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Wiercioch W, Nieuwlaat R, Dahm P, Iorio A, Mustafa RA, Neumann I, Rochwerg B, Manja V, Alonso-Coello P, Ortel TL, Santesso N, Vesely SK, Akl EA, Schünemann HJ. Development and application of health outcome descriptors facilitated decision-making in the production of practice guidelines. J Clin Epidemiol 2021; 138:115-127. [PMID: 33992716 DOI: 10.1016/j.jclinepi.2021.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 04/06/2021] [Accepted: 04/21/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Stakeholders involved in developing recommendations need to have a common understanding of health outcomes and the perspective of affected individuals. In this paper we report on the development and application of health outcome descriptors (HODs) to inform decision-making by panels developing guideline recommendations. STUDY DESIGN AND SETTING Ten American Society of Hematology guideline panels addressing the management of venous thromboembolism developed HODs, rated their importance and health utility, applied them to prioritize outcomes, and to balance potential benefits and harms to formulate recommendations. RESULTS It was feasible to involve 18 panelists in developing 127 HODs. There was high agreement (82%) across the ten panels about outcomes perceived as critical or important for decision-making. Panelists' utility ratings of the outcomes were strongly correlated with panelists' outcome importance ratings (Pearson's r=-0.88). HODs were incorporated into Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence-to-decision (EtD) frameworks to support a shared understanding of health outcomes in panel deliberations. CONCLUSION HODs serve as a valuable tool to promote an explicit, common understanding of health outcomes during clinical guideline development and across different stakeholders. They are helpful across multiple steps of guideline development to facilitate panels' judgements, aiming to avoid variable implicit interpretations of health outcomes.
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Affiliation(s)
- Wojtek Wiercioch
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Robby Nieuwlaat
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA; Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS USA
| | - Ignacio Neumann
- Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Veena Manja
- Department of Surgery, University of California Davis, CA, USA; Department of Medicine, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Thomas L Ortel
- Departments of Medicine and Pathology, Duke University Medical Center, Durham, NC, USA
| | - Nancy Santesso
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Sara K Vesely
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Internal Medicine, American University of Beirut, Lebanon
| | - Holger J Schünemann
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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2
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Baldeh T, Saz-Parkinson Z, Muti P, Santesso N, Morgano GP, Wiercioch W, Nieuwlaat R, Gräwingholt A, Broeders M, Duffy S, Hofvind S, Nystrom L, Ioannidou-Mouzaka L, Warman S, McGarrigle H, Knox S, Fitzpatrick P, Rossi PG, Quinn C, Borisch B, Lebeau A, de Wolf C, Langendam M, Piggott T, Giordano L, van Landsveld-Verhoeven C, Bernier J, Rabe P, Schünemann HJ. Development and use of health outcome descriptors: a guideline development case study. Health Qual Life Outcomes 2020; 18:167. [PMID: 32503619 PMCID: PMC7275587 DOI: 10.1186/s12955-020-01338-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 03/23/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND During healthcare guideline development, panel members often have implicit, different definitions of health outcomes that can lead to misunderstandings about how important these outcomes are and how to balance benefits and harms. McMaster GRADE Centre researchers developed 'health outcome descriptors' for standardizing descriptions of health outcomes and overcoming these problems to support the European Commission Initiative on Breast Cancer (ECIBC) Guideline Development Group (GDG). We aimed to determine which aspects of the development, content, and use of health outcome descriptors were valuable to guideline developers. METHODS We developed 24 health outcome descriptors related to breast cancer screening and diagnosis for the European Commission Breast Guideline Development Group (GDG). Eighteen GDG members provided feedback in written format or in interviews. We then evaluated the process and conducted two health utility rating surveys. RESULTS Feedback from GDG members revealed that health outcome descriptors are probably useful for developing recommendations and improving transparency of guideline methods. Time commitment, methodology training, and need for multidisciplinary expertise throughout development were considered important determinants of the process. Comparison of the two health utility surveys showed a decrease in standard deviation in the second survey across 21 (88%) of the outcomes. CONCLUSIONS Health outcome descriptors are feasible and should be developed prior to the outcome prioritization step in the guideline development process. Guideline developers should involve a subgroup of multidisciplinary experts in all stages of development and ensure all guideline panel members are trained in guideline methodology that includes understanding the importance of defining and understanding the outcomes of interest.
