Health State Utilities: A Framework for Studying the Gap Between the Imagined and the Real

Abstract

Objectives: Health state utilities play an important role in decision analysis and cost-utility analysis. The question whose utilities to use at various levels of health-care decision-making has been subject of considerable debate. The observation that patients often value their own health, but also other health states, higher than members of the general public raises the question what underlies such differences? Is it an artifact of the valuation methods? Is it adaptation versus poor anticipated adaptation? This article describes a framework for the understanding and study of potential mechanisms that play a role in health state valuation. It aims at connecting research from within different fields so that cross-fertilization of ideas may occur. Methods: The framework is based on stimulus response models from social judgment theory. For each phase, from stimulus, through information interpretation and integration, to judgment, and, finally, to response, we provide evidence of factors and processes that may lead to different utilities in patients and healthy subjects. Results: Examples of factors and processes described are the lack of scope of scenarios in the stimulus phase, and appraisal processes and framing effects in the information interpretation phase. Factors that play a role in the judgment phase are, for example, heuristics and biases, adaptation, and comparison processes. Some mechanisms related to the response phase are end aversion bias, probability distortion, and noncompensatory decision-making. Conclusions:The framework serves to explain many of the differences in valuations between respondent groups. We discuss some of the findings as they relate to the field of response shift research. We propose issues for discussion in the field, and suggestions for improvement of the process of utility assessment.

Genetic testing for inherited heart diseases: longitudinal impact on health-related quality of life

“…[8][9][10] Adaptation to the shift in health status, as well as the advantages of a gain in knowledge and more accurate risk perception have all been suggested to account for this lack of psychological harm following a positive predictive result, and this is well described in the literature. 22,23 Of note, both proband groups (Groups 1 and 2) showed low HR-QoL scores, reflecting the fact they have clinical evidence of disease. 1 Specifically in cardiology, limited data exist about the impact of genetic testing for inherited heart diseases.…”

Differences between hypothetical and experience-based value sets for EQ-5D used in Sweden: Implications for decision makers

“…The differences between and potential explanatory parameters of how patients and the general population give value to health states have been previously analysed [22,23].The choice between hypothetical and experience-based value sets is extensively debated as both methods have advantages as well as disadvantages.…”

Breast cancer-related preferences among women with and without BRCA mutations

“…The sources of utilities most widely used in studies of medical decision-making are physicians and nurses who treat patients with or at risk for a disease, who may be candidates for a particular medical intervention, not the patients themselves [17]. Health care providers and other healthy people typically rate diseases and other health states lower than do patients in those states, but whether that pattern is consistent for all health states and interventions and what factors account for individual variations in ratings have not been well studied [18].…”