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The Prevalence, Correlates, and Impact of Logically Inconsistent Preferences in Utility Assessments for Joint Health States in Prostate Cancer

Dale, William MD, PhD*†; Bilir, S. Pinar MS*; Hemmerich, Joshua PhD*; Basu, Anirban PhD; Elstein, Arthur PhD§; Meltzer, David MD, PhD‡¶∥

doi: 10.1097/MLR.0b013e3181f37bf2
Original Article

Background: Variations in health state utilities can impact cost-effectiveness analyses. One potential source of error is when joint health state (JS) utilities are rated higher than the embedded single state (SS) utilities. Knowing when and in whom this occurs can improve cost-effectiveness analyses.

Methods: Men (n = 323) were surveyed at the time of prostate biopsy. Time tradeoff SS and JS utilities for prevalent prostate cancer (PCa) health states were collected. JS utilities assessed included those most prevalent for PCa. “Inconsistency” was defined in the following 3 ways: (1) any size rank order violation; (2) total number of violations; and (3) differences greater than 1 standard deviation (SD). Regression analysis assessed independent patient characteristics associated with inconsistent responses.

Results: Aggregate JS utilities were consistent. At the individual level, 36% to 41% of responses violated rank order and 12% to 14% were larger than 1 SD. In all, 69% of respondents had at least 1 JS inconsistency, and 24% had >1 SD inconsistencies. Being married and feeling anxious were independently correlated with giving all types of inconsistent ratings, and lower education correlated with making >SD errors. SS utilities, and not JS utilities, were significantly lower for the inconsistent group. “Correcting” JS inconsistencies decreased aggregate utilities 1 to 9 units.

Conclusions: Inconsistent JS utilities for PCa are prevalent in men at biopsy. Being married, more anxious, and having less education are correlated with inconsistencies. It is the SS utilities, rather than the JS utilities, that differ between consistent and inconsistent raters. Better understanding of the source of these inconsistencies is needed.

From the *Section of Geriatrics & Palliative Medicine, University of Chicago, Chicago, IL; †Section of Hematology/Oncology, University of Chicago, Chicago, IL; ‡Section of Hospital Medicine, University of Chicago, Chicago, IL; §Department of Medical Education, University of Illinois-Chicago, Chicago, IL; ¶Department of Economics, University of Chicago, Chicago, IL; and ∥Harris School of Public Policy Studies, University of Chicago, Chicago, IL.

Supported by Paul B Beeson Career Development Award (K23 AG 024812 - NIA); Center for Health and the Social Sciences; Pfizer Pharmaceuticals.

Reprints: William Dale, MD, PhD, University of Chicago, Department of Medicine MC6098, 5841 S. Maryland Avenue, Chicago, IL 60637. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.