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Affiliation(s)
- Tejan Baldeh
- Department of Health Research Methodology, Evidence and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada.,Michael G. DeGroote Cochrane Canada and MacGRADE Centres, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Zuleika Saz-Parkinson
- European Commission, Joint Research Centre (JRC), Via E. Fermi 2749 - TP 127, I-21027, Ispra, VA, Italy
| | - Paola Muti
- Department of Health Research Methodology, Evidence and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada.,Department of Oncology, McMaster University, Hamilton, Canada
| | - Nancy Santesso
- Department of Health Research Methodology, Evidence and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada.,Michael G. DeGroote Cochrane Canada and MacGRADE Centres, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.,Cochrane GRADEing Methods Group, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Gian Paolo Morgano
- Department of Health Research Methodology, Evidence and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada.,Michael G. DeGroote Cochrane Canada and MacGRADE Centres, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Wojtek Wiercioch
- Department of Health Research Methodology, Evidence and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada.,Michael G. DeGroote Cochrane Canada and MacGRADE Centres, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Robby Nieuwlaat
- Department of Health Research Methodology, Evidence and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada.,Michael G. DeGroote Cochrane Canada and MacGRADE Centres, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Axel Gräwingholt
- European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy.,Private Group Practice for Radiology, Radiologie am Theater, Paderborn, Germany
| | - Mireille Broeders
- European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy.,Department for Health Evidence, Radboud University Medical Center, PO Box 9101, 6525 EZ, HB, Nijmegen, The Netherlands.,Dutch Expert Centre for Screening, PO Box 6873, 6503, GJ, Nijmegen, the Netherlands
| | - Stephen Duffy
- European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy.,Centre for Cancer Prevention, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, United Kingdom
| | - Solveig Hofvind
- European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy.,Cancer Registry of Norway, PO 5313, Majorstua, 0304, Oslo, Norway.,Oslo Metropolitan University, Pilestredet 48, 0167, Oslo, Norway
| | - Lennarth Nystrom
- European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy.,Umeå University, 90187, Umeå, Sweden
| | - Lydia Ioannidou-Mouzaka
- European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy.,Leto Gynecological-Surgical and Obstetrical Clinic, 18, Avenue Kifissias, 11526, Athens, Greece
| | - Sue Warman
- European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy
| | - Helen McGarrigle
- European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy.,Cardiff and Vale Breast Centre, University Hospital Llandough, Llandough, United Kingdom
| | - Susan Knox
- European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy.,EUROPA DONNA - The European Breast Cancer Coalition, Piazza Amendola 3, 20149, Milan, Italy
| | - Patricia Fitzpatrick
- European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy.,National Screening Service, Kings Inns House, 200 Parnell Street, Dublin, D01 A3Y8, Ireland
| | - Paolo Giorgi Rossi
- European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy.,Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Cecily Quinn
- European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy.,School of Medicine, University College Dublin, BreastCheck, Irish National Breast Screening Programme, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Bettina Borisch
- European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy.,Insitute of Global Health, University of Geneva, chemin des Mines 9, 1202, Geneva, Switzerland
| | - Annette Lebeau
- European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy.,Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Chris de Wolf
- European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy
| | - Miranda Langendam
- Cochrane GRADEing Methods Group, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.,European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Thomas Piggott
- Department of Health Research Methodology, Evidence and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada
| | - Livia Giordano
- European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy.,CPO Piedmont-AOU Citta della Salute e della Scienza, via Cavour 31, 10131, Turin, Italy
| | - Cary van Landsveld-Verhoeven
- European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy.,Dutch Expert Centre for Screening, PO Box 6873, 6503, GJ, Nijmegen, the Netherlands
| | - Jacques Bernier
- European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy
| | - Peter Rabe
- European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy
| | - Holger J Schünemann
- Department of Health Research Methodology, Evidence and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada. .,Michael G. DeGroote Cochrane Canada and MacGRADE Centres, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada. .,Cochrane GRADEing Methods Group, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada. .,European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy. .,Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
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Hajdu K, Brodszky V, Stalmeier PFM, Ruzsa G, Tamási B, Gulácsi L, Péntek M, Sárdy M, Bata-Csörgő Z, Kinyó Á, Szegedi A, Rencz F. Patient-assigned health utility values for controlled and uncontrolled pemphigus vulgaris and foliaceus. J Eur Acad Dermatol Venereol 2019; 33:2106-2113. [PMID: 31265151 DOI: 10.1111/jdv.15765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 06/19/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The assessment of health-related quality of life (HRQoL) in patients with pemphigus is now of increasing interest due to the availability of highly effective new therapies. Preference-based HRQoL values or health utilities required for medical and financial decision-making are not yet available directly from pemphigus patients. OBJECTIVE To obtain health utility values for current health and hypothetical health states from the perspective of pemphigus patients. METHODS A cross-sectional questionnaire survey was carried out with pemphigus patients. Disease severity was rated by Autoimmune Bullous Skin Disorder Intensity Score (ABSIS). Patients were asked to evaluate their current health as well as three common hypothetical pemphigus health states [uncontrolled pemphigus vulgaris (PV), uncontrolled pemphigus foliaceus (PF) and controlled PV/PF] by using composite time trade-off (cTTO). Multiple regression was applied to explore determinants of utility values. RESULTS Responses of 108 patients (64.8% women, mean age 57.4 years) were analysed. Mean ABSIS score was 11.6. The mean utility values for the hypothetical uncontrolled PV, uncontrolled PF and controlled PV/PF health states were 0.41, 0.52 and 0.66 with cTTO. The mean cTTO scores for current health were higher compared with the hypothetical health states (0.76; P < 0.001). Patients with higher ABSIS, worse pain intensity scores and those having a caregiver reported lower utility values for current health (P < 0.05). CONCLUSIONS In pemphigus, HRQoL impairment expressed in utility values seems to be considerable, especially in comparison with other chronic dermatological conditions (e.g. psoriasis, atopic eczema, chronic hand eczema). These health utilities inform physicians, policymakers and funders about the overall extent of health loss in pemphigus and provide evidence to guide medical decisions and cost-effectiveness analyses of treatment strategies. Future research is needed to evaluate the caregiver burden in pemphigus.
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Affiliation(s)
- K Hajdu
- Departments of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Dermatological Allergology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - V Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - P F M Stalmeier
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - G Ruzsa
- Doctoral School of Psychology, Institute of Psychology, Eötvös Loránd University of Sciences, Budapest, Hungary.,Department of Statistics, Corvinus University of Budapest, Budapest, Hungary
| | - B Tamási
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - L Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - M Péntek
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - M Sárdy
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Z Bata-Csörgő
- Department of Dermatology and Allergology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Á Kinyó
- Department of Dermatology, Venereology and Oncodermatology, University of Pécs, Pécs, Hungary
| | - A Szegedi
- Departments of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Dermatological Allergology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - F Rencz
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.,Hungarian Academy of Sciences, Premium Postdoctoral Research Program, Budapest, Hungary
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4
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Pahuta M, Frombach A, Hashem E, Spence S, Sun C, Wai EK, Werier J, van Walraven C, Coyle D. The Psychometric Properties of a Self-Administered, Open-Source Module for Valuing Metastatic Epidural Spinal Cord Compression Utilities. Pharmacoecon Open 2019; 3:197-204. [PMID: 30178420 PMCID: PMC6533369 DOI: 10.1007/s41669-018-0092-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Web surveys are often used for utility valuation. Typically, custom utility valuation tools that have not undergone psychometric evaluation are used. OBJECTIVES This study aimed to determine the psychometric properties of a metastatic epidural spinal cord compression (MESCC) module run on a customizable open-source, internet-based, self-directed utility valuation platform (Self-directed Online Assessment of Preferences [SOAP]). METHODS Individuals accompanying patients to the emergency department waiting room in Ottawa, Canada, were recruited. Participants made SOAP MESCC health state valuations in the waiting room and 48 h later at home. Validity, agreement reliability, and responsiveness were measured by logical consistency of responses, smallest detectable change, the interclass correlation coefficient, and Guyatt's responsiveness index, respectively. RESULTS Of 285 participants who completed utility valuations, only 113 (39.6%) completed the re-test. Of these 113 participants, 92 (81.4%) provided valid responses on the first test and 75 (66.4%) provided valid responses on the test and re-test. Agreement for all groups of health states was adequate, since their smallest detectable change was less than the minimal clinically important difference. The mean interclass correlation coefficients for all health states were > 0.8, indicating at least substantial reliability. Guyatt's responsiveness indices all exceeded 0.80, indicating a high level of responsiveness. CONCLUSIONS To our knowledge, this is the first validated open-source, web-based, self-directed utility valuation module. We have demonstrated the SOAP MESCC module is valid, reproducible, and responsive for obtaining ex ante utilities. Considering the successful psychometric validation of the SOAP MESCC module, other investigators can consider developing modules for other diseases where direct utility valuation is needed.
