COST-EFFECTIVENESS OF UTILITY ASSESSMENT IN HYPERTENSION

适当地结合个人患者的偏好构成了一个 临床实践指南开发者面临的挑战。有时， 最佳治疗方法不仅取决于可能的危害和好处 治疗方案的选择，也取决于患者如何权衡这些伤害 和福利。在轻度高血压的管理背景下， 一些患者可能对中风的可能性有强烈的担忧， 而其他人可能对相关的副作用有强烈的反感 通过药物治疗或改变生活方式。当患者发生变化时 存在偏好，提出通用治疗建议的指南 可能是不合适的。 拟议研究的长期目标是制定一项正式的 确定个人患者偏好是否应该 纳入了实践指南。这个项目的具体目的是 就是在轻度高血压的环境中应用一种这样的方法。至 为了达到这个目的，研究人员将估计 相对于使用偏好固定准则的成本效益， 个体化治疗建议，以解释每一个 病人的喜好。 支持对个性化服务的成本效益进行评估 效用评估，研究调查人员将评估200项效用 轻度高血压患者。公用事业是正式的、定量的衡量标准 潜在医疗后果的可取性。公用事业公司将 使用现有的自动化评估工具U-滴度进行评估。这个 然后将公用事业合并到现有的决策模型中，以 确定患者偏好的变化对 相对于监测而言，医疗提供的健康益处。这个 个性化效用评估的成本效果比就是成本 公用事业评估除以公用事业带来的健康收益 评估。个性化效用的成本效益比 评估将与美国卫生署接受的其他卫生干预措施进行比较 医学界。个性化效用的确定 评估具有成本效益将表明，未来的指导方针 轻度高血压的管理包含了足够的灵活性来 适应患者偏好的变化。 除了提供对所需灵活性程度的洞察 根据轻度高血压的管理指南，该项目是 旨在满足卫生保健政策机构和 研究(AHCPR)以提高其使用的技术的有效性 制定实践指南。虽然拟议的研究涉及 方法论在轻度高血压具体问题上的应用 作为这一努力的一部分而开发的可以用来改善健康 AHCPR赞助的所有指南所提供的好处。

Appropriately incorporating individual patient preferences poses a challenge for developers of clinical practice guidelines. Sometimes, the best treatment depends not only on the likely harms and benefits of the treatment alternatives but also on how patients trade off the those harms and benefits. In the setting of the management of mild hypertension, some patients may have strong concerns about the possibility of stroke, while others may have a strong dislike for the side effects associated with medical therapy or changes in lifestyle. When variations in patient preferences exist, guidelines that make generic treatment recommendations may be inappropriate. The long-term goal of the proposed study is the development of a formal approach for determining whether individual patient preferences should be incorporated into practice guidelines. The specific aim of this project is to apply one such approach in the setting of mild hypertension. To achieve this aim, the study investigators will estimate the cost-effectiveness, relative to the use of a preference-fixed guideline, of individualizing treatment recommendations to account for each patient's preferences. To support the estimation of the cost-effectiveness of individualized utility assessment, study investigators will assess the utilities of 200 mild hypertension patients. Utilities are formal, quantitative measures of the desirability of potential medical outcomes. Utilities will be assessed using an existing automated assessment tool, U-titer. The utilities will then be incorporated into an existing decision model to determine the impact of the variation in patient preferences on the health benefit offered by medical treatment relative to monitoring. The cost-effectiveness ratio of individualized utility assessment is the cost of utility assessment divided by the health benefit derived from utility assessment. The cost-effectiveness ratio of individualized utility assessment will be compared to other health interventions accepted by the medical community. The determination that individualized utility assessment is cost-effective would suggest that future guidelines for the management of mild hypertension incorporate sufficient flexibility to accommodate variations in patient preferences. In addition to providing insight into the degree of flexibility required by guidelines for the management of mild hypertension, this project is designed to meet the need of the Agency for Health Care Policy and Research (AHCPR) to improve the effectiveness of the techniques it uses to develop practice guidelines. While the proposed study involves an application to the specific problem of mild hypertension, the methodology developed as part of this effort can be used to improve the health benefit offered by all AHCPR -sponsored guidelines.