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The Danger of Applying Group-level Utilities in Decision Analyses of the Treatment of Localized Prostate Cancer in Individual Patients

Author

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  • Mark E. Cowen
  • Brian J. Miles
  • Daniel F. Cahill
  • R. Brian Giesler
  • J. Robert Beck
  • Michael W. Kattan

Abstract

The optimal management strategy for men who have localized prostate cancer remains controversial. This study examines the extent to which suggested treatment based on the perspective of a group or society agrees with that derived from individual patients' preferences. A previously published decision analysis for localized prostate cancer was used to suggest the treatment that maximized quality-adjusted life expectancy. Two treatment recommendations were obtained for each patient: the first (group-level) was derived using the mean utilities of the cohort; the second (individual-level) used his own set of utilities. Group-level utilities misrepresented 25-48% of individuals' pref erences depending on the grade of tumor modeled. The best kappa measure achieved between group and individual preferences was 0.11. The average quality-adjusted life years lost due to misrepresentation of preference was as high as 1.7 quality-adjusted life years. Use of aggregated utilities in a group-level decision analysis can ignore the substantial variability at the individual level. Caution is needed when applying a group- level recommendation to the treatment of localized prostate cancer in an individual patient. Key words: decision analysis; utility assessment; prostate cancer; patient pref erences. (Med Decis Making 1998;18:376-380)

Suggested Citation

  • Mark E. Cowen & Brian J. Miles & Daniel F. Cahill & R. Brian Giesler & J. Robert Beck & Michael W. Kattan, 1998. "The Danger of Applying Group-level Utilities in Decision Analyses of the Treatment of Localized Prostate Cancer in Individual Patients," Medical Decision Making, , vol. 18(4), pages 376-380, October.
    • Handle: RePEc:sae:medema:v:18:y:1998:i:4:p:376-380
    DOI: 10.1177/0272989X9801800404
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    References listed on IDEAS

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    1. Louis Eeckhoudt, 1996. "Expected Utility Theory—Is It Normative or Simply "Practical"?," Medical Decision Making, , vol. 16(1), pages 12-13, February.
    2. Raisa B. Deber & Vivek Goel, 1990. "Using Explicit Decision Rules to Manage Issues of Justice, Risk, and Ethics in Decision Analysis," Medical Decision Making, , vol. 10(3), pages 181-194, August.
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    Cited by:

    1. Scott Cantor & Robert Volk & Murray Krahn & Alvah Cass & Jawaria Gilani & Susan Weller & Stephen Spann, 2008. "Concordance of Couples’ Prostate Cancer Screening Recommendations from a Decision Analysis," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 1(1), pages 11-19, January.

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