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Affiliation(s)
- Markian Pahuta
- Department of Orthopaedic Surgery, Henry Ford Health System, 2799 West Grand Blvd, CFP-6, Detroit, MI USA
| | | | | | | | | | - Eugene K. Wai
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON Canada
| | - Joel Werier
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON Canada
| | - Carl van Walraven
- Department of Epidemiology and Community Medicine, Institute for Clinical Evaluative Sciences, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
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5
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Rencz F, Stalmeier PFM, Péntek M, Brodszky V, Ruzsa G, Gönczi L, Palatka K, Herszényi L, Schäfer E, Banai J, Rutka M, Gulácsi L, Lakatos PL. Patient and general population values for luminal and perianal fistulising Crohn's disease health states. Eur J Health Econ 2019; 20:91-100. [PMID: 31102158 PMCID: PMC6544586 DOI: 10.1007/s10198-019-01065-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/13/2019] [Indexed: 05/04/2023]
Abstract
BACKGROUND In patients with Crohn's disease (CD), luminal disease activity paralleled by perianal fistulas may seriously impair health-related quality of life (HRQoL). Health utility values are not available from patients with CD that reflect the health loss associated with both luminal and perianal CD. OBJECTIVE To generate utilities for luminal and concomitant perianal fistulising CD health states directly from patients and from members of the general public. METHODS A cross-sectional survey was undertaken enrolling CD patients and a convenience sample of members of the general population. Respondents were asked to evaluate four common CD heath states [severe luminal disease (sCD), mild luminal disease (mCD), severe luminal disease with active perianal fistulas (sPFCD), and mild luminal disease with active perianal fistulas (mPFCD)] by 10-year time trade-off (TTO). In addition, patients assessed their current HRQoL by the TTO method. RESULTS Responses of 206 patients (40.8% with perianal fistulas) and 221 members of the general population were analysed. Mean ± SD utilities among patients for sPFCD, sCD, mPFCD and mCD states were 0.69 ± 0.33, 0.73 ± 0.31, 0.80 ± 0.29 and 0.87 ± 0.26. Corresponding values in the general public were: 0.59 ± 0.31, 0.65 ± 0.29, 0.80 ± 0.26 and 0.88 ± 0.25. Patients with active perianal fistulas, previous non-resection surgeries, and higher pain intensity scores valued their current health as worse (p < 0.05). CONCLUSIONS TTO is a feasible method to assess HRQoL in patients with perianal fistulising disease, often not captured by health status questionnaires. Utilities from this study are intended to support the optimization of treatment-related decision making in patients with luminal disease paralleled by active perianal fistulas.
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Affiliation(s)
- Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary.
- Premium Postdoctoral Research Program, Hungarian Academy of Sciences, Nádor u. 7, 1051, Budapest, Hungary.
| | - Peep F M Stalmeier
- Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary
| | - Gábor Ruzsa
- Doctoral School of Psychology, Institute of Psychology, Eötvös Loránd University of Sciences, Izabella u. 46, 1064, Budapest, Hungary
- Department of Statistics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary
| | - Lóránt Gönczi
- 1st Department of Medicine, Semmelweis University, Korányi Sándor u. 2/a, 1083, Budapest, Hungary
| | - Károly Palatka
- Division of Gastroenterology, Department of Internal Medicine, University of Debrecen, Nagyerdei krt. 98, 4032, Debrecen, Hungary
| | - László Herszényi
- Medical Centre, Hungarian Defence Forces, Podmaniczky u. 109-111, 1062, Budapest, Hungary
| | - Eszter Schäfer
- Medical Centre, Hungarian Defence Forces, Podmaniczky u. 109-111, 1062, Budapest, Hungary
| | - János Banai
- Medical Centre, Hungarian Defence Forces, Podmaniczky u. 109-111, 1062, Budapest, Hungary
| | - Mariann Rutka
- 1st Department of Internal Medicine, University of Szeged, Korányi fasor 8-10, 6720, Szeged, Hungary
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary
| | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Korányi Sándor u. 2/a, 1083, Budapest, Hungary
- Division of Gastroenterology, McGill University, MUHC, Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
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Zhang Y, Tikkinen KAO, Agoritsas T, Ayeni OR, Alexander P, Imam M, Yoo D, Tsalatsanis A, Djulbegovic B, Thabane L, Schünemann H, Guyatt GH. Patients' values and preferences of the expected efficacy of hip arthroscopy for osteoarthritis: a protocol for a multinational structured interview-based study combined with a randomised survey on the optimal amount of information to elicit preferences. BMJ Open 2014; 4:e005536. [PMID: 25326208 PMCID: PMC4202002 DOI: 10.1136/bmjopen-2014-005536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Symptomatic hip osteoarthritis (OA) is a disabling condition with up to a 25% cumulative lifetime risk. Total hip arthroplasty (THA) is effective in relieving patients' symptoms and improving function. It is, however, associated with substantial risk of complications, pain and major functional limitation before patients can return to full function. In contrast, hip arthroscopy (HA) is less invasive and can postpone THA. However, there is no evidence regarding the delay in the need for THA that patients would find acceptable to undergoing HA. Knowing patients' values and preferences (VP) on this expected delay is critical when making recommendations regarding the advisability of HA. Furthermore, little is known on the optimal amount of information regarding interventions and outcomes needed to present in order to optimally elicit patients' VP. METHODS AND ANALYSIS We will perform a multinational, structured interview-based survey of preference in delay time for THA among patients with non-advanced OA who failed to respond to conservative therapy. We will combine these interviews with a randomised trial addressing the optimal amount of information regarding the interventions and outcomes required to elicit preferences. Eligible patients will be randomly assigned (1 : 1) to either a short or a long format of health scenarios of THA and HA. We will determine each patient's VP using a trade-off and anticipated regret exercises. Our primary outcomes for the combined surveys will be: (1) the minimal delay time in the need for THA surgery that patients would find acceptable to undertaking HA, (2) patients' satisfaction with the amount of information provided in the health scenarios used to elicit their VPs. ETHICS AND DISSEMINATION The protocol has been approved by the Hamilton Integrated Research Ethics Board (HIREB13-506). We will disseminate our study findings through peer-reviewed publications and conference presentations, and make them available to guideline makers issuing recommendations addressing HA and THA.
