Predicting utility ratings for joint health states from single health states in prostate cancer: Empirical testing of 3 alternative theories
Predicting utility ratings for joint health states from single health states in prostate cancer: Empirical testing of 3 alternative theories
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DOI：
10.1177/0272989x07309639
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发表时间：
2008-01-01
影响因子：
3.6
通讯作者：
Meltzer, David
中科院分区：
文献类型：
--
作者：
Dale, William;Basu, Anirban;Meltzer, David
背景成本效益分析通过将公用事业与特定的健康状况相关联来衡量生活质量。实用程序通常由单一的健康状态定义，例如前列腺癌治疗中的失禁或阳痿。健康状况通常同时发生，产生联合健康状态（例如，阳痿伴失禁）。考虑到所涉及的组合数学，即使是少量的条件也可能导致大量的潜在联合状态，使所有相关状态的效用推导变得复杂。对联合状态效用的分析预测基于3个理论模型：1）乘法模型，2）加法模型和3）最小模型。这些模型的经验准确性联合国效用预测已被最低限度地检查。作者比较了这3种模型在前列腺活检时预测男性的联合状态效用和单一状态效用。方法.在2个大学前列腺活检诊所（N = 147）中使用时间权衡收集实用程序。单态效用被引出阳痿，尿失禁，观察等待，和直肠切除术后。联合状态效用被引出用于合并阳萎与1）失禁、2）尿道切除术后或3）观察等待的状态。测试3个预测模型的联合状态效用的偏差和一致性，预测进行了比较，直接引发的联合状态效用。结果三种模型都有偏差。最小模型是首选的，是最小的偏见和最有效的，结论。目前还没有一个模型能够准确地预测联合状态效用，使用组件的单一状态效用。在可能的情况下，应引出联合国公用事业。如果不可能，则建议使用最低型号。需要进行研究以确定更好的模式。
Background. Cost-effectiveness analyses measure quality of life by associating utilities with specific health states. Utililies are often defined by single health states, such as incontinence or impotence in the case of prostate cancer treatments. Health conditions often occur simultaneously, yielding joint health states (e.g., impotence with incontinence). Given the combinatorial mathematics involved, even a small number of conditions can result in large numbers of potential joint states, complicating utility elicitation for all relevant states. Analytic predictions for joint-state utilities have been based on 3 theoretical models: 1) multiplicative, 2) additive, and 3) minimum models. These models' empirical accuracy for joint-state utility prediction has been minimally examined. The authors compared these 3 models for predicting joint-state utilities from single-state utilities in men at the time of prostate biopsies. Methods. Utilities were collected using time tradeoff in 2 university-based prostate biopsy clinics (N = 147). Single-state utilities were elicited for impotence, incontinence, watchful waiting, and postprostatectomy. joint-state utilities were elicited for states combining impotence with 1) incontinence, 2) postprostatectomy, or 3) watchful waiting. Testing 3 prediction models of joint-state utilities for bias and consistency, the predictions were compared against directly elicited joint-state utilities. Results. All 3 models are biased. The minimum model is preferred, being the least biased and most efficient, Conclusions. No current model accurately predicts joint-state utility using the component single-state utilities. When possible, joint-state utilities should be elicited. if not possible, the minimum model is recommended. Research to identify better models is needed.