Strength of public preferences for endovascular or open aortic aneurysm repair

Wickramasekera, Nyantara; Howard, Aoife; Philips, Peter A.; Rooney, Gill; Hughes, Jane; Wilson, Emma; Aber, Ahmed; Michaels, J; Shackley, Phil

doi:10.1002/bjs.11265

Cited by 11 publications

(10 citation statements)

References 23 publications

(22 reference statements)

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“…[50] There are a number of methods for obtaining empirical societal valuations through techniques such as discrete choice experiments, [51] time-trade-off, [4] contingent valuation [52] and standard gamble. [53] Such methods have been used to quantify societal preferences for HRQoL and many other aspects of healthcare, including location, [54,55] process utilities, [29,56] waiting times [57,58] and other characteristics of care. [51,59] However, in practice, attributes other than QALYs are considered by advisory committees through a deliberative process within a policy framework.…”

Section: Decision Makingmentioning

confidence: 99%

Value assessment frameworks: who is valuing the care in healthcare?

Michaels

2021

J Med Ethics

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Many healthcare agencies are producing evidence-based guidance and policy that may determine the availability of particular healthcare products and procedures, effectively rationing aspects of healthcare. They claim legitimacy for their decisions through reference to evidence-based scientific method and the implementation of just decision-making procedures, often citing the criteria of ‘accountability for reasonableness’; publicity, relevance, challenge and revision, and regulation. Central to most decision methods are estimates of gains in quality-adjusted life-years (QALY), a measure that combines the length and quality of survival. However, all agree that the QALY alone is not a sufficient measure of all relevant aspects of potential healthcare benefits, and a number of value assessment frameworks have been suggested. I argue that the practical implementation of these procedures has the potential to lead to a distorted assessment of value. Undue weight may be ascribed to certain attributes, particularly those that favour commercial or political interests, while other attributes that are highly valued by society, particularly those related to care processes, may be omitted or undervalued. This may be compounded by a lack of transparency to relevant stakeholders, resulting in an inability for them to participate in, or challenge, the decisions. The makes it likely that costly new technologies, for which inflated prices can be justified by the current value frameworks, are displacing aspects of healthcare that are highly valued by society.

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Section: Decision Makingmentioning

confidence: 99%

Value assessment frameworks: who is valuing the care in healthcare?

Michaels

2021

J Med Ethics

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“…For example, studies have demonstrated that the EQ-5D is insensitive to levels of hearing loss [32] and may not adequately capture the outcome of interventions that affect mental health, [33] dementia [34] or multiple sclerosis. [35] Such measures also fail to include other widely valued aspects of healthcare such as processes of care, [36] compassion, dignity and autonomy. It seems inevitable that rationing decisions based upon evidence that fails to quantify areas such as mental health, disability or compassionate care will result in displacement of healthcare that provides benefits in these domains.…”

Section: Injustices In the Interpretation Of Evidencementioning

confidence: 99%

Potential for epistemic injustice in evidence-based healthcare policy and guidance

Michaels

2020

J Med Ethics

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The rapid development in healthcare technologies in recent years has resulted in the need for health services, whether publicly funded or insurance based, to identify means to maximise the benefits and provide equitable distribution of limited resources. This has resulted in the need for rationing decisions, and there has been considerable debate regarding the substantive and procedural ethical principles that promote distributive justice when making such decisions. In this paper, I argue that while the scientifically rigorous approaches of evidence-based healthcare are claimed as aspects of procedural justice that legitimise such guidance, there are biases and distortions in all aspects of the process that may lead to epistemic injustices. Regardless of adherence to principles of distributive justice in the decision-making process, evidential failings may undermine the fairness and legitimacy of such decisions. In particular, I identify epistemic exclusion that denies certain patient and professional groups the opportunity to contribute to the epistemic endeavour. This occurs at all stages of the process, from the generation, analysis and reporting of the underlying evidence, through the interpretation of such evidence, to the decision-making that determines access to healthcare resources. I further argue that this is compounded by processes which confer unwarranted epistemic privilege on experts in relation to explicit or implicit value judgements, which are not within their remit. I suggest a number of areas in which changes to the processes for developing, regulating, reporting and evaluating evidence may improve the legitimacy of such processes.

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“…In addition to the health outcomes measured by EQ‐5D™, processes of care may be very important to patients, particularly in relation to interventional procedures where options may include major invasive surgery. It is possible to measure the value that is put on aspects of process, and formally consider trade‐offs against other aspects of outcome.…”

Section: Improving Decision‐makingmentioning

confidence: 99%