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Affiliation(s)
- Yuqing Zhang
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Kari A O Tikkinen
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Departments of Urology and Public Health, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Thomas Agoritsas
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Paul Alexander
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Maha Imam
- Faculty of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Daniel Yoo
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Benjamin Djulbegovic
- Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Holger Schünemann
- Department of Clinical Epidemiology and Biostatistics, and Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gordon H Guyatt
- Department of Clinical Epidemiology and Biostatistics, and Medicine, McMaster University, Hamilton, Ontario, Canada
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Santesso N, Rader T, Nilsen ES, Glenton C, Rosenbaum S, Ciapponi A, Moja L, Pardo JP, Zhou Q, Schünemann HJ. A summary to communicate evidence from systematic reviews to the public improved understanding and accessibility of information: a randomized controlled trial. J Clin Epidemiol 2014; 68:182-90. [PMID: 25034199 DOI: 10.1016/j.jclinepi.2014.04.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/01/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate a new format of a summary, which presents research from synthesized evidence to patients and the public. STUDY DESIGN AND SETTING We conducted a randomized controlled trial in 143 members of the public from five countries (Canada, Norway, Spain, Argentina, and Italy). Participants received either a new summary format (a plain language summary [PLS]) or the current format used in Cochrane systematic reviews. The new PLS presents information about the condition and intervention, a narrative summary of results, and a table of results with absolute numbers for effects of the intervention and quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation. RESULTS With the new PLS, more participants understood the benefits and harms and quality of evidence (53% vs. 18%, P < 0.001); more answered each of the five questions correctly (P ≤ 0.001 for four questions); and they answered more questions correctly, median 3 (interquartile range [IQR]: 1-4) vs. 1 (IQR: 0-1), P < 0.001). Better understanding was independent of education level. More participants found information in the new PLS reliable, easy to find, easy to understand, and presented in a way that helped make decisions. Overall, participants preferred the new PLS. CONCLUSION This new PLS format for patients and the public is a promising tool to translate evidence from synthesized research.
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Affiliation(s)
- Nancy Santesso
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4L8.
| | - Tamara Rader
- Cochrane Musculoskeletal Group, Institute of Population Health, University of Ottawa, 1 Stewart St., Ottawa, Ontario, Canada K1N 6N5
| | - Elin Strømme Nilsen
- The Norwegian Branch of the Nordic Cochrane Centre, Norwegian Knowledge Centre for the Health Services, Pilestredet Park 7, 0130 Oslo, Norway
| | - Claire Glenton
- The Norwegian Branch of the Nordic Cochrane Centre, Norwegian Knowledge Centre for the Health Services, Pilestredet Park 7, 0130 Oslo, Norway
| | - Sarah Rosenbaum
- The Norwegian Branch of the Nordic Cochrane Centre, Norwegian Knowledge Centre for the Health Services, Pilestredet Park 7, 0130 Oslo, Norway
| | - Agustín Ciapponi
- Argentine Cochrane Centre, Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024, Buenos Aires, Argentina C1414CPV - C1181ACH
| | - Lorenzo Moja
- Department of Biomedical Sciences for Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Clinical Epidemiology Unit, IRCCS Orthopedic Institute Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy
| | - Jordi Pardo Pardo
- Cochrane Musculoskeletal Group, Institute of Population Health, University of Ottawa, 1 Stewart St., Ottawa, Ontario, Canada K1N 6N5
| | - Qi Zhou
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4L8
| | - Holger J Schünemann
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4L8; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4L8
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8
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Glenton C, Santesso N, Rosenbaum S, Nilsen ES, Rader T, Ciapponi A, Dilkes H. Presenting the results of Cochrane Systematic Reviews to a consumer audience: a qualitative study. Med Decis Making 2010; 30:566-77. [PMID: 20643912 DOI: 10.1177/0272989x10375853] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To develop and obtain feedback about a summary format for Cochrane reviews that is accessible to a consumer audience, without oversimplification or incorrect presentation. METHODS We developed 3 versions of a Plain Language Summary (PLS) format of a Cochrane Systematic Review. Using a semi-structured interview guide we tested these versions among 34 members of the public in Norway, Argentina, Canada, and Australia. The authors analyzed feedback, identified problems, and generated new solutions before retesting to produce a final version of a Plain Language Summary format. RESULTS Participants preferred results presented as words, supplemented by numbers in a table. There was a lack of understanding regarding the difference between a review and an individual study, that the effect is rarely an exact number, that evidence can be of low or high quality, and that level of quality is a separate issue from intervention effect. Participants also found it difficult to move between presentations of dichotomous and continuous outcomes. Rephrasing the introduction helped participants grasp the concept of a review. Confidence intervals were largely ignored or misunderstood. Our attempts to explain them were only partially successful. Text modifiers (''probably,'' ''may'') to convey different levels of quality were only partially understood, whereas symbols with explanations were more helpful. Participants often understood individual information elements about effect size and quality of these results, but did not always actively merge these elements. CONCLUSION Through testing and iteration the authors identified and addressed several problems, using explanations, rephrasing, and symbols to present scientific concepts. Other problems remain, including how best to present confidence intervals and continuous outcomes. Future research should also test information elements in combination rather than in isolation. The new Plain Language Summary format is being evaluated in a randomized controlled trial.
