Can the standard gamble be used to determine utilities for uncertain health states? An example using postoperative maintenance therapy in Crohn's disease

The objective of this study was to determine whether patients with Crohn's disease (CD) value the absolute reduction in postoperative recurrence risk attributable to therapy with mesalamine (5-ASA). One hundred subjects evaluated state A (taking 5-ASA; 25% risk of recurrence), state B (not taki...

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Published inMedical decision making Vol. 20; no. 1; p. 72
Main Authors Kennedy, E D, Detsky, A S, Llewellyn-Thomas, H A, O'Connor, B I, Varkul, M, Steinhart, A H, Cohen, Z, McLeod, R S
Format Journal Article
LanguageEnglish
Published United States 01.01.2000
Subjects
Adult
Analysis of Variance
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Crohn Disease - drug therapy
Crohn Disease - prevention & control
Crohn Disease - surgery
Decision Support Techniques
Female
Humans
Logistic Models
Male
Mesalamine - therapeutic use
Pain Measurement
Postoperative Period
Risk-Taking
Secondary Prevention
Sick Role
Surveys and Questionnaires
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Summary:The objective of this study was to determine whether patients with Crohn's disease (CD) value the absolute reduction in postoperative recurrence risk attributable to therapy with mesalamine (5-ASA). One hundred subjects evaluated state A (taking 5-ASA; 25% risk of recurrence), state B (not taking 5-ASA; 40% risk of recurrence), and state C (100% risk of recurrence) by rank order, visual analog scale (VAS), and standard gamble (SG). Sixty-five of 91 patients (71%) with completed and usable questionnaires had the same preference order for state A (25% risk), state B (40% risk), and state C (100% risk) on both the VAS and the SG. The mean scores for state A (25% risk), state B (40% risk), and state C (100% risk), respectively, were 67.5, 49.8, and 19.8 on the VAS and 0.977, 0.972, and 0.910 on the SG. Subgroup analyses using stepwise logistic regression showed that risk attitude seemed to be predictive of subjects' preferences for 5-ASA. These results suggest that most subjects seem to value the 15% absolute risk reduction offered by 5-ASA. Furthermore, the SG seems to be a feasible method for measuring utilities for uncertain health states in patients with CD.
ISSN:0272-989X
DOI:10.1177/0272989X0002000109