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Background: National EQ-5D value sets are developed because preferences for health may vary in different populations. UK values are lower than US values for most of the 243 possible EQ-5D health states. Although similar protocols were used for data collection, analytic choices regarding how to model values from the collected data may also influence national value sets. Participants in the UK and US studies assessed the same subset of 42 EQ-5D health states using the time trade-off (TTO) method. However, different methods were used to transform negative values to a range bounded by 0 and -1, and values for all 243 health states were estimated using two different regression models. The transformation of negative values is inconsistent with expected utility theory, and the choice of which transformation method to use lacks a theoretical foundation. Objectives: Our objectives were to assess how much of the observed difference between the UK and US EQ-5D value sets may be explained by the choice of transformation method for negative values relative to the choice of regression model and the differences between elicited TTO values in the respective national studies (datasets). Methods: We applied both transformation methods and both regression models to each of the two datasets, resulting in eight comparable value sets We arranged these value sets in pairs in which one source of difference (transformation method, regression model or dataset) was varied. For each of these paired value sets, we calculated the mean difference between the two matching values for each of the 243 health states. Finally, we calculated the mean utility gain for all possible transitions between pairs of EQ-5D health states within each value set and used the difference in transition scores as a measure of impact from changing transformation method, regression model or dataset. Results: The mean absolute difference in values was 1.5 times larger when changing the transformation method than when using different datasets. The choice of transformation method had a 3.2 times larger effect on the mean health gain (transition score) than the choice of dataset. The mean health gain in the UK value set was 0.09 higher than in the US value set. Using the UK transformation method on the US dataset reduced this absolute difference to 0.02. The choice of regression model had little overall impact on the differences between the value sets. Conclusions: Most of the observed differences between the UK and US value sets were caused by the use of different transformation methods for negative values, rather than differences between the two study populations as reflected in the datasets. Changing the regression model had little impact on the differences between the value sets. [ABSTRACT FROM AUTHOR]

The increasing use of the risk concept in healthcare has caused concern among medical doctors, especially general practitioners (GPs). Critics have claimed that risk identification and intervention create unfounded anxiety, that the concept of risk is not useful at the individual patient level, that patients' risk concept is different from an epidemiological one, that resources are better spent elsewhere, or that commercial interests take advantage of risk information to promote sales. In this paper the authors discuss the concept of risk and address the critique. There is evidence that commercial interests promote risk interventions, that patients may misunderstand risk information, and that risk information can cause unnecessary anxiety. The authors have found no empirical data on the amount of time primary healthcare providers spend on risk interventions, and have not identified any valid arguments that risk information is not useful for the individual patient. Decision-making under uncertainty is a core element of medical practice, and GPs need to be suitably trained to inform patients such that they make good decisions when they are faced with uncertainty. The concept of risk is therefore useful for GPs, and in fact a key issue. It is concluded that risk critique should be based on sound theory and empirical data. Critics may do well in making clear distinctions between facts and value judgements. [ABSTRACT FROM AUTHOR]

A better understanding of the risk concept in relation to treatment of chronic disease processes is warranted. Consequences of therapies may be described in terms of risk reductions or postponement of adverse outcomes. This review argues that for most interventions, neither of these measures adequately characterize the distribution of treatment benefit across patients. More focus should be placed on choosing the context-relevant outcome measure and on developing techniques for extracting and communicating 2D outcome measures where the distribution of outcomes across patients is explicitly reflected. Since the distribution of outcomes affects patients' valuation of interventions, more research into risk communication is likely to lead to improved decision making. [ABSTRACT FROM AUTHOR]

Objectives. We sought to determine the long-term cost-effectiveness of two reperfusion modalities in patients with acute ST-segment elevation myocardial infarction: primary percutaneous coronary intervention (PCI) versus thrombolytic therapy . Design. A state-transition model that follows patients from when they develop STEMI until they die was developed. The model encompassed events and health states. Sensitivity analyses were undertaken. Results. For a 65-year old man, life expectancy was 8.3 years with primary PCI and 7.6 years with thrombolytic therapy. The lifetime costs were €19 250 (NOK 154 000) and €29 250 (NOK 234 000), respectively, for patients living close to an invasive unit. Cost savings from PCI were mainly due to the reduction in future coronary interventions. For patients needing helicopter transport to arrive in time to an invasive unit for PCI, the costs were €24 000 (NOK 192 000) and €29 250 (NOK 234 000), respectively (all costs undiscounted). For women, the estimates were somewhat higher due to lower mortality. Conclusion . Compared with thrombolytic therapy, reperfusion by primary PCI results in greater health benefits at reduced lifetime costs. These findings may have important clinical implications in an increasing cost-conscious health care environment. [ABSTRACT FROM AUTHOR]

A sample of 3,201 Danes was subjected to personal interviews in which they were asked to state their preferences for risk-reducing health care interventions based on information on absolute risk reduction (ARR) and relative risk reduction (RRR). The aim of the study was to measure the relative weighting of different types of risk information under various circumstances. The effect of presenting questions, and of explicitly formulating RRR, was analyzed. A preference for increases in RRR was demonstrated. There was a stronger inclination to choose the intervention that offered the highest RRR if RRR was explicitly stated. Individuals with more than 10 years of schooling also demonstrated a preference for increased ARR, but only when facing individually framed choices. In a social choice context, preferences for RRR remained intact, but the magnitude of ARR had no impact on choices. Results imply that social framing may induce a propensity to prefer interventions that target high-risk populations. Those respondents who had received ≤10 years of schooling demonstrated preferences for RRR but not ARR, and no impact of social framing was observed. [ABSTRACT FROM AUTHOR]

The article examines ways to describe the benefits of risk-reducing treatments. It aims to determine a laypersons responses to scenarios that describe benefits as postponing an adverse event or the equivalent the number needed to treat (NNT) with the use of cross-sectional survey with random allocation to different scenarios.

Presents comments on the reply by Reventlow et al. for their article related to concept of risk communication in relation to a patient with osteoporosis as published in December 2002 issue of 'Scandinavian Journal of Primary Health Care.' Disagreement over conclusions drawn by Reventlow et al. from their observations; Assertion over personal valuation of risk deductions; Importance of risk in medical practice.

Abstract: Objectives: In EuroQol five-dimensional questionnaire valuation studies, each participant typically assesses more than 10 hypothetical health states by using the time trade-off (TTO) method. We wanted to explore potential learning effects when using the TTO method, that is, whether the valuations were affected by the number of previously rated health states (the sequence number). Methods: We included 3773 respondents from the US EQ-5D valuation study, each of whom valued 12 health states (plus unconscious) in random order. With linear regression, we used sequence number to predict mean and standard deviations across all health states. We repeated the analysis separately for TTO responses indicating a state better than death and a state worse than death. Each TTO value requires a specific number of choice iterations. To test whether respondents used fewer iterations with experience, we used linear regression with sequence number as the independent variable and number of iterations as the dependent variable. Results: Mean TTO values were fairly stable across the sequence number, but analyzing state better than death and state worse than death values separately revealed a tendency toward more extreme values: state better than death values increased by 0.02, while state worse than death values decreased by 0.21 (P < 0.0001) over the full sequence. The standard deviations increased slightly, while the number of choice iterations was the same over the sequence number. The findings were stable across the levels of health state severity, age, and sex. Conclusions: TTO values become more extreme with increasing experience. Because of the randomized valuation order, these effects do not bias specific health states; however, they reduce the overall validity and reliability of TTO values. [Copyright &y& Elsevier]