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Affiliation(s)
- Claire Glenton
- Norwegian Branch of the Nordic Cochrane Centre, Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
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Abstract
The impact that research evidence can have on patients making decisions about their own care is often overlooked. Regardless of whether patients want to lead or fully participate in their care, it appears that patients still want to be informed. We have health information that patients could benefit from knowing, a growing body of evidence and experiences about how to translate this information to patients. The Cochrane Collaboration, an organisation that produces and disseminates systematic reviews of healthcare interventions, translates the evidence from their reviews into summaries for the public. Research is presently being conducted to test a format for the plain language summaries. Principles such as presenting evidence in standard qualitative statements, as relative and absolute risks, as natural frequencies, and in tables are being incorporated into the format. Groups within the Collaboration are also translating the evidence for use by patients and the public. Effective strategies are being used to target patients directly and via their physicians, such as dissemination on specific patient group websites and decision aids. Research evidence and experiences can feed into the creation of evidence that patients can understand and use.
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Affiliation(s)
- Nancy Santesso
- IFO Italian National Cancer Institute Regina Elena, Rome, Italy.
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Abstract
A general population sample of 104 Australian respondents completed an interviewer-administered contingent valuation (CV) survey that asked them to value five scenarios representing the same core improvement in health status. These scenarios varied only in the degree of narrative used to describe the condition causing the health problem being valued and labeling of this health problem. Results indicate no significant difference in willingness to pay (WTP) between expressing symptoms as a brief or moderate narrative, but a significantly lower WTP value when expressed in an extensive narrative. WTP also differed significantly according to condition 'labels'. Possible implications for CV research are outlined.
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Affiliation(s)
- Richard D Smith
- Health Policy Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
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11
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Levy AR, Kowdley KV, Iloeje U, Tafesse E, Mukherjee J, Gish R, Bzowej N, Briggs AH. The impact of chronic hepatitis B on quality of life: a multinational study of utilities from infected and uninfected persons. Value Health 2008; 11:527-38. [PMID: 18179664 DOI: 10.1111/j.1524-4733.2007.00297.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Chronic hepatitis B (CHB) is a condition that results in substantial morbidity and mortality worldwide because of progressive liver damage. Investigators undertaking economic evaluations of new therapeutic agents require estimates of health-related quality of life (HRQOL). Recently, evidence has begun to accumulate that differences in cultural backgrounds have a quantifiable impact on perceptions of health. The objective was to elicit utilities for six health states that occur after infection with the hepatitis B virus from infected and uninfected respondents living in jurisdictions with low and with high CHB endemicity. METHODS Standard gamble utilities were elicited from hepatitis patients and uninfected respondents using an interviewer-administered survey in the United States, Canada, United Kingdom, Spain, Hong Kong, and mainland China. Generalized linear models were used to the effect on utilities of current health, age and sex, jurisdiction and, for infected respondents, current disease state. RESULTS The sample included 534 CHB-infected patients and 600 uninfected respondents. CHB and compensated cirrhosis had a moderate impact on HRQOL with utilities ranging from 0.68 to 0.80. Decompensated cirrhosis and hepatocellular carcinoma had a stronger impact with utilities ranging from 0.35 to 0.41. Significant variation was observed between countries, with both types of respondents in mainland China and Hong Kong reporting systematically lower utilities. CONCLUSIONS Health states related to CHB infection have substantial reductions in HRQOL and the utilities reported in this study provide valuable information for comparing new treatment options. The observed intercountry differences suggest that economic evaluations may benefit from country-specific utility estimates. The extent that systematic intercountry differences in utilities hold true for other infectious and chronic diseases remains an open question and has considerable implications for the proper conduct and interpretation of economic evaluations.
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Bremner KE, Tomlinson G, Krahn MD. Marker states and a health state prompt provide modest improvements in the reliability and validity of the standard gamble and rating scale in prostate cancer patients. Qual Life Res 2007; 16:1665-75. [PMID: 17912614 DOI: 10.1007/s11136-007-9264-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Accepted: 09/11/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the combined effect of marker states and a prompt on the reliability and validity of direct utility assessment. METHODS In a structured interview, 141 prostate cancer (PC) patients provided rating scale (RS) and standard gamble (SG) utilities for their "own health" (RS-/SG-). Following self-completion of comparison instruments (two generic utility and one disease-specific psychometric), they answered a checklist of PC-related items (a prompt to consider self-health) and provided utilities for self-health and mild and severe PC marker states (RS+/SG+). The interview was repeated 5 weeks later, but without comparison instruments. Using Bayesian modeling, we computed and compared correlation coefficients to assess RS and SG test-retest reliability and validity and the effects of the prompt and marker states. RESULTS RS and SG had acceptable test-retest reliability (intraclass correlation coefficients = 0.57-0.63). The prompt and marker states decreased the reliability of the RS by 0.01 (from 0.58 to 0.57) but increased the reliability of the SG by 0.05 (from 0.58 to 0.63). The probability that the reliability of the SG+ was greater than that of the SG- was very high (0.96). Correlations with comparison instruments were higher by 0.01-0.06 for RS+ vs RS-, and higher by 0.03-0.06 for SG+ vs SG-. The probabilities that the prompt and marker states improved validity ranged from 0.55 to 0.74 (RS), and from 0.61 to 0.70 (SG). CONCLUSIONS A self-health description prompt and marker states modestly improved the reliability and validity of direct utility elicitation.
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Affiliation(s)
- Karen E Bremner
- Toronto General Hospital, University Health Network, Toronto, ON, Canada.
