Examination of assumptions in using time tradeoff and standard gamble utilities in individuals with spinal cord injury

Mau Roung Lin, Wen Yu Yu, Shih Chieh Wang

研究成果: 雜誌貢獻文章

17 引文 (Scopus)

摘要

Objective: To examine how the time tradeoff (TTO) and standard gamble (SG) utilities perform at different lengths of life expectancy and across patient characteristics such as risk attitudes and injury severity in individuals with traumatic spinal cord injury (SCI). Design: Survey. Setting: Structured telephone interviews of patients after discharge from 4 teaching hospitals. Participants: Subjects (N=270) who had sustained SCI were block-randomized in groups of 4 to receive 1 of 2 questionnaire versions. One version asked about the TTO and SG at 2 life expectancies of 10 and 20 years, and the other at 20 and 30 years. Interventions: Not applicable. Main Outcome Measures: The TTO and SG were used to elicit preferences for patients with an SCI. Results: Patients with SCI who were younger and had more severe neurologic lesions, had higher intense risk-taking attitudes, and experienced depression had significantly lower TTO and SG scores than their counterparts. A longer life expectancy was also significantly associated with lower TTO scores. As the life expectancy increased, patients who had sustained SCI more recently (≤1y ago) were more willing to trade off life years for full health (ie, lower TTO scores). SG scores did not significantly vary according to different life expectancies. Conclusions: Among patients with SCI, there was a nonlinear relation between the TTO and life expectancy that violated the fundamental assumption of risk neutrality toward life years. Accordingly, TTO utilities elicited for different life expectancies should not be compared in quality-of-life assessments or used in cost-utility analyses. In contrast, SG utilities remained stable at different lengths of life expectancy in SCI patients. Moreover, certain patient characteristics such as age, time lapse since the injury, neurologic severity, risk attitudes, and depressive status can account for some TTO and SG variations among patients with SCI.

原文英語
頁(從 - 到)245-252
頁數8
期刊Archives of Physical Medicine and Rehabilitation
93
發行號2
DOIs
出版狀態已發佈 - 二月 2012

指紋

Spinal Cord Injuries
Life Expectancy
Nervous System
Patient Preference
Patient Discharge
Wounds and Injuries
Risk-Taking
Teaching Hospitals
Cost-Benefit Analysis
Quality of Life
Outcome Assessment (Health Care)
Interviews
Depression
Health

ASJC Scopus subject areas

  • Rehabilitation
  • Physical Therapy, Sports Therapy and Rehabilitation

引用此文

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abstract = "Objective: To examine how the time tradeoff (TTO) and standard gamble (SG) utilities perform at different lengths of life expectancy and across patient characteristics such as risk attitudes and injury severity in individuals with traumatic spinal cord injury (SCI). Design: Survey. Setting: Structured telephone interviews of patients after discharge from 4 teaching hospitals. Participants: Subjects (N=270) who had sustained SCI were block-randomized in groups of 4 to receive 1 of 2 questionnaire versions. One version asked about the TTO and SG at 2 life expectancies of 10 and 20 years, and the other at 20 and 30 years. Interventions: Not applicable. Main Outcome Measures: The TTO and SG were used to elicit preferences for patients with an SCI. Results: Patients with SCI who were younger and had more severe neurologic lesions, had higher intense risk-taking attitudes, and experienced depression had significantly lower TTO and SG scores than their counterparts. A longer life expectancy was also significantly associated with lower TTO scores. As the life expectancy increased, patients who had sustained SCI more recently (≤1y ago) were more willing to trade off life years for full health (ie, lower TTO scores). SG scores did not significantly vary according to different life expectancies. Conclusions: Among patients with SCI, there was a nonlinear relation between the TTO and life expectancy that violated the fundamental assumption of risk neutrality toward life years. Accordingly, TTO utilities elicited for different life expectancies should not be compared in quality-of-life assessments or used in cost-utility analyses. In contrast, SG utilities remained stable at different lengths of life expectancy in SCI patients. Moreover, certain patient characteristics such as age, time lapse since the injury, neurologic severity, risk attitudes, and depressive status can account for some TTO and SG variations among patients with SCI.",
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N2 - Objective: To examine how the time tradeoff (TTO) and standard gamble (SG) utilities perform at different lengths of life expectancy and across patient characteristics such as risk attitudes and injury severity in individuals with traumatic spinal cord injury (SCI). Design: Survey. Setting: Structured telephone interviews of patients after discharge from 4 teaching hospitals. Participants: Subjects (N=270) who had sustained SCI were block-randomized in groups of 4 to receive 1 of 2 questionnaire versions. One version asked about the TTO and SG at 2 life expectancies of 10 and 20 years, and the other at 20 and 30 years. Interventions: Not applicable. Main Outcome Measures: The TTO and SG were used to elicit preferences for patients with an SCI. Results: Patients with SCI who were younger and had more severe neurologic lesions, had higher intense risk-taking attitudes, and experienced depression had significantly lower TTO and SG scores than their counterparts. A longer life expectancy was also significantly associated with lower TTO scores. As the life expectancy increased, patients who had sustained SCI more recently (≤1y ago) were more willing to trade off life years for full health (ie, lower TTO scores). SG scores did not significantly vary according to different life expectancies. Conclusions: Among patients with SCI, there was a nonlinear relation between the TTO and life expectancy that violated the fundamental assumption of risk neutrality toward life years. Accordingly, TTO utilities elicited for different life expectancies should not be compared in quality-of-life assessments or used in cost-utility analyses. In contrast, SG utilities remained stable at different lengths of life expectancy in SCI patients. Moreover, certain patient characteristics such as age, time lapse since the injury, neurologic severity, risk attitudes, and depressive status can account for some TTO and SG variations among patients with SCI.

AB - Objective: To examine how the time tradeoff (TTO) and standard gamble (SG) utilities perform at different lengths of life expectancy and across patient characteristics such as risk attitudes and injury severity in individuals with traumatic spinal cord injury (SCI). Design: Survey. Setting: Structured telephone interviews of patients after discharge from 4 teaching hospitals. Participants: Subjects (N=270) who had sustained SCI were block-randomized in groups of 4 to receive 1 of 2 questionnaire versions. One version asked about the TTO and SG at 2 life expectancies of 10 and 20 years, and the other at 20 and 30 years. Interventions: Not applicable. Main Outcome Measures: The TTO and SG were used to elicit preferences for patients with an SCI. Results: Patients with SCI who were younger and had more severe neurologic lesions, had higher intense risk-taking attitudes, and experienced depression had significantly lower TTO and SG scores than their counterparts. A longer life expectancy was also significantly associated with lower TTO scores. As the life expectancy increased, patients who had sustained SCI more recently (≤1y ago) were more willing to trade off life years for full health (ie, lower TTO scores). SG scores did not significantly vary according to different life expectancies. Conclusions: Among patients with SCI, there was a nonlinear relation between the TTO and life expectancy that violated the fundamental assumption of risk neutrality toward life years. Accordingly, TTO utilities elicited for different life expectancies should not be compared in quality-of-life assessments or used in cost-utility analyses. In contrast, SG utilities remained stable at different lengths of life expectancy in SCI patients. Moreover, certain patient characteristics such as age, time lapse since the injury, neurologic severity, risk attitudes, and depressive status can account for some TTO and SG variations among patients with SCI.

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KW - Utility theory

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