Abstract
BackgroundUtility scores are integral to health economics decision-making. Typically, utility scores have not been scored or developed with mental health service users. The aims of this study were to i) collaborate with service users to develop descriptions of five mental health states (psychosis, depression, eating disorder, medication side effects and self-harm); ii) explore feasibility and acceptability of using scenario-based health states in an e-survey; iii) evaluate which utility measures (standard gamble (SG), time trade off (TTO) and rating scale (RS)) are preferred; and iv) determine how different participant groups discriminate between the health scenarios and rank them.Design and methodsThis was a co-produced mixed methods cross-sectional online survey. Utility scores were generated using the SG, TTO and RS methods; difficulty of the completing each method, markers of acceptability and participants’ preference were also assessed.ResultsA total of 119 participants (58%) fully completed the survey. For any given health state, SG consistently generated higher utility scores compared to RS and for some health states higher also than TTO (i.e. SG produces inflated utility scores relative to RS and TTO). Results suggest that different utility measures produce different evaluations of described health states. The TTO was preferred by all participant groups over the SG. The three participant groups scored four (of five) health scenarios comparably. Psychosis scored as the worst health state to live with while medication side-effects were viewed more positively than other scenarios (depression, eating disorders, self-harm) by all participant groups. However, there was a difference in how the depression scenario was scored, with service users giving depression a lower utility score compared to other groups.ConclusionMental health state scenarios used to generate utility scores can be co-produced and are well received by a broad range of participants. Utility valuations using SG, TTO and RS were feasible for use with service users, carers, healthcare professionals and members of the general public. Future studies of utility scores in psychiatry should aim to include mental health service users as both co-investigators and respondents.
Highlights
Mental ill health is a key contributor to the burden of disease [1] costing an estimated £70£100 billion per year in the United Kingdom (UK), equivalent to 4.5% of gross domestic product (GDP) [2]
For any given health state, standard gamble (SG) consistently generated higher utility scores compared to rating scales (RS) and for some health states higher than time trade-off (TTO) (i.e. SG produces inflated utility scores relative to RS and TTO)
Results suggest that different utility measures produce different evaluations of described health states
Summary
Mental ill health is a key contributor to the burden of disease [1] costing an estimated £70£100 billion per year in the United Kingdom (UK), equivalent to 4.5% of gross domestic product (GDP) [2]. Over half of this cost relates to reduced quality of life [3]. Utility scores are obtained by asking people to evaluate their preference for living in particular health states (e.g., depression) or experiencing a health-related event (e.g., medication side effects). The aims of this study were to i) collaborate with service users to develop descriptions of five mental health states (psychosis, depression, eating disorder, medication side effects and self-harm); ii) explore feasibility and acceptability of using scenario-based health states in an e-survey; iii) evaluate which utility measures (standard gamble (SG), time trade off (TTO) and rating scale (RS)) are preferred; and iv) determine how different participant groups discriminate between the health scenarios and rank them
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