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. 2008 Sep-Oct;28(5):732-50.
doi: 10.1177/0272989X08315251. Epub 2008 Aug 25.

Obtaining utility estimates of the health value of commonly prescribed treatments for asthma and depression

Maria Orlando Edelen  1 , M Audrey Burnam, Katherine E Watkins, José J Escarce, Haiden Huskamp, Howard H Goldman, Gary Rachelefsky
Affiliations

Obtaining utility estimates of the health value of commonly prescribed treatments for asthma and depression

Maria Orlando Edelen et al. Med Decis Making. 2008 Sep-Oct.

Abstract

Background: Comparing the costs and health value associated with alternative quality improvement efforts is useful. This study employs expert panel methodology to elicit numerical estimates based on a 0 to 1 utility scale of the health benefit of usual treatment patterns for 2 medical conditions.

Method: The approach includes development of clinical profiles and derivation of treatment benefit estimates via the elicitation of utility ratings before and after treatment. Clinical profiles specified characteristics of patient groups, treatments to be rated, and their combinations. A panel of 13 asthma and depression experts made a series of utility ratings (before any new treatment, 1 or 3 mo later with no treatment, 1 or 3 mo after initiating various common treatments) for adult patient groups with depression or asthma. The panel convened to discuss discrepancies and subsequently made final ratings. Treatment benefit estimates were derived from the ratings made by the panelists after the panel meeting.

Results: The treatment benefit estimates had face validity and minimal variability, indicating considerable consensus among experts. Treatment benefit estimates ranged from -0.03 to 0.25 for depression and from -0.04 to 0.24 for asthma. There was minimal variation in the estimates for both conditions (the estimates' standard deviations ranged from 0.01 to 0.06). Comparisons of the treatment benefit estimates before and after the expert panel meeting indicated substantial convergence, and evidence suggests that the benefit estimates are comparable across the 2 health conditions.

Conclusion: Comparable estimates of treatment benefit for distinct health conditions can be obtained from experts using the expert panel methodology.

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Figures

Figure 1
Figure 1
Flow chart of expert rating exercises and discussions.
Figure 2
Figure 2
Screen for before-treatment depression ratings.
Figure 3
Figure 3
Screen for after-treatment depression ratings.
Figure 4
Figure 4
Utility ruler provided to experts. HRQOL = health-related quality of life.
Figure 5
Figure 5
Depression profiles rated by all experts: treatment benefit estimates before (ATi – BT) and after (ATf – BT) panel discussion by expertis.
Figure 6
Figure 6
Asthma profiles rated by all experts: treatment benefit estimates before (ATi – BT) and after (ATf – BT) panel discussion by expertise.
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