Background

Within the UK, standard methods of economic evaluation centre on the maximisation of the quality-adjusted life-year (QALY). However, preference-based measures used to estimate QALYs may not be suited to all economic evaluations, as they routinely measure only health outcomes.

Aim

This study used an economic evaluation alongside a clinical trial (EEACT) comparing patients’ preferences for a telephone versus a face-to-face consultation to incorporate process utility into cost-effectiveness analyses.

Methods

An EEACT is described that generates QALYs using Short-form 6-dimension version 1 (SF-6Dv1) responses. These results exclude specific consideration of process utility. A health state valuation study is then reported that bolts a process domain onto the SF-6Dv1 using data obtained from the EEACT. These results therefore include the consideration of process utility. The results of the EEACT with and without process utility are then compared.

Results

This study shows that the QALY, in its current form, does not capture patient benefits associated with the process of receiving healthcare. The EEACT illustrates this, showing a statistically significant difference between control and intervention groups for the patient experience questionnaire communication domain, indicating that patients preferred the intervention. This preference was not identified in the cost-effectiveness outcomes, and the point estimates lie in the north-west quadrant of the cost-effectiveness plane. The preference is captured after adding a communication domain. The point estimate moves to the north-east quadrant, where the intervention is more effective and more costly than the control.

Conclusion

This study indicates that it is possible to capture patients’ preferences for processes associated with care, in a format compatible with the QALY.

中文翻译：

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通过 SF-6D 的固定域将过程效用纳入成本效益分析：一项探索性研究

背景

在英国，经济评估的标准方法集中在质量调整生命年 (QALY) 的最大化上。然而，用于估计 QALYs 的基于偏好的测量可能并不适合所有经济评估，因为它们通常只测量健康结果。

目的

本研究使用经济评估和临床试验 (EEACT) 比较患者对电话咨询与面对面咨询的偏好，以将过程效用纳入成本效益分析。

方法

EEACT 被描述为使用短格式 6 维版本 1 (SF-6Dv1) 响应生成 QALY。这些结果排除了对过程效用的特定考虑。然后报告了一项健康状态评估研究，该研究使用从 EEACT 获得的数据将过程域固定到 SF-6Dv1 上。因此，这些结果包括对过程效用的考虑。然后比较使用和不使用过程效用的 EEACT 结果。

结果

该研究表明，当前形式的 QALY 并未涵盖与接受医疗保健的过程相关的患者利益。EEACT 说明了这一点，在患者体验问卷交流领域，对照组和干预组之间存在统计学上的显着差异，表明患者更喜欢干预。这种偏好并未在成本效益结果中确定，点估计位于成本效益平面的西北象限。添加通信域后捕获该首选项。点估计移动到东北象限，在那里干预比控制更有效且成本更高。

结论

该研究表明，有可能以与 QALY 兼容的格式捕获患者对与护理相关的过程的偏好。