Utility Assessment in Cancer Patients

Abstract

The standard gamble (SG) and the time tradeoff (TTO), two frequently used methods of utility assessment, have often been found to lead to different utilities for the same health state. The authors investigated whether adjustment of TTO scores for the utility of life years (risk attitude) eliminated this difference. In addition, the association between risk attitude and sociodemographic and medical variables was studied. In 30 disease-free testicular cancer patients, SG and TTO were used to assess the utilities of four health profiles relevant to testicular cancer. Utility of life years was estimated from certainty equivalents (CEs). SG scores were significantly higher than unadjusted TTO scores for all profiles. As the majority of patients (85%) were risk-averse, CE-adjusted TTO scores were higher than unadjusted scores, and were not significantly different from those obtained from the SG for three of the four profiles. However, adjusted scores were still slightly but consistently lower than SG scores. Possible explanations for this discrepancy are discussed. An association was found between risk aversion and medical treatment: patients who had received chemotherapy for their cancers were more risk-averse than were patients who had been in a surveillance protocol only. As risk aversion can have an impact on treatment decisions, it is important to assess the risk posture of the patient to whom the decision pertains.

Sociological Perspectives on the Quality of Life Correlated with the State of Health

“…Increasing the health level can be solved by improving social and environmental conditions and promoting individual control. Social change, in the sense of increasing freedom, would lead to the reduction of health inequalities by facilitating individual and community involvement in decisions that may affect life (Stiggelbout et al, 1994).…”

Demographic Differences in Health Preferences in the United States

“…(2–5) Physicians who wish to personalize treatments may prescribe differently or tailor clinic protocols, because they take the time to inquire about the preferences of the patient in front of them and account for the variability of preferences within the clinic populations. (6–8) Knowledge of differences in health preferences also influences study design, particularly quota sampling. For example, if men and women share values on all domains of health, studies that oversample men or women would produce identical results (e.g., U.S. valuation of the EQ-5D).…”

Preferences, Beliefs, and Self‐Management of Diabetes

“… 4 Using the HRS risk tolerance measure, Picone, Sloan, and Taylor (2004) found that risk‐tolerant women were more likely to have regular recommended cancer screenings, which runs counter to the view that such individuals would be the ones least likely to undergo cancer screening. However, Stiggelbout et al (1994) found that more risk‐averse persons with cancer were more likely to undergo chemotherapy rather than only undergo a surveillance protocol. van der Pol and Ruggeri (2008) found that individuals are risk averse with respect to monetary gambles and gambles between immediate death and 5 life years, while individuals were risk seeking with respect to longevity and quality‐of‐life tradeoffs, implying that risk tolerance varies in effect, depending on the outcome being considered. …”