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13
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Schünemann HJ, Norman G, Puhan MA, Ståhl E, Griffith L, Heels-Ansdell D, Montori VM, Wiklund I, Goldstein R, Mador MJ, Guyatt GH. Application of generalizability theory confirmed lower reliability of the standard gamble than the feeling thermometer. J Clin Epidemiol 2007; 60:1256-62. [PMID: 17998080 DOI: 10.1016/j.jclinepi.2007.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Revised: 03/08/2007] [Accepted: 03/24/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Recent studies suggest that rating clinical marker states (CMS) does not improve the measurement properties of the standard gamble (SG) and only slightly improves those of the feeling thermometer (FT). The poor intrarater (test-retest) reliability of CMS may explain their meager performance. Further, lack of interrater reliability may compromise the use of CMS in interpreting health state ratings. The aim of this study was to assess the reliability of CMS ratings for the SG and the FT. STUDY DESIGN AND SETTING Two similar studies in patients with chronic obstructive pulmonary disease (COPD, n=91) and in patients with gastroesophageal reflux disease (GERD, n=112) provided data for this analysis. Patients rated three different CMS (mild, moderate, and severe disease) twice several weeks apart. We used generalizability theory to calculate reliability coefficients. RESULTS Test-retest reliability for CMS ratings was higher for the FT compared to the SG (COPD: 0.86 vs. 0.67; GERD: 0.86 vs. 0.67). Interrater reliability was much higher for the FT compared to the SG (COPD: 0.78 vs. 0.46; GERD: 0.71 vs. 0.26). CONCLUSIONS These results suggest that the markedly poorer reliability of CMS for the SG than the FT is driven largely by poor interrater reliability.
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Affiliation(s)
- Holger J Schünemann
- Department of Epidemiology, INFORMA Unit/CLARITY Research Group, Italian National Cancer Institute Regina Elena, Via Elio Chianesi 53, 00144 Rome, Italy.
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Stein K, Sugar C, Velikova G, Stark D. Putting the ‘Q’ in quality adjusted life years (QALYs) for advanced ovarian cancer – An approach using data clustering methods and the internet. Eur J Cancer 2007; 43:104-13. [PMID: 17095206 DOI: 10.1016/j.ejca.2006.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Revised: 09/13/2006] [Accepted: 09/20/2006] [Indexed: 11/20/2022]
Abstract
There are few clearly described utility studies in advanced ovarian cancer, despite the public health importance of condition and the need for preference based measures of quality of life in economic evaluation of the new treatments. We used data clustering techniques to develop health state descriptions based on data from 66 women who completed the EORTC QLQ-C30 over a six month period while receiving chemotherapy for ovarian cancer. The health state descriptions were presented to a group of members of the general public (n=38), via the internet, and preferences elicited using the standard gamble technique. Mean utility values ranged from 0.685 to 0.977, although the range of individual preferences was wider, including values as low as 0.125. This is the first study to use data clustering methods combined with internet preference elicitation in oncology. The resulting health state model is parsimonious, data driven, and incorporates quality of life items tailored to cancer. The estimates therefore meet the needs of policy makers while reflecting more accurately the experience of disease than those based on generic preference measures.
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Affiliation(s)
- Ken Stein
- Peninsula Technology Assessment Group, Peninsula Medical School, University of Exeter, Noy Scott House, Barrack Road, Exeter, Devon EX2 5DW, United Kingdom.
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Stein K, Dyer M, Crabb T, Milne R, Round A, Ratcliffe J, Brazier J. A pilot Internet "value of health" panel: recruitment, participation and compliance. Health Qual Life Outcomes 2006; 4:90. [PMID: 17129380 PMCID: PMC1716763 DOI: 10.1186/1477-7525-4-90] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Accepted: 11/27/2006] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To pilot using a panel of members of the public to provide preference data via the Internet METHODS A stratified random sample of members of the general public was recruited and familiarized with the standard gamble procedure using an Internet based tool. Health states were periodically presented in "sets" corresponding to different conditions, during the study. The following were described: Recruitment (proportion of people approached who were trained); Participation (a) the proportion of people trained who provided any preferences and (b) the proportion of panel members who contributed to each "set" of values; and Compliance (the proportion, per participant, of preference tasks which were completed). The influence of covariates on these outcomes was investigated using univariate and multivariate analyses. RESULTS A panel of 112 people was recruited. 23% of those approached (n = 5,320) responded to the invitation, and 24% of respondents (n = 1,215) were willing to participate (net = 5.5%). However, eventual recruitment rates, following training, were low (2.1% of those approached). Recruitment from areas of high socioeconomic deprivation and among ethnic minority communities was low. Eighteen sets of health state descriptions were considered over 14 months. 74% of panel members carried out at least one valuation task. People from areas of higher socioeconomic deprivation and unmarried people were less likely to participate. An average of 41% of panel members expressed preferences on each set of descriptions. Compliance ranged from 3% to 100%. CONCLUSION It is feasible to establish a panel of members of the general public to express preferences on a wide range of health state descriptions using the Internet, although differential recruitment and attrition are important challenges. Particular attention to recruitment and retention in areas of high socioeconomic deprivation and among ethnic minority communities is necessary. Nevertheless, the panel approach to preference measurement using the Internet offers the potential to provide specific utility data in a responsive manner for use in economic evaluations and to address some of the outstanding methodological uncertainties in this field.
