utilities for ESKD-related health states varied widely from patient to patient. Mean values were highest for -transplantation with an HCV-uninfected kidney (0.89, SD: 0.18), and were 0.825 (SD: 0.231) and 0.755 (SD: 0.282), respectively, for hemodialysis and transplantation with an HCV-viremic kidney. Patient-specific decision analyses indicated 37 (59%) of the 63 ESKD patients in the cohort would have a net gain in quality-adjusted life years from transplantation of an HCV-viremic kidney, while 26 would have a net loss. Conclusions. It is feasible to gather dialysis patients’ health state utilities and perform personalized decision analyses. This approach could be used in the future to guide shared decision-making discussions about transplantation strategies for ESKD patients.

From Clinical Outcomes to Health Utilities: The Role of Mapping to Bridge the Evidence Gap

2019 ◽  
Author(s):  
Mónica Hernández Alava
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Economic Evaluation ◽  
Health Utility ◽  
Health State ◽  
Health States ◽  
Descriptive System ◽  
Healthcare Technologies ◽  
Health State Utility Values

The assessment of health-related quality of life is crucially important in the evaluation of healthcare technologies and services. In many countries, economic evaluation plays a prominent role in informing decision making often requiring preference-based measures (PBMs) to assess quality of life. These measures comprise two aspects: a descriptive system where patients can indicate the impact of ill health, and a value set based on the preferences of individuals for each of the health states that can be described. These values are required for the calculation of quality adjusted life years (QALYs), the measure for health benefit used in the vast majority of economic evaluations. The National Institute for Health and Care Excellence (NICE) has used cost per QALY as its preferred framework for economic evaluation of healthcare technologies since its inception in 1999. However, there is often an evidence gap between the clinical measures that are available from clinical studies on the effect of a specific health technology and the PBMs needed to construct QALY measures. Instruments such as the EQ-5D have preference-based scoring systems and are favored by organizations such as NICE but are frequently absent from clinical studies of treatment effect. Even where a PBM is included this may still be insufficient for the needs of the economic evaluation. Trials may have insufficient follow-up, be underpowered to detect relevant events, or include the wrong PBM for the decision- making body. Often this gap is bridged by “mapping”—estimating a relationship between observed clinical outcomes and PBMs, using data from a reference dataset containing both types of information. The estimated statistical model can then be used to predict what the PBM would have been in the clinical study given the available information. There are two approaches to mapping linked to the structure of a PBM. The indirect approach (or response mapping) models the responses to the descriptive system using discrete data models. The expected health utility is calculated as a subsequent step using the estimated probability distribution of health states. The second approach (the direct approach) models the health state utility values directly. Statistical models routinely used in the past for mapping are unable to consider the idiosyncrasies of health utility data. Often they do not work well in practice and can give seriously biased estimates of the value of treatments. Although the bias could, in principle, go in any direction, in practice it tends to result in underestimation of cost effectiveness and consequently distorted funding decisions. This has real effects on patients, clinicians, industry, and the general public. These problems have led some analysts to mistakenly conclude that mapping always induces biases and should be avoided. However, the development and use of more appropriate models has refuted this claim. The need to improve the quality of mapping studies led to the formation of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Mapping to Estimate Health State Utility values from Non-Preference-Based Outcome Measures Task Force to develop good practice guidance in mapping.

Value of life and time: A survivorship perspective.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18298-e18298
Author(s):  
Jennifer M. Hinkel ◽  
Daniel B. Sexton ◽  
Justine Egan-Kunicki
Keyword(s):  
Online Survey ◽  
Full Range ◽  
Health Utility ◽  
Hematologic Malignancies ◽  
Quality Adjusted Life Year ◽  
Value Of Life ◽  
Health States ◽  
Convenience Sample ◽  
Potential Health ◽  
Life Years

e18298 Background: Common tools to quantify value of life years after a cancer diagnosis include the Quality Adjusted Life Year (QALY). This measure is partly based on health utility states derived from Quality of Life (QoL) survey instruments such as the EQ-5D. Research has identified shortcomings in applying the QALY, including the potential for underestimating value. QoL surveys may fail to capture the full range of potential health states, or the values derived may fail to reflect patient perspectives of value. Methods: An online survey was piloted with a convenience sample of cancer survivors via two US survivor Facebook groups over two weeks in Jan. 2017 to explore these themes. Results: 116 complete responses were analyzed (of 123 respondents). Original diagnoses included solid tumors and hematologic malignancies, and respondents were between one and 32 years post-diagnosis (PoD). Most (101, 87%) had completed active treatment. A majority (85, 73%) rated PoD years as having more value than years pre-diagnosis (PreD). 83% (98) indicated that they felt their time is more valuable since their diagnosis. While the majority of respondents (57%) assigned a lower value to the 12 months immediately following diagnosis compared to the value of a PreD year, a majority (55%) also valued the most recent twelve months to have equal or greater value than a PreD year. Many assigned higher valuations to PoD years even when simultaneously reporting limitations in Activities of Daily Living (ADLs). Conclusions: Comparing survivor valuations of PoD life years to valuations derived by utility state instruments has not been heavily researched. This survey generates additional hypotheses. First, assuming PoD years hold lower value than PreD years may underestimate value compared to a survivor’s view. Second, QoL instruments may not be capturing positive changes in PoD years, some of which have been documented in psychology research, such as Post-Traumatic Growth or increased feeling of meaningfulness. Further investigation is imperative to ensure that value determinations have a solid evidentiary basis and reflect patient-centered viewpoints, particularly as the “value debate” influences patient access to care.

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