Course:CPSC522/Utility Assessment for Decision Support System

Title[edit | wikitext]

Utility assessment implemented to find utility of patients

Principal Author: Fardad Homafar

Collaborators:

Abstract[edit | wikitext]

On this page, we will cover our proposed approach to advising patients and health professionals on what they should do, and how can the system ascertain the goals or preferences of the patient. To do so, we propose a utility assessment to find patients' utility based on some techniques such as calibrating low-probability outcomes that patients may encounter with familiar gambles. We will elaborate on how to implement our method, what the patient and/or health professional needs to do to use it.

Builds on[edit | wikitext]

We suppose we are developing a decision-support system. Utility and utility assessment are two important concepts that we build our model on. Utility assessment involves the quantitative measurement of how patients feel about health outcomes. Utilities can capture degree of impairment, degree of bother, and willingness to undergo risk to reduce bother and offer an important means for measuring QoL (Quality of Life) and the effects of interventions.

Related Pages[edit | wikitext]

Utility assessments provide a quantitative measure of the patient's preferences for different health states. Although, they might be expensive, they can give us desirable results. Some of the methods used for utility assessment of patients are: EQ-5D, SF-6D, and HUI

Content[edit | wikitext]

Introduction

The ultimate goal of this project is to recommend a decision to both patients and doctors to improve patients' health-related quality of life (HRQoL) by measuring and quantifying the HRQoL or health utility of individuals. Utility assessment aims to capture a patient's preferences for different health states, providing a numerical representation of the perceived value or desirability of those states. This is important to note that this is a life-death matter to carry out. So, we need precise and reliable data. To do so, we utilize different techniques such as calibrating low-probability outcomes that patients may encounter with familiar gambles. Furthermore, different methods can have different costs. We need to find the most helpful one and optimize our costs of implementation.

Why Utility Assessment?

We believe that this is the best method of identifying the best medical treatments for patients. There are some reasons for thinking that way:

1. Patient-centered care: Using utility assessments to capture patients’ preferences supports patient-centric care. By recognizing that quality-of-life outcomes are subjective, healthcare providers can focus on interventions that support the patient’s goals and priorities.
2. Outcome measurement: Health utility assessments can be used to evaluate the impact of interventions over time. By periodically assessing a patient's utility values, healthcare providers can monitor changes in HRQoL and adjust treatment plans accordingly.
3. Resource Allocation: Health utility data from utility assessments can be used in cost-utility assessments. In healthcare policy and resource allocation decisions, they assess how cost-effective different healthcare interventions were by considering the cost and the impact on patient's QoL.
4. Treatment preferences: There are many different cases in which doctors have different ways of treating patients. Not all the patients prefer the same ways of treatment. Knowing the patient's utility values can guide treatment decisions that best suit their individual preferences to maximize their HRQoL.
5. Population health: Planning for public health and allocating resources can benefit greatly from aggregated health utility data from a population. It aids in locating potential hotspots for treatments that could significantly enhance population health as a whole

Different Methods of Utility Assessment

Utility assessment in patients is often carried out using standardized instruments designed to measure health-related quality of life (HRQoL) These instruments aim to quantify the impact of a health condition on an individual's well-being and preferences for different health states. Some of the methods used in utility assessment:

1. Disease-specific measures: Some utility assessment tools are devoted to one specific disease. They are more accurate. For example, the Asthma Quality of Life Questionnaire (AQLQ) assesses the impact of asthma on the quality of life of patients with asthma.
2. Time Trade-Off (TTO): It is a direct utility assessment method, which is used to know how much time in current health state they are willing to trade off for time in perfect health. For example, patients may be asked how many years of their life they would be willing to sacrifice to achieve perfect health.
3. Patient-reported outcome measures (PROMs) : PROMs are measurement tools that patients use to provide information on aspects of their health status that are relevant to their quality of life, including symptoms, functionality, and physical, mental, and social health.
4. Population Surveys: Although they might not be used for sensitive diseases, health utility assessments can be conducted as part of population health surveys. This way, health professionals can have an estimate of a population's preferences.
5. EuroQol-5 Dimension (EQ-5D): EQ-5D is a widely used utility assessment tool that evaluates health in five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Patients rate their health in each dimension, and the responses are converted into a utility score.
6. Short Form Health Survey (SF-6D): This method is derived from another one named SD-36. SF-6D considers patients' health in six different dimensions: physical functioning, role limitations, social functioning, pain, mental health, and vitality. This method has some general scores for each dimension, and unlike other methods, there is no questionnaire for the patients to engage them.

Calibrating low probability outcomes that patients may encounter with familiar gambles

This approach helps individuals better comprehend and assess the impact of rare or uncertain health events by relating them to more familiar and concrete situations, such as everyday gambles or risks. This can have numerous benefits:

1. Improve patients' engagement: All the benefits of health utilities can be gone if the patients are not convinced to engage. Using analogies in discussions about probabilities enhances patient engagement and accessibility. This engagement, in turn, nurtures a collaborative relationship between healthcare providers and patients, promoting active participation by patients in their care and treatment decisions.
2. Analogies for Probability Explanation: It is obvious that not all patients have the same knowledge and sense of low probabilities. When discussing low probability health outcomes with patients, healthcare providers can use analogies from familiar gambles to explain the likelihood of such events. For example, if a certain health event has a 1% probability, providers can compare it to a familiar gamble, like the chances of winning a specific lottery.
3. Mitigating anxiety and psychological relief: The lack of familiarity with low-probability health events may lead to patient anxiety. Using analogies involving familiar gambles can alleviate this anxiety by making abstract probabilities more tangible and relatable. Patients may find greater comfort when they can relate probabilities to concepts from their everyday experiences.
4. Understanding Risk and Benefit Trade-Offs: Patients frequently base decisions on perceived risks and benefits. Healthcare providers can assist patients in comprehending the trade-offs associated with various treatment options by aligning low-probability outcomes with familiar gambles. This may involve conversations about potential benefits and risks, enabling patients to assess the possibilities using a relatable framework.

Utility assessment implementation with calibration of low probability outcomes with familiar gambles

As we saw, there are different ways of carrying out utility assessment of the patients. Let's consider a real-life example to see how a utility assessment method can be implemented. We consider the implementation of PROMs. To start, health professionals need to provide every patient with appropriate PROMs. To measure how an intervention affected the patients, doctors can use PROMs pre- and post-event. So, the first step is to provide proper PROM. They could be generic or disease-specific. Before the disease, it is wise to use generic ones and after that, they should use disease-specific ones. These PROMs may contain some probabilities that are hard for the patients to interpret. This is where calibrating outcomes with familiar gambles comes into play. By using this technique, the patients can better report their preferences, which results in their higher satisfaction. After that, the practitioners would be provided with those reports. They can help doctors better choose the patients' treatments. In sum, it involves these steps:

1. Choose the utility assessment method based on available resources (usually EQ-5D)

2. Prepare different versions of them for different conditions and diseases by consulting doctors

3. Refine them using calibrations

4. Utilize those methods on patients

5. Interpret the results to choose the best treatment

Over time, the post-event measurements can be used to better improve our method based on the data we get from the patients.

Conclusion

We proposed our approach for a decision-support system used in medicine. Utility assessment can be really helpful in increasing general health as well as aligning with individual preferences. Different methods of utility assessment were investigated and a technique of implementing everyday gambles in utility assessment and its advantages were discussed. Finally, we elaborate on the steps of implementing this system

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