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Affiliation(s)
- Ken Stein
- Peninsula Technology Assessment Group, Peninsula Medical School, University of Exeter, Noy Scott House, Barrack Road, Exeter, EX2 5DW, UK
| | - Matthew Dyer
- Peninsula Technology Assessment Group, Peninsula Medical School, University of Exeter, Noy Scott House, Barrack Road, Exeter, EX2 5DW, UK
| | - Tania Crabb
- Peninsula Technology Assessment Group, Peninsula Medical School, University of Exeter, Noy Scott House, Barrack Road, Exeter, EX2 5DW, UK
| | - Ruairidh Milne
- National Coordinating Centre for Health Technology Assessment, University of Southampton, Boldrewood, Bassett Crescent East, Southampton, SO16 7PX, UK
| | - Alison Round
- Peninsula Technology Assessment Group, Peninsula Medical School, University of Exeter, Noy Scott House, Barrack Road, Exeter, EX2 5DW, UK
| | - Julie Ratcliffe
- Sheffield Health Economics Group, School of Health and Related Research (ScHARR), University of Sheffield, 30 Regent Court, Sheffield, S1 4DA, UK
| | - John Brazier
- Sheffield Health Economics Group, School of Health and Related Research (ScHARR), University of Sheffield, 30 Regent Court, Sheffield, S1 4DA, UK
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Stein K, Ratcliffe J, Round A, Milne R, Brazier JE. Impact of discussion on preferences elicited in a group setting. Health Qual Life Outcomes 2006; 4:22. [PMID: 16571106 PMCID: PMC1440847 DOI: 10.1186/1477-7525-4-22] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Accepted: 03/29/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The completeness of preferences is assumed as one of the axioms of expected utility theory but has been subject to little empirical study. METHODS Fifteen non-health professionals was recruited and familiarised with the standard gamble technique. The group then met five times over six months and preferences were elicited independently on 41 scenarios. After individual valuation, the group discussed the scenarios, following which preferences could be changed. Changes made were described and summary measures (mean and median) before and after discussion compared using paired t test and Wilcoxon Signed Rank Test. Semi-structured telephone interviews were carried out to explore attitudes to discussing preferences. These were transcribed, read by two investigators and emergent themes described. RESULTS Sixteen changes (3.6%) were made to preferences by seven (47%) of the fifteen members. The difference between individual preference values before and after discussion ranged from -0.025 to 0.45. The average effect on the group mean was 0.0053. No differences before and after discussion were statistically significant. The group valued discussion highly and suggested it brought four main benefits: reassurance; improved procedural performance; increased group cohesion; satisfying curiosity. CONCLUSION The hypothesis that preferences are incomplete cannot be rejected for a proportion of respondents. However, brief discussion did not result in substantial number of changes to preferences and these did not have significant impact on summary values for the group, suggesting that incompleteness, if present, may not have an important effect on cost-utility analyses.
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Affiliation(s)
- Ken Stein
- Peninsula Technology Assessment Group, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, EX2 5DW, UK
| | | | - Ali Round
- Peninsula Technology Assessment Group, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, EX2 5DW, UK
| | - Ruairidh Milne
- National Coordinating Centre for Health Technology Assessment, University of Southampton, UK
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Schünemann HJ, Goldstein R, Mador MJ, McKim D, Stahl E, Griffith LE, Bayoumi AM, Austin P, Guyatt GH. Do Clinical Marker States Improve Responsiveness and Construct Validity of the Standard Gamble and Feeling Thermometer: A Randomized Multi-Center Trial in Patients with Chronic Respiratory Disease. Qual Life Res 2006; 15:1-14. [PMID: 16411026 DOI: 10.1007/s11136-005-0126-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND Optimizing the validity and responsiveness of utility measures will enhance their usefulness in randomized trials. We evaluated the impact of clinical marker state (CMS) rating prior to patients' rating their own health on two utility instruments (feeling thermometer (FT) and standard gamble (SG)) in patients with chronic respiratory disease (CRD). METHODS We randomized 182 patients with CRD to complete the FT (self-administered) and SG with CMS (FT+/SG+, n=91) or without marker states (FT-/SG-, n=91) before and after undergoing respiratory rehabilitation in a multi-center trial. RESULTS Use of CMS did not influence baseline utility scores. Improvement after therapy on the scale from 0 (dead) to 1.0 (full health) was 0.04 both in FT+ (p=0.03) and FT- (p=0.02; the difference between FT+ and FT- was 0.00, p=0.83). Improvement on the SG was 0.05 in both SG+ (p=0.08) and SG- (p=0.04; difference between SG+ and SG- 0.00, p=0.95). Correlations with other health related quality of life scores were highest for FT+. CONCLUSION Administration of CMS did not improve responsiveness of the FT but may have improved construct validity. The SG showed limited construct validity and responsiveness that was not influenced by CMS use.
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Affiliation(s)
- Holger J Schünemann
- Division of Clinical Research Development and INFORMAtion Translation/INFROMA, Italian National Cancer Institute Regina Elena, Rome, Italy.
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Puhan MA, Guyatt GH, Montori VM, Bhandari M, Devereaux PJ, Griffith L, Goldstein R, Schünemann HJ. The standard gamble demonstrated lower reliability than the feeling thermometer. J Clin Epidemiol 2005; 58:458-65. [PMID: 15845332 DOI: 10.1016/j.jclinepi.2004.07.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2004] [Accepted: 07/13/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Participants rated clinical marker states (CMS) to make respondents familiar with the task of preference instruments, ground their ratings in relation to other health states, and help investigators interpret patient ratings. The objective was to assess the reliability of CMS using appropriate reliability statistics. STUDY DESIGN AND SETTING Eighty-one patients rated CMSs for mild, moderate, and severe chronic respiratory disease using the feeling thermometer (FT) and the standard gamble (SG) before and after a 3-month respiratory rehabilitation program. To assess reliability we used (a) intraclass correlation coefficients (ICC) with the variance between CMSs as signal and the variance between raters, the variance within raters, and the signal as noise; (b) scatter plots; and (c) Bland-Altman plots. RESULTS ICCs were 0.47 for the FT and 0.37 for the SG. Scatter and Bland-Altman plots showed large between- and within-person variability; 64.2% and 11.3% of the CMSs ratings were in the correct order on both occasions on the FT and SG, respectively. CONCLUSION Our results suggest moderate reliability of CMSs ratings for the FT and poor reliability for the SG, which may explain their lack of improving the SG's measurement properties. Investigators should use appropriate reliability statistics when addressing related issues.
