COST-EFFECTIVENESS OF UTILITY ASSESSMENT IN HYPERTENSION

适当地结合患者的个人偏好， 临床实践指南开发者面临的挑战。 有时 最好的治疗不仅取决于可能的危害和好处， 治疗方案，以及患者如何权衡这些伤害 和利益。 在轻度高血压管理的背景下， 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厌恶 药物治疗或生活方式的改变。 当患者的变化 偏好存在，指导方针，使通用治疗建议 可能不太合适 拟议研究的长期目标是制定一项正式的 一种确定患者个人偏好是否应该 纳入实践指南。 该项目的具体目标是 就是在轻度高血压的情况下应用这样一种方法。 到 为了实现这一目标，研究人员将估计 相对于使用固定优惠准则的成本效益， 个性化的治疗建议， 患者的偏好。 为了支持个体化治疗的成本效益估计， 效用评估，研究者将评估200例 轻度高血压患者。 公用事业是正式的、定量的措施 潜在医疗结果的可取性。 公用事业将 使用现有的自动化评估工具U-效价进行评估。 的 公用事业将被纳入现有的决策模型， 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。 的 个体化效用评估的成本-效果比是成本 效用评估除以效用产生的健康效益 考核 个体化效用的成本-效果比 评估将与接受的其他健康干预措施进行比较， 医学界。 个性化效用的确定 评估是否具有成本效益将表明， 轻度高血压的管理包括足够的灵活性， 适应患者偏好的变化。 除了提供对所需灵活性程度的深入了解之外， 根据轻度高血压管理指南，该项目是 旨在满足保健政策局的需要， 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一个 应用于轻度高血压的具体问题，方法学 作为这项工作的一部分， 所有AHCPR赞助的指南提供的好处。

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.