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Health State Valuation in Mild to Moderate Cognitive Impairment: Feasibility of Computer-Based, Direct Patient Utility Assessment

Author

Listed:
  • Neal V. Dawson

    (Department of Medicine, University Memory and Aging Center, nvd@po.cwru.edu, Department of Epidemiology and Biostatistics, University Memory and Aging Center, Center for Health Care Research and Policy at MetroHealth Medical Center, Cleveland, Ohio)

  • Mendel E. Singer

    (University Memory and Aging Center, Center for Health Care Research and Policy at MetroHealth Medical Center, Cleveland, Ohio)

  • Leslie Lenert

    (Department of Medicine, University Memory and Aging Center, HSR&D Service of the VA San Diego Health System, San Diego, California)

  • Marian B. Patterson

    (Department of Medicine, University Memory and Aging Center)

  • Susie A. Sami

    (University Memory and Aging Center)

  • Iahn Gonsenhouser

    (University Memory and Aging Center)

  • Heather A. Lindstrom

    (University Memory and Aging Center)

  • Kathleen A. Smyth

    (University Memory and Aging Center)

  • Melissa J. Barber

    (University Memory and Aging Center)

  • Peter J. Whitehouse

    (University Memory and Aging Center, Departments of Neurology, Cognitive Science, Psychiatry, Neuroscience, Psychology, Nursing, Organizational Behavior, and History Case Western University, Cleveland, Ohio)

Abstract

Background. Most patients with dementia will, at some point, need a proxy health care decision maker. It is unknown whether persons with various degrees of cognitive impairment can reliably report their health-related preferences. Methods. The authors performed health state valuations (HSVs) of current and hypothetical future health states on 47 pairs of patients with mild to moderate cognitive impairment and their caregivers using computer-based standard gamble, time tradeoff, and rating scale techniques. Results. Patients' mean (SD) age was 74.6 (9.3) years. About half of the patients were women (48%), as were most caregivers (73%), who were on average younger (mean age= 66.2 years, SD= 12.2). Most participants were white (83%); 17% were African American. The mean (SD) Mini-Mental State Examination (MMSE) score of patients was 24.2 (4.6) of 30. All caregivers and 77% of patients (36/47) completed all 18 components of the HSV exercise. Patients who completed the HSV exercise were slightly younger (mean age [SD]= 74.1 [8.5] v. 75.9 [11.8]; P = 0.569) and had significantly higher MMSE scores (mean score [SD] = 25.0 [4.3] v. 21.4 [4.4]; P = 0.018). Although MMSE scores below 20 did not preclude the completion of all 18 HSV ratings, being classified as having moderate cognitive impairment was associated with a lower likelihood of completing all scenario ratings (44% v. 82%). Patient and caregiver responses showed good consistency across time and across techniques and were logically consistent. Conclusion. Obtaining HSVs for current and hypothetical health states was feasible for most patients with mild cognitive impairment and many with moderate cognitive impairment. HSV assessments were consistent and reasonable.

Suggested Citation

  • Neal V. Dawson & Mendel E. Singer & Leslie Lenert & Marian B. Patterson & Susie A. Sami & Iahn Gonsenhouser & Heather A. Lindstrom & Kathleen A. Smyth & Melissa J. Barber & Peter J. Whitehouse, 2008. "Health State Valuation in Mild to Moderate Cognitive Impairment: Feasibility of Computer-Based, Direct Patient Utility Assessment," Medical Decision Making, , vol. 28(2), pages 220-232, March.
    • Handle: RePEc:sae:medema:v:28:y:2008:i:2:p:220-232
    DOI: 10.1177/0272989X07311750
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    References listed on IDEAS

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    1. Sylvie M. C. van Osch & Peter P. Wakker & Wilbert B. van den Hout & Anne M. Stiggelbout, 2004. "Correcting Biases in Standard Gamble and Time Tradeoff Utilities," Medical Decision Making, , vol. 24(5), pages 511-517, October.
    2. Keeney,Ralph L. & Raiffa,Howard, 1993. "Decisions with Multiple Objectives," Cambridge Books, Cambridge University Press, number 9780521438834.
    3. L. A. Lenert & A. Sturley & M. E. Watson, 2002. "iMPACT3: Internet-Based Development and Administration of Utility Elicitation Protocols," Medical Decision Making, , vol. 22(6), pages 464-474, December.
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    1. Michaël Schwarzinger & Fabrice Carrat & Stéphane Luchini, 2009. ""If you have the flu symptoms, your asymptomatic spouse may better answer the willingness-to-pay question". Evidence from a double-bounded dichotomous choice model with heterogeneous anchori," Post-Print inserm-00636179, HAL.
    2. Schwarzinger, Michaël & Carrat, Fabrice & Luchini, Stéphane, 2009. ""If you have the flu symptoms, your asymptomatic spouse may better answer the willingness-to-pay question": Evidence from a double-bounded dichotomous choice model with heterogeneous anchori," Journal of Health Economics, Elsevier, vol. 28(4), pages 873-884, July.

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