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A Method for Estimating the Cost- Effectiveness of Incorporating Patient Preferences into Practice Guidelines

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  • Robert F. Nease
  • Douglas K. Owens

Abstract

Many clinical practice guidelines fail to account for the preferences of the individual patient. Approaches that seek to include the preferences of the individual patient in the decision- making process (e.g., interactive videodisks for patient education), however, may incur sub stantial incremental costs. Developers of clinical practice guidelines must therefore determine whether it is appropriate to make their guidelines flexible with regard to patient preferences. The authors present a formal method for determining the cost-effectiveness of incorporating the preferences of individual patients into clinical practice guidelines. Based on utilities assessed from 37 patients, they apply the method in the setting of mild hypertension. In this example, they estimate that the cost-effectiveness ratio for individualized utility assessment is $48,565 per quality-adjusted year of life, a ratio that compares favorably with other health interventions that are promoted actively. This approach, which can be applied to any clinical domain, offers a formal method for determining whether the incorporation of individual patient preferences is important clinically and is justified economically. Key words: cost-effective ness analysis; cost-utility analysis; utility assessment; decision analysis; practice guidelines; patient preferences. (Med Decis Making 1994;14:382-392)

Suggested Citation

  • Robert F. Nease & Douglas K. Owens, 1994. "A Method for Estimating the Cost- Effectiveness of Incorporating Patient Preferences into Practice Guidelines," Medical Decision Making, , vol. 14(4), pages 382-392, October.
    • Handle: RePEc:sae:medema:v:14:y:1994:i:4:p:382-392
    DOI: 10.1177/0272989X9401400409
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    References listed on IDEAS

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    1. Oster, G. & Epstein, A.M., 1986. "Primary prevention and coronary heart disease: The economic benefits of lowering serum cholesterol," American Journal of Public Health, American Public Health Association, vol. 76(6), pages 647-656.
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    Cited by:

    1. Jack Dowie, 1998. "Towards the equitably efficient and transparently decidable use of public funds in the deep blue millennium," Health Economics, John Wiley & Sons, Ltd., vol. 7(2), pages 93-103, March.
    2. Francis Pang & Mike Drummond & Fujian Song, 1999. "The use of meta-analysis in economic evaluation," Working Papers 173chedp, Centre for Health Economics, University of York.
    3. Mark Sculpher & Amiram Gafni, 2001. "Recognizing diversity in public preferences: The use of preference sub‐groups in cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 10(4), pages 317-324, June.
    4. Mark Sculpher, 1998. "The cost‐effectiveness of preference‐based treatment allocation: the case of hysterectomy versus endometrial resection in the treatment of menorrhagia," Health Economics, John Wiley & Sons, Ltd., vol. 7(2), pages 129-142, March.

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