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Affiliation(s)
- Milo A Puhan
- Horten Center, University of Zurich, Zurich, Switzerland
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Degl' Innocenti A, Guyatt GH, Wiklund I, Heels-Ansdell D, Armstrong D, Fallone CA, Tanser L, van Zanten SV, El-Dika S, Chiba N, Barkun AN, Austin P, Schünemann HJ. The influence of demographic factors and health-related quality of life on treatment satisfaction in patients with gastroesophageal reflux disease treated with esomeprazole. Health Qual Life Outcomes 2005; 3:4. [PMID: 15649314 PMCID: PMC545938 DOI: 10.1186/1477-7525-3-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2004] [Accepted: 01/13/2005] [Indexed: 11/24/2022] Open
Abstract
Background The correlation between treatment satisfaction and demographic characteristics, symptoms, or health-related quality of life (HRQL) in patients with gastroesophageal reflux disease (GERD) is unknown. The objective of this study was to assess correlates of treatment satisfaction in patients with GERD receiving a proton pump inhibitor, esomeprazole. Methods Adult GERD patients (n = 217) completed demography, symptom, HRQL, and treatment satisfaction questionnaires at baseline and/or after treatment with esomeprazole 40 mg once daily for 4 weeks. We used multiple linear regressions with treatment satisfaction as the dependent variable and demographic characteristics, baseline symptoms, baseline HRQL, and change scores in HRQL as independent variables. Results Among the demographic variables only Caucasian ethnicity was positively associated with treatment satisfaction. Greater vitality assessed by the Quality of Life in Reflux and Dyspepsia (QOLRAD) and worse heartburn assessed by a four-symptom scale at baseline, were associated with greater treatment satisfaction. The greater the improvement on the QOLRAD vitality (change score), the more likely the patient is to be satisfied with the treatment. Conclusions Ethnicity, baseline vitality, baseline heartburn severity, and change in QOLRAD vitality correlate with treatment satisfaction in patients with GERD.
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Affiliation(s)
| | - Gordon H Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Diane Heels-Ansdell
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - David Armstrong
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Carlo A Fallone
- Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada
| | | | | | - Samer El-Dika
- Department of Medicine, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Naoki Chiba
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Surrey GI Research/Clinic, Guelph, Ontario, Canada
| | - Alan N Barkun
- Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada
| | - Peggy Austin
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Holger J Schünemann
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
- Department of Social & Preventive Medicine, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, USA
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Fallone CA, Guyatt GH, Armstrong D, Wiklund I, Degl'Innocenti A, Heels-Ansdell D, Barkun AN, Chiba N, Zanten SJOV, El-Dika S, Austin P, Tanser L, Schünemann HJ. Do physicians correctly assess patient symptom severity in gastro-oesophageal reflux disease? Aliment Pharmacol Ther 2004; 20:1161-9. [PMID: 15569119 DOI: 10.1111/j.1365-2036.2004.02257.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The accuracy of physicians' assessment of the severity of gastro-oesophageal reflux disease is unclear. AIM To correlate physician and patient assessment of gastro-oesophageal reflux disease severity and its response to treatment. METHODS Adult uninvestigated gastro-oesophageal reflux disease patients (n = 217) completed symptom and health-related quality of life questionnaires at baseline and after treatment with esomeprazole 40 mg p.o. daily. Pearson coefficients quantified correlations between physician assessments and patient responses. RESULTS At baseline, the strongest correlations were heartburn severity (0.31), overall symptom severity (0.44) and a domain of the quality of life in reflux and dyspepsia questionnaire (0.31) (P < 0.001). Correlations of change with treatment were greater than baseline correlations: heartburn (0.39), overall symptoms (0.50) and global rate of change -- stomach problems (0.72, all P < 0.001). The mean difference between the physicians' assessment of change and the patients' global rating of change was 0.20 (95% confidence intervals: 0.10-0.29) with physicians overestimating benefit. CONCLUSIONS Correlations were often significant, although weak to moderate and better with symptom severity than with health-related quality of life instruments as well as with change after therapy than at baseline. Increasing attention to health-related quality of life may help physicians better understand patients' experience. In clinical trials, treatment success should be assessed by the patient as well as the physician.
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Affiliation(s)
- C A Fallone
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada.
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Schünemann HJ, Armstrong D, Degl'innocenti A, Wiklund I, Fallone CA, Tanser L, Van Zanten SV, Heels-Ansdell D, El-Dika S, Chiba N, Barkun AN, Austin P, Guyatt GH. A Randomized Multicenter Trial to Evaluate Simple Utility Elicitation Techniques in Patients With Gastroesophageal Reflux Disease. Med Care 2004; 42:1132-42. [PMID: 15586841 DOI: 10.1097/00005650-200411000-00013] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite recommendations that patients rating their own health using utility and preference measures such as the feeling thermometer (FT) and standard gamble (SG) should also rate hypothetical marker states, little evidence supports marker state use. We evaluated whether the administration of marker states improves measurement properties of the FT and SG. METHODS We randomized 217 patients with gastroesophageal reflux disease to complete the FT (self-administered) and SG with marker states (FT+ / SG+, n = 112) or without marker states (FT- / SG-, n = 105) before and after 4 weeks of treatment with a proton pump inhibitor, esomeprazole. Patients also completed other health-related quality of life instruments. RESULTS The use of marker states did not influence baseline utility scores (FT+ 0.66, FT- 0.68; SG+ 0.77, SG- 0.78, on a scale from 0 [dead] to 1.0 [full health]). Improvement after therapy was 0.21 in FT+ and 0.15 in FT- (both P < 0.001; difference between FT+ and FT- = 0.06, P = 0.02). Improvement in SG+ was 0.07 (P < 0.001) and 0.06 in SG- (P = 0.003) (difference between SG+ and SG- = 0.01, P = 0.63). Correlations with other health-related quality of life scores were generally stronger, with some statistically significant differences in correlations, for FT+ compared with FT-, but tended to be weaker for SG+ compared with SG-. CONCLUSION The administration of marker states improved the responsiveness and validity of the FT but not of the SG. Decisions about administering marker states should depend on whether the FT and SG is of primary interest and the importance of optimal validity and responsiveness relative to competing objectives such as efficiency.
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Affiliation(s)
- Holger J Schünemann
- Department of Medicine, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
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