Interrelations between thyrocalcitonin and parathyroid hormone in rats.
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Biomedical subjects
Publications and source records attributed to A M Holmes.
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BACKGROUND: The measurement of utilities, or preferences, for health states may be affected by the technique used. Unfortunately, in papers reporting utilities, it is often difficult to infer how the utility measurement was carried out. PURPOSE: To present a list of components that, when described, provide sufficient detail of the utility assessment. METHODS: An initial list was prepared by one of the authors. A panel of 8 experts was formed to add additional components. The components were drawn from 6 clusters that focus on the design of the study, the administration procedure, the health state descriptions, the description of the utility assessment method, the description of the indifference procedure, and the use of visual aids or software programs. The list was updated and redistributed among a total of 14 experts, and the components were judged for their importance of being mentioned in a Methods section. RESULTS: More than 40 components were generated. Ten components were identified as necessary to include even in an article not focusing on utility measurement: how utility questions were administered, how health states were described, which utility assessment method(s) was used, the response and completion rates, specification of the duration of the health states, which software program (if any) was used, the description of the worst health state (lower anchor of the scale), whether a matching or choice indifference search procedure was used, when the assessment was conducted relative to treatment, and which (if any) visual aids were used. The interjudge reliability was satisfactory (Cronbach's alpha = 0.85). DISCUSSION: The list of components important for utility papers may be used in various ways, for instance, as a checklist while writing, reviewing, or reading a Methods section or while designing experiments. Guidelines are provided for a few components.
This paper examines how values should be assigned to health states when policy decisions must be made about who should receive treatment. The paper demonstrates that, if priority were to be assigned to those people who would benefit most from treatment, standard health-state utilities might fail to identify resource allocations that would maximize total health-related well-being in society. A new measurement instrument is proposed that is based on the direct comparison of the well-being achieved by different people in various health states and thus captures such community priorities. A sample of 72 health administration students used the instrument to evaluate speech and mobility dysfunctions as they afflicted hypothetical people who differed by gender, family status, and occupational type. This preliminary analysis indicates that the instrument is feasible to use, and that the valuations of respondents did, for some health conditions, significantly depend on the type of person afflicted.