Abstract
BackgroundDecision-making can be based on treatment preferences of the patient, the doctor, or by guidelines based on lay people's preferences. We compared valuations assigned by three groups: patients, obstetrical care professionals, and laypersons, for health states involving both mother and (unborn) child. Our aim was to compare the valuations of different groups using different valuation methods and complex obstetric health outcome vignettes that involve both maternal and neonatal outcomes.MethodsPatients (n = 24), professionals (n = 30), and laypersons (n = 27) valued the vignettes using three valuation methods: visual analogue scale (VAS), time trade-off (TTO), and discrete choice experimentation (DCE). Each vignette covered five health attributes: maternal health ante partum, time between diagnosis and delivery, process of delivery, maternal outcome, and neonatal outcome. We used feasibility questionnaires, Generalization theory, test-retest reliability and within-group reliability to compare the valuation patterns between groups and methods. We assessed relative weights from each valuation method to test for consistency across groups.ResultsTest-retest reliability was equal across groups, but different across methods: highest for VAS (ICC = 0.61-0.73), intermediate for TTO (ICC = 0.24-0.74) and lowest for DCE (kappa = 0.15-0.37). Within-group reliability was highest in all groups with VAS (ICC = 0.70-0.73), intermediate with DCE (kappa = 0.56-0.76) and lowest with TTO (ICC = 0.20-0.66). Effects of groups were smaller than effects of methods. Differences between groups were largest for severe health states.ConclusionBased on our results, decision making among laypersons should use TTO or DCE; patients should use VAS or TTO.
Highlights
Decision-making can be based on treatment preferences of the patient, the doctor, or by guidelines based on lay people’s preferences
We aim to compare the valuations of different groups using different valuation methods and complex obstetric health outcome vignettes that involve both maternal and neonatal outcomes in order to establish which group, or perhaps group-method combination, should be used for decision making
The group of patients consisted of women who had a pregnancy that was complicated either by gestational hypertension (GH), PE, or intra-uterine growth retardation (IUGR) and have participated to either the DIGITAT or the HYPITAT trials [22,26]
Summary
Decision-making can be based on treatment preferences of the patient, the doctor, or by guidelines based on lay people’s preferences. Alternatives to the QALY in such cases are the recently introduced preference- or attitude-based measures These measures provide a numerical value to a combination of health characteristics specific to the decision problem. Such preference measures, explicitly rely on preference statements of ‘judges’ which may be recruited from various groups of stakeholders, e. Heterogeneous responses may occur within and across various groups of stakeholders [3,4,5,6,7,8,9,10,11,12,13,14,15] Part of this heterogeneity may reflect the disagreement between the groups, but another part is more likely caused by method effects [5,16,17,18,19]. We investigate whose values we should use when the health outcomes are complex, using three widely-used